MILITARY MEDICAL MANUAL (Court*>7 of U. S. Army Medical Museum) Surgeon Johnathan Letterman (1824-1872) The Medical Officer who devised the plan of field hospitalization and evacuation which has influenced that service in every modern army. MILITARY MEDICAL MANUAL 5th Edition REVISED APRIL, 1943 THE MILITARY SERVICE PUBLISHING COMPANY HARRISBURG, PENNSYLVANIA Copyright, 1943, By The Military Service Publishing Co Harrisburg, Pa. 5th Edition, October, 1942 5th Edition Revised, April, 1943 ALL RIGHTS RESERVED The Military Service Publishing Co. 100 TELEGRAPH BUILDING HARRISBURG, PA. The Telegraph Press Harrisburg, Pa. PRINTED IN THE U.S.A. FOREWORD BY MAJOR GENERAL JAMES C. MAGEE The Surgeon General, U. S. Army Earlier editions of this book have been a great help to medical officers. The present issue has been modified, where necessary, to meet the requirements of current practice and may be accepted as a practical and reliable text concerning military medical matters. PUBLISHER’S PREFACE The purpose of this book is to present information of practical value to officers and noncommissioned officers of the Medical Department of the Army of the United States. The sources of the subject matter are official publications of the War Depart- ment and instructional material published by the general and special service schools. However, no person is to conclude, because of the use of these sources, that this volume is in any sense “Official.” It is divided into the three divisions with which the medical of- ficer must concern himself in the full sweep of his responsibili- ties. Part I contains military matters of which the medical officer should have knowledge; it is presented with special consideration of his requirements. Part II contains professional subjects peculiar to the responsibilities of the medical officer. Historical and other interesting data about the Medical Department arc included. Part III contains complete and detailed information about the tactical employment of medical units in the field and includes the subjects of administration, supply, and mess management, with special reference to the problems of small units. An extensive index of the entire volume is included to simplify reference to this fund of knowledge. Grateful acknowledgment is made to the considerable number of officers whose work in preparing, editing, and reviewing has made this manual possible. The Publishers MILITARY MEDICAL MANUAL TABLE OF CONTENTS PART I MILITARY SUBJECTS Page I. The Army of the United States 1 II. Tactical Functions of the Arms 25 III. Organization of Large Units 79 IV. Tactical Employment of the Combined Arms 85 V. Command and Staff Procedure 133 VI. Supply and Evacuation of Large Units 151 VII. Leadership 161 VIII. Defense Against Chemical Warfare 167 IX. Map Reading 189 X. Interpretation of Aerial Photographs 233 XI. Care and Operation of Motor Vehicles 251 XII. Military Courtesy and Discipline 339 XIII. Customs of the Service 357 XIV. Ballistics and Projectiles 361 PART II MEDICAL SUBJECTS I. Medico-Military History 371 II. Organization and Activities of the Medical Department 411 III. Field Sanitation 429 IV. Essentials of Military Preventative Medicine 469 V. Military Hygiene • 491 VI. First Aid 511 VII. Medical Aspects of Chemical Warfare 565 VIII. Aviation Medicine 589 PART III MEDICAL TACTICS AND ADMINISTRATION I. Attached Medical Personnel With Units of the Infantry and Cavalry Divisions 603 II. The Medical Regiment, the Medical Squadron, and the Medical Battalions 663 III. The Medical Service Within the Division 703 IV. The Medical Service Within the Corps and Field Army 755 V. The Medical Service of a Field Force 819 VI. Training of Medical Units 875 VII. Plans and Orders (The Solution of the Medical Problem) 913 VIII. Administration 933 IX. Mess Management 973 X. Supply 995 Index 998 CHAPTER I THE ARMY OF THE UNITED STATES “We are going to win the war and we are going to win the peace that follows." —Franklin Delano Roosevelt. The days of prelude have ended. Japan and her Axis allies took the action which our wise men had foreseen but which public opinion could not accept. War was de- clared against us at a time when our every effort was to seek peaceful solutions. Their acts gave us a united people, and for that happy circumstance at a later time we may have full occasion to be grateful. The tragic events of December 7, 1941, and the weeks which followed brought many disappointments to the United States. But in the depths of those unwelcome experiences Americans began to show their true worth. Confidence in the successful outcome of the war has been freely proclaimed. Perhaps, even, it has been too freely proclaimed. Courage has been displayed by the American public to an extent which the thoughtful may have questioned. The example of the de- fenders of Pearl Harbor, of Wake Island, and General MacArthur’s epic stand in the Philippines have gained the admiration which the events deserve. Our people have shown an abundant courage. Finally there is zeal, a new zeal, a tremendous zeal to do whatever is necessary to win this war—a condition which was quite dormant in the hearts and minds of too many citizens prior to Pearl Harbor. Shoulders which had been resting lightly against the wheels began really to push! These are the factors which make morale. The great making up of the National Mind has been accomplished. That it was forced upon a reluctant people by events they could no longer control is not a factor. The troubled and unhappy days of prelude are no more. Foolish arguments are beginning to blend into the past. Do you remember the weighty arguments about the Service Ex- tension Act? The hubbub about limitations on service? Once they were hotly argued. They fade into the insignificance they have always deserved since the threats to the security of our nation are made clear to all. We have a war to win. If we do our jobs well, we will win this war. And this time, we propose to win the peace which is to follow. In this war, thoughtful citizens will ask—how strong should America become? Should the armed forces be increased to seven, or ten, or more millions. Should we have fifty thousand or two hundred thousand airplanes? And how many tanks and guns? These questions are without meaning. America must become strong enough to make ultimate victory a certainty! We cannot afford to lose or risk losing. The strength we need to insure a peace of our own choosing will be created. Our enemies are strong and resolute. A tendency to complacency in our National viewpoints causes us to take these enemies too lightly. They, too, are resolved to win. They are prepared for this war and have chosen the time and place to wage it. We will win only by developing our full strength and placing it where it is needed. This gigantic undertaking gives to the Medical profession a task which must strain its resources to the utmost. Vast numbers of officers and men must be trained, equipped, and taught to perform tasks which equal in importance those which are given to the arms and other services. In size alone, the Medical Department will excel by far the total strength of the Regular Army of early 1941. Medical units are a part of the tactical structure of the regiments, divisions, corps, and field armies; of the several Air Forces; of the swiftly expanding Armored Force. Station hospitals and general hos- pitals, depots of supply, and other installations are being provided as the needs increase. Task forces take with them as a matter of course the men and means to provide medical support wherever it may be needed. Doctors and Nurses, Dentists, Veterinarians, members of the Medical Administrative Corps, officers of the Sanitary Corps, each with their invaluable helpers—the Medical Soldiers—will undertake the inspiring and gigantic tasks which lie before them to conserve the fighting strength of the armed forces. The INTRODUCTION MILITARY MEDICAL MANUAL professional medical men pledge themselves to the successful execution of their tasks. Anxious citizens may take hope and have confidence. The Medical Department will succeed. Our sons will have the medical service their needs may require. THE CONGRESS AND THE ARMY Responsibility of the Congress. Under the Constitution the Congress is given many responsibilities, including the power to “raise and support armies” for the defense of our nation and the power to declare war. Thus Congress determines the size of the Army and each of its three components and appropriates money to maintain the mili- tary establishment. The Senate and the House of Representatives each have a Com- mittee on Military Affairs and a Committee on Appropriations. Practically all legis- lation affecting the Army of the United States, except appropriations, is referred by each House to its Committee on Military Affairs for study and report. Since the Constitution requires that legislation for appropriations must originate in the House of Representatives, the work of studying the budget estimates and of pre- paring bills for Army appropriations is done by the War Department Subcommittee of the House Committee on Appropriations. This committee is not bound by the totals given in the President’s budget, though generally it follows the budget rather closely. The War Department and the Congress. The War Department General Staff, under the direction of the Deputy Chief of Staff, draws up instructions to guide the chiefs of the arms, services, and bureaus in preparing estimates of the cost of the activities for which they are responsible. After approval of the Secretary of War, the Budget Officer of the War Depatment (the Chief of Finance) submits the War Department estimates to the Bureau of the Budget. Thus, before presentation to Congress, legis- lation proposed by the War Department is first processed through the Bureau of the Budget to be certain it is in accord with the program of the President. Other legislation affecting the War Department, proposed by individual members of Congress, is re- ferred to the appropriate committee, and the War Department is generally requested by the committee to submit a report upon it. The War Department. The Department of War, usually designated as the War De- partment, was the second executive department to be provided by the statutes of the First Congress under the Constitution. It was created by an Act of Congress approved August 7, 1789, succeeding a similar department which was established prior to the adoption of the Constitution. Subsequent acts and executive orders have gready altered the scope and functions of the activities of the Department since its inception, as it originally en- compassed many activities later delegated to the Navy and Interior Departments. War Department Reorganization. The President approved a reorganization of the War Department and the Army, effective March 9, 1942. The plan was adopted after long and searching study in order to provide the most effective structure for the waging of successful war. It provides, under the Secretary of War and the Chief of Staff, a War Department General Staff, a Ground Force, an Air Force, and Army Service Forces, all with headquarters in Washington, D. C., and in addition thereto such number of oversea departments, task forces, base commands, defense commands, commands in theaters of operations, and other commands as may be necessary in the national security. (Circular No. 59, March 2, 1942) Plate 1. The functions, duties, and powers of the chiefs of the following arms are transferred to the jurisdiction of the Commanding General, Army Ground Forces: Infantry, Cavalry, Field Artillery, and Coast Artillery Corps (except those relating to procurement, storage, and issue.) The latter are transferred to the Commanding General, Army Service Forces. President is Commander in Chief. The President is the constitutional Commander in (The Constitution of the United States, Section 2, Article 11) Chief of the Army. Command is exercised through the Secretary of War, who is (PAR 1, AR 1-15) charged with carrying out the policies of the President in military matters. THE WAR DEPARTMENT PROCUREMENT UNDER SECRETARY of WARj COMMANDING GENERAL SERVICES Of SUPPLY ASSISTANT SECRETARY of WAR for AIR COMMANDING GENERAL ARMY AIR FORCES LEGISLATIVE AND LIAISON OIVISION SPECIAL STAFF INSPECTOR GENERAL COMMANDING GENERAL ARMY GROUND FORCES Plate 1. Organization of the Army. SECRETARY of WAR| CHIEF of STAFF DEPUTY CHJEF of STAFF G-4 fUBLIC RELATIONS G-3 SENERAL STAFF THEATER UJ <150 5dl 5 G-2 ASSISTANT SECRETARY of WAR SECRETARIAT DEFENSE COMMANO 6-1 OPNS ADMINISTRATIVE ASSISTANT and CHIEF CLERK TASK FORCE OPERATIONS COMMANDS POLICY DIRECTOR OF MANAGEMENT CONTROL DIRECTOR OF LEGISLATIVE PLANNING OtRCCTOR OF statistical, CONTROL FERRY COMMANO BUOGET OFFICER DIRECTOR OF ORGANIZA- TION At Ft AWNING AIR SERVICE COMMAND AIR JUDGE ADVOCATE AIR ADJUTANT FISCAL JFFlCCR AIR INSPECTOR AIR SURGEON ADVISORY COUNCIL CIVIL MATERIEL COMMAND PLANS OIRECTOR OF PERSOW4EL Plate 2. Organization of the Army Air Forces. | MILITARY BA SC SCR VICCS COMMANDING GENERAL ARMY AIR FORCES DEPUTY CHIEF OF THE AIR STAFF PUBLIC RELATIONS OFFICER WEATHER COMMAND CHIEF OF THE AIR STAFF A-4 AIR FORCE (Typical) GROUND SUFFORT S it as ig * 2| o p* COMMUNICATIONS COMMAND BOMBARD- MENT A-3 OIRFCTOR or PHOTOGRAPM'f AIR DEFENSE A-2 LtCLUGCNCB SCRVICC DIRECTOR OF TECHNICAL SERVICES OIRCCTOR OF TRAFFIC CONTROL B RCOULATIONS PROVING GROUND COMMAND A-l OIRCCTOR OF WEATHER OIRCCTOR OF MAMUWCATlCF FLYING TRAINING COMMAND OIRCCTOR OF INDIVIDUAL TRAINING OIRCCTOR OF WAR ORGANIZATION A NO WOVEWENT TECHNICAL TRAINING COMMAND DIRECTOR OF MftJTARY REQUIREMENTS OIRCCTOR OF BASE SCRVICC S TECHNICAL ADVISORS OIRCCTOR GROUNO SUFFORT OIRCCTOR OF WWBAROMCNT OIRCCTOR OF [AIR OCFCNSC THE ARMY OF THE UNITED STATES 7 War Department, with preparing reports to Committees of Congress, and with the liaison necessary thereto. Preparation of reports on legislation affecting the Army Ground Forces, the Army Air Forces, or the Services of Supply may be assigned to the command concerned. The Military Intelligence Service. The Military Intelligence Service, under the direc- tion of the Assistant Chief of Staff, Military Intelligence Division, War Department General Staff, collects, compiles, and disseminates military intelligence. The activities and personnel of the Foreign Liaison Section of the Air Staff are transferred to the Military Intelligence Service. Bureau of Public Relations. The War Department Bureau of Public Relations dis- tributes all War Department material of general public interest. The Inspector General’s Department. The Inspector General’s Department inquires into, and reports upon, all matters affecting the efficiency and economy of the Army, and makes inspections, investigations, and reports prescribed by law or directed by the Secretary of War, by the Chief of Staff, or requested by the Commanding Generals of the Army Ground Forces, of the Army Air Forces, and of the Services of Supply. Task Forces. The direction of Task Forces is vested in the War Department. A task force is a body of troops organized to do a specific job. THE ARMY AIR FORCES Mission. The Army Air Forces procure and maintain equipment peculiar to the Army Air Forces, and provide air force units properly organized trained, and equipped for combat operations. Under policies prescribed by the Chief of Staff, the Command- ing General, Army Air Forces, is charged in general with the command authorized by law, Army Regulations, and custom over individuals and units assigned to the Army Air Forces. The training mission requires the operation of replacement training centers and schools, including officer candidate schools, for the training of personnel in pilot functions and specialist nonpilot functions of combat and ground crews and in all duties involving the care, supply, and maintenance of aeronautical material. Since the ultimate purpose of the Army Air Forces is decisive participation in combat, their basic responsibility is to organize tactical units and to develop tactical and train- ing doctrines to guide these units. The finest aviation equipment used by these units can be obtained only by experiment and test. There are many other duties which fall to the Army Air Forces and their com- manding general. They must operate with the Army Ground Forces as a tactical team to gain ultimate victory. They must operate with the Army Service Forces in all problems of procurement, shipment, distribution and construction. They must be prepared to operate in joint action with the Navy. It is a huge task. This organizational structure is designed and intended to supply the needs. The Air Staff. The Chief of the Air Staff is the immediate adviser of the Com- manding General, Army Air Forces. He exercises control of the Air Staff and is assisted by the Deputy Chief of the Air Staff. The Air Staff is organized on the same basis and with the same general responsi- bilities as the divisions of the War Department General Staff. Under the direction of the Commanding General, Army Air Forces, it coordinates and develops the Air Forces. Plate 2 shows the organizational structure of the Army Air Forces. THE ARMY GROUND FORCES Mission. The mission of the Army Ground Forces is to provide ground force units properly organized, trained, and equipped for combat operations. Under policies pre- scribed by the Chief of Staff, the Commanding General, Army Ground Forces, is charged in general with the command authorized by law, Army Regulations and custom over individuals and units assigned to the Army Ground Forces. 8 MILITARY MEDICAL MANUAL The training mission requires the operation of schools and replacement training centers, including officer candidate schools, for Infantry, Field Artillery, Coast Artillery, and Cavalry, which functions, heretofore, were performed by the chiefs of the arms named. In the execution of this function he is assisted by the Replacement and School Command. Tactical units such as infantry divisions, armored division, cavalry divisions, and others, as well as the larger units of the combined arms are organized, developed, and trained as directed by the War Department. Tactical and training doctrines are developed. The finest equipment is developed and tested. The Commanding General, Army Ground Forces, is responsible jointly with the Commanding General, Army Air Forces, of ground-air support, tactical doctrine and training in confomity with policies prescribed by the Chief of Staff. The Army Ground Forces operate with the Army Service Forces in order to facilitate the procurement, shipment, and distribution of supplies and services under the control of the Commanding General, Army Service Forces. AIDES COMMANDING GENERAL ARMY GROUND FORCES GROUNO STATISTICS SECTION ARmV GROUNO FORCES DEPUTY CHIEF OF STAFF GROUND PUBLIC RELATIONS SECTION SECRETARIAT GROUND STAFF (GSC) PLANS SECTION g | SECTION 61 SECTION ©.| SECTION & 4 SECTION REQUIREMENTS SECTION MILITARY OPERATIONS SUPPLY. CONSTRUCTION DEVELOPMENT. PUBLICATIONS PLANS PERSONNEL iNTEiiiGFNrf AND TRANSPORTATION AND ORGANIZATION * EQUIPMENT TRAINING EVACUATION PERTAINING TO THE ARMS SPECIAL GROUNO ADJUTANT GENERAL S SECTION GROUNO ENGINEER SECTION GROUND MEDICAL SECTION GROUND ORDNANCE SECTION GROUND HEADQUARTERS COMMANDANT GROUND SIGNAL SECTION GROUND FISCAL SECTION GROUND CHEMICAL SECTION GROUND QUARTERMASTER SECTION COMMANDS ARMIES S OTHER UNITS OR FORCES ASSIGNED ARMORED ANTIAIPCR ATT TANr DESTROYER command COMMAND COMMAND DESERT TRAINING CENTER REPLACEMENT SCOOL COMMANO l-cl *o UM.r 320 7 8 fAGF) (4 74 42) A.my Fore.. J-,ly 8 1447 Sib,.e* O q.-i..*io- a« Plate 3. Organization of the Army Ground Forces. The Ground Staff. The Commanding General, Army Ground Forces, is provided with a General Staff, an Operating Staff, and a Special Staff. The Ground Staff, or General Staff, is organized on the same basis and has the same functional responsibilities as the several divisions of the War Department General Staff. Plate 3 shows the organizational structure of the Army Ground Forces. Board (Member) A-my & Navy’ Munitions Board (Member) Air Forces and Related Army & Navy Board (Army Side) Air Forces Materiel Corps Administration and Delegated Office of the Surgeon ASSISTANT CHIEF OF STAFF FOR MATERIEL DIRECTOR OF PROCUREMENT Special Legal and Liaison Division Division °"c^ Signal Officer Provides legal Services for the Commanding General Upon Request supply SERVICES IX SERVICE COMMAND Ass.stents Resources Division Office of the Chief of SERVICE COMMAND Plate 4. Organization of the Army Service Forces. production Division Office of the Chief of Chemical Warfare VII SERVICE COMMAND UNDER SECRETARY OF WAR ASSISTANT CHIEF OF STAFF FOR OPERATIONS Distribution Division Office of the Chief of Ordnance DIVISIONS COMMANDS VI SERVICE COMMAND Plans Quartermaster j SECRETARY OF COMMANDING GENERAL SERVICES OF SUPPLY CHIEF OF STAFF Public Relations SERVICE COMMAND Division Adiutani Office STAFF Marshal General SERVICE SERVICE COMMAND CHIEF OF STAFF Fiscal Office of the SERVICE COMMAND CHIEF OF ADMINISTRATIVE SERVICES SERVICES Office •! the Chief of SERVICE COMMAND administrative Office of the Chief of Chaplains SERVICE COMMAND ACorp7 ASSISTANT CHIEF OF STAFF FOR PERSONNEL Executive for Reserve and ROTC Affairs Military National 10 MILITARY MEDICAL MANUAL Mission. The Army Service Forces provide services and supplies to meet military re- quirements except those peculiar to the Army Air Forces. Procurement and related functions are executed under the direction of the Under Secretary of War. The Army Service Forces consolidates under the jurisdiction of the Commanding Gen- eral, Army Service Forces, the supply services, certain administrative services of the War Department, certain parts of the office of the Under Secretary of War, certain boards and committees, general depots, ports of embarkation and auxiliaries, and the nine service commands (formerly called corps areas.) The duties and responsibilities of the Commanding General, Army Service Forces, and the many agencies under his control, are concerned primarily with development, pro- curement, storage, and distribution of supplies, except those peculiar to the Army Air Forces. The duties include transportation and traffic control; construction; the adminis- tration of Army-wide functions pertaining to military and non-militay personnel as in- dividuals; the operation of replacement training centers and schools for the supply services, including officer candidate schools; the operation of all reception centers; the organization of all units assigned to the Army Service Forces and, among, still other responsibilities, the command and control of all stations except those assigned the Army Air Forces, defense commands, and theaters of operation. The Staff, Army Service Forces. The staff of the Commanding General, Army Service Forces, consists of a chief of staff, and the several staff divisions shown in Plate 4. This staff may be regarded as similar to the General Staff of other commanding generals and consists, in part, of officers detailed in the General Staff Corps. The Supply Services. The several Supply Services carry out their functions as heretofore except that their missions are guided and coordinated by the Commanding General, Army Service Forces. They are: The Quartermaster Corps, Corps of Engineers, Transportation Corps, including ports of embarkation, Ordnance Department, Medical Department, Signal Corps, and Chemical Warfare Service. The Administrative Services. The several administrative services perform their func- tions, as heretofore, under the Chief of Administrative Services. These agencies are: Post Exchange Services, Chief of Chaplains, Chief of Finance, Judge Advocate General, Statistical Services, Adjutant General, Provost Marshal General, Chief of Special Services. The Service Commands. The nine Service Commands (formerly corps areas) which heretofore have been responsible directly to the War Department are placed under the Commanding General, Army Service Forces. COMPONENTS OF THE ARMY OF THE UNITED STATES The Army of the United States. The Army of the United States consists of the Regu- lar Army, the National Guard while in the service of the United States, and the Or- ganized Reserves, including the Officers’ Reserve Corps and the Enlisted Reserve Corps. The strength of these components during the period 1920-1940 is shown in Plate 5. Units of the Army, as of December 7, 1941, are shown in Plate 6. While the strength of the Army of the United States has continued to grow in keeping with the needs of the huge task ahead, the figures on strength of September 25, 1941, are reproduced as an interesting study. The exact current strength figures of course are unavailable for publication. OFFICERS Regular Army 15,000 National Guard 22,000 Reserve Officers 74,000 Total *111,000 ENLISTED MEN Regular Army, 3 year enlistments 503,000 Regular Army Reserve and one year enlistments 17,500 National Guard in Federal Service 256,000 Selective Service Trainees 712,000 Total 1,488,500 ARMY SERVICE FORCES THE ARMY OF THE UNITED STATES TOTAL COMBINED STRENGTH 11 Regular Army 535,500 National Guard 278,000 Reserve Officers 74,000 Selective Service Trainees 712,000 Total 1,599,500 A major accomplishment has been the welding of separate prewar components into an integrated whole. Component distinctions have been largely eliminated. No single unit can be said to be composed of members of the Regular Army or of the National Guard. Individual officers and men have merged themselves into the larger and more important structure. The fact is that few know or care especially from which com- ponent an individual was drawn. This is a good and worthy accomplishment. All stand together in all ways, united in the common cause of winning a hard war. THE REGULAR ARMY Definition. The Regular Army is our only permanent, professional military force. It consists of officers and soldiers who have chosen as a career the lifetime study of military matters. The military instructors, strategists, technicians, and technical experts in the Regular Army form the structural foundation of an enlarged Army and consti- tute the backbone of the land forces required for any military effort undertaken by the United States. The historic policy of the United States has been to maintain a small standing army of trained officers and enlisted men around which an adequate military force must be constructed in a time of national peril. Mission. The National Defense Act, as amended, stipulates the following specific missions for the Regular Army. Garrisons for the continental frontiers of the United States and overseas possessions, small garrisons in a few of the seacoast defenses, and caretakers for the remainder. Personnel for the development and training of the National Guard, Organized Re- serves, and Reserve Officers’ Training Corps, and for the conduct of Citizens’ Military Training Camps. An organization for the administration and supply of the peacetime establishments. A framework for rapid expansion to meet wartime requirements. A repository of cumulative military knowledge, and a laboratory for military develop- ments so as to keep this country up to date and prepared. In conjunction with the National Guard, a covering force in case of a major war. The mission of the Regular Army during the period of trial following the recurrence of war in Europe and Asia has included the responsibility of training, equipping, and organizing the vast number of men who have been brought within its ranks into a formidable fighting force. Its own expansion from a strength of some 174,000 men and 14,000 officers, on July 1, 1939, to a total of 535,500 on September 25, 1941, pre- sented special difficulties. Had the nation lacked professional soldiers the tremendous task of expanding the nation’s active service strength tenfold would have verged upon the impossible. The contribution of the Regular Army in this great national effort is of vital importance to its ultimate success. Research by the Regular Army has been conducted continually to insure the latest developments in arms, ammunition, and essential equipment. The goal has been to ob- tain the best airplanes, tanks, guns, ammunition, experimenting, planning, and testing. The strength of the Regular Army through the years of peace is established by the Congress and is determined annually by appropriations. Its commissioned strength has varied from about 12,000, in 1923, to more than 14,000 in 1942. Its enlisted strength hovered at about 125,000 during the period 1923 until the remilitarization of Germany, in 1935, at which time a gradual increase was accomplished to about 250,000, in 1940, since which time the increase bias been more rapid. Plate 5. 12 MILITARY MEDICAL MANUAL STRENGTH IN THOUSANDS Plate 5. Strength of the Army of the United States, 1920-1940. THE ARMY OF THE UNITED STATES 13 Units Strength (approximate) Rank of commander (normal) Other names for units of similar size Arms and services composing the unit 16 or less Sergeant or corporal. Sergeant 2-136 4-177 Second or first Called “subflights” in the Air Forces. Called “batteries” in the Field and Coast Artillery; “troops” in the Cavalry; “flights” in the Air Forces. Called “squadrons” in the Cavalry and Air Corps. Called “groups” in the Air Forces. Called “wings” in the Air Forces. 12-700 lieutenant. Capta.n Found in nearly all arms and serv- ices. composed only of troops from a single arm or service, except that chaplains and medical personnel form part of any regiment of any arm or service. Battalion 128-1250 Lieutenant col- Regiment 800-3700 onel or major Colonel Brigade 3400-6900 Brigadier gen- eral. Major general . F \5und only in the Infantry, Cavalry, Field Artillery and Coast Artillery. The triangular infantry division contains no bri- gades. Composed of regi- ments, and bat- talions from many different arms ana services. Division. (There Triangular in- fantry division, 15,500; cavalry divisions, 10,000. C are three main types of divi- sions — infan- try, cavalry and armored.) In infantry divisions, infan- try forms the basic fighting strength, and in cavalry divi- sions the main combat arm is cavalry. There may also be special divisions as motorized, mountain, etc., organized for particular mis- sions. Corps (often called “army corps” to dis- tinguish it from arms and serv- ices which have the word “corps” as part of their names, such as the corps of Engi- neers and the Coast Artillery Corps). Army (often called “field army” to dis- tinguish it from the whole Army of the United States, of which such a unit forms only a part). 65,000-90,000 200,000-400,000 .. Lieutenant Composed of infan- try divisions or of cavalry divisions, or armored divi- sions and of addi- tional brig ades, regiments, and battalions. from many different Composed of corps, and of additional units from several arms and services, arms and services. Contains officers of general. all arms and serv- ices. Plate 6. Units of the Army as of December 7, 1941. 14 MILITARY MEDICAL MANUAL THE NATIONAL GUARD Introduction. The National Guard is made up of citizens of the United States who are so interested in national defense that they take an active part in military matters outside of the time devoted to their regular professions and occupations. There are National Guard units in each of the forty-eight States, in Hawaii, Puerto Rico, Alaska, and in the District of Columbia. Like the Regular forces, the National Guard con- tains units of all the different arms and services that go to form the modern army. The National Guard receives money for many of its needs by annual appropriation from Congress. These funds provide arms and other equipment, uniforms, motor ve- hicles, horses, and airplanes, for the construction and repair of certain buildings at camps, for sending officers to the service schools of the Regular Army for courses of training, and for many other needs. The National Guard receives money from the States for the building and upkeep of armories and camps, for extra field training pay and extra pay in times of State emergency, and for numerous other expenses. The National Guard is organized into divisions, brigades, regiments, and other units like the Regular Army. The units in each corps area come under the supervision of the corps area commander in time of peace, and automatically become part of his com- mand when they are first ordered into the active military service of the United States in case of national emergency. During the World War I, National Guard units of the various States and Territories contributed nearly half a million men to the Army. Two out of every five divisions that went to France were National Guard units, and by far the greater part of these saw service on the field of batde. Definition and Purpose. The National Guard is legally defined as the “organized militia of the several States, Territories, and the District of Columbia,” but it is far from being “militia” as that term is generally understood. There are National Guard or- ganizations in each of these political subdivisions. Service in the National Guard, for both officers and enlisted men, is wholly voluntary. While essentially State or Territorial troops, they are equipped, trained, and limited as to number by regulations promulgated by the Federal government. The National Guard has two aspects. First, it comprises the organized military force of the State to which it pertains. As such, it can be utilized by the State authorities for any legitimate purpose authorized by the laws of the State. When not in the Federal service it is under the command of the Governors of the various States. Second, when authorized by Congress, the President may call or draft any or all units, and the members thereof, into the active service of the United States. Its personnel and units thus constitute a reserve component of the Army of the United States. When serving in this capacity members of the National Guard become Federal troops subject only to the orders of the Federal government. In time of peace, the mission of the National Guard is to provide an adequate, organized and effective force, sufficiendy trained and developed so that it will be available in minor emergencies for employment within the limits of the United States by the States or by the United States, and so that it will be immediately available for employ- ment in the execution of limited missions. In time of war or major emergencies, when Congress has authorized the use of troops in excess of those of the Regular Army, the mission of the National Guard is to provide an adequate and effective component of the Army of the United States for employment by the United States without restrictions as to missions or place of employment. Composition of the National Guard and the National Guard of the United States. The National Guard of each State, Territory, and the District of Columbia shall consist of members of the militia voluntarily enlisted therein, who upon original enlistment shall (Sec. 58, N.D.A., as amended) be not less than 18 nor more than 45 years of age, or who in subsequent enlistment shall be not more than 64 years of age, organized, armed, equipped, and federally recognized as hereinafter provided, and of commissioned officers and warrant officers who are citizens THE ARMY OF THE UNITED STATES 15 of the United States between the ages of 21 and 64 years: Provided, that former members of the Regular Army, Navy, or Marine Corps under 64 years of age may enlist in said National Guard. The National Guard of the United States is a reserve component of the Army of the United States consisting of federally recognized National Guard units, and organizations, and of the officers, warrant officers, and enlisted members of the National Guard of the several States, Territories, and the District of Columbia, who shall have been enlisted and appointed, or enlisted, as the case may be, in the National Guard of the United States, and of such other officers and warrant officers as may be appointed therein. That the members of the National Guard of the United States shall not be in the active service of the United States except when ordered thereto in accordance with law, and, in time of peace, they shall be administered, armed, uniformed, equipped, and trained in their status as the National Guard of the several States, Territories, and the District of Columbia as provided in this act: And provided further, that under such regulations as the Secretary of War shall prescribe, noncommissioned officers, first-class privates, and enlisted specialists of the National Guard may be appointed in corresponding grades, ratings, and branches of the National Guard of the United States, without vacating their respective grades and ratings in the National Guard. “Militia” Defined. The militia of the United States consists of all male citizens of the United States and all other able-bodied males who have or shall have declared their intention to become citizens of the United States, who are more than 18 years of age and not more than 45 years of age, and said militia shall be divided into three classes, the National Guard, the Naval Militia, and the Unorganized Militia. (Sec. 57, National Defense Act.) There are important exemptions from militia duty which are listed in Section 59, National Defense Act. Strength and Organization. The National Guard, by the executive order of Sep- tember 8, 1939, was increased to an authorized strength of approximately 15,000 officers and 235,000 enlisted men. NATIONAL GUARD INFANTRY DIVISIONS Service Commands Division States I 26th Division... Massachusetts. I 43d Division... Connecticut, Maine, Rhode Island, Vermont. II 27th Division... New York. II 44th Division... New Jersey, New York. Ill 28th Division... Pennsylvania. Ill 29th Division... Maryland, Virginia, District of Columbia, Pennsyl- vania. IV 30th Division... Georgia, North Carolina, South Carolina, Tennessee. Alabama, Florida, Louisiana, Mississippi. IV 31st Division... V 37th Division... Ohio. V 38th Division... Indiana, Kentucky, West Virginia. VI 32d Division... Michigan, Wisconsin. VI 33d Division... Illinois. VII 34th Division... Iowa, Minnesota, North Dakota, South Dakota. VII 35th Division. .. Kansas, Missouri, Nebraska. VIII 36th Division... Texas. VIII 45th Division... Arizona, Colorado, New Mexico, Oklahoma. IX 40th Division. .. California, Nevada, Utah. IX 41st Division . . Idaho, Montana, Oregon, Washington, Wyoming. There are National Guard units in each of the forty-eight States, in Hawaii, Puerto Rico, and Alaska. These units are distributed in 1500 different stations. Like the Regular Army, the National Guard contains units of all the different arms and services that go to form a modern army. Units of the National Guard, like those of the Regular Army and the Organized 16 MILITARY MEDICAL MANUAL Reserves, are designated by numbers. Regiments have, in general, numbers between 100 and 300, and infantry divisions have numbers between 26 and 75. The National Guard Bureau. The National Guard Bureau in Washington is the central agency which supervises the work of the National Guard. The Chief of the National Guard Bureau is an officer of the National Guard appointed by the President to active duty for four years with the rank of major general. THE ORGANIZED RESERVES Organization and Purpose. The Organized Reserves consist of the Officers’ Reserve Corps, the Enlisted Reserve Corps, and the Organized Reserve units. It constitutes one of the components of the Army of the United States, the other two being the Regular Army and the National Guard. The Officers’ Reserve Corps, consisting of approximately 118,000 officers at the close of fiscal year 1940, is composed of men who have voluntarily accepted commissions therein, from second lieutenant to brigadier general. Serving generally on an inactive status without pay, they are occasionally ordered to short periods of active duty; during the fiscal year ending June 30, 1938, for example, a total of 27,685 received this training. The older officers are those who served, mostly as officers, during the World War. The younger officers have been commissioned since World War I, usually after graduation from the Reserve Officers’ Training Corps. Legend Service Command Boundary Division Boundary Service Command Headquarters The Service Command Headquarters are: I, Boston; II, New York; III, Baltimore; IV, Atlanta; V. Columbus; VI, Chicago; VII, Omaha; VIII, Dallas. IX, Douglas; Northwest Service Command, Whitehorse. Yukon Territory, Canada. Plate T. Organized Reserves—Division Areas. The Enlisted Reserve Corps is composed of persons voluntarily enlisted for service in the corps. The Organized Reserve units are composed of officers of the Officers’ Reserve Corps and of enlisted men of the Enlisted Reserve Corps. Through the years, many such units have been officered at war strength, prepared for mobilization, the reception of enlisted personnel, and further trained to perform their functions in the event of war. Units allotted to each Service Command usually include three infantry divisions and a proportion of corps, army, auxiliary, and special troops. Within Service Commands, units are allocated to states by Service Command commanders, under general instruc- tions issued by the War Department. War strength tables of organization form the basis of organization. Plate 7 shows the allocation of Organized Reserve divisions. THE ARMY OF THE UNITED STATES 17 The Organized Reserves, which form the smallest component of our peace time army, and consists mosdy of officers, undergo by far the largest expansion in time of war, and supply initially about the same number of organizations as the Regular Army and National Guard combined. The Officers’ Reserve Corps is a means whereby officers are provided: For the Organized Reserves at all times. For the Regular Army and National Guard for expansion on mobilization. For other specific duties pertaining to mobilization and subsequent operations of the Army. Sections of the Officers’ Reserve Corps. The authorized sections of the Officers’ Reserve Corps correspond with the arms and services of the Regular Army. But in addition to these, several other sections have been established in the Officers’ Reserve Corps by the President’s direction in which officers procured for special purpose are commissioned. The existing sections, with their proper abbreviated designations, are listed below: Adjutant General’s Department Reserve, AG-Res. Air Corps Reserve, Air-Res. Cavalry Reserve, Cav-Res. Chaplain’s Reserve, Ch-Res. Chemical Warfare Service Reserves, CW-Res. Coast Artillery Corps Reserve, CA-Res. Corps of Engineers Reserve, Engr-Res. Field Artillery Reserve, FA-Res. Finance Department Reserve, Fin-Res. Infantry Reserve, Inf-Res. Judge Advocate General’s Department Reserve, JAG-Res. Medical Department Reserve. Dental Corps Reserve, Dent-Res. Medical Administrative Corps Reserve, MA-Res. Medical Corps Reserve, Med-Res. * Sanitary Corps Reserve, Sn-Res. Veterinary Corps Reserve, Vet-Res. * Military Intelligence Reserve, Mi-Res. •Military Police Corps Reserve, MP-Res. Ordnance Department Reserve, Ord-Res. Quartermaster Corps Reserve, QM-Res. Signal Corps Reserve, Sig-Res. * Specialist Reserve, Spec-Res. * Inactive Reserve, Inact-Res. (PAR 6, AR 140-5) Active Duty in an Emergency. In time of a national emergency expressly declared by Congress, the President may order Reserve officers to active duty for indefinite periods without their consent. Reserve officers called to active duty for service in time of a national emergency expressly declared by Congress will, upon written application, be relieved from active duty within six months after the termination of the emergency (Par. 53, AR 140-5). Appointment of Officers. In time of peace a Reserve officer must at the time of appoint- ment be a citizen of the United States or a citizen of the Philippine Islands in the military service of the United States, between the ages of 21 and 60 years. Initial appointments in the lowest grades of the Officers’ Reserve Corps are restricted to applicants who on date of appointment do not exceed the following ages: (1) Thirty years. For the Infantry, Cavalry, Field Artillery, Coast Artillery Corps, Air Corps, Corps of Engineers, and Signal Corps. (2) Thirty-five years. For the Adjutant General’s Department, Quartermaster Corps, Finance Department, Medical Department (including Dental, Medical Administrative, • Sections which are not provided In the Regular Army. 18 MILITARY MEDICAL MANUAL Sanitary, and Veterinary Corps), Ordnance Department, Chemical Warfare Service, Chaplains, Military Intelligence Reserve, and Specialist Reserve. (3) Forty-two years. For the Judge Advocate General’s Department Reserve. In applying these age limitations, persons who have attained their thirtieth, thirty-fifth, or forty-second birthdays, respectively, will be considered as ineligible for appointment. The length of appointment in every case is for a period of five years, but an appoint- ment in force at the outbreak of war or made in time of war will continue in force until six months after the termination of the war, should the 5-year period covered by the ap- pointment terminate prior to that time. Reappointment of Officers. In time of peace when the 5-year period of appointment (PAR 26, AR 140-5) of a Reserve officer expires, he may be reappointed in his former grade and section with eligibility for promotion, assignment, and active-duty training in peace time, provided he passes a satisfactory physical examination and it has been officially recorded that dur- ing his current appointment he has established his eligibility as provided below: He has obtained a certificate of capacity for promotion to the next higher grade; or He has obtained a certificate of capacity for his present grade; or He has demonstrated his interest in military affairs by having a written record of at least 200 hours of credits, of which at least 100 hours have been earned on an inactive- duty status. Inactive-duty credits are earned by Army extension course work, attendance at classes, administrative duties in connection with his unit, or active participation with troops on inactive-duty training. Credit for 100 hours is given for each 14-day period of active duty provided only that an efficiency rating of “Satisfactory” is attained under the entry “Manner of performance.” He has satisfactorily completed the prescribed course of instruction for Reserve officers at the special service schools of his arm or service or the special course for Reserve officers at the Command and General Staff School, or at the Army War College. In case eligibility has not been thus established, he may be reappointed for one 5-year period only, to the same grade and section without eligibility for promotion, assignment, and active duty training in peace time. Promotion. Members of the Officers’ Reserve Corps may obtain promotion successively, through all grades of the Army, including the grade of major general. In general, the qualifications to be demonstrated include professional fitness, the existence of an appro- priate vacancy in the higher grade, minimum service in each grade prior to promotion as shown hereafter, and the completion of at least 14 days of active training with an efficiency rating of at least “Satisfactory.” He must again pass the required physical examination. The appointment of general officers is subject to confirmation by the Senate. The wartime system of promotion is applicable to Reserve officers as to all others. The required minimum service in each grade in time of peace is as follows: As a second lieutenant Years 3 As a first lieutenant . 4 As a captain 5 As a major 6 As a lieutenant colonel 7 Professional fitness is demonstrated, in part, by earning a “certificate of capacity” for pro- motion to the next higher grade. This is defined as an instrument, issued by the corps area commander of the officer concerned, that the officer named therein has met the professional qualifications prescribed for the grade and section specified in the certificate. A certificate of capacity is obtained by an applicant after the successful completion of two essential requirements: (1) A written military knowledge examination designed to test the applicant’s military knowledge qualifications; (2) A practical test designed to test the applicant’s ability qualifications. The former is conducted by an individual examiner appointed by the corps area commander; the latter is conducted by a board of officers appointed for that purpose. THE ARMY OF THE UNITED STATES 19 The subjects in which military knowledge and practical ability must be proven arc prescribed, for each branch and grade, in separate Army Regulations of the 140 series. Waivers and exemptions may be secured for promotion through the following methods: (1) By satisfactory completion of appropriate courses of instruction for National Guard and Reserve officers at general and special service schools. (2) By completing appropriate subcourses of the Army extension courses. (3) By submitting evidence of graduation, for promotion to grade of 1st lieutenant only, from the United States Military or Naval Academies, Air Corps Training Center, or senior units of the ROTC. Graduation must have been within five years of application for certificate of capacity or promotion. Waiver is restricted to subjects in which instruction was received at the institutions listed. (4) The efficiency ratings awarded for periods of active service may be accepted in lieu of the practical tests. Ratings of not less than “Satisfactory” are required. Active Duty. In time of a national emergency expressly declared by Congress, the (PAR 5 3, AR 140-3) President may order Reserve officers to active duty for indefinite periods without their consent. By June 30, 1942, nearly all of the more than one hundred thousand Reserve officers who were physically qualified and troop age were on active duty. In time of peace Reserve officers may not be ordered to active duty without their consent. For training purposes, Reserve officers are ordered to active duty for periods of 14 days in numbers determined by the amount of the annual appropriation for that purpose. This training is restricted to those who qualify themselves by pursuing appropriate extension courses or taking other inactive duty training. In addition to active duty for 14-day periods, active duty is available for Reserve officers for the following purposes: (1) As additional members of the War Department General Staff. (2) As student officers at special courses conducted for or available to Reserve officers at the special service schools, the Command and General Staff School, and the Army War College. (3) For duty with tactical units of the Air Corps. (4) For duty as instructors for periods of not more than 30 days at Citizens’ Military Training Camps. (5) For extended active duty of 1 year with the Regular Army. Training. The ultimate object in training units of the Organized Reserves in time of peace is to provide partially organized and partially trained units which may be readily expanded to war strength and completely trained in time of emergency and which, in combination with the Regular Army and the National Guard, will provide an adequate, balanced, and effective force sufficient to meet any national emergency declared by Con- gress. The primary purpose is efficient mobilization. The objects in training the individual Reserve officer in time of peace are: (1) To prepare him to perform efficiently the duties of his mobilization assignment; (2) To prepare him for promotion to the next higher grade. The facilities for training while on an inactive status are as follows: (1) Courses of instruction at troop schools and group schools. These schools are established at home stations of units of the Organized Reserves. Subjects of instruction include applicatory exercises employing map problems, map maneuvers, and tactical exercises; in addition, the instruction may include conferences for discussion of assigned subjects or mobilization plans. (2) Army Extension Courses. (3) Special assemblies of officers for individual training in the tactics and technique of their arm or service (4) Duty on various boards of officers, on inactive status. (5) Attachment to units of the Regular Army or National Guard. (6) Duty on an inactive status at special and general service schools. (7) Firing practice on inactive status. (8) Use of Army aircraft. 20 MILITARY MEDICAL MANUAL The facilities for training while on active status include the following: (1) Utilization of the 14-day training period. (2) Duty at special assemblies for individual training in the technique or tactics of an arm or service. (3) Active duty with the Regular Army or the National Guard. (4) Duty on active status on various boards of officers. (5) Active duty as instructor at Citizens’ Military Training Camps. (6) Specified courses at the various special service schools and the Command and General Staff School. (7) Selected courses at the Army War College. Uniform Regulations. A Reserve officer on active duty is required to wear the uniform, including insignia, prescribed for officers of the Regular Army. Blue uniforms, however, are not required to be worn by Reserve officers although they are authorized to be worn. Reserve officers who are not on active duty and when within the United States or its possessions may wear the uniform on occasions of military ceremony, at social functions of a military character, at informal gatherings of the same character, when engaged in the instruction of a cadet corps or similar organization, or when responsible for military education at an educational institution. Under the conditions of war service the uniform requirements are applicable equally to officers on active duty of all components.1 THE RESERVE OFFICERS’ TRAINING CORPS Object* of the Reserve Officers’ Training Corps (ROTC). The general object of the (PAR 2, AR 145-10) courses of instruction of the ROTC is to qualify students for positions of leadership in time of national emergency. Primarily, it is an agency for the production of Reserve officers for those arms which are restricted as to their sources of production, and it should produce for those arms the number of Reserve officers required in the initial periods of a general mobilization. There is a very important by-product which accrues to the benefit of the nation from our system of military training in schools and colleges. Those of our citizens who know from study or experience the futility of national weakness are not readily swayed by the specious arguments of the few among our people who seek to weaken or destroy our system of national defense. The presence in all professional groups of an increasing per cent of leaders who have enjoyed the benefits of military instruction serves as a stabilizing influence over the whole nation which supports and champions a sympathetic understand- ing of the needs of the military establishment and its purposes. Students who complete the course, according to their own abundant testimony, secure personal benefits which are valuable to them in their occupations. They are better citizens because they have had inculcated an understanding of the responsibilities of citizenship. They realize more fully that the benefits their own generation enjoys were secured by the sacrifices made by their predecessors. They learn the necessity for discipline, the responsi- bility of an individual to the group as a whole, and the methods by which discipline is developed and enforced. Finally, they learn the principles of leadership and have an opportunity to exercise this art to a greater extent than that which is available to them in any other phase of their instruction. Thus our system of military education in schools and colleges provides valuable benefits to the nation, to the Army of the United States, and to the individuals who participate in its activities. In a democracy this is the better way. Authorization of the Reserve Officers* Training Corps. The Act of Congress approved June 3, 1916, as amended by the Act of June 4, 1920, established for the United States the system of military education in schools and colleges as we have it today. By these provisions the Reserve Officers’ Training Corps has become an important part of the well- ’* The Officer's Guide, Military Service Publishing Company, contains complete afcfl authoritative information concerning the uniform. THE ARMY OF THE UNITED STATES 21 integrated system of national defense upon which the nation now relies. The essential soundness of the basic Acts is well attested by consideration of the amending legislation through the years which has been concerned largely with matters of improvement or clari- fication. Based upon a concept which adheres strictly to American principles and ideals, the policy of military training in educational institutions has proven itself by its economy, its efficiency, and the excellence of the very large number of Reserve officers who have been commissioned into the Army of the United States. Extent of Military Education. During the academic year 1940-41, the Army List and Directory records 310 educational institutions which maintain one or more units of the ROTC. The following chart lists the annual enrollment since 1919-20. Medical units of the ROTC were in operation during the academic year 1941-42 at the following institutions: Boston University, Boston, Mass. University of Vermont, Burlington. Cornell University Medical College, New York City. Syracuse University, Syracuse, New York. University of Buffalo, Buffalo, New York. Georgetown University, Washington, D. C. George Washington University, Washington, D. C. Jefferson Medical College, Philadelphia, Penna. University of Pennsylvania, Philadelphia. University of Pittsburgh, Pittsburgh, Penna. Medical College of Virginia, Richmond. Vanderbilt University School of Medicine, Nashville, Tenn. Indiana University, Bloomington. Ohio State University, Columbus. Western Reserve University, Cleveland, Ohio. University of Michigan, Ann Arbor. The State University of Iowa, Iowa City. University of Minnesota, Minneapolis. St. Louis University School of Medicine, St. Louis, Mo. Washington University, St. Louis, Mo. Baylor University, College of Medicine, Dallas, Texas. University of California Medical School, San Francisco. University of Oregon Medical School, Portland. Supervision by the War Department. The War Department is the agency of the Federal Government charged by law with the preparation of regulations and instructions carrying into effect the provisions of the national defense act and other federal statutes relating to the ROTC, and is likewise charged with the supervision of the execution of the pro- visions of pertinent law and regulations. In general, the supervisory powers of the War Department are delegated to the corps area commanders who act as the immediate representatives of the War Department in all relations with the educational institutions, and they are responsible that the requirements of law and regulations relating to this sub- ject are effectively carried out. Control at Institutions. The control of the operation of ROTC units at institutions is vested in the institutional authorities. Civilian heads of institutions exercise the same general control over the department of military science and tactics that they ordinarily exercise over their other departments. This provision of the regulations, while not difficult of execution and compliance, in- cludes a dual responsibility for the officers on ROTC duty. In their strictly military capacity these officers are subordinates of the corps area commander and are subject to his orders. In their academic capacity they are subject to institutional regulations. Direct correspondence between superior military authorities and professors of military science and tactics is limited to subjects of a purely military nature. Eligibility for Enrollment. Eligibility to membership in the ROTC is limited to students at institutions in which units of the corps may be established, who are citizens of the 22 MILITARY MEDICAL MANUAL United States, who are not less than 14 years of age, and whose bodily condition is such as to meet the prescribed physical standard. In general, a student is ineligible for enrollment who is a member of any component of the Army of the United States, the Navy, or of the Marine Corps. Bask and Advanced Courses. The four years’ ROTC course of the senior division is divided into the basic course and the advanced course. The basic course consists of the first two years in the department of military science and tactics which correspond to the Freshman and Sophomore years in the academic departments. The advanced course consists of the last two years in the department which correspond to the Junior and Senior years. Students electing the ROTC training courses do so for only two years at a time. The first election is for the two years’ basic course, and completion of the basic course is a prerequisite for advancement. Upon the completion of the basic course, if a student be rec- ommended for further training, he may elect the advanced course. Once the student has signed an agreement to take the advanced course it becomes a requirement for academic graduation by virtue of the fact that the institution has agreed to make it a required subject of the institutional course. Entrance into the advanced course is both voluntary and selective in that it is entirely optional with the student as to his application, and entirely optional with the professor of military science and tactics whether he shall be accepted. Attendance at one summer camp of six weeks’ duration is a requirement of the advanced course. Hours of Instruction. The minimum number of hours of instruction required to be given in the basic course is an average of 3 hours per week, and in the advanced course, 5 hours per week. An exception is made for medical units in which 90 hours per annum is required in both the basic and advanced courses. Year Jr.Div1 Senior Div2 Graduates Graduates Appointed ToORC 1919-20 45,139 43,605 (No record) 135 1920-21 56,538 44,253 1272 934 1921-22 37,225 51,742 2774 2465 1922-23 37,346 57,505 4143 3786 1923-24 40,324 63,570 4370 4048 1924-25 42,190 69,368 5069 4884 1925-26 38,225 68,553 5919 5728 1926-27 38,148 70,809 5956 5836 1927-28 39,978 72,371 6127 6013 1928-29 40,521 71,903 6293 6049 1929-30 41,334 73,030 5969 5684 1930-31 41,637 75,786 6062 5602 1931-32 40,556 73,989 6447 5418 1932-33 39,466 66,729 6663 6497 1933-34 88,728 65,419 6495 6490 1934-35 41,053 76,260 6390 6350 1935-36 53,202 92,688 5663 5619 1936-37 57,777 101,728 5960 5848 1937-38 61,791 106,041 6425 6337 1938-39 65,282 111,614 6565 6700 1939-40 68,895 117,855 7992 6444 1940-41 72,151 125,647 88627 88000 1 In colleges, universities and essentially military schools. iln secondary schools. * Approximate number. Summer Camps Suspended. Reserve Officer Training Corps summer camps for col- lege students who have completed a year of the advanced course have been discontinued for the duration of the war and for six months thereafter. OFFICERS' INSIGNIA OFFICERS’ AND AVIATION CADETS ADJUTANT GENERAL'S DEPARTMENT AIDES TO GENERAL AIDES TO LIEUT GENERAL AIDES TO MAJ GENERAL AIDES TO BRIG GENERAL AIR CORPS AND AVIATION CADETS CAVALRY CHAPLAINS (CHRISTIANS) CHAPLAINS (JEWISH) CHEMICAL WARFARE SERVICE COAST ARTILLERY CORPS CORPS OF ENGINEERS FIELD ARTILLERY FINANCE DEPARTMENT GENERAL STAFF INSPECTOR GENERAL'S DEPARTMENT INFANTRY JUDGE ADVOCATE GENERAL'S DEPT MEDICAL CORPS DENTAL CORPS VETERINARY CORPS MEDICAL ADMINI- STRATIVE CORPS ARMY NURSE CORPS MILITARY INTELLIGENCE DIVISION CONTRACT SURGEONS SANITARY CORPS RESERVE MILITARY POLICE NATIONAL GUARD BUREAU ORDNANCE DEPARTMENT QUARTERMASTER CORPS SIGNAL CORPS OFFICERS NOT MEMBERS OF AN ARM OR SERVICE (SPECIALIST RESERVE) WARRANT OFFICERS U. S. MILITARY ACADEMY U. S. ARMY BAND ARMORED FORCE ARMY TRANSPORTATION CORPS GENERAL LIEUT GENERAL MAJOR GENERAL BRIG. GENERAL COLONEL LIEUT COLONEL MAJOR CAPTAIN 1ST LIEUTENANT 2ND LIEUTENANT CHIEF WARRANT OFFICER WARRANT OFFICER (JUNIOR GRADE) FLIGHT OFFICER TYPICAL INSIGNIA UNITED STATES ARMY GENERAL HEADQUARTERS HEADQUARTERS 1 ARMY GROUND FORCES AND ARMY GROUND FORCES OVERHEAD HEADQUARTERS ARMY GROUND FORCES 3 RESERVE HEADQUARTERS SERVICES OF SUPPLY AND SERVICES OF SUPPLY OVERHEAD ARMY AIR FORCE ARMIES 1ST ARMY 2ND ARMY 3RD ARMY 4TH ARMY 5TH ARMY 6TH ARMY CORPS 1ST CORPS 2ND CORPS 3RD CORPS 4TH CORPS 5TH CORPS 6TH CORPS 7TH CORPS 8TH CORPS 9TH CORPS 10TH CORPS 11TH CORPS 12TH CORPS 13TH CORPS 14TH CORPS 19TH CORPS DIVISIONS 1ST ARMORED CORPS 1ST DIV 3RD DIV. 2ND DIV. 4TH DIV. 5TH DIV. 6TH DIV. 7TH DIV. 8TH DIV. 9TH DIV. 10TH DIV 11TH DIV. 12TH DIV. 13TH DIV 14TH DIV. 18TH DIV. 19TH DIV. 26TH DIV. 27TH DIV. DIVISIONS (continued) 28TH DIV. 29TH DIV. 30TH DIV. 31ST DIV. 32ND DIV. 33RD DIV. 34TH DIV. 35TH DIV 36TH DIV. 37TH DIV. 38TH DIV. 39TH DIV. 40TH DIV 41ST DIV. 42ND DIV. 43RD DIV. 44TH DIV 4STH DIV. 76TH DIV 77TH DIV. 78TH DIV. 79TH DIV. 80TH DIV 81ST DIV 82ND DIV 83RD DIV 84TH DIV. 85TH DIV. 86TH DIV. 87TH DIV. 88TH DIV 89TH DIV. 90TH DIV. 91ST DIV 92ND DIV. 93RD DIV 94TH DIV 95TH DIV. 96TH DIV. 97TH DIV, 98TH DIV 99TH DIV. 100TH DIV 101 ST DIV. 1C2HD DIV 103RD DIV 104TH DIV. OTHER ORGANIZATIONS 1ST CAVALRY DIV 2ND CAVALRY DIV. 3RD CAVALRY DIV. 21ST CAVALRY DIV. 24TH CAVALRY DIV 61 ST CAVALRY DIV. 62ND CAVALRY DIV 63RD CAVALRY DIV 64TH CAVALRY DIV 6STH CAVALRY DIV. 66TH CAVALRY DIV. TANK DESTROYER UNIT 1ST SERVICE COMMAND 2ND SERVICE COMMAND 3RD SERVICE COMMAND 4TH SERVICE COMMAND 5TH SERVICE COMMAND 6TH SERVICE COMMAND 7TH SERVICE COMMAND 8TH SERVICE COMMAND 9TH SERVICE COMMAND NEW ENGLAND FRONTIER N. Y. AND PHILA FRONTIER CHESAPEAKE BAY FRONTIER ARMORED DIVS. NUMERAL CHANGES INDIGO TASK FORCE PACIFIC COASTAL FRONTIER C SOUTHERN 'OASTAL FRONTIER ALASKA DEFENSE COMMAND PANAMA CANAL DEPT. HAWAIIAN DEPT HAWAIIAN DIV PHILIPPINE DEPT. PHILIPPINE DIV U. S. MILITARY ACADEMY AIR FORCES COMMAND AVIATION CADET OFFICERS CANDIDATE SCHOOL PARACHUTIST HO. MIL. DIST. WASHINGTON, D. C. Insignia of the CITIZENS DEFENSE CORPS BASIC INSIGNE DRIVERS CORPS MESSENGERS RESCUE SQUADS AUXILIARY POLICE BOMB SQUADS AIR RAID WARDENS AUXILIARY FIREMEN FIRE WATCHERS DEMOLITION AND CLEARANCE CREWS ROAD REPAIR CREWS DECONTAMINATION SQUAD EMERGENCY FOOD & HOUSING CORPS MEDICAL CORPS NURSES’ AIDES CORPS THE ARMY OF THE UNITED STATES 23 Duties of the Head of the Military Department. When one or more officers are detailed to an educational institution for duty with the ROTC, the senior line officer will be the professor of military science and tactics and will be the head of the department. Where officers of the services only are detailed to an educational institution the senior officer thereof will assume these responsibilities. It is considered essential to the effective performance of his duties that the professor of military science and tactics have the academic rank which the institution accords the heads of its other departments, that he be a member of the faculty and, as such, entitled to all the rights and privileges of a faculty member with responsibilities and obligations similar to those of the heads of other departments. The professor of military science and tactics (PMS&T) coordinates the instruction of the several units in the department. All reports, records, and other administrative requirements are performed under his supervision. It is also considered essential by the War Department that the PMS&T be em- powered to draft the rules, and orders relating to the organization, control, and training of the members of the ROTC and the appointment, promotion, and reduction of cadet officers, at civil colleges and schools (Class CC and CS), subject to coordination with general institutional regulations and arrangements and the approval of the head of the institution. At military colleges and essentially military schools (Class MC, MI, and MS) where the PMS&T is not charged with the discipline of cadets, this power except in respect to training, may properly be exercised jointly by the PMS&T and the commandant of cadets under the supervision of the head of the institution. Restrictions Applied to Officers Assigned to ROTC Duty. Officers are required to live at or near the institution to which assigned. They are required to appear in the proper uniform when in the performance of their military duties (including classroom instruction as well as the practical exercises). Officers are prohibited from conducting any course of instruction in the institution other than those prescribed by the War Department. Officers may not pursue any course of instruction conducted by the institution until after the completion of two years of their details and then only subject to approval by the War Department in each individual case. An exception to this general ruling is that corps area commander may authorize an officer to pursue pedagogical and allied psychological courses for the purpose of familiarizing themselves with the in- structional policies in respect to methods of instruction and improving instructional methods in the ROTC. Appointment of Graduates as Reserve Officers. Graduates of ROTC courses who fulfill the requirements in all ways may be commissioned into the Army of the United States as Reserve officers. Appointments are made only in the lowest authorized grade of the proper section. The annual increment of young Reserve officers into the Officers Reserve Corps is a very important addition to the national defense. As the years pass, there is an ever- decreasing number of officers with World War experience, and the per cent of officers trained for the Reserve in the ROTC increases accordingly. The Army and the Nation have come to rely on the system of military education in colleges and universities for the supply of trained officers to be available in a time of national emergency. It is a national asset of proven value. Under prescribed conditions students enrolled in certain medical schools may be appointed second lieutenants, Medical Administrative Corps and complete their medical training prior to being called to active duty as officers of the medical corps. CHAPTER II TACTICAL FUNCTIONS OF THE ARMS INTRODUCTION The student of the tactical employment of large military forces must acquire a clear understanding of the function of each of the several components. Only in this manner may he envision the complete function of his own arm or service in all of the conditions imposed by combat. An army is a carefully integrated organization of all required func- tions, the needs for which can be foreseen and provided for in advance. No one of these functional components wins battles alone. The combined, joint action of all is essential for success. For these reasons large military forces, such as the division, corps, and field army, consist of “arms,” the units which engage directly in combat, and “services” which provide the required administration, supply, evacuation, and hospitalization. Each of these components is given the necessary personnel to execute its mission. This personnel is organized into units for control and efficient operation. Each component is provided with essential equipment including transportation which it will require. Doctrines and principles announced by the War Department are then applied. In battle, the commander assigns a mission or objective for the whole force and a specific task to each of its several components to achieve its accomplishment. He then coordinates and directs the action of all to achieve the ends sought. The student must learn what each arm and service is required to do, and then he may proceed to acquire an understanding of when, where, and how it is to do it. It is particularly desirable that the officer of each of the several corps of the Medical Department possess this broad understanding. He serves and works with each arm and service. In garrison, camp, or bivouac, on the march, in battle and campaign, in success or failure, he accompanies the fighting force with his medical unit to provide, wherever his humanitarian services may be needed, medical attendance for the sick, the injured, or wounded, as well as facilities for evacuation and hospitalization. There is no single factor so destructive of the morale of fighting men as the suspicion or knowledge that the sick or wounded are being inadequately attended. In our army, medical units are an integral part of the tactical structure. The plan for any projected military operation must include a medical plan. Its preparation will fall to the medical officer. It is a doctrine that the medical plan must provide adequate support for the tactical plan, however difficult this task may be. In the execution of this mission he will make judicious use of the means in medical personnel, equipment, and transportation which are available to him. He will allot these means to units in accordance with their needs, place them where they can perform their tasks with greatest effectiveness, and move them as the supported units move, in order that continuous medical service may be provided. These are the tasks which pertain to the medical officer. If he is to perform them to the standard he will wish to attain he must possess a considerable knowledge of the functions, battle tasks, and methods of operation of each component of an army. The record achieved by members of the Medical Department in Hawaii, on Bataan and Corregidor, and elsewhere, indicates events for which the medical officer must prepare. In addition to a discussion of each of the arms with their tactical employment, this chapter contains the elements of camouflage and scouting and patrolling. Useful informa- tion on communications applicable to all arms and services is included in the discussion of the Signal Corps. The components of the Army of the United States (Regular Army, National Guard, Organized Reserves) pertain to two functional subdivisions, the arms and the services. The arms engage directly in combat and are known collectively as the line of the Army. The arms are: The Air Forces, Cavalry, Coast Artillery Corps, Corps of En- gineers, Field Artillery, Infantry, and Signal Corps. While not so classified, the Ar- mored Force has many characteristics of the separate arms and may be so regarded. 26 MILITARY MEDICAL MANUAL The services are supply and administrative agencies designed to maintain the efficiency and morale of the combat force. The services are: Adjutant General’s Department, Chap- lains, Chemical Warfare Service, Finance Department, Inspector General’s Department, Judge Advocate General’s Department, Medical Department, Ordnance Department, Quartermaster Corps, and the Transportation Corps. Of the arms, the Air Forces, Coast Artillery Corps, Corps of Engineers, and Signal Corps have service functions which are concerned, chiefly, with procurement and dis- tribution of supplies peculiar to the arm. The Chemical Warfare Service has combat units. INFANTRY Mission. Infantry is the arm of close combat. In the attack it advances upon the enemy, then closes with him to effect his destruction or capture. In the defense, infantry holds the positions to which it is assigned, checks the advance of the enemy, and throws him back by counterattack. As the arm which is charged with the principal mission in battle, the mission of the infantry becomes the mission of the entire command. The other arms and the services which are present have as their battle functions the duty of assisting the infantry, enabling it to achieve a victory which, unaided, would be beyond its powers, or to enable it to gain its objectives with fewer casualties or in a shorter time. Plate 1. Private John Doe, Infantry, Infantry carries out its mission by fire action, movement, and shock action. The fire of infantry weapons is to inflict losses on the enemy, reduce the accuracy and volume of his fire and, in its ultimate application, to cause the enemy to abandon all else save self- preservation. Movement enables infantry units to close upon the enemy, to occupy posi- tions more favorable for the accurate delivery of fire, or to penetrate between or around areas held by an enemy. Fire power is constantly combined with movement in such a manner that the one facilitates the progress of the other. Finally, shock action is the TACTICAL FUNCTIONS OF THE ARMS 27 culmination of fire and movement in which the destruction or capture of the enemy is effected by hand-to-hand combat. There are many kinds of infantry. There are the rifle regiments, for example, of the infantry divisions. In numbers, this type is most numerous. There are also the motorized regiments of infantry of motorized divisions; armored regiments which are an organic part of armored divisions; parachute infantry; air-borne infantry; and infantry of the mountain regiments. There is great diversification within the infantry regiment of any type. There is the rifleman, the light machine gunner, and the operator of the 60-mm mortar; the machine gunner and the 81-mm mortar operator of the heavy weapons company; members of crews of the 37-mm antitank gun and guns of other calibers; truck drivers; radio and telephone men; Intelligence personnel; supply personnel; clerks and typists; cooks, and many others. The regiment includes attached medical personnel who retain their identity as members of the Medical De- partment but are members in fact of the regiment they serve. While infantry is the arm of close combat, it must not be pictured as fighting alone or operating alone. It works inseparably with field artillery and often with air units. Infantry may be said to contribute the power of deception, of maneuver and movement, as well as a considerable firepower in its own right, as it works its way forward by groups or by individuals in the attack, or clings tenaciously to ground held or won in the defense. Field artillery may be said to contribute the power, or muscle of the attack or defense by using its great firepower to assist and support infantry. Nor is this all. Infantry works with combat engineers, with Air Force units which provide support of ground troops, and with the other arms and services as occasion requires in the accomplish- ment of missions. The hazards of infantry in battle (as well as the principal task of the medical officer) are sufficiently attested by considering the AEF casualty rates. The batde casualties of the AEF were 260,783; of this total the infantry incurred 229,223 or approximately 88 per cent. The casualty rate per thousand of infantrymen was 583.96. Already, in this new and global war, the blood of infantrymen has been shed in the battles of the nation they serve, in Hawaii, the Philippines, at other distant points in the far east, in Dutch Harbor, and elsewhere. These are precious lives. The medical officer who serves and works with infantry may expect to find full use for the knowledge in his mind and the skills in his hands. He may save lives which otherwise might be lost. If he does his work well he may become the good comrade of men who know war as it is, with its mud and grime, sweat and blood, cold and rain, and awful fatigue. Organization of Infantry Units. The squad is the elementary combat unit. It is the largest infantry unit habitually controlled by the voice and signals of its leader. A well-trained squad constitutes a team capable of resisting and overcoming the hazards of battle and carrying out its assigned mission. The rifle squad consists of a leader, a second-in-command, and five to ten riflemen. Personnel armed with weapons heavier than the rifle are organized in squads for purposes of control. In general, these squads consist of a leader and a gun crew to operate one or more weapons. The rifle platoon is the smallest unit with capacity for deployment in depth and width and endowed with independent power of maneuver. It includes no weapons appreciably less mobile than those of the rifle squad nor any weapons presenting con- siderable relief in firing position. The platoon is the smallest unit which is commanded by an officer. The company is the basic infantry unit with administrative and supply functions. It comprises a company headquarters and several platoons with the agencies necessary for their control, subsistence, and administration. Companies are classified as combat companies and headquarters and service companies. The company is the appropriate command of a captain. Combat companies of rifle regiments include rifle companies, antitank companies, heavy weapons companies and the cannon company. The rifle company combines the action of several rifle platoons with that of a weapons platoon. It is the smallest unit which habitually organizes a base of fire in the attack. It contains only elements which 28 MILITARY MEDICAL MANUAL have a normal march mobility approximately that of the rifleman. Heavy weapons companies comprise machine gun and mortar platoons. Headquarters companies are principally constituted by groups charged with collecting information and disseminating orders and instructions. They may include other ele- ments not large enough to justify a separate supply and administrative overhead. Service companies furnish staff, supply, and transportation personnel, and operate transportation. The rifle battalion is the basic tactical unit of infantry. It consists of a headquarters and headquarters company, three rifle companies, and a heavy weapons company. The battalion constitutes a complete infantry unit capable of assignment to a mission requiring the application of all the usual foot infantry means of action. Organically, it includes no weapon which cannot be manhandled over a distance of several hun- dred yards. It is commanded by a lieutenant colonel. The details of organization are no longer available for publication. The infantry regiment is the complete tactical and administrative unit. The regi- mental commander, in addition to coordinating the action of his own units in battle, usually motivates the action of a varying allotment of weapons in supporting arms, particularly artillery. It is commanded by a colonel. Commanders of infantry regiments and battalions require staff assistants. These staff groups are relatively small. The staff of the battalion commander consists of an executive and operations officer (S-3), an adjutant and intelligence officer (S-l and S-2), and a detachment commander and transport officer. The battalion may be supplied from means available to the regimental commander with a supply officer, a communi- cations officer with personnel to install and operate communications facilities, and a battalion section of the regimental medical detachment, including an officer to func- tion as battalion surgeon. The staff of the regimental commander consists of an executive officer, an adjutant (S-l), intelligence officer (S-2), operations officer (S-3), a supply officer (S-4) who commands the regimental supply service, a regimental surgeon who commands the regimental medical detachment, other staff assistants for functional purposes, and three chaplains. The term combat team is in common usage in field operations. It consists of an infantry regiment, a battalion of light field artillery, and such other units as may be prescribed by the division commander. The expression “CT 21” means the 21st infantry with the supporting and service elements which accompany it as standing operating procedure. Designation of Units by Number or Letter. The battalions are numbered. Companies are lettered or named. The units of the infantry regiment are designated as shown below: Regimental headquarters Headquarters company Service company Antitank company Cannon Company 1st battalion: Battalion headquarters and headquarters company Company A (rifle) Company B (rifle) Company C (rifle) Company D (heavy weapons) 2d battalion: Battalion headquarters, headquarters company, companies E, F, G (rifle), and H (heavy weapons) 3d battalion: Battalion headquarters, headquarters company, companies I, K, L (rifle), and M (heavy weapons) Regimental medical detachment (attached) Chaplains (attached) TACTICAL FUNCTIONS OF THE ARMS 29 Infantry Weapons. The weapons furnished the rifle company are designed to satisfy the special missions of this unit. It is the infantry unit which leads the way in attack, and holds the most advanced positions in defense. The weapons are the rifle, the automatic rifle, light machine gun, 60-mm mortar, and the bayonet. The automatic pistol or carbine is carried by some members of the company. Hand grenades are used on short-range missions. The rifleman fights on foot. Motor transport is used to place him quickly at a location close to the battle area, to supply him, and to evacuate his casualties. All weapons of the rifle company are carried by hand, and, except for supply of ammunition, transport is not required in battle. The weapons are light in weight, capable of a high volume of accurate fire, and reach their greatest effectiveness at relatively short ranges. Plate 2. The Rifle. Plate 3. The Browning' Automatic Rifle. The intrenching tool is an important article of equipment of the infantry soldier. With few exceptions he is equipped with some form of portable tool: shovel, pick- mattock, hand ax, or wire cutter. The heavy weapons company provides supporting fires for rifle companies of the infantry battalion. This may involve adding to the intensity of their fires to assist in gaining fire superiority, or engaging targets which are beyond the range or capabilities of rifle-companies weapons. The weapons provided are the caliber .30 machine gun (8 MG’s), and the 81-mm mortar (4 mortars). The caliber .50 machine gun, truck mounted, is used for antiaircraft missions. The machine guns provide a high volume of flat-trajectory fire which can be employed effectively by day or night, in fog, rain or smoke, in any condition of weather or visibility. These characteristics are available because of the tripod which provides a fixed mount, enabling fire to be delivered in any predetermined elevation or direction. While the principal method of fire delivery is by direct laying, in which the target is visible to the gunner, the machine guns may also be used effectively for indirect laying when the target is invisible to the gunner, by the use of instrument or map-firing methods. Machine guns support rifle units from positions abreast of their advanced elements or from positions in their rear or on their flanks. Fires from rear positions are delivered through gaps between rifle 30 MILITARY MEDICAL MANUAL Plate 4. The Light Machine Gun. Plate 5. The 60-mm Mortar. TACTICAL FUNCTIONS OF THE ARMS 31 units, by overhead fire, or to points outside their flanks. Many members are armed with the carbine. The 81-mm mortar is a high-trajectory weapon using a heavy shell with a bursting radius substantially equal to the 75-mm light artillery projectile, and a lighter shell which reaches to much greater ranges with a reduction in bursting effect. The weapon is used to engage enemy targets in areas in defilade from flat-trajectory weapons such as targets on reverse slopes, ravines, and trenches. Plate 6. Machine Gun, Caliber .30. Plate 7. Machine Gun, Caliber .50, with Ground Mount. Infantry heavy weapons may be moved by hand for short distances without undue fatigue or for long distances with sacrifice of speed and with fatigue losses. They are provided with transport for batde movement and displacement as the action pro- 32 MILITARY MEDICAL MANUAL Plate 8. 81-mm Mortar. Plate 9. The 37-mm Antitank Gun. TACTICAL FUNCTIONS OF THE ARMS 33 ceeds. Trucks and pack mules are employed. Transport is also required for am- munition supply. The antitank company and the battalion are each furnished the 37-mm antitank gun. It is used to engage hostile mechanized vehicles, including tanks. The company is organized into three platoons, each of which operates four AT guns, a total of twelve guns. Truck transport is required for moving this weapon except for short changes of position incident to changes of firing position. Other weapons used by infantry such as the weapons of the cannon company and carbine have not been released for publication. It may be said, however, that the carbine is a light weight hand weapon which replaces the pistol; it possesses great ruggedness, delivers a high rate of accurate fire and is effective at sufficient range to provide a major contribution to infantry on the battlefield. Weapon Maximum Caliber range (inches) (yards) Service effective range (yards) Weight of piece (pounds) Usable rate of fire (per minute) Weight of ammunition Rifle, Ml (Garand) .30 5500 1000 9.4 15-30 1 ounce Rifle. M1903 .30 5500 1000 8.4 7-10 1 ounce Automatic rifle .30 5500 1000 17.1 40-60 1 ounce Machine gun .30 5500 3500 82.0 250 1 ounce Machine gun .50 7500 5000 128.0 250 4 ounces 37-mm AT gun 1.4 7500 1600 850.0 15-20 4 lbs. 60-mm mortar 2.4 1300 1000 51.4 30-35 2.4 lbs. 81-mm mortar 3.2 3280 2000 134.0 30-35 7.2 lbs. 1500 30-35 15.8 lbs. Pistol .45 1600 50 2.4 1.5 ounces Hand grenade 50 50 1.3 lbs. Plate 10. Characteristics of Infantry Weapons. Communications, Supply, and Evacuation. Communication facilities of the regiment of infantry include telephone, telegraph, radio, and messenger service. The head- quarters company contains the communication platoon with four sections which install and operate the facilities. Each battalion has personnel to operate its own message center. Sections are provided for regimental headquarters and, when required, for each of the three battalions. The service company contains a transportation platoon with a section for each bat- talion, and non-lettered companies of the regiment. This arrangement pools all transportation available to the regiment, except tactical vehicles which remain with the organizations to which they are issued. The regimental medical detachment (attached medical personnel) initiates evacua- tion of the sick and wounded. For functional purposes it may be divided into a regi- mental section and three battalion sections. Each section is staffed and equipped to set up and operate an aid station at which casualties are assembled and prepared for evacuation. Basic Factors of Infantry Combat As infantry is the arm of close combat, it operates in the zone of intense hostile fire. This obliges infantry to adopt extended formations and to take the fullest advantage of the terrain in order to reduce the degree of vulner- ability. Even small tactical units are distributed over a considerable area, and battle- field control is difficult. Infantry subordinate leaders see only a small portion of the battlefield and often fight in ignorance of the general situation and the major results obtained. They direct the local combats which make up the battle, the sum of which constitutes success or failure. Fire and Movement. Foot infantry has two principal means of action: fire and movement. There must be the closest possible coordination between them in order that infantry may close with the enemy and break his resistance. Fire destroys or neutralizes the enemy and must be used to piotect all movement in the presence of the enemy not masked by cover, darkness, fog, or smoke. Through movement, in- fantry places itself in positions which increase its destructive powers by decrease of the range, by the development of convergent fifes, and by flanking action. 34 MILITARY MEDICAL MANUAL Movement. Infantry is adapted to movement on all kinds of terrain. Its ability to move in small and inconspicuous formations minimizes the effects of hostile fire and permits the use of covered routes of approach for its advance, and minor accidents of terrain as firing and cover positions. Motorized weapon and ammunition carriers are used to maintain battlefield mobility of heavy weapons. Fire. The fires of the various infantry weapons require coordination. The flat- trajectory weapons pin the enemy to the ground and cause him to seek shelter; the fire of curved-trajectory weapons reaches an enemy protected from flat-trajectory fire. Frontal fires directed upon an enemy combined with flanking fires produce destructive convergent fires. Field of fire. The field of fire is the area throughout which fire can be delivered from a single firing position. Good fields of fire are to be found in level or uniformly sloping terrain unbroken by vegetation which might conceal an enemy from view and free from terrain formations which provide the enemy with defilade from fire. DIRECTION OF ADVANCE ADVANCE GUARDS FLANK GUARDS FLANK GUARDS MAIN COLUMNS REAR GUARDS Plate 11. Area of Marching Columns. Base of fire. In the presence of the enemy, infantry seeks to protect its movements by fire action including a base of fire. The organization of a base of fire comprises establish- ment of the attacking echelon on a departure position; emplacement of the supporting weapons of the unit in firing position to support the advance of the attacking echelon; synchronization of the debouchment of the attacking riflemen with the fire of the supporting weapons from the base of fire. The rifle company is the smallest unit which habitually employs a base of fire in the attack. TACTICAL FUNCTIONS OF THE ARMS 35 Terrain. Terrain exercises an important and often a decisive influence in tactical operations. It usually dictates the dispositions of infantry units and their plan of maneuver or defense plan. Small infantry units have only a limited latitude in the choice of the terrain of operations. They must make the best possible use of the terrain of the zone of action or sector to which they are assigned. Gently sloping, open terrain permits full use of the flanking action of flat-trajectory infantry weapons and hence increases the power of the defense against infantry attack. Conversely such terrain offers little cover to attacking foot troops but favors tank attack. Strong tank or artillery support is required to permit infantry to attack successfully over such terrain without severe losses. Broken terrain limits the defender’s field of observation and flat-trajectory fire and offers cover by which attacking foot infantry may approach a hostile position. Defensive positions located on terrain of this character require increased density of occupation of forward defensive areas and an increased allotment of curved-trajectory weapons. DIRECTION or ADVANCE MOTORIZED PATROLS. POINT 200 YARDS AOVANCC PARTY SUPPOR' +00 YAROS SUPPORT PROPCR advance GUARD 600 YARDS reserve aoo YAR OS MAIN 000V Plate 12. Advance Guard. Rolling terrain affording some cover and facilities for observation is the most favor- able for attacking foot infantry. Crests, ridges, woods, or other features which extend generally parallel to the direction of advance divide the terrain into corridors which are natural avenues of penetration. The visible horizon will therefore usually delimit an infantry maneuver phase and often constitutes an initial objective. Long, narrow terrain compartments which lead in the general direction of a defensive area form advantageous corridors for attack. Infantry in Security. The cardinal military sin is to allow one’s self to be surprised. Security measures must be taken if surprise is to be avoided. The measures must be continuous, in camp or bivouac, on the march, and during batde. Advance guards, flan\ guards, rear guards, and outposts, as the situation may require, are provided 36 MILITARY MEDICAL MANUAL Motorized Patrols - precede point by 3 to 5 miles Point: t serceant ana one scjuaa. v Connect! nc files Patrol on hill civinc view ternortn and west Patrol on hill view to north and - cost /x . Advance, paktt lone platoon \and bompany, commander.' Support: 1 company . I (less rdetss J* battalion Qi commander oMrol returninc from small Wood ‘ Patrol in larce wood until passace of main w* Connecting Main body- battalion (less one-company) Patrol (from adv cd.) returning from waod > Note: Patrols- sent ahead to critical points. Not drawn to scale. Plate 13. A Company of Infantry as an Advance Guard to a Battalion in March. TACTICAL FUNCTIONS OF THE ARMS 37 for the purpose. It would be rare to use more than one-third of the strength of a command in security missions. The advance guard is a force sent out to the front to precede and cover the main body on the march. It prevents the enemy from observing and firing on the main body, main- tains the proper direction of march, and removes obstacles from the route to facilitate the march. When resistance is encountered the advance guard takes prompt and aggressive action to dislodge the enemy and provide for the uninterrupted advance of the main body. If the resistance is too strong or too .extensive to be thus overpowered, the advance guard fixes the enemy in position, locates the flanks of the enemy, and facilitates action which may later be required by all or a portion of the main body. The advance guard consists of the point, advance party, support, and reserve. A small advance guard may omit the re- serve. Connecting files consisting of one or two men provide communication and contact between elements of the advance guard. Flan\ guards and rear guards protect the flanks and rear of the main body in a similar manner. Elements of the advance guard are separated so that, for example, in an advance guard as large as a battalion with artillery, the point might be as much as 3/4 miles in advance of the head of the main body. In rugged or wooded terrain and at night, distances are reduced. When possibility of contact with an enemy is remote, the advance guard will march on roads, in suitable formation, and utilize patrols to investigate areas of potential danger which might conceal an enemy. This obtains the maximum rate of advance. / Usually Squads or Fractions thereof Visiting Patrol Not drawn to scale Reserva Plate 14. Diagram of Outpost Dispositions. When possibility of contact with an enemy is imminent, advance guards deploy so that they cover the entire zone of advance of the marching column or columns. Many of the elements must now march across country, and accordingly the rate of march is materially decreased. A zone of advance is prescribed, limited by lateral boundaries. Forward progress is limited by phase lines prescribed by the superior commander. Should contact with an enemy be made, the advance guard is partially deployed, the entire area can be searched for hostile groups, and offensive action may be taken prompdy. This procedure is similar to approach march in attack and the procedure obtains maximum security as well as great readiness for action. In general, flan\ guards and rear guards adhere to the same principles of organiza- tion and operation as advance guards. They are to prevent an enemy from gaining 38 contact with the main body or from interrupting the movement of the main body. Motor transportation is especially useful for flank guards and rear guards. No system of security is any better than its warning service. In fact, an advance guard is itself a warning service since its mission serves to prevent a surprise attack against the bulk of the force before it has prepared itself for action. A warning system is necessary to protect against air attack and mechanized attack. Motorized reconnaissance detachments operating well to the front and flanks are especially suitable. Whatever the means employed, an intelligence and signal communication system carefully co- ordinated must be provided. Within marching columns there should be men especially designated to watch for hostile threats from air or ground and give warning. Members of all units must be taught to apply measures effectively and quickly which will reduce or nullify the effect of sudden attack. The alert commander will foresee the ever present chance of enemy action and be prepared constantly to meet it. The outpost protects the main body while in camp or bivouac. A column halted for a period longer than the hourly rest is protected by a march outpost constituted at once by the advance guard. Troops in camp or bivouac are protected by part of their number forming the outpost so that they may rest without the hazard of sudden and unexpected attack. Areas of definite responsibility are assigned to units of the outpost designated as supports. Each support sends out small detachments to important terrain localities where they remain in observation. Active patrolling is maintained between supports and their units in observation, for further protection. A reserve is held under the control of the outpost commander for disposition in case any part of the outpost line is threatened. An outpost defends or withdraws into the main position in accordance with orders of the commander of the main body. See Plate 14. Infantry in Attack. In an attack, an infantry unit may be placed in “assault,” which means that it leads the advance, or it may be held in “reserve.” The commander of an infantry regiment, for example, may place two of his three battalions in assault and hold one in reserve; or place one in assault and hold two in reserve; or, in rare instances, the entire regiment less one rifle company in assault, the one company constituting the regimental reserve. In a similar manner an infantry battalion commander would prescribe assault or reserve missions to his three rifle companies, and the rifle company commander would dispose his three rifle platoons. The heavy weapons company and the weapons platoon would support (i.e., assist with fire action) the assault units of the battalion and company, respectively. The heavy weapons company of an assault battalion is not usually held in reserve. This organization for combat of an infantry unit depends upon the mission, the terrain, and the capabilities of the enemy. In an obscure situation where little is known of the enemy the commander will wish to commit minimum strength to the assault in order to retain a strong reserve. When the advance is made within a wide zone, especially in broken, wooded, or rugged country, he will likewise prefer to retain a strong reserve. A regiment making the main attack will need a strong reserve element in order to have forces available to extend an envelopment, or pass through an assault battalion in order to continue the action with fresh troops, or to counter quickly actions which may be launched by the enemy. On the other hand, a regiment which is making the holding attack is not expected to penetrate deeply into the enemy position; it will need to develop its maximum power quickly to prevent the enemy from moving to meet the main attack, and to give the impression that the main attack is launched on his front. In such a case the commander will hold a weaker reserve. The organization for combat depends upon the mission assigned the infantry unit, the capabilities of the enemy, the width of the zone through which it is to advance, and the nature of the terrain. Rifle companies of assault battalions “carry the fight to the enemy,” but they do not fight alone. An overwhelming fire or tank support is usually required to permit an attacker to advance against strong resistance. The heavy weapons company pro- vides strong fire support with its machine guns and mortars, placing the fires where MILITARY MEDICAL MANUAL TACTICAL FUNCTIONS OF THE ARMS 39 they will be of the greatest help to the assault units. In a similar manner and for the same reasons the weapons platoon of rifle companies assists the rifle platoons with fire support, using the light machine guns and 60-mm mortars. The rifle platoon has automatic rifles which it may employ to assist the squads. It is an application of the principle that infantry operates by combining “fire and movement,” which means that a portion of a unit forms a base of fire and fires upon an enemy position in order to gain or maintain fire superiority while the remainder moves or maneuvers through concealed or defiladed routes to approach closer to the immediate objective. All of the weapons available to the battalion commander or rifle company commander are employed in a coordinated action to reach the objective, as the first goal, and then, as the second, to reach it with minimum casualties and in the quickest time. DIRECTION OF ADVANCE OBJECTIVE LINE OF DEPARTURE AREA' ''OCCUPIED PRIOR TO THE ATTACK. Plate 15. A Battalion Zone. An infantry battalion in assault operates, in the usual case, within a zone of action. This zone includes the line of departure from which the attack will start; the ob- jective, or destination, or goal of the advance; and, for interior battalions, a right boundary and left boundary. A battalion on the right flank of a larger force may have only a left boundary with no restrictions as to the area of movement on its right. Boundaries are prescribed only where necessary to assist coordination of adjacent units. For small units, such as the infantry battalion, boundaries should be outlined by clearly visible objects to prevent the likelihood of loss of direction and straying into the zone of action of an adjacent organization. The orders for the attack pre- scribe the line of departure, the objective, and the boundaries if any are necessary. 40 The order also prescribes the time of attack at which assault units leave the line of departure or cross the line of departure. Prior to the time set for the attack, battalions often occupy an “assembly position” in rear of the line of departure where many arrangements are made which may include partial issue of orders, feeding the troops, issue of extra ammunition, and dropping of packs. Somewhat in advance of the time of attack, units are moved forward to the line of departure. Here appropriate formations are taken to start the advance, final orders are issued, supporting weapons are emplaced, and coordination completed, all in time to start the advance at the time prescribed. At other times these arrangements are completed so as to cross the line of departure at the proper time without halt or pause. It is essential that small units under- stand, before the start, their destination or the objective they are to reach, the route they are to follow (limits of the zone of action), and the initial formation they are to use. After the start, events will control their action. The main effort of a unit aims at securing ground, the possession of which will facilitate the capture of the objective, the destination of the hostile force, or the advance of other elements. It is usually made against a weak area in the hostile dispositions. Infantry rifle units pass through the following phases in an attack which is launched from a line of departure outside the area of contact: the approach march, the fire fight or conduct of the attac\, the assault, and the subsequent operations among which will be re- organization, defense or preparations to defend the position captured, resumption of the attack, or pursuit. The approach march is the advance forward, in suitable formations, from an assembly area through the zone of hostile artillery fire to and across the line of departure. Lead- ing infantry units are preceded by scouts who search for enemy positions, forcing him to disclose himself. Formations are used of minimum vulnerability and maximum ease of control which also facilitate the skillful use of cover. For example, a platoon might advance in line of squad columns, the members of each squad following gen- erally behind the squad leader who is responsible, within limits, for selecting the best and safest route. Within squads the men are separated in depth, and the squads are separated by intervals as great as fifty yards. Dangerous areas are avoided. Fire-swept areas which cannot be avoided are crossed as quickly as possible with minimum ex- posure. Rifle units do not fire during the approach march but seek to advance rapidly with minimum exposure. The fires delivered, if any, are from infantry heavy weapons and artillery. The approach march ends when the effectiveness of hostile fire makes it necessary for rifle units to return the fire with their own weapons and obtain fire superiority in order to continue the advance without suffering ruinous losses. Rifle fire is not ordinarily opened at ranges beyond 400 yards. In the conduct of the attac\ rifle units seek to combine their fires with those of the sup- porting weapons. The combined fire action creates the conditions which make possible the movement of the attacking echelon. The rifle units exploit these conditions by alternate fire and movement. While some of the riflemen open fire to hold down the fire of the enemy resistances, others advance from one cover or firing position to another. Every lull in hostile fire is utilized to push groups to the front and occupy points from which covering fire, particularly the flanking fire of light machine guns, will facilitate the further progress of attacking units. The infantry supporting weapons, displacing forward when necessary, cover the advance of the rifle units to close range, protect their flanks, and assist in the reduction of hostile resistance. Infantry action continues in this manner until hostile resistance is broken, advancing by bounds on successive terrain features or objectives where the fire support for the next advance is arranged. In such action the importance of the small units and the leaders of small units should be apparent. Along the extended front of a large force in an offensive operation there are a large number of these actions, each striving to overcome the hostile resistance, and each seeking to advance upon its objective. During the progress of the attack, commanders will employ the units held in reserve. For example, assume that an assault rifle company has been stopped by hostile resist- ance which it cannot avoid or overcome. The battalion commander, after calling for such supporting artillery fires as are available and providing for the support of the MILITARY MEDICAL MANUAL TACTICAL FUNCTIONS OF THE ARMS 41 heavy weapons of the battalion, might direct a reserve company to maneuver to strike the resistance from a different direction, or avoid it and pass on toward the objective, or add its fires to the troops engaging the enemy and then pass through them to be- come the assault company, whichever seems most likely to achieve the success. He will not employ his reserve piecemeal, or fritter it away in driblets, but use it to make a strong, coordinated blow. In this manner the advance is continued by infantry units. By fire action they seek to neutralize the effect of the hostile resistance. By movement they seek to occupy his position. It must be seen that the action is controlled and coordinated by commanders of successive echelons and that assault units are given all possible support by infantry heavy weapons, by artillery, and by tanks to precede assault rifle units when tanks are available. Plate 16. Successive Objectives. The assault is the final advance into an enemy position. It may terminate in hand- to-hand fighting. There is no set distance from the enemy position at which the as- sault is begun. Supporting fires are shifted to other targets which do not endanger the attacking friendly troops. The assault is a very critical period. Following a successful assault, troops occupy the captured ground, prepare to resist counterattack, reorganize, replenish ammunition, and prepare for the next action which may be a continuation of the attack, pursuit, or defense. Attach frontages for the infantry battalion depend upon the nature of the terrain, the mission, the nature of enemy organization, and the actual combat strength of the sub- ordinate units. As a basis of comparison, a battalion making a strong attack against an organized position may advance within a zone 600-1000 yards in width. Against a hastily organized position in which somewhat less resistance is to be expected the zone may be 42 MILITARY MEDICAL MANUAL increased to a width of 700-1000 yards. A battalion making a holding attack or secondary attack may advance within a zone of 900-1200 yards. Attach zones of action are sought which provide terrain corridors, such as stream valleys, leading towards the objective. Such avenues of advance provide natural cover and defilade. When the advancing unit is able to control the ridge lines bounding the corridor they can reduce or eliminate the hazard of flanking fire. Direct support artillery (light artillery) operates in close coordination with attacking infantry as a combat team. Fire is delivered upon enemy areas which are holding back an infantry advance, or which threaten to do so. An artillery liaison officer and detachment with communication facilities accompanies each assault battalion. This agency communi- cates requests for artillery fire, designates the exact location of suitable targets, and may observe the fire to communicate at once corrections in firing data to move the fire into the area desired. For example, a company commander of an assault unit may encounter a strong enemy position over which he is unable to secure fire superiority. He should call upon his battalion commander for fire support. The battalion commander will cause fires to be delivered from the battalion heavy weapons company and, if desirable, will request the artillery liaison officer to place fire upon the target. In an extreme ca?e this request may result in fire into the area from artillery supporting adjacent units and in fire from medium artillery in general support of the entire force. ENEMY BATTALION SECTOR (aoo-jneoo yards) REGIMENTAL SECTOR. PLATOON OR DETACHMENTS COMPANY SECTOR ICO AREA) CO area£ ICO AREA) • COMBAT GROUP * LIMITING POINT MAIN LINE OF RESISTANCE ■REGIMENTAL RESERVE LINE Plate 17. Diagram of a Regimental Sector in Defense. Infantry in Defense. In the defense, infantry units may be assigned to defend a sector, or defense area, on the main line of resistance or be placed in reserve. If in reserve they may occupy a defense area on the regimental reserve line or be held farther back in general reserve for the use of the commander, such as the division commander, when the direction and intensity of the hostile attack are disclosed. The infantry battalion is the “unit of measure” for planning or studying a defensive system. The sector assigned a battalion will usually include an important terrain feature; the size of this sector will depend upon the mission and the terrain. The important factor is that battalions are assigned key points of terrain, in width as well as depth, and these localities, called “defense areas,” are then organized to resist attack from any direction. TACTICAL FUNCTIONS OF THE ARMS 43 LEGEND COMBAT GROUP LIGHT MACHINC GUM SOUAO HEAVY MACHINC GUNS nJ’mu ANTITANK GUN 60 MM MORTAR 61 MM MORTAR 60UM MORTAR OCrtNllVC CONCENTRATION SIMM MORTAR DCTCNSIVC CONCENTRATION ARTILLERY NORMAL CONCENTRATION Plate 18. Defensive Fires. The Automatic Rifles are Located to Cover Gaps in the Fires of the Machine Guns. 44 MILITARY MEDICAL MANUAL Battalion sectors having been designated, the battalion commander provides for the defense by assigning company areas; in turn company commanders dispose their platoons. The frontage which an infantry battalion on the main line of resistance can defend depends upon the mission, the terrain, and the natural obstacles to hostile advance. As a basis of comparison, where the observation is poor and the area is vital a battalion can defend on a front of 800 yards. On average terrain under the same conditions this frontage can be doubled. Where natural obstacles protect a position the frontage can be extended to as great a width as 3500 yards. Under a mission to effect delay on successive positions without becoming decisively engaged, this frontage may be further increased to a width as great as 5000 yards. A natural avenue of hostile approach, such as a terrain corrider leading into the position, should be assigned entirely to one battalion in order to avoid division of responsibility. The depth of a battalion sector depends upon terrain, but it should have a minimum depth of 400-500 yards; it may be as deep as 1200 yards. The regimental reserve line (RRL) is placed ahead of the dominant observation of the locality, and is usually from 800-2000 yards in rear of the main line of resistance. The battle position includes the area between the forward limit of the main line of resist- ance and the rearmost parts of the regimental reserve line. Mobile infantry reserves held by the commander to extend the flanks of the battle position or to launch counterattacks, and the supporting artillery, command, communication, supply, and evacuation establishments are placed in appropriate locations behind the battle position. Tt must not be inferred that a battalion occupying a sector on the main line of resistance places its units to obtain uniform density. The contrary is the fact. Each rifle company will be assigned an area for defense having width and depth. Key points of terrain are actually occupied. Gaps between occupied areas are defended by fire. The next step is the organization of the ground and the coordination of defensive fires. Trenches and gun positions are dug to increase safety and defensive strength. Camouflage is executed. Arrangements must be completed to cover the front and flanks of the position with defensive fires by assigning definite targets or definite areas of responsibility to each unit and each supporting weapon. Coordination with supporting artillery and adjacent units is obtained. An outpost line of resistance is established on the next high ground in advance of the main line of resistance so that warning of an enemy approach may be obtained. This consists of small groups. Road blocks may be established as a precaution against attack by mechanized forces. Demolitions may be executed to further hamper a hostile advance. Plans for the conduct of the defense, anticipating all hostile capabilities, are developed. When the enemy approaches the position in attack, machine guns covering the main line of resistance and rifle company weapons open fire when the enemy arrives within ranges which compel him to lift the fire of his artillery to rearward areas. If the enemy succeeds in effecting a close approach to the main line of resistance, all close-in prearranged fires are released. If the enemy succeeds in entering the position, the de- fender seeks to strengthen and hold the flanks of the gap and counterattack the pene- trating elements from the flank rather than attempt to close the gap by throwing troops across the head of the salient. Antimechanized Defense. Infantry units must be prepared to resist attack or sudden raids by hostile mechanized units. Selection of positions for defense or bivouac will require a consideration of this danger and, wherever it is practicable to do so, advantage will be taken of natural obstacles such as streams, swamps, and other unsuitable terrain features along the front and flanks of the position. Road blocks defended by antitank guns may be used extensively at botdenecks such as bridges, mountain passes, and roads through swamps. The use of tank mines further increases the effectiveness of such obstacles. Demolitions executed along the front and flanks of a position may be used to destroy bridges, culverts, or roads and to increase the difficulty of movement, especially when the works will not be needed for future use of the force. The infantry weapons which are provided for antimechanized defense are the caliber TACTICAL FUNCTIONS OF THE ARMS 45 37-mm antitank gun and heavier weapons. These guns are sited in depth throughout the battle position. Upon the approach of hostile mechanized units they are engaged at the maximum range and at a high rate of fire. Combat Teams and Teamwork. The functioning of all infantry units envolves the con- stant application of principles of cooperation and teamwork. Within the rifle company the rifle platoons function with the supporting fires of the 60-mm mortar and the light machine gun under the control of the company commander. Within the battalion the heavy weapons company constitutes a combat team with the rifle companies, all controlled by the battalion commander. Above all this is the infantry-artillery combat team in which direct-support artillery is in constant contact with the infantry units supported; it must be ready to place its strong supporting fires quickly upon areas as requested by infantry battalion commanders. Thus it should be clear that infantry does not fight alone. The mission of the infantry, however, becomes the mission of the entire force. It is the infantry soldier, particularly the soldier of the rifle company, who goes forward to occupy in person areas held by the enemy. But he is helped in his task by the supporting weapons within the infantry, at times by tanks, by the artillery, and by all other arms and the services. Team- work between units on the battlefield is an absolute requirement for victory. CAVALRY Characteristics. The cavalry arm is equipped, organized, and trained to perform essential missions which occur in combat. Its dominant characteristic, mobility, is gained to a high degree by the use of horses (horse cavalry) or by the use of armored vehicles in which it moves and fights. Because of this mobility it can shift its very material fire power from one tactical locality to another or from one position to another within the same tactical locality. Each type of transport and equipment has its advantages or favorable characteristics, and each has its disadvantages or unfavorable char- acteristics. Each type of cavalry can operate unaided by the other, if terrain or weather conditions make such use desirable, or they can operate in conjunction with one another. Horse cavalry can operate under very difficult terrain conditions. It may not be wholly true that a well-mounted, well-trained cavalry unit can negotiate while mounted any terrain which can be traversed by dismounted men, but it approaches that condition more closely than motorized or mechanized units. Horse cavalry reaches its greatest role in difficult terrain where it alone may operate effectively or under conditions where the necessity for speed transcends all other requirements. On roads cavalry can sustain a rate of six miles per hour by day and five miles per hour at night; for movements across country these rates are reduced to five and four miles per hour, respectively. For short periods these rates can be greatly in- creased. Horse cavalry in the United States Army has marched over ioo miles in a period of 24 hours. Under forced march conditions, infantry units require approxi- mately 100 hours to march the same distance. The mobility of cavalry varies from about twice that of infantry for long marches to six times that of infantry for distances of a few miles. Cavalry is sensitive to the conditions of its mounts. The losses in horseflesh incident to battle may be difficult to replace promptly. The deficiency in heavier supporting weapons limits the kinds of combat, especially the defense or attack of organized positions, which it should be called upon to undertake. While mounted action may be feasible under favorable conditions, horse cavalry units habitually dismount to engage in combat, conceal their horses, and fight as infantry. Cavalry Missions. Cavalry, whether horse or mechanized, should be assigned missions in accordance with its characteristics. Since its dominant characteristic is mobility, assigned missions should require this trait. Furthermore, adequate measures must be observed to retain this mobility. Missions which may be performed by other available troops should usually be avoided as a means of conserving cavalry for the time when other forces will not serve so well. The two types of cavalry may operate in conjunction with one another or independently of one another. Horse cavalry is especially suited to combat in which its mobility may be utilized to fullest advantage. It is not well suited for attack of an organized 46 MILITARY MEDICAL MANUAL position or for a sustained defense of a position. Mechanized cavalry reaches its greatest usefulness on distant reconnaissance missions; it is well suited for wide encircling move- ments to strike the lines of communication of hostile forces and disrupt their supply and communication facilities. Plate 19. Cavalry on the March. (Photo, U. S. Army Pictorial Service.) Enemy rese Enemy position Pivot Axis of advance Reserve Plate 20. Combined (Mounted and Dismounted) Action, Showing Pivot, Maneuvering Force, and Reserve. Horse cavalry may be used on independent missions in large units such as a cavalry division or cavalry corps, or it may be employed as a reinforcing unit of an infantry division or corps. In the latter case units less than a division, as appropriate to the conditions to be expected, would be attached as required. Reinforcing cavalry units are especially useful in open warfare for reconnaissance and counter-reconnaissance, for flank protection, for security missions, for delaying operations, for prevention of hostile ground reconnaissance, for intervention in the decisive stage of a general attack, and in pursuit. TACTICAL FUNCTIONS OF THE ARMS 47 Reconnaissance. Cavalry is especially well suited for reconnaissance missions. Acting alone it can search areas in detail far to the front or flanks to determine the location strength, and disposition of hostile forces. In conjunction with air units it can maintain contact with hostile forces whose positions have been discovered from the air and search areas over which air reconnaissance may not be entirely effective, such as in dense woods. Counterreconnaissance. The purpose of counterreconnaissance is to prevent effective hostile reconnaissance by ground forces. Often the mission assigned to cavalry for this purpose is to prevent hostile reconnaissance beyond a specified line. It is disposed along an extended front in points of good observation and in positions blocking roads and defiles Security. Cavalry units may be used in the service of security of larger forces while in march or bivouac. In the execution of this mission they search areas well to the front of the main force to make certain that large hostile forces are discovered and engaged. While this does not relieve the main force of providing its own security measures, it adds greatly to the safety against hostile attack in force. Delaying action. Cavalry is well adapted to engage large hostile forces to effect delay. It can deploy on a relatively wide front, engage approaching hostile columns with fire, and force them off roads into deployed formations and into position for attack. It can then move rapidly to new positions in rear and repeat the action without becoming decisively engaged. By this process hostile reinforcements may be kept out of the main engagement, or time may be gained to permit the main force to complete a projected operation such as a retirement, occupation of a defensive position, or other action, without enemy interference. Pursuit. Cavalry is especially well adapted to pursuit. A defeated enemy wiH seek to withdraw from contact, retire to a place of security, and reorganize for further action. At this stage they are most vulnerable to final defeat and destruction. Cavalry units may move rapidly to harrass their flanks or move to key positions in their rear and block the retreat, thus permitting other forces to complete their destruction. Attac\. In advancing to the attack cavalry units move mounted until circumstances require dismounted action. After that point the mounts are concealed and the units operate in a manner similar to infantry units of comparable strength. The led horses are advanced by bounds as the advance progresses in order to have them available for use when required. As the characteristics of cavalry make it more suitable for attack by envelopment than by penetration, it may employ rapid mounted maneuver to reach suitable attack positions from which to attack by dismounted action. In an attack of hostile infantry, cavalry seeks to avoid the enemy’s greater power and, by utilizing its superior power of maneuver, strikes where the defender is least prepared to resist. A noteworthy capability of cavalry is action with widely separated detachments without fear of defeat in detail because of the speed with which units can concentrate or move away from contact if such action is indicated. Defense. Cavalry is well adapted for missions envolving seizure of a position and its defense pending the arrival of other forces. It is not well adapted for defense of a position during a prolonged period. Support of Other Arms. Cavalry units are organized into squads, platoons, troops, squadrons, regiments, brigades and divisions. In combat they require the support of artillery, engineers, and signal troops, and of air force units for distant reconnaissance, liaison, control, and communication. Likewise, the cavalry division needs the essential services performed by the quartermaster corps for supply and transportation, and the services of ordnance and medical units. Organization of the Horse Cavalry Regiment. (TO 2-11, April 1, 1942.) The regiment of horse cavalry consists of the following components: Regimental Headquarters and band, if band is authorized. Headquarters Service Troop Weapons Troop Two rifle squadrons. A rifle squadron consists of three rifle troops, each troop having a troop headquarters, three rifle platoons, and a light machine-gun platoon. 48 MILITARY MEDICAL MANUAL Squadrons are designated by number, as 1st, 2d. Rifle troops are designated by letter, in one series throughout the regiment, as Troop A, Troop B. The term troop is analagous to the term company of infantry, medical units, and others, and to the term battery of corresponding units of field artillery. A captain is the grade of the commander of most troops, batteries, and companies. FIELD ARTILLERY Mission. Field Artillery has a dual mission in battle. First, it assists infantry, cavalry, or armored units in contact with an enemy by engaging its great fire power against those targets most dangerous to the supported troops. Second, by the use of its range it gives depth to combat by firing upon targets beyond the range of infantry or cavalry weapons such as the hostile artillery (counterbattery fire), his reserves whether on the march or in bivouac, and his agencies for command, supply, and communication. The division or higher commander is able to use the artillery as a powerful tool to affect the outcome of battle as it progresses. Because of the considerable ranges at which it can fire effectively and the speed with which the direction of fire can be shifted, fires may be concentrated at any desired point throughout a zone of great width and depth. Therefore, as targets are discovered or new threats develop, at least a portion of the artillery may shift to engage them. Characteristics of Artillery. Artillery acts by fire alone. It is especially useful against exposed hostile personnel, particularly when it is in compact formations. It is able to destroy targets which are invulnerable to infantry or cavalry weapons such as concrete emplacements, stone houses, cellars, bridges, and protected shelters. Plate 21 shows the trajectories of the artillery weapons. It has the ability to converge its fire, from many widely separated positions, to obtain an overwhelming hurricane of fire with violent sur- prise effect upon one critical or sensitive point of the enemy’s organization. Artillery posi- tions are relatively stable, since by making use of its capability of delivering fire at long ranges it can continue to provide support for advancing troops by advancing only its per- sonnel in observation with their communication facilities. Its moral effect upon the troops supported is a valuable by-product. Field artillery has definite limitations. It requires time to occupy and organize a posi- tion, establish communications, obtain and compute fire data, and be ready to open fire. When artillery units occupy positions under cover of darkness it will require approximately one hour of daylight before well coordinated supporting fires can be delivered. The prob- lem of ammunition supply is extremely important, and conditions may be present which make it difficult. Artillery requires transport, and the speed and ease of displacement is dependent upon road conditions, terrain, and weather. It is vulnerable to hostile artillery fire when its positions can be observed; it is especially vulnerable on the march. It acts by fire alone, and movement by artillery units is solely to reach positions from which more effective fire can be delivered upon appropriate targets. For these reasons it cannot act as an independent, self-sustaining arm. Control and Adjustment of Artillery Fire. Accuracv of artillerv fires is greatly increased when the area of burst is noted by an observer who communicates data so that corrections in laying of the pieces in direction and elevation may be made. The observer may be in a favorable ground location, in an observation balloon, or in an observation airplane. Com- munication may be by telephone, telegraph, or radio. Unobserved fire may be delivered, such as fire delivered from data computed from a map, but it is less effective and requires larger expenditures of ammunition to obtain comparable results. Classification of Artillery by Caliber. Artillery is classified bv caliber as light artillery, medium artillery, and heavy artillery. The trend in artillery development is to develop self-propelled guns and mounts. Light artillery includes 75-mm and 105-mm weapons. 75-mm artillery is available in three types: the 75-mm pack howitzer, the 75-mm howitzer, and the 75-mm gun. The maximum effective range of this type is, in general, approximately 8000 yards for shell and somewhat less for shrapnel. The weight of the projectile is 15 lbs. TACTICAL FUNCTIONS OF THE ARMS 49 Area defiladed from flat trajectory fire mortar Plate 21. Trajectories of Guns, Howitzers, and Mortars. fl_AT TR.AJtCTOR.Y_ field artillery Heavy mortar Howitzer Heavy field artillery howitzer Gun lAnti air- kraftc,un .-^^ljrajectq^ 50 MILITARY MEDICAL MANUAL The maximum effective range of the 105-mm howitzer is 10,500 yards with shell and 6,500 yards with shrapnel. The weight of its projectile is 33 lbs. Light artillery may be animal-drawn or truck drawn. However, the 105-mm howitzer is entirely truck drawn. Medium artillery includes only the 155-mm howitzer. (See Plate 23.) Its range is approximately 10,500 yards with both shell or shrapnel. The weight of its projectile is 96 lbs. It is truck-drawn. Plate 22. 75-mm Gun, Truck-Drawn ModeL Plate 23. 155-mm Howitzer, Truck-Drawn. Heavy artillery consists of the 155-mm gun (See Plate 24) and the 240-mm howitzer. The range of the gun is 15,000-20,000 yards depending upon the type of projectile; the howitzer has a range of 14,000 yards. The weights of the projectiles are 96 lbs. and 346 lbs., respectively. Characteristics of Artillery Ammunition. Artillery ammunition is available in shrapnel, high explosive shell, chemical shell, and smoke shell. Shrapnel consists of a case filled with round balls, or bullets, and a fuze. The fuze may be set so that explosion occurs at the desired range from the gun. The explosion releases the bullets so that they strike the ground in the area of the target. The ease and fuze are TACTICAL FUNCTIONS OF THE ARMS 51 also effective. The size of the effective area depends upon the elevation of the projectile above the ground at the time of burst, and the range—the lesser the range, the flatter the trajectory and the longer the effective area. At a range of 2000 yards the effective area is 72 yards in length. At 6000 yards it is 43 yards in length. This ammunition is used against exposed personnel. High explosive shell may be set to burst on impact, or at a slight interval after impact to obtain the maximum effect of penetration, or to burst in the air. Its effectiveness is obtained from the shell fragments and from the force of the detonation. An air burst of 75-mm shell has an effective radius from fragments to a depth of 5 yards and a width of 30 yards, with large fragments effective to a radius of 150 yards. Medium artillery is effective to 9 yards, 40 yards, and 300 yards, respectively. Plate 24. 155-mm Gun, Heavy Field Artillery. Chemical shell is filled with toxic chemical agents which are liberated on impact. Smo\e shell is filled with a non-toxic chemical which develops a dense smoke cloud on impact in order to prevent hostile observation and aimed fire. Classification of Artillery by Assignment. Division artillery consists of light and medium artillery. The type of division determines the size of its artillery component. The infantry or motorized division made up of three infantry regiments (the “triangular” division) has three battalions of light artillery (105-mm howitzers) and one battalion of medium artillery (155-mm howitzers). Reinforcing artillery units may be attached to divisions for tactical missions; such units are classified as division artillery while so attached. Corps artillery includes medium artillery and heavy artillery organized as a brigade. Additional units may be attached from higher echelons. Tactically, the term corps artillery refers to those units, organic or attached, which are not attached or reallotted to its several divisions, hence, that which is retained directly under corps control. Army artillery includes units which can support the army as a whole; its organizations are not fixed. GHQ artillery in reserve includes field artillery of various categories for allocation to subordinate units in accordance with their special needs. For example, light artillery may be allotted so that a division is temporarily reinforced with one or several additional regi- ments from GHQ reserve. 52 MILITARY MEDICAL MANUAL Terms Used in Assignment of Missions. Direct support artillery includes those units given the mission of providing support for a designated subordinate infantry, cavalry, or armored unit. It establishes liaison and cooperates closely with the supported unit. However, it remains under centralized control in contrast to attached units described below. General support artillery is given the mission of supporting an entire unit such as the division, rather than a single subordinate infantry unit. Attached artillery consists of units temporarily attached to another command to serve under the orders of the commander of the unit to which attached. Illustrative of such use, a light artillery battalion may be attached to an infantry regiment on an independent- mission or a mission which removes it from the proximate area of the division as a whole. Artillery Firing Positions. Artillery units are habitually emplaced by battalion units as fire is usually controlled by battalion. The batteries of a battalion may be separated by short distances or by as much as a mile, according to the mission and terrain. Guns of a single battery will tend to be compactly placed. Battalions of artillery may be widely separated. Battery positions should be in defilade from hostile ground observation and concealed against observation from the air by natural cover or camouflage. In support of an attack, artillery units tend to be placed well forward with respect to the line of departure so that fire support may be continued without change of position until assault units have advanced a considerable distance. A distance of 1,500 yards in rear of the line of departure is reasonable for purposes of visualization. In support of a defense, artillery units in support of the battle position will be emplaced in rear of the regimental reserve line which itself is located in advance of the dominant observation in the locality. Units are distributed laterally so as to provide fire support to the flanks as well as to the front. Batteries of a battalion are distributed in depth so that some can fire far to the front and others can fire in support of the regimental reserve line and in front of the battle position. In this manner the enemy continues to encounter effective artillery fire after entering a position. In the defense of a position with open flanks, some artillery may be held “in readiness.” This means that it is not in firing position, but occupies a central location with respect to the battle position so that it can move quickly to engage the hostile attack from whatever direction it may come. Several positions should be selected and organized, anticipating all hostile capabilities for attack, so that prompt delivery of fire may be obtained. Organization. The detailed organization of a field artillery regiment is subject to a con- siderable variation. The caliber of the weapon with which it is equipped and the compo- sition of the division of which it forms a part are the controlling factors. The battery of artillery is commanded by a captain and is similar to a company as a term. The Infantry-Field Artillery Combat Team. The action of infantry and field artillery is so coordinated that the infantry and the field artillery of the infantry division function as a team. Infantry may be said to contribute the elements of maneuver, deception, and surprise. Artillery contributes the element of power, the “muscle” of attack or defense. The effectiveness of this team is developed by the assignment of specific missions to the artillery and by close liaison between infantry and artillery commanders. The commander of the field artillery unit will maintain close touch during combat with the division com- mander; often his command post will be near the division command post. A light artillery battalion is often assigned the mission of providing direct support of an infantry regi- ment. When this is the case the artillery commander will maintain close touch with the infantry regimental commander. Each artillery battalion has personnel to furnish liaison detachments to accompany the troops supported. It is desirable that such a de- tachment accompany each assault battalion in attack, and during the defense each bat- talion on the main line of resistance. These detachments include an officer, the necessary enlisted personnel, and communication facilities. The officer advises the infantry battalion commander as to ways in which the artillery may be used to advantage, transmits re- quests for fire with the location of the targets, and may observe the fire in order to send back information to increase its accuracy and effectiveness. By these means joint action is TACTICAL FUNCTIONS OF THE ARMS 53 obtained. The flexibility of artillery fires, and the ease with which it may be shifted in elevation and direction permit it to assist adjacent units which may have a temporary need for greater fire support. Medium artillery may likewise be assigned missions in direct support, but it is more usual for it to be held in general support of all units in the division area. When so used it may support light artillery regiments, adding to the density of those fires, or engage targets beyond the range and powers of light artillery. The distinction is that it will receive requests for fire from the light artillery regiments rather than from supported infantry units. It will also engage targets which are discovered by observers in observation balloons, observation airplanes, as directed by the division commander, or other sources. The problem of developing effective, closely-knit infantry-artillery teams is of the greatest importance. Upon its successful accomplishment may hinge success in battle. Purpose of the Engineer Component of Large Forces. A large field force finds constant need for units trained and equipped to execute construction and maintenance missions. The Corps of Engineers is charged with the execution of these tasks. It will be charged with the maintenance of existing facilities needed by the force, particularly those which lie within the theater of operations. It will be called upon to build entirely new installations which arc required, particularly of lines of communications. It must be able to perform all of the special engineering tasks required in battle or campaign by large forces such as infantry divisions, cavalry divisions, corps, and armies. The diversity of tasks requires that engineer units be trained and equipped to accomplish each of these special purposes. General engineer units are able to undertake a wide variety of construction tasks. Combat engineer battalions or regiments arc included within this classification. Special engineer units are trained and equipped for the execution of tasks within a restricted technical field. , Combat engineers of infantry or cavalry divisions participate in battle. The execution of assigned missions may include contact with the enemy as, for example, in the execution of demolitions to impede a hostile advance. They may be used at a critical stage in combat, and their orders will frequently include a requirement that they be prepared to assemble at a prescribed area within a definite time limit. They are trained to operate as infantry, particularly as infantry rifle companies. Specific Missions of Combat Engineers. Combat engineers arc able to facilitate the advance of friendly troops. This requires the maintenance and repair of roads and rail lines within the division or corps area. This is often a difficult task because of the heavy overload which these facilities may be called upon to bear. It will include the repair of bridges and culverts which may have been damaged by the enemy. Motorized and armored units are especially dependent upon engineer units for work of this nature during an advance in hostile territory. In addition to facilitating the advance of friendly troops, engineer units impede a hostile advance. This includes such tasks as demolition of bridges, roads, railway facilities, the construction of obstacles such as road blocks, tank barriers, mine fields, and barbed wire entanglements. It includes the marking out of defensive positions under some situations and may include phases of such construction. They provide for the shelter and comfort of friendly troops by providing for the supply of water, the operation of utilities within the theater of operations, and construction or improvement of facilities necessary for the health and welfare of troops. Map reproduction is an important function of combat engineers so that an adequate supply of maps may be available. This work must be done rapidly and accurately by methods appropriate to service in the field. The organization of a position requires the use of large numbers of tools, picks and shovels particularly, which are not included in the equipment of infantry units. The division engineer unit would then distribute these tools from its own supplies and, if these were insufficient in number, would secure additional quantities from engineer depots. Units within the division have need of engineer support in the execution of their routine ENGINEERS 54 MILITARY MEDICAL MANUAL tasks. The quartermaster may need improvement of an area at the railhead to permit a large number of trucks to load or unload simultaneously. Improvement of an area about an ammunition refilling point may be necessary. Rains may make an important road impassable at some poipts. The division surgeon may need assistance from the engineers in the vicinity of the hospital station. The air officer may require construction or im- provement of an advanced landing field. Water for men and animals may have to be pumped, made potable for drinking, transported, and distributed. There are many other tasks similar in nature. Their nature indicates the importance of the missions which are regularly performed by engineer units. A cursory examination of terrain structure indicates the importance of rivers in military operations. Destruction of bridges by a retreating enemy creates a difficult obstacle. River crossing operations are common, and their execution difficult. Engineer units equipped with pontons and assault boats are equipped and trained for these missions. Organization and Equipment of Combat Engineers. A company of combat engineers consists of a company headquarters and two platoons. Each platoon has a platoon head- quarters, an operating section, and a tool section. The division engineer battalion has three such companies. SIGNAL CORPS Mission. The signal corps operates the message center and installs and operates the communication facilities for the headquarters of divisions and higher echelons. The com- munication means include wire circuits and radio nets, the wire being used for telegraph, teletype, and telephone. The maintenance of these facilities under the conditions imposed by combat is included in the mission. The extent to which communication facilities are maintained by a unit having signal corps personnel, such as the infantry division, is as follows: To, but not including, the headquarters or command posts of the next subordinate unit and to the attached units. This would require the division signal company to install communication facilities to the headquarters of the infantry regiments and to the divi- sion artillery battalions; to the headquarters of the engineer battalion; to the unit in division reserve; to the clearing station; to the headquarters of attached units such as antiaircraft artillery, chemical units, or units of the Air Forces. To the headquarters of the corresponding unit on its left, unless higher authority prescribes otherwise, in order that lateral communications facilities may be available. Organization. The signal company, infantry division, consists of a headquarters platoon, an operating platoon, and a construction platoon. The operating platoon has a message center section which establishes and operates the message center at division headquarters or at the division command post, a radio section, and a telegraph and telephone section. The construction platoon is provided for the installation of wire communications. Subordinate units of the division are provided with personnel to perform the same mis- sions under identical principles. The difference lies in the fact that the personnel is not furnished by the signal corps, but is a part of the organic strength of the units concerned. The Signal Corps, however, exercises technical control over the various signal agencies of a command. Responsibility of the Commander. Communication facilities provide the necessary chan, nds through which a commander receives information and directs the action of his troops. Although the tempo of modern combat has in no sense reduced the necessity for a com- mander to visit his troops, confer with subordinate commanders, and observe in person the execution of assigned missions, the very size and scope of operations place an increasing burden on these facilities. Reliable and continuous communications are vital to success in battle. Since communications are an important agency of command, it follows that a com- mander is responsible for their efficient operation. The signal corps unit or communica- tions personnel of a command is merely the agency which executes the will of the com- mander in supplying this need. TACTICAL FUNCTIONS OF THE ARMS Plate 25. An Infantry Regimental Command Post. 56 MILITARY MEDICAL MANUAL The commander of each unit exercises supervision over the signal systems of subordinate units in the same manner as for all other functions. This supervision may be exercised by the signal officer, upon the approval of the commander, through the normal channels of command. Technical control and coordination is usually exercised directly between the signal officers concerned. The Message Center. A command post, which includes a message center, is defined as a control locality at which the tactical stafl does its works and through which the com- mander may be reached. A message center is a signal agency established at a headquarters or command post which is charged with the receipt, transmission, and delivery of all messages except those handled by the postal service or those messages transmitted from the originator or addressee by telephone or personal agency. It operates under the unit signal or communication officer. The message center moves with its headquarters. An advance message center may be established at an advanced location for the convenience of the commander and staff when operating well forward of the message center. Installation, operation, and maintenance. The installation, operation, and maintenance of communication facilities is included within the mission of signal or communication agencies. Under the conditions of battle this is often a difficult operation, especially when movement is rapid. It is a principle that communication must be continuous, regardless of the rapidity of movement during the conduct of operations. Axis of Signal Communication. During combat, when the movement of a command post to successive locations is contemplated, as in an attack, successive locations of the command post are announced in the direction of movement. '1 his is called the axis of signal communication. This practice facilitates the coordination of communication agencies and assists in their ready location as the action proceeds. Messengers and Messenger Service. The requirements for communication in combat lead to the use of all types of messengers, such as: runners (toot messengers), horse messen- gers, motorcycle messengers, motor messengers, using combat vehicles, airplane messengers, bicycle messengers, and homing pigeons. A scheduled messenger service is maintained between units or establishments whenever such service will reduce the personnel required without seriously delaying transmission. This class of service is usually operated on a time schedule. Visual Signals. While the introduction of radio and wire communications has reduced the need tor communication by visual means, messages may be transmitted by signal lamps, pyrotechnics, flags, and panels. Pyrotechnics are used from the air and from the ground to send short, prearranged messages such as a call for artillery fire. Panels are used to signal from the ground to aircraft for such purposes as marking the position of assault units or identifying a unit in a locality. Communication Facilities of a Medical Unit. Except in units provided with radio, communication is maintained by transmission of messages by vehicles in the execution of other missions, by messengers, or by utilizing the communication facilities of the most convenent unit of the force supported. The clearing station will often be provided with telephone communication by the division signal officer. Definition and Classification of Messages. The term “message,” as used herein, includes all instructions, reports, orders, dispatches, and documents of whatever nature whether in secret or in clear text, and also all photographs, maps, overlays, or sketches transmitted by field agencies of signal communication, as distinguished from those transmitted by mail or commercial agencies. (A telephone conversation between two persons over a field wire system is not classed as a “message”). Certain messages, because of their importance, should be given priority over others in transmission. For this reason messages are divided into the following classification: urgent, priority, and routine. Messages are considered routine by transmitting agencies unless the writer specifically classifies them as urgent or priority by writing the appropriate word on the face cf the message. The urgent classi- fication is reserved for those messages that require the greatest speed in handling. When so marked, the message will be sent immediately upon receipt by the transmitting agency TACTICAL FUNCTIONS OF THE ARMS 57 unless another urgent message is being sent. Priority messages are given precedence over all routine messages waiting to be sent. Commanders should resort to the preferred message only in cases of actual necessity, as indiscriminate use of this device decreases its effectiveness. No greater priority should be demanded for a message than its relative importance warrants. Preparation of Field Messages. The transmission of field messages is facilitated by a uniform arrangement of their contents. Irregularity in the address or authorization delays transmission and increases the chance of error. The inclusion of the correct date and hour of origin of the message is essential to proper evaluation by its recipient. Serial num- bers on the messages aid in control of traffic. Therefore, special forms for field messages are prepared, bound in books, and issued to the service. These forms have definite places for all the items mentioned above, a space for the text or body of the message, and spaces for the use of transmitting agencies. In writing field messages be brief, concise, but above all legible and accurate. Adopt a telegraphic style as if each word were being charged for at commercial rates but do not omit anything which is essential to a full and complete understanding of the message by the recipient. Use only the authorized and generally understood abbreviations. Be care- ful of such words as “right” and “left” when compass directions as “east,” “west,” “north,” or “south” are more specific. When a message is written, read it from the viewpoint of the person to whom it is to be delivered, assuming that he has normal intelligence, in all probability a compass, but no “Ouija Board.” If it still makes sense and tells the com- plete story, it is ready for transmission. Plate 26. Form M-105 Message Blank Correctly Filled Out. The full size of the message sheet is 5% x4% inches. The Field Message Book. The field message book, Type M-105, is the most recently adopted message book for general use, and is the type carried by infantry officers, noncommissioned officers, and anv other personnel who have occasion to write field mes- sages. The book is designed to fit the shirt pocket. Each message sheet in the book has a carbon back, except the tissue sheets intended for the writing of messages to be sent by pigeon. In addition there are vellum sheets for sketches or overlays. 58 MILITARY MEDICAL MANUAL To prepare the book for the writing of a normal message, the cardboard stop is inserted between the third and fourth unused message sheets, in order to block otl the remaining message sheets. One writing thus makes an original and two copies of the message. The second copy is retained in the book for the writer’s hie or reference. The original and the first copy are dispatched to the message center, the original for transmission and the first copy for temporary file at the message center. At the proper time, the staff officer charged with the preparation of the unit journal should incorporate the temporary file copy in the journal. Plate 26 shows a message blank correctly filled out by the writer. The numbers in parenthesis refer to the following notes: (1) Not to be used by the writer. (2) The writer may enter here a preferred classification, such as urgent or priority. (3) The writer ordinarily does not indicate the agency of transmission. If he de- sires physical transmission, he should enter here: “by Msgr.” (4) The writer’s own message number. Message numbers run serially through the 24 hour day. The first message written after 12:00 midnight is always No. 1. (5) The date is always written in the order: day, month, year. (6) Insert the official designation of the person addressed, not “Colonel X. Y. Jones.” Col. Jones may have become a casualty, but there is always an incumbent commanding officer of the 1st Infantry. Add the actual location only when necessary to insure delivery. Do not use telephone code names as an address. (7) Write plainly, using a pencil that will make clean-cut carbon copies. Print proper names (except signature and grade of writer) and code or cipher groups in CAP- ITALS. Poor writers should print the entire message. (8) This is the official designation of the authority for the message. (9) The time signed is often as important as the date. It may be written as shown, or simply as “6:00P,” omitting the “M." “12:00 AM" and “12:00 PM” are confusing. It is better to write “12:00 Midnight” or “12:00 Noon.” The 24-hour clock system may be used as a means of eliminating confusion between AM and PM (10) This is either the signature of the sender of the message or the person author- ized to write the message for him. Thus, in the example given, Major Joe Wilson is authorized, as a staff officer, to write messages for the Commanding General, 1st Division. Before Major Joe Wilson turns the above message over for transmission he reads it carefully, remembering that “If a message can be misunderstood it will be misunderstood.” Mission. The Coast Artillery Corps is characterized by the great fire power it can deliver primarily against naval and aerial targets. Its armament comprises seacoast artillery, antiaircraft artillery, and submarine mines. The missions of the Coast Artillery Corps are to attack enemy naval vessels by means of artillery fire and submarine mines, and to combat hostile aircraft by means of fire from the ground. Cooperating in coastal frontier defense with the Navy off shore, the Coast Artillery Corps mans and serves the harbor defenses established in time of peace and augmented in time of war. These harbor defenses are highlv organized and strongly protected localities, organized administratively and tactically for the defense of a harbor or other water area. Seacoast Artillery. Seacoast artillery) comprises all the artillery, whether fixed or mobile, employed against hostile naval vessels. It is classified according to caliber as primary armament which includes cannon of 12-inch or greater caliber, and secondary which includes all other armament. Seacoast artillery has the same general characteristics of fire as Field Artillery except for its greater power and range, and the armor-piercing ability of its projectiles which, in general, are not suitable for use against land targets. Tt is provided with special equipment to facilitate the delivery of accurate fire on moving targets at sea. Fixed seacoast artillery secures protection from naval and air attack by fortifications and other permanent structures; its operation and service are greatly facilitated by mechanical means; its stability permits great accuracy of fire. The provision of per- COAST ARTILLERY CORPS TACTICAL FUNCTIONS OF THE ARMS 59 manently installed communications, stations and fire control equipment makes possible the establishment of a common fire direction to exploit the flexibility of artillery fire to the maximum extent. Mobile seacoast artillery comprises railway artillery and tractor-drawn artillery. Both types combine strategical mobility with a limited tactical mobility and require a con- siderable time for emplacement. Mobile seacoast artillery provides additional gun fire for existing harbor defenses and is used in conjunction with other forces to protect harbors or coastal areas for which no permanent defenses have been provided. Plate 27. Coast Artillery 16-Inch Harbor Defense Gun. Photo by U. S. Army Signal Corp*». Seacoast artillery is organized into groups and groupments in order to develop the maximum fire power and provide efficient fire direction. Antiaircraft Artillery. The mission of the antiaircraft artillery is to combat hostile aircraft. For this purpose, it is equipped with antiaircraft guns, machine guns, search- lights, sound-locators, and equipment required for observation, fire-control, and signal communication. These means of antiaircraft defense are combined in the regiment. Antiaircraft artillery operates both by day and by night. Because of the mobility of its materiel, antiaircraft artillery lends itself to rapid concentration in critical areas. Antiaircraft artillery reinforces the antiaircraft measures of other troops and, in co- operation with our own aviation, operates especially against hostile aircraft flying beyond the range of the weapons of other troops. It provides protection for those vital elements of a command most likely to be subjected to hostile air observation or attack. It is employed also in harbor defenses and for the protection of airdromes and other sensitive points in the rear areas. The establishment of a coordinated antiaircraft defense is facilitated by centralized Plate 28. 3-Incb Coast Artillery Antiaircraft Gun. control of antiaircraft units. In some situations, however, such as during an advance, it may be necessary to decentralize control of part of the antiaircraft artillery to protect widely separated units or installations. An essential agency of antiaircraft artillery is its intelligence service. This service gathers and transmits information of the enemy’s air activities necessary for the proper employment of the antiaircraft artillery units. It should not be confused with the aircraft warning service which is a regional service forming part of a theater, sector, or area, and serving all agencies of antiaircraft defense. The aircraft warning service operates directly under the control of the commander of a sector or area or the theater of operations concerned. TACTICAL FUNCTIONS OF THE ARMS 61 Plate 29. 37-mm Coast Artillery Antiaircraft Gun. Materiel. The weapons used by antiaircraft artillery consist of the antiaircraft artillery gun, 3 inches or larger in caliber, which is provided for attack of high-flying aviation, the 37-mm antiaircraft gun, and the caliber .50 machine gun. The 3-inch antiaircraft guns fire a 12.7-pound projectile to a vertical range of 9,700 yards and a horizontal range of about 14,200 yards. Rate of fire is 25 shots per gun per minute. The total weight of the piece and its carriage is approximately 8 tons. The 37-mm antiaircraft gun is a highly mobile antiaircraft gun capable of full auto- matic fire at a rate of 120 shots a minute. Its range is approximately 2,500 yards. Total weight of gun and carriage is 2x/i tons. The caliber .50 machine gun has an efTective range of 1760 yards and delivers fire at a rate of 250 shots per minute. Detection of approaching aircraft, obtaining and computing firing data time to be of use, and transport of the weapons and equipment requires the following rather elaborate and costly equipment: searchlights, sound locators, stereoscopic height finders, data com- puters, fuze setters, and fire directors. Organization. The antiaircraft artillery regiment consists of the following units: Regimental headquarters. Headquarters battery. Gun battalion consisting of battalion headquarters, headquarters battery, and ammuni- tion train; searchlight battery with five platoons, each operating one searchlight and one sound locator; and three gun batteries, each operating four mobile antiaircraft guns and four caliber .50 antiaircraft machine guns, the latter for protection of the battery from attack by hostile low-flving airplanes. Automatic weaponc battalion consisting of battalion headquarters, headquarters battery, and combat train; one machine-gun battery of three platoons, each operating four caliber .50 machine guns; and three 37-mm gun batteries of four platoons each, each operating two guns. 62 MILITARY MEDICAL MANUAL The regiment may be formed into provisional battalions, constituted as may be appro- priate to the mission, for temporary attachment or support of other arms, when less than the entire regiment is required by the mission or available for employment. Mission. The general mission of the Army Air Forces is the preparation for and execu- tion of air operations as a part of the field forces. ARMY AIR FORCES Plate 30. Caliber .50 Antiaircraft Machine Gun. Photo by U. S. Army Signal Corps. Characteristics. Military aviation is characterized by an extremely high degree of mobility, the ability to move in three dimensions, and extreme range of fire power. Air operations may be restricted by hostile counter air force operations and antiaircraft measures, by the availability of air bases, and by adverse weather conditions. The mobility of aircraft enables them to cover great distances in a short period of time and makes possible their rapid intervention at critical points in a theater of operations and rapid movement between widely separated theaters. The power of aircraft to move in any direction enables them to maneuver in altitudes beyond the range of ground weapons, to approach terrestrial objectives from such altitudes, and to make deep incursions into enemy territory. The operating range and fire power of combat aircraft are reciprocal functions and depend upon the distribution of the useful load between fuel and ammunition. TACTICAL FUNCTIONS OF THE ARMS 63 Types of Air Operations. In general, air operations involve three fundamental tactical functions: Air attack,\, which is the attack of objectives on the earth’s surface by aircraft; Air fighting, which is the act of fighting between aircraft in flight; Air reconnaissance and observation, which is the gaining of information through visual and photographic means carried in aircraft. Types of Aircraft. In accordance with the purpose for which aircraft are ordi- narily employed, military aviation is divided as follows: combat; reconnaissance, obser- vation, and liaison; transport; and training and special purpose aviation. Combat aviation is organized, equipped, and trained to engage in offensive and de- fensive air operations by air attack and air fighting. Corresponding to the means with which equipped, combat aviation is organized into bombardment and pursuit units. Medium and long-range reconnaissance is performed by bombardment types of aircraft. Plate 31. North American 0-47A Observation Airplane. Olliciat n.ot.-Kiaph, b. b. Ai‘in> Ail tuipb. Reconnaissance, observation, and liaison aviation is organized, equipped, and trained to conduct air reconnaissance, observe fire, gain military information by visual and photographic means, and transmit instructions and reports in accordance with the orders of supported units to which organically assigned or attached. It includes both heavier- than-air aircraft and balloons. Although armed for their own protection, they are not suitable for air attack or air fighting. Transport aviation is organized, equipped, and trained to carry personnel and cargo. It is indispensable for facilitating the operations of Air Corps units through the rapid transport of personnel and essential items of supply, and is particulaily suitable for increasing the mobility of foot troops in an emergency. Training and special purpose aviation is organized, equipped, and trained especially for the training of flying personnel and for other special purposes not connected with air operations; it is neither suited nor intended for combat use. 'Powers and Limitations. A knowledge of the powers and limitations of combat aviation is a prerequisite to sound employment. These powers and limitations arc derived from the characteristics of its constituent aircraft. These characteristics change rapidly with the development of new aircraft. Bombardment aviation is characterized by its ability to carry large loads of destructive agents to attack surface objectives. It includes light, medium, and heavy bombardment. Light bombardment aviation constitutes the principal element which operates in 64 MILITARY MEDICAL MANUAL direct support of ground forces. Its principal weapons are light bombs and chemicals. It is capable of applying these destructive agents to destroy light material objectives, to interdict routes of communication and supply, to render airdromes temporarily useless, and to attack troops in the open or under light shelter. Medium and heavy bombardment aviation constitute the offensive power of air striking forces. They are designed to carry the maximum bomb loads to great dis- tances and to conduct long-range strategic reconnaissance over land and sea. Their principal weapon is the heavy bomb. They rely primarily upon high altitude flying, speed, defensive fire power, darkness, and the cover of clouds for security. They are particularly suitable for the destruction of heavy material objectives. Their radius of action is such that they can strike objectives at a great distance from their base and still find service and security deep in friendly territory. Official Photograph, U. S. Army Air Corps. Plate 32. Bombardment Airplane, Boeing B-17B, the “Flying Fortress.” Pursuit aviation is characterized by its great speed and maneuverability in the air and by its ability to engage in air fighting. It includes interceptor and fighter pursuit. Interceptor pursuit aviation is designed primarily for defensive missions in the anti- aircraft security of important areas and ground installations, and the protection of ground troops and their observation aviation. It extends protection beyond the range of antiaircraft artillery and its operations are coordinated therewith. Fighter pursuit aviation has greater range than interceptor pursuit and is designed to accompany and protect bombardment aviation exposed to attack by hostile combat aviation. Although pursuit aviation is designed primarily for air fighting, it can also be used to attack troops and their transportation. Balloons constitute elevated observation posts and serve as a means for extending the field of view under continuous observation. They possess a considerable degree of mobility and can be moved frequently without material loss of efficiency. They are, however, vulnerable to attack by hostile combat aviation and antiaircraft artillery if within range of the latter. For purposes of observing and adjusting artillery fire, the balloon or the observa- tion airplane is employed, whenever practicable, in preference to the reconnaissance airplane which is provided for and intended to perform reconnaissance missions. Fire Power. The fire power of combat aircraft used in air attack is characterized by its potential concentration and cumulative effect. This effect depends upon the nature and extent of the objective, upon the enemy’s measures for antiaircraft defense, and upon the number and characteristics of combat aircraft used against the objective. The constant threat of air attack exerts a strong influence on surface movements and operations. Air Fighting. Because of the speed and powers of evasion inherent in all aircraft, air fighting is generally of a brief duration and the results are often indecisive. As a result, pursuit aviation is incapable of controlling the air in the same sense that surface forces can control an area. Air fighting will, therefore, be carried on as necessary to limit hostile air operations. TACTICAL FUNCTIONS OF THE ARMS 65 Plate 33. Bell XFM-1 Pursuit Airplane (Multiplace). oilu’iai IMioiograprt. U. S. Army Air Corps. Air Reconnaissance. Air reconnaissance and observation operations are characterized by wide range and great depth, by the excellence and precision of the air photographs taken, and by the rapidity with which information is obtained and transmitted. They are limited by poor visibility, bad weather, antiaircraft fire, and the opposition of hostile combat aviation. All aircraft except balloons are equipped with two-way radio; balloons are able to communicate by telephone with the ground. Other means of communication between air and ground are dropped and picked-up messages, pyrotechnics, flares, and other visual signals. Care and Maintenance. Much of the equipment pertaining to aircraft is of a complex and highly technical nature; its operation requires highly trained combat crews; its maintenance and repair require mechanics with specialized skill. As a consequence, all aircraft need constant care and maintenance and are vulnerable to air attack both in flight and on the ground. The fatigue of combat crews and the repair and rcserv- icing of equipment and materiel require all aviation units to operate from air bases where the necessary facilities are provided for rest, replacement, maintenance, and repair. The frequency of engagements of the elements of an aviation unit depends upon the urgency of the situation and the demands already made on the particular unit. It is essential that aviation units be conserved in their employment during less active periods of operations so that crews and equipment may be pushed to the limit of endurance during critical phases of operations. 66 Air Bases. Air bases, suitably located, are essential for the operations of combat aviation. Without a suitable air base from which to operate, combat aviation soon becomes impotent. An air base is an Air Forces command which comprises the landing facilities and the installations for shelter, supply, maintenance, and repair that are necessary to sustain the operations of combat aviation. Such a base will, as a rule, cover a considerable area. Its security requires a wide distribution of base facilities and installations and adequate means for their protecton. Organization. The basic administrative and tactical unit of the Air Forces is the squadron. The group, composed of two or more squadrons, is the principal tactical unit and contains all the essential elements necessary for operation, maneuver, and combat. The next higher Air Forces unit is the wing which may consist of two or more types of aviation but will rarely, if ever, operate tactically as a unit in the air. GHQ Aviation. GHQ aviation, under command of the Commanding General, Army Air Forces, comprises: Striding forces which operate as strong offensive air units to extend air operations to a great distance from their operating bases. Defense forces which provide the necessary antiaircraft defense of the most vulnerable and important areas of the zone of the interior. Support forces which operate in direct support of the operations of the ground troops. Special forces which meet the requirements for air operations in coastal defense and similar operations in minor theaters. The aviation assigned to an oversea department conducts whatever air operations may be required incident to the application of the defense plans cf the particular oversea department. Aviation Component of Large Units. The aviation organically assigned to large units is generally limited to reconnaissance, observation, and liaison types, suitable in range and speed to the missions to be executed. The organization of these Air Force units is determined on the basis of the estimated minimum requirements in aviation of the several large units. When greater strength in aviation is required for any particular operation, the increase is provided by attaching additional units. A portion of GHQ aviation may be attached to or placed in support of larger units, the size and composition of such support forces depending upon the task or mission to be executed. The aviation assigned to the zone of the interior comprises training and special pur- pose aviation and such other Air Force units and establishments as are required for effective mobilization and training, and for replacement and maintenance of aviation in the theatre of operations. A portion of GHQ aviation (defense forces) may be assigned for antiaircraft defense in the zone of the interior. Battle Employment. The organization for combat of the aviation of a command is a function of the commander; each chief of aviation (air officer in the field army) acts as adviser to his commander in the performance of this duty. This organization for combat is based on the consideration of the characteristics and the amount of aviation available, and a study of the air operations to be conducted in accordance with the situation. The organization should be such as to constitute a suitable task force to accomplish the mission, and render command, tactical control, communication, and supply most effective. The selection of objectives against which air operations are to be directed is of vital importance. Air operations must be pushed with energy and dispatch, using every opportunity to take full advantage of surprise. Since the replacement of flying per- sonnel and equipment is both slow and expensive, economy of force is especially im- portant. Combat aviation should be employed in mass against objectives of decisive importance for the accomplishment of the mission of the field forces, and not dis- persed or dissipated in operations of minor or secondary importance. Air operations beyond the sphere of action of the ground forces are undertaken in MILITARY MEDICAL MANUAL TACTICAL FUNCTIONS OF THE ARMS 67 furtherance of the strategical plan of the commander of the field forces. These operations are discussed in FM 1UU-15. Combat aviation placed in support of large units operates to further the mission of the supported command. The superior commander under whom such support aviation is operating is responsible for the assignment of air missions or objectives, and for its employment within or beyond the sphere of action of ground forces. In general, the greatest effectiveness of military aviation is secured through centralized control. When decentralization of support aviation becomes necessary in situations requiring immediate tactical support of specified units, the superior commander attaches to or places a part or all of his support aviation in support of a specified large unit so that it may act with greater promptness and better understanding in meeting the requirements of the supported unit. In the hands of higher commanders, support aviation constitutes a powerful means for influencing the course of combat after the ground forces have become engaged. The increased application of motorization and mechanization extends the possibilities for air attack. The difficulty of gaining fire superiority over a well-organized defense points to an increasing need of air attack in support of ground troops, especially in critical situations when the available means of support on the ground are inadequate. The hostile rear area is the normal zone of action of support aviation since operations in this area permit the full utilization of striking power against concentrated targets with the minimum losses and the maximum results. Ordinarily the most effective results will be obtained from bombing attacks launched at altitudes above the effective range of ground weapons. Support aviation usually is not employed against objec- tives which can be ellectively engaged by available ground weapons within the time required. THE ARMORED FORCE Introduction. The Armored Force has taken on the characteristics of a separate arm. Since it contains within its structure elements of other separate arms and services it may also be likened in this respect to the Army Air Forces. With tank regiments forming the keystone of its power, the armored division is a versatile large organization capable of operating at great speed over long distances always retaining the capacity to deliver a strong blow in the accomplishment of important missions. The warfare of today places ever-increasing emphasis upon the importance of armored power and air power. It is a form of warfare in which the United States may expect with reason to excel. We have the manufacturing resources. We have the raw materials. Our people are motor-minded, tank minded, and airplane minded. The swift increase in the number of armored divisions and the certainty that more will follow should enable even the blind to see that the United States will make its weight felt in due time. There are major problems to be solved, especially in the field of transportation. Each development in warfare is dependent for success upon many factors. The Armored Force will con- tribute its full share to the victory which somehow and sometime we have resolved to fashion. Elements of Armored Force Organization. The armored division may be visualized as the basic large unit of the Armored Force. It consists of the following essential elements: The command element, reconnaissance element, striking element, support element, and service element. The commander and his staff comprise the command element. The general officer commanding an armored division has the same responsibilities as the commanders of other types of large forces. His staff is organized along conventional functional lines consisting of a general staff and a special staff. The reconnaissance element is furnished to provide the information the commander requires in order that he may lead and control the division with adequate knowledge of obstacles to be encountered or avoided, and opportunities he may exploit. He must rely upon much information gained from reports from air support units in support of his division. From organic reconnaissance units he must obtain detailed information MILITARY MEDICAL MANUAL Plate 34. A Medium Tank. Plate 35. Scout Car Emerging from Woods. TACTICAL FUNCTIONS OF THE ARMS 69 from ground observation far to the front, flanks, or rear as the situation requires. Since an armored division may operate independently at considerable distance from other troops, surprise action by an enemy may result in capture or destruction. Adequate reconnaissance is the means to prevent such unhappy results. A study of the action in North Africa indicates the constant need for accurate information as well as the disaster resulting from its lack. The striking element includes the armored regiments which are equipped with tanks. All action of an armored division may be said to have for its purpose the placing of the striking element in position to deliver the final, crushing blow. It is obvious that the reconnaissance element must gain the information to permit the tanks to be placed at the right place and time to accomplish the assigned mission. The support element is provided to assist the armored regiment with their tank units. It comprises infantry, field artillery, and combat engineers. The service element enables the division to sustain itself in action. It consists of elements for supply, evacuation, repair and salvage. Characteristics of Armored Units. Armored units have capabilities and limitations which bear directly upon their strengths and their weaknesses. Each type of vehicle relies upon its capacity for swift movement over varied terrain. Each type of vehicle encounters conditions it can overcome superbly; those which it can do fairly well; and others it should not be called upon to execute. It is a law of physics that for each action there is an equal and opposite reaction. Accordingly, if an undue emphasis is placed upon mere speed of movement there must be a reduction in weight. This will be reflected in less armor for the protection of crews, reduced gun power, and greater fragility throughout. On the other hand, if safety of crews and great gun power is overemphasized, speed must be reduced and swifter vehicles will have their more sluggish adversaries at their mercy. Hence, design of each type of vehicle may be said to con- stitute a series of compromises. Whether there can ever be a “best” tank in the possession of any world power is open to argument in the minds of many students of the question. There is always the possibility that some genius in design, or metallurgy, or manufacturing may fashion a model which will be superior in several of the essential traits. The nation which can produce this genius, and produce his machines in quantity, either of the ground or air, may have won its war. The capabilities of the tank, or things it can do well, are the following: A sufficiently high road speed enabling the unit to move over great distances in relatively short time. It can move across country at speeds depending entirely upon the terrain encountered. Generally the cross country speed will approximate 50% of the road speed of the same vehicle although this rule of thumb is open to the widest variation since some move- ments off roads may be accomplished at road speed while others may traverse only at minimum speed because of obstacles or terrain conditions. The tank is able to cross small obstacles, ditches, and shallow streams. More serious obstacles require the assistance of combat engineers or special equipment. Thin woods and brush are readily negotiated. The tank has great fire power. In fact, the tank may be regarded as a movable gun platform with armor protection for the crew while it moves to positions from which to fire or fires while in movement. Because of its weight and speed, the tank has crushing ability to overrun enemy personnel, and to destroy hostile guns and equipment. Armor protection for the crews enables tanks to operate within the zone of hostile small arms fire as well as under hostile fire of any kind which has not sufficient power to disable the tank. While the above favorable characteristics are of the utmost importance, there are limitations or less favorable capabilities which must be understood. It is true of all tools of war. Defense against any device consists of seeking to avoid its strong points and exploitation of its weaknesses. The tank unaided cannot cross deep streams, soft- bottomed streams, marshy ground, or swamps. Some ground which can be easily crossed in dry weather becomes impassable for tanks after heavy rains. They cannot cross wide ditches or other large obstacles unaided. Dense woods with heavy timber should be avoided. Bridges and culverts of light construction such as are encountered 70 on all but our best-constructed highways may be impassable. Operations in mountains must tend to follow the road net. Tanks are noisy and their operations difficult to con- ceal. Antitank guns and artillery are effective against tanks. The student should observe with interest the constant race between the power of antitank guns and the development of armor to resist them. Fire from moving vehicles has sharp limitations, especially because of the limited vision of gunners in moving tanks with ports and doors closed. Tanks are helpless without an adequate fuel, lubricant, and ammunition supply. True or false, the Germans have claimed the capture of a French armored division because its fuel tanks were dry and its ammunition expended. Tanks require periodic main- tenance. It is true that these are important handicaps. Skill in leadership, in training, in reconnaissance, in repair and maintenance, ingenuity and foresight on the field of battle reduce the importance of the limitations and increase the accomplishments to be expected from the powers of tanks. The famous wrestling coach at West Point who coined the expression, “There ain’t no holt that can’t be broke” fathered a philosophy which our new army could well adopt. Missions for Armored Forces. Armored forces can perform missions as varied as other ground components. They cover the field of offensive combat, defensive combat, and special operations. Since the armored division is organized and equipped for great speed in operations, it follows that its primary role is in offensive operations against hostile rear areas. In mobile warfare where the nature of the terrain is favorable, the speed and deftness with which an armored division is able to operate gives it a position of dominance. Bold maneuvers may be executed at high speed and thus confront the enemy with a dominant power in a decisive area. The maximum success may be expected only when the attacking armored force possesses air superiority, surprise, favorable terrain, and the absence or neutralization of massed enemy defensive means. When these factors are present, the armored unit may penetrate a hostile position on a narrow front, and move with devastating effect into the hostile rear areas where are located the command, communication, and supply facilities, as well as the hostile reserves. However, when free to choose, the commander will prefer to avoid the hostile organized position and move deep around the flanks and approach the critical areas over undefended or lightly defended ground. The commander will seek the route which promises most for swift success. The employment of an armored division on defense denies the opportunity to exploit fully its powers of movement. Units of the support echelon will be used to the utmost. Tanks may employ delaying tactics, and launch counterattacks. GHQ Tank Battalions and Groups. The Armored Division should be understood as a well-rounded unit of essential arms and services which enables it to operate either in conjunction with other ground troops, such as infantry divisions, or independently on missions which may be distant from friendly troops. The GHQ tank battalions or groups, on the other hand, are provided to assist ground troops and their independent action would be more than unusual. These units precede, accompany, or follow other attack units, such as an infantry regiment, and enter the action at the decisive time and place as determined by the commander to whom they are attached. As they are essentially offensive weapons their use can be regarded as restricted to the offense except in the counterattack phase of defense. Typical of the action of these units might be the following. One echelon of tanks moves swiftly upon the enemy position with the mission of destroying hostile antitank guns. The next echelon either accompanies or precedes other attacking units and has the mission of entering and overrunning hostile position just prior to the arrival of the assaulting troops. Hence, tanks, infantry, and field artillery operate as a team in the capture of a hostile position. MILITARY MEDICAL MANUAL TACTICAL FUNCTIONS OF THE ARMS 71 Introduction. The Tank Destroyer Force is essentially defensive in nature since it is created for the purpose of nullifying the strength of hostile armored power. Its weapons and vehicles are designed to meet and best the tank. The development of this force is another splendid example of the defense rising to meet new-found powers of offense. The struggle is as old as man, or as old as warfare, as you prefer. In World War I the power of the machine gun is held by some authorities to have immobilized armies. The accurate 37-mm gun was designed initially to seek out and destroy hostile machine guns which, easily concealed, required a weapon of great accuracy to counter. But machine guns are easily built in huge numbers and there was no effective means to eliminate them. The losses by troops which attemped to advance against them reached astronomic proportions. The British introduced the tank which was invulnerable to machine-gun fire and had this development been used in sufficient quantities initially there are experts who contend that Germany might much sooner have been brought to her knees. The 37-mm gun then became an antitank gun and the modern race between gunpower and armor really got under way. Artillery of the period had too limited a traverse and required too much time for movement to stop the tank. Tank Destroyer units have taken over the task. The organization, weapons, and methods of operation are not available for open publication. Characteristics. Logic and analysis can combine to explain the problem which must be satisfied by tank destroyers—a most colorful and completely descriptive functional name for these organizations. The problem resolves into the development of weapons, means of transport, and methods of employment which will produce characteristics superior from a defensive viewpoint than the tank can throw against them. The weight of the tank holds down its speed; hence, the tank destroyer must be able to move at greater speeds than the tank. Tank operation is limited by terrain, although tanks can move through difficult country which would have stopped them in earlier stages of development; hence, the tank de- stroyer must have greater cross-country capabilities than tanks. The observation of gunners within tanks is limited and often difficult; hence, the tank destroyers must have better visibility and accept a greater vulnerability. There is a practicable weight limit of the guns which may be used in tanks because of the need for over-all armor protection; hence, the tank destroyer must possess weapons of greater power, and preferably with greater range, velocity, and flexibility. It adds up to a self-propelled gun mount, with great cross-country capacity, light armor, extremely heavy gun power, maximum visi- bility, speed greater than tanks, and flexibility of operation in all particulars. Factors in Tactical Employment. The skillful leader of tank destroyer units must first acquire a thorough understanding of tank action, and especially the methods used by hostile tank commanders. To accomplish his mission he must always be a jump ahead of his adversary. The information service must be developed to a high degree of excellence. The commander must be informed when hostile tanks are in his vicinity; he must know where they are; when they move; the routes over which they are moving; and the several destinations which they may have selected. When he has that information he may utilize his greater speed and cross-country capacity to occupy position to inter- cept the enemy. He must outguess his enemy. An inherrent advantage of the tank destroyer is that his mission can be accomplished while stationary. He moves in order to enter a new firing position. His greater gun power enables him to engage the tanks of the enemy before their guns of lesser range can engage him. The tank can also stop to fire and thus increase its effectiveness. But when the tank stops it forfeits its greatest strength in its capacity to move into an area. In fact, the tank destroyer may accomplish its mission in part by preventing hostile tanks from approaching a position. Here are opportunities for the alert, aggressive, commander of the utmost interest and importance. There are ample examples from North Africa of tanks advancing against them to their certain doom. The reading of the possibilities presents a rosy picture of simplicity. The opposite is the truth. It is a battle of wits as well as a battle of power. TANK DESTROYER FORCE 72 MILITARY MEDICAL MANUAL Introduction. It is to be expected that all nations will strive to obtain an ever- widening exploitation of the powers of the airplane. Modern combat resolves into a struggle which includes as a single operation the employment of ground power, armored power, air power, and even naval power, in one integrated effort. The nation which maintains the best coordination between these power elements has the best chance of ultimate victory unless other factors are injected which upset the balance. The use of the airplane in moving troops into battle has progressed to a point of great importance. The Battle for Crete is the best current example but there are others and there will be more. The possibilities are without practicable limit. Details of organization and employ- ment are unavailable for publication. Analysis of Common Terms. In the United States, the spotlight has been focussed for months upon the parachute troops, or “paratroopers” and indeed theirs is the most spectacular phase of the development. These units are transported in airplanes and land by means of parachutes. Parenthetically, parachute units include their own attached medical personnel and medical officers may apply for this service. Those who join these units will undergo a rich experience. The officers and men are carefully selected and only the most promising applicants are chosen. It is a “volunteer” organization in which esprit is high. The training system through which each member is conducted is superb. When the time comes for the novice to make his first jump, and shout “Geronimo” as he leaves the plane, as other medical officers have done, he will be ready for the experience. Extra pay is involved. The matter of personal hazard is not excessive and anyhow participation in the conduct of war is not famed for safety. The officer whose age permits, who enjoys sports of bodily contact, whose physique is rugged and whose movements are well coordinated should acquire the necessary facility as routine procedure. More than likely he will enjoy the experience. When he has made his final training jump with success he may don the paratrooper’s badge and enjoy the cameraderie of officers and men who are knit together by common bonds of ex- ploring a new field of warfare the limitations of which may be beyond our present comprehension. Air landing troops disembark from airplanes or gliders after reaching the ground. In the presence of the enemy the parachute troops constitute the advance guard for air landing troops, as in the German attack against Dutch cities in the invasion of the Low Countries. These units are organized, trained, and equipped especially for the sort of missions they will encounter and again a unique opportunity is presented to the air-minded medical officer. AIR BORNE TROOPS Introduction. The art of camouflage is a modern essential for all arms and services. Medical units must be adept in certain phases of this subject in their own protection, for the safety of patients in their care, and to avoid disclosing the positions of other components of the force. The commander of troops subject to attack by an enemy, either from the ground or air, will demand concealment of units and installations which, if discovered, may disclose his locations or intentions. Medical units must stand ready to conceal their personnel, transportation, and installations. FM 5-20, EFM, covers the subject. Purpose and Value. Camouflage is the art of concealing the presence of our troops and their activities from enemy observation, or of deceiving the enemy as to the extent and purpose of our activity where concealment is impossible. In small units camouflage reduces casualties by denying the enemy knowledge of the exact positions occupied by troops, thereby preventing the delivery of accurate, observed fire. Means of Observation. Two means of observation are available to the enemy, direct visual observation through the eyes of scouts and observers, and indirect recorded observa- tion through the lens of the aerial camera. The data supplied by the aerial photograph is by far the most important source of information open to the enemy, and our own forces jas well. Deceiving the expert interpreter of aerial photographs is much more difficult CAMOUFLAGE TACTICAL FUNCTIONS OF THE ARMS 73 than deceiving a direct observer. For these reasons the best test of all camouflage is that made by friendly aviation through observation, photography, and report. Contrast. The camera records and the eye perceives the differences in the appear- ance of objects due to the manner in which they reflect light. These differences are called contrast. Contrast results from certain characteristics of objects, such as form and spacing, shade and shadow, color, and texture. The whole purpose of camouflage tech- nique is to eliminate contrast or to render meaningless such contrast as does exist. Form and Spacing. All natural forms are irregular in shape and irregularly spaced. Man is prone to work with regular forms and he spaces them regularly, unless a conscious effort is made to maintain the confusion of nature. Successful camouflage requires that all regularity of form and spacing be avoided. Shades and Shadows. Shades and shadows are one of the principal sources of con- trast, particularly on photographs, and are the means through which form is usually re- vealed. Shadows should be reduced as much as possible by keeping all works low and by breaking up regular shadows so that they will blend with those naturally present. Color. Color is more important in direct visual observation than in photography, although similar objects of different colors do show contrast on pictures. The importance of color in camouflage is well illustrated by the protective coloration given the uniforms worn by troops. Texture. Texture is the ability of a surface to absorb light. It is the source of a great deal of contrast on photographs. The entrance to a deep shelter will photograph black because all the light that enters the hole is absorbed and none of it emerges from the entrance again. The correct camouflage procedure is to hang a curtain over the entrance so that the spot will photograph like the adjacent trench slopes. Tall grass will photograph very dark but one man walking across it may tramp down enough grass to make a distinct path that will show on the picture. The trampled grass has a different texture and will reflect enough light to cause a distinct gray streak when photographed. Obviously, texture has nothing to do with color. Camouflage Problems. Camouflage problems occur in almost infinite numbers and varieties. Solutions depend upon avoiding contrast. Certain elements of great importance, common to the solution of all problems, are listed below with their relative weights in attaining success in any particular problem. Choice of position in favorable terrain, 40%. Camouflage materials, 15 %. Skill in installation, 20%. Camouflage discipline, 25%. Choice of Position. Successful camouflage depends very largely on the initial choice of favorable terrain, because the other factors are themselves limited by the characteristics of the chosen position. The particular features to be considered in selecting a position are: Accessibility by existing roads and trails. Defilade from direct ground and balloon observation, including flash defilade for guns. Suitable locations for all necessary auxiliaries, such as kitchens, latrines, ammunition dumps, observation and command posts, animals, and carts. Convenience requires that these installations be near the main position, but they must be kept far enough away so that their discovery will not betray its location. Natural Cover. Terrain that presents a great variety of contrast in the form of woods and brush, villages and houses, road and trails, gullies, streams, and fence lines is favorable for camouflage works. On the other hand, uniform ground such as pastures, grassland, cultivated fields, and flat sandy waste land, even though covered by low brush, makes concealment of works, and particularly the trails necessary for cir- culation, almost impossible. The options available to company officers are usually quite limited, but often a change of only a few yards will permit the location of machine guns and other weapons in broken terrain where concealment is relatively easy. Every ad vantage must be taken of existing opportunities to make concealment easy rather than depending upon elaborate camouflage works after elements of the defense have been located in exposed positions. 74 MILITARY MEDICAL MANUAL Fig.l TELL-TALE TRACKS They indicate something of importance at 0, al though the object itself is not visible. Fig'-2 CONTINUOUS TRACKS If the tracks are carried past the locality to which they really lead(O) they do not betray its importance. But a junction is suspicious, hence O-C should be suppressed andaejummy path D-Y, put in. Parados Original surface Fig. 3 CONCEALING A TRENCH FROM. GROUND OBSERVATION A-B'C-D should appear as a continuous line approach trench Fig.4 CONCEALMENT AND COVER ARE AFFORDED BY A PARAPET WITH AN IRREGULAR CREST Fig.5 CONCEALMENT OF COMBAT GROUPS BY DUMMY TRENCHES The arms A- B and C*D are concealed by nets. Fig.6 OBSTACLE CONCEALED IN AN ARTIFICIAL ° DEPRESSION Plate 36. Camouflage Expedients. TACTICAL FUNCTIONS OF THE ARMS 75 Tracks. The most obvious sign of military activity is the record of movements made on the earth’s surface in the form of tracks. This record is relatively permanent and can, therefore, be photographed and studied at leisure by the enemy. For this reason important works and activities are betrayed by tracks and paths more frequently than in any other way. Tracks already in existence should be used as far as possible and movements should be confined to a minimum number of these tracks. Where a new road or path to a position is unavoidable, it should be carried on to a dummy position, another road, house, or other false destination. Circulation should be one-way to insure that no part of a road appears unused. Camouflage Materials. Camouflage materials are of two kinds, natural and artificial. Natural materials. In open warfare only natural materials will be available in suf- ficient quantities for effective work. These materials include such items as trees, brush, sod, top soil, and debris found in the locality. Their availability and use make the re- production of the local forms, textures, and colors relatively easy if they are carefully placed and properly maintained. Artificial materials. The most common artificial materials used in camouflage work are: For coverings: canvas, burlap, cotton sacking, and visinct drapes. For coloring: aniline dyes water paints, whitewash, and mud. For erection: poles and stakes, smooth and barbed wire, chicken wire, fishnets, and nails. Skill in Installation. Flat-tops. The most important application of both natural and artificial camouflage materials is in the installation of what is known as a flat-top. A flat-top consists of wire netting or fishnets, garnished with burlap or natural materials of suitable color and texture, and supported in position parallel to the ground surface by smooth wire stretched over poles and anchored by stakes. It is used where the establish- ment to be concealed is low and the flat-top can be made to blend into the background. The emplacement or other object to be camouflaged is covered by the flat-top and the flat-top is garnished so that it presents no contrast with its surroundings and simply dis- appears. The skill necessary to make the flat-top appear natural can be acquired only by long study and constant practice. Camouflage Discipline. Camouflage discipline is habitual obedience to the rules of individual and collective conduct necessary for the concealment of activities and estab- lishments from enemy observation. Every soldier should learn to act at all times as if he knew himself to be under observation by the enemy. It is of little use to screen an im- portant position if the men come out from under the screen and stand in groups to watch hostile aircraft passing overhead. The conduct of personnel should be uniform and con- sistent. If troops are known to be in a certain locality, their daily habits may be very closely studied by enemy observers. Any change in these daily habits indicates a change in the military situation. Details of Camouflage Discipline. Camouflage discipline involves the continuous application of common sense rules of conduct. Some of the more important of these rules are: Never expose yourself unnecessarily to any possible hostile ground or air observer. Men in trenches should crouch in the bottom when enemy aircraft is overhead. Movement attracts attention. Hence, avoid all unnecessary movement. In moving about follow the prescribed routes and do not make new tracks to im- portant localities. Keep off skylines; move and remain in the shadows as much as possible. Do not stand in groups in the open, especially near important places such as machine gun emplacements, and observation and command posts. No parking of vehicles or animals in the vicinity of any vital position. Unusual activity of any sort is almost certain to attract attention and should be avoided or always carefully concealed. Avoid doing anything that will cause a change in the previous appearance of the ground. Excavations, piles of supplies and materials, or refuse of any kind are plainly 76 visible. Do not throw trash around where it can be seen. Bury it in concealed trenches. Do not expose highly colored or shiny objects. Smoke is very conspicuous and is sure to attract attention. Avoid fires. It is helpful to break up the column of smoke from kitchens by placing them under large trees, in buildings, or by stretching a shelter half a foot or two above the flue. Examples. Camouflage requires close attention to minute details. Common sense is the main ingredient of success, particularly in open warfare where both time and materials are limited. The study of examples of both successful and unsuccessful camou- flage is a valuable aid in attaining proficiency in the art. Failures are often most in- structive. The following cases illustrate some typical faults. A couple of truck loads of footbridge equipment were brought up at night and concealed on a stream bank in heavy underbrush and drift. The stream had re- cently been in flood, and the underbrush was mud-covered and brown. But the foot- bridge equipment was covered with green pine boughs, and the mound of green in a field of brown was the most conspicuous object for miles. The camouflage material selected was wrong in color. Scattering the bridge sections around in small irregular piles, and covering them with mud and debris to make them look like drift probably would have been effective and have required less work. Squad trenches were dug in very broken, washed, sandy clay. Before they were covered with underbrush, the parapets were beaten with the flat of a spade to insure “a neat, soldierly job.” The smooth glittering surfaces were apparent in places through the covering of brush because they were the only unweathered surfaces in sight. In this case the texture was wrong. A battalion train was halted in a clearing. The wagons were carefully backed into the woods, the animals tied up among the trees, and pine saplings leaned against the wagon covers; then—the harness was carefully piled on the wagon poles, extending into the clearing, where it looked exactly like harness piled on wagon poles at intervals around an otherwise empty clearing. Thus, carelessness in details spoiled an otherwise good job. A reserve company marched to a large clearing in the woods, stacked arms in the open, and then concealed itself in the edge of the woods, leaving the arms’ stacks shining in the sun. MILITARY MEDICAL MANUAL SCOUTING AND PATROLLING Scope. Scouting and patrolling deals with the duties of individual scouts and small dismounted patrols which operate on missions of reconnaissance, or security, or both. Raiding parties sent into hostile positions by surprise action to capture prisoners or for other purposes operate in a similar manner. Detachments performing these mis- sions must be able to operate by day or night over varied ground and frequently dose to or within the enemy position. This duty requires a high degree of training in concealment, movement, and observation. Importance to Medical Personnel. The duties performed by scouts and patrols arc hazardous and casualties are probable. Many of these parties are required to be ac- companied by medical personnel.1 Aid men of companies, litter bearers, and contact agents with medical detachments serving infantry regiments will be drawn upon for these assignments. The same personnel will require much the same training incident to searching a batde field for wounded and evacuating wounded, when under hostile observation or fire. Suggested Instruction for Medical Personnel. Selected personnel of medical detach- ments with infantry, it is suggested, should be trained in the following subjects included in Scouting and Patrolling. Missions of scouts, patrols, and raiding parties. Equipment. Formations by day and night. 1 The exploit of the 1st Battalion, 261h Infantry, commanded by Major Theodore Roosevelt Jr., on June 29, 1918, la particularly informative. It Is discussed on page 43, Infantry in Battle. United States Infantry Association. TACTICAL FUNCTIONS OF THE ARMS 77 Routes followed by day and night. Concealment by day and night. Movement by day and night. Control signals. FM 7-5, Infantry Field Manual, and FM 21-45, Scouting and Patrolling, arc sourec references. The training goal might well be to provide sufficient training to enable medical personnel to accompany such detachments with safety to themselves, the casualties for whom they may be obliged to provide care, and to avoid acts which would interfere with the accomplishment of the mission of the detachment. As in other operations, accompany- ing medical personnel must be able to function as a part of the tactical structure, using methods which are in consonance with the force as a whole. Missions of Scouts, Patrols, and Raiding Parties. A scout is a soldier whose duty is to reconnoiter or to gain information of the whereabouts, movements, and condition of the enemy. A patrol is a detachment of troops sent out from a larger body on a mission of recon- naissance or security, or both. Patrols are classified in accordance with the mission upon which sent, such as reconnaissance patrols, visiting patrols, combat patrols, flanking patrols, or connecting patrols. Raids upon hostile units arc conducted (by raiding parties which operate as patrols) to capture prisoners for identification of enemy units and for other purposes. Equipment. The arms, equipment, and clothing of patrol members will vary with the seasons, light, weather, geographical location, mission, and character of operation. The usual items of equipment of a patrol operating in daytime are rifle or pistol, haversack with rations, canteen, map, compass, watch, pencil and paper, field message book, field glass, and a cloth cover for the helmet. White uniforms, snowshoes, and skis may be used in snow. At night the helmet and bayonet may be discarded. The following articles may be added: riot gun, trench knife, clubs, blackjack, brass knuckles, sweater, knitted cap. Articles which rattle or glisten in light must be avoided. The mission and probable action of a patrol will determine its equipment. Formations. The formations used must facilitate control by the leader and provide concealment and safety. They must facilitate immediate action to the front or flanks. They will be altered constantly to meet the changing terrain and visibility. All forma- tions should provide a point, flank protection, and a rear point. The leader goes wherever his presence is necessary, but a position near the center is used most fre- quently. A patrol of six or eight men might be deployed during daylight, for example, 100 or more yards in depth and 50 or more yards in width. At night, distances are greatly reduced. Routes, Concealment, and Movement of Patrols. The route to be followed by a patrol will be carefully planned in advance, by map study if necessary. The time and place of leaving and reentering the friendly lines will be arranged. During daylight, concealment from hostile observation is necessary. Visible move- ment discloses the presence of men instantly. Hence, patrols take the fullest advantage of natural cover, detouring around exposed areas. Before entering a new area, the patrol will halt and study it carefully before venturing forward. Silence is important, but concealment from observation during daylight is vital. Training is conducted to enable men to select routes by which they may move without being seen, and in the study of areas to detect the presence of an enemy as well as to select the route to be followed. During darkness, movement without noise is the vital factor. Routes in open spaces free from underbrush, leaves, and twigs or fallen branches are preferred. Even at night, however, movement across a skyline is visible for considerable distances. Training is conducted to enable men to move without being detected under the cover of darkness. Control and Signals. During daylight, visual signals are used by the leader to the maximum extent. Simple, visual signals are used for the following (Sec Infantry Drill Regulations, Chapter 11): Forward, By the right (left) flan{; To the rear; Halt; Lie 78 MILITARY MEDICAL MANUAL down (or 1 at{c cover); Double time (or Rush); Change direction; Assemble; As skir- mishers; Are you ready (l am ready); Enemy in sight. At night, hand signals cannot be seen, and talking or whispering betrays the patrol to the enemy. Control signals should be familiar night sounds and as little like human sounds as possible. The following are suitable examples: the scraping together of two sticks or stones, the rustling of a piece of paper, imitation of birds, animals, or insects. Whatever its nature, the signal should be only loud enough for all members of the patrol to hear. By such signals it must be possible to stop and move forward 01 check to see that all members are present. CHAPTER m ORGANIZATION OF LARGE UNITS Introduction. The military structure consists of units of the separate arms, and units of the combined arms. The former term applies to squads, platoons, companies (troops, batteries, flights), battalions (squadrons), regiments, and brigades; in these organiza- tions are found officers and men of the same arm or service, as infantry, members of medical battalions and regiments and others. It must be remembered however that medical personnel forms an organic part of regiments and separate battalions as attached medical detachments. These units are also classed as “small units.” The term “large units” applies to divisions, corps, armies, and groups of armies, which include com- ponents drawn from all or several of the arms and services. In the infantry division, for example, are “small” units of infantry, field artillery, combat engineers, quarter- master, signal, and medical. The organization of all military units is subject to constant and progressive change. A new weapon, vehicle, or tactic may cause sweeping changes in organic structure. In war a new art or invention will be adopted as soon as developed and tested. The Army of the United States organizes and reorganizes on the basis of swiftly changing conditions and newer tools. For these reasons it is no longer wise to disclose for general distribution details of organization or armament which may aid our enemies. Hence all recent changes in our organic structure of combat units has been excluded in this edition. New lessons are still to be learned. As time passes still further changes in the details of organization are to be expected. BASIC STRUCTURE OF THE ARMY Chapter I contains information on the components and structure of the Army of the United States. From a combat viewpoint, it consists of the Army Ground Forces, the Army Air Forces, and the Services of Supply. This is an inadequate picture in a sense for there are also the Defense Commands, theatres where contact may be forced or expected with our enemies, Air Forces, and the many task forces which are now far-flung about the world. Within continental United States the Army Ground Forces consists of its headquar- ters, the Replacement and School Command which controls the operation of the replace- ment training centers, special service schools, officer-candidate schools of the ground arms; the Antiaircraft Command; the armies, corps, and divisions which form its com- ponent parts. It may be regarded as a huge training organization since it is the agency which activates new ground combat units; fills them with officers and men; trains and equips them to the point where they are ready for combat. In an overseas theatre the ground forces are the ground component of the air, ground, service of supply and even naval forces which are placed under a single commander. The Army Air Forces are the air component of the army. They include the many air commands which are necessary for its training and development, and the fighting or service units it requires in combat. The novice will not understand that many ground units (but not necessarily units of the Army Ground Forces) are required within the Air Forces. For example, there are quartermaster, ordnance, medical, signal, engineer, and other corrmonents of an Air Force. The ground arms and services furnish large numbers of officers and men for these assignments. The Services of Supply function equally for ground and air units. Under the conditions of global war with which we are now confronted, the lines of communication devised, maintained, and serviced by the Services of Supply stretch amazingly around the sea lanes of the world and across continents. Thev may be said to stretch from the factories of the midd’e west by rail, ship, and airplane to each continent and to a multitude of islands throughout the world wherever American soldiers are stationed. These soldiers must be supplied with food and clothing, guns, tanks, and planes; ammunition, medical and other supplies of infinite variety. Without these essentials 80 MILITARY MEDICAL MANUAL they would be doomed just as were the heroic defenders of Bataan. The gigantic tasks of procurement of raw materials, manufacture, transportation, storage, distribution, repair, and salvage must be solved adequately before victory can be achieved. The operation of lend-lease adds enormously to the task, for the United Nations look to the United States for the tools they must possess. The wastage and destruction of war is utterly beyond the comprehension of those who have not witnessed the phenomenon. Balanced units of the Services of Supply accompany ground and air units wherever they operate. Often they precede them. For these tasks our army has the supply services which function under the Commanding General, Services of Supply. LARGE TACTICAL UNITS The Army. The army consists of a headquarters, certain organic army troops, and a variable number of divisions. These divisions, together with certain auxiliary troops called corps troops are organized into corps each with a corps headquarters. Troops of the GHQ Reserve and aviation may be attached to an army as needed. The army may be regarded as an administrative unit in the same sense as a division, a regiment, a company. This is true because it possesses in army troops the required service units for supply, evacuation, and transportation. These units consist of medical units, quartermaster units, and certain ordnance, signal and miscellaneous units. In the army troops are also combat units such as antiaircraft artillery, aviation, field artillery, engineers, and others. The army troops are visualized best as being con- stituted especially to meet the size of the army, which is variable, and the special con- ditions of terrain or combat it is expected to encounter. Armies are designated by number, thus: First Army. But not 1st Army, nor I Army. The Corps. The corps is the unit next smaller than the field army. It consists of a corps headquarters, certain organic corps troops, and a variable number of divisions. The corps troops consist of combat elements and service elements. The combat elements include field artillery for the support of the corps as a whole, anti- aircraft artillery, combat engineers, and reconnaissance units. Its service elements are provided for the corps troops although certain ordnance units may be included for the corps as a whole. Unless reinforced by additional service units, the typical corps would be incapable of independent operation. In practice, it is unlikely that the corps troops would ever follow one organizational pattern and each would be constituted to meet the special conditions of terrain or combat which it is expected to encounter. Corps are designated by number, thus: / Corps, II Corps, etc. Not First Corps, or 1st Corps. The expression “EYE” Corps for l Corps is meaningless and confusing. Divisional Organizations. The division is the basic large unit of the combined arms. There are many varieties and types of division. Fortunately, each follows a typical pattern and a thorough understanding of one will help immeasurably in gaining an understanding of others. The term is defined as a unit comprising a headquarters and troops of essential arms and services, all in correct proportion, and so organized as to make it tactically and ad- ministratively a self-contained force capable, to a limited extent, of independent action. The armies of the great powers include divisional organizations of the following types although the interior structure of the several armies is subject to considerable variation. Infantry Division Cavalry Division Armored Division Mountain Division Motorized Division Air-borne Division There is nothing sacred or limited about the types of division. There might for example be a desert division, a jungle division, or any other sort which would gain an advantage over the enemy. Further, the size, equipment, and interior organization must be altered whenever ways are devised to attain improvement. Whatever the form or purpose of a divisional organization it will be found to con- ORGANIZATION OF LARGE UNITS 81 tain the three basic components or elements: Command, combat, and service. Descrip- tion of armored divisions usually separate into command, reconnaissance, striding, support, and service elements. This classification is applicable equally to each of the several types and is adopted herein to emphasize the similarity of structure. The commander and his staff constitute the command element. In large units the staff includes a general staff section and a special staff section. A broader concept would place the signal unit (divisional signal company, for example), the military police company, and the headquarters company within the scope of the term, command element, since each of these organizations are provided to facilitate the exercise of com- mand or control. Information of the enemy is important equally to commanders of each type of division. A modern development has been the placing of a unit specially organized, equipped, and trained for reconnaissance missions. In earlier organizations horse cavalry was used for ground reconnaissance and was attached to the division, or operated under the corps commander in securing information. The division com- mander is now provided with his own organic reconnaissance unit in the current divisions and usually consists of a company or larger unit equipped with scout cars, motorcycles, or other light, swift vehicles. Radio equipment is standard. This unit constitutes the reconnaissance element of the division, although each subordinate com- ponent is provided with reconnaissance personnel and equipment for its own purposes. The striking element consists of the component of the force which leads the way in contact with an enemy. In the infantry division, motorized division, or mountain division, it is the infantry regiment or regiments. In the cavalry division it is the cavalry regiment. In the armored division it is the armored tank regiment. The support element is quite similar in all divisions. Field artillery is the primary component. It adds power to attack or defense; it contributes depth to battle by use of its great range; by swift changes in direction of fire it supplies a factor of flexibility enabling the commander to effect the outcome by engaging hostile targets which otherwise might achieve success by surprise action from an unexpected direction. By counterbattery fires it reduces the effect of hostile artillery and antitank guns. Modern artillery is effective against tanks since it is equipped to follow moving targets and engage them with accuracy. Combat engineers are part of the support element since they execute demolitions, install mines, lay out positions, mark routes, improve routes of communication, repair bridges and culverts, and other tasks, as well as standing available for combat employment in case of dire necessity. In the armored division the infantry regiment may be regarded as part of the support element. The service element of each division includes the medical battalion, the quarter- master battalion, and ordnance units. The presence of these units enables the division to sustain itself in action since it can evacuate its casualties within the division area, supply itself with food and ammuniton, and repair its guns and weapons to a limited extent. Divisions are designated by number and type, thus: 1st Infantry Division, (but not First Infantry Division, nor / Infantry Division)', 1st Armored Division; 1st Cavalry Division; 1st Motorized Division, and so on. REINFORCING UNITS Source and Purpose of Reinforcing Units. The organic units of a military force are prescribed by tables of organization issued by the War Department. In all cases the sup- porting units, such as field artillery, and service units, such as medical and quartermaster organizations, are provided in a strength sufficient only for normal operations and tactical missions, if there is in fact such a thing as a “normal” operation in campaign. They are not burdened with units for which there is net a continual need. It is a principle of command that the assignment of a mission should be accompanied by the allotment of means sufficient for its accomplishment. This condition requires the allotment, from time to time, of reinforcing units. The necessity for alloting reinforcing units is more general for divisions or oarpt 82 MILITARY MEDICAL MANUAL which are operating on independent missions. In such a case the reinforcing units are attached temporarily to a subordinate command at which time they function as directed by the commander of the unit to which attached in the same manner as his organic units. A division operating as part of a corps may also have reinforcing units attached in the same manner, but in many instances it may be provided with additional aid by units which continue to operate under corps control. For example, observation aviation attached to a division would receive orders from the division commander; if not attached, it might execute the same missions upon request of the division submitted to the corps commander who would direct that the mission be executed. This permits the same unit of observation aviation to execute missions for several units of the corps, each executed under corps control. Reinforcing units are furnished from organizations available to the next higher com- mander for employment or allotment. A division commander might reinforce an infantry regiment which is sent on an independent mission with field artillery, engineers, medical units, quartermaster units, and other organizations to meet their requirement. Similarly, a corps commander might reinforce one or more of his divisions from his corps troops. In many instances reinforcing units will be furnished from GHQ reserve. In all cases units attached revert to their former status for control when released from attachment. As a further aid to visualizing the need for reinforcing units, consider the problem of an infantry division making a river crossing in the face of anticipated strong resistance. It has the immediate need for engineer ponton companies to cross the initial combat teams by means of assault boats, and for the construction of ponton bridges on which to move the heavy weapons and equipment. There will be a need for construction of ap- proaches to the river to reach the ponton bridge for which still more engineer troops will be required. The enemy may seek to destroy the ponton bridge by use of aviation, and this forces the employment of antiaircraft artillery. Chemical units may be necessary for laying smoke to screen the crossing in order to reduce the effect of hostile aimed fire. Strong artillery support to protect the units making the initial crossing may be necessary, and additional field artillery units may be provided. Distant reconnaissance beyond the scope of ground agencies may be desirable to locate the positions of hostile reserves and their rtiovement to block the crossing; observation aviation may be provided for this mission. The need for tank units may be foreseen as soon as they can be crossed on the ponton bridge; if this is the case they may be furnished from GHQ reserve. The principle should be appreciated that means must be furnished in accordance with the requirements of the assigned mission. For purposes of convenience, problems given in the Army Correspondence Courses and at the general and special service schools often make use of such terms as “The 1st Infantry Division Reinforced” without specifying the nature and extent of the reinforce- ments. In such a case the units included are stated within the problem or listed in special tables of organization which are quoted. It is important that the attached units be definitely ascertained and their use provided for in the contemplated action in the same manner as the organic units. TASK FORCES Definition. A Tas\ Force is a temporary tactical unit, composed of elements of one or more arms and services, formed for the execution of the specific mission or operation. In its smaller concept, in an infantry division for example, the term combat team is usually applied to a task force consisting of a regiment of infantry, a battalion of light artillery, and essential units of other arms in suitable proportion. In the armored division, the combat command includes an armored (tank) regiment, a battalion of artillery, and essential units of other arms. It is a grouping of command, combat, and perhaps service elements within the division to accomplish a specific task. Such group- ments are often maintained as standing operating procedures in order that greater teamwork may be developed. Most large forces operating in a theatre are organized as task forces. Consider for example the components of the forces which have occupied bases in the Pacific such as Hawaii, New Caledonia, Dutch Harbor, and others. Each is faced with special ORGANIZATION OF LARGE UNITS 83 problems of terrain, distance from a base of supplies, and enemy action. It is natural to expect that each constitutes a specially created task force consisting of a balanced ratio of ground, air, service, and even naval units to meet its own situation. They con- sist of forces which are formed of units deemed adequate for the accomplishment of the mission assigned. In a still larger conception the American Expeditionary Force of World War I was a task force. CHAPTER IV TACTICAL EMPLOYMENT OF THE COMBINED ARMS It ain’t the guns or armament, or the money they can pay, It’s the close cooperation that ma\es them win the day; It ain’t the individual, nor the army as a whole, But the everlastin’ teamwor\ of every bloomin’ soul. —J. Mason Knox in Cooperation This chapter presents several phases of the tactical employment of the combined arms. Large scale military operations consist of the joint action of each of the arms and services, organized into divisions, corps, and field armies, in the accomplishment of a single assigned mission, or objective, in accordance with the will of the commander as expressed in orders. At the outset it must be realized that unity of effort is essential to success. This means that each of the separate arms and services, and each unit in which they are organized for functional purposes, must operate in such a manner that each accomplishes its as- signed task, and coordinates its action with others to the end that the action of the whole is directed towards a common goal. No one arm or service operates alone or wins battles alone. It is well to remember that. Each contributes something that is vital, something that cannot be omitted, to the action of the whole force. The military student should start with a study of the mission, equipment, organization, and tactical employment in battle of each of the several components. He may then proceed to an analysis of the action of large military forces of the combined arms, in all of the wide pattern of battle conditions. When this study is reinforced with actual experience or obser- vation, even in maneuvers, and in the study of historical illustrations, his understanding of the infinite variety of battle conditions is expanded. If he will then obtain a thorough understanding of the tactics and technique of his own arm or service, and a proven ability to execute its numerous arts, he is better equipped to function as a member of a tactical team. That is the goal. It is not easy of accomplishment. Even the best officer can be expert in but a very few phases of the tremendous scope of military operations. But a wide understanding and appreciation of many of its phases is possible of attainment. This chapter presents an analysis in brief of the following battle phases and is pre- sented to the military student as an approach to the study: Marches, Security, Offensive Combat, Pursuit, Defensive Combat, Withdrawal from Action, Delaying Action, Retire- ment, Antiaircraft Defense, Antimechanized Defense, mountain warfare, desert warfare, jungle warfare, attach and defense of river lines and Standing Operating Procedures. INTRODUCTION MARCHES Importance. The ability of a command to concentrate superior forces where required depends in large measure upon the march capacity of the troops. Ability to march long distances, in good order, and arrive in condition fit to fight has long been recognized as a unit of measure of the combat worth of an organiza- tion. Motorization has cased the difficulty of marching, in some particulars, but has not reduced its importance. Some men may “march” in motor vehicles, rather than afoot. Individual equipment heretofore carried on (lie backs of men, may be transported in trucks. The use of combat vehicles as a means of transport is a material aid. But the art of con- ducting marches includes movements by motor transport, and the need for careful plan- ning is in no way reduced. Nor is motor transportation available in such quantities as to free any considerable portion of combat units from the recurring necessity of marching. 86 MILITARY MEDICAL MANUAL It is hard to endure long marches. In campaign, marches must be conducted with little regard to weather. When men march through mud or snow, at night, in rain, or in the sweltering heat of summer through the dust-laden air ot dm roads, serious strains arc imposed upon their endurance. With all the hardships, except lor physical incapacity to continue, men cannot be allowed to break ranks. The march must continue. The planning of a march requires skill and foresight on the part ot commanders and staffs. When a command marches in several columns, by dillerent routes, and at varying rates, coordination is required, or confusion and delay will be inevitable. Training of the staff in planning the march is an important factor in the marching ability of large units. Purpose of Marches. The purpose of marches is to place the troops at the desired place, at the desired time, in proper condition for the contemplated duty. In the execution of marches to attain these purposes, the following principles must be observed: (1) To facilitate any maneuver that may be necessary or desirable. This includes an analysis of the enemy’s capabilities. (2) To assure speed of movement and rapidity of deployment. This includes judicious use of means of transport, arrangements to facilitate ease ot marching, and the arrange- ment of the components of a command in a suitable formation for prompt entry into action. (3) To conserve as much as possible the strength of troops. (4) To protect the troops from attack by hostile aviation and mechanized forces or surprise attack by other ground troops. Rates and Lengths of Marches. Rates and lengths of marches are subject to variation from the effects of weather, the size of the command, the condition of roads, the weight of individual equipment for which transport cannot be provided, and the nature of the terrain. The accompanying table shows the average rates and lengths of marches under different conditions and methods ot transport. Average Kales ol March impu) Unit On lioads Vcross Country Lengths ol March Day Night Day Night 12 lor a division Foot troops 2% 2 1 16 lor smaller units Tanks, truck-drawn light artillery, cavalry com- bat cars, trucks, ambulances, motorized units .. 25 25* 10* 8 6 160-176 Horse-drawn artillery s* 8 3 2 20 Cavalry, animal elements 6* 5 6 4 35 Cars, armored or scout 35 35l 10* 10 5 200 Troop Movement by Motor Transport Few units within the infantry division are fully motorized. When it is desired to move an entire division at one time, additional vehicles must be attached for the purpose from the quartermaster truck battalions of the corps and the army. Based upon 12 men with individual equipment to each truck and 20 per 2{4-ton vehicle, the following numbers of additional trucks are neces- sary to haul representative war-strength units: 1 With lights. * Without lights. s May exceed this rate for short distauees or limited periods. 1 y2 -ton 2*4-ton Infantry battalion 35 21 Infantry regiment 121 74 Infantry brigade 244 150 Infantry division 544 334 It is practicable to move an entire infantry division by its own organic transportation. To use this method it is necessary to divide the force into two or more subdivisions, each to be transported separately. For tactical moves each subdivision should be formed into TACTICAL EMPLOYMENT OF THE COMBINED ARMS 87 a balanced fighting team. Cargoes of the organic vehicles arc unloaded at the point of origin of the movement, or delivered at the destination, as desired. The trucks are then made available for the movement of each subdivision in turn. This process is called “shuttling.” The distance which may be covered by a force in one day depends, among other factors, upon the time required for loading and unloading and the total number of trips required. It has been determined that it is reasonable to move an infantry division 75 miles in one day by this process under favorable conditions. The minimum distance at which it is faster to move by the shuttling process than by marching is considered to be 12 miles for a large force. Each subdivision must provide its own security measures while en route, including adequate measures against attack by air or mechanized units. Definitions of Common March Terms. Daylight march. A march which begins and ends in daylight. Except in oppressive heat they are easier on the troops than night marches. The hazard of attack from the air or by mechanized forces may require special precautions. Night march. A march which begins and ends in darkness. Forced march. A march in which the distance covered in a single stage is greater than normal, or in which the distance covered in several stages is accomplished in a time less than that which would be employed in marching by normal stages with normal long halts. A march by foot troops longer than 15 miles in a single stage is a forced march. Forced marches seriously impair the fighting efficiency of even the best troops. They arc undertaken only in cases of urgent necessity. Troops should be informed why the march is necessary. Cross-country march. The tactical situation may require a marching column to leave the road and move across-country at a reduced rate. If made at night such marches arc most fatiguing as well as difficult to control. Non-tactical march. A march conducted when contact with an enemy is impossible. The comfort and convenience of troops becomes the dominant consideration. Ease of marching is enhanced by forming march serials of units having the same march rate. Tactical march. A march conducted when contact with hostile ground forces is pos- sible. Under these conditions columns arc constituted in such a manner as to be quickly developed for battle. Marches for training and concentration purposes. Marches conducted in the course of training are for the purpose of instilling knowledge in how to prepare for the march, for enforcing march discipline, and for hardening the men. Since they arc usually conducted in time of peace, or if in time of war at places remote from interference by the enemy, they are conducted so as to best facilitate their purposes and with every consideration being given to the comfort and convenience of the troops participating. Marches con- ducted by green or inexperienced troops are short. As experience is gained, and the troops become trained and hardened, the length of the daily march is gradually extended until the maximum rate and distance can be accomplished without difficulty. Marches for concentration purposes are conducted for the purpose of gathering together the scattered elements of a large command. Depending on the situation, speed is some- times necessary, and the daily marches may be longer than those for training purposes. Since marches for this purpose, however, arc usually conducted without the probability of enemy interference, primary consideration is given to the comfort and convenience of the men. March unit. The movement of marching troops is based upon a unit that halts and moves at the command or signal of its commander. This is called the march unit. In the infantry and horse-drawn artillery the march unit is the battalion; in the cavalry, the squadron. Road space. The road space of a unit is its length from head to tail when in pre- scribed march formation. Time length. The time length of a column is the time in minutes required by the entire column, moving at a given speed, to pass a given point. This is determined by dividing its road space in yards by its speed in yards per minute. 88 MILITARY MEDICAL MANUAL Time distance. This is the time required to move from one place to another at a given speed. It is determined by dividing the distance between the two points in yards by the rate of march in yards per minute. Initial point. The initial point is an easily recognizable topographical feature, such as a road junction or house, at which units which are to be formed into a march column arrive at the exact minute to take their places in the column. It should be so selected that no unit is forced to march to the rear in order to reach it. Hour of arrival. The hour of arrival is the hour at which the head of the march unit reaches the initial point. Hour of clearance. The hour of clearance is the hour at which the tail of the unit (march unit) passes the initial point. Order of march. In a non-tactical march units are arranged in order in the column or columns to enhance the comfort and convenience of the troops. In a tactical march a column is arranged from head to tail in the approximate order of entry into combat. Column combat teams. When a large force marches in several columns, each column may be formed of units which will tacihtate ellective entry into combat. These are often referred to as column combat teams or march groups. For example, a column might be formed to include a regiment of infantry, a battalion of light artillery, a small engineer unit such as a platoon, and a medical detachment from the division medical battalion. Stage. A march stage is a distance covered by marching which is broken by a long rest period of several hours. Normally, it is a march between bivouac areas. A march in several stages is one which is too long to be made in a continuous movement; the time en route is broken by one or more periods to allow the troops to rest and re- cuperate. Coordinating point or coordinating line. Control of a large command marching in several columns is often a difficult procedure. When contact with an enemy is possible it may be desirable to maintain a fixed formation, as columns abreast or echeloned to the right (left) rear. The routes of the several columns will often vary in length. This can result in disrupting the desired formation. A coordinating point, or scries of points, may be designated by the commander for each column with the prescription that it be reached, passed, or cleared at a stated time. A coordinating line, such as a road cross- ing the several routes, is used in the same manner. By this process some units will be required to halt until others reach the coordinating point, whereupon the advance of the force is resumed in the prescribed formation. Preparation for a March. Preliminary preparation contributes to the success of a march. The commander and staff must plan the march in all of its details, including selection of routes, time of starting the march, formation, and security measures. A warning order issued to subordinate unit commanders enables them to make orderly arrangements to facilitate the movement. Upon receipt of information from a superior that a march is to be made at a certain hour and date, or to be ready to march with a definite short notice, the commander of a subordinate unit should begin preliminary arrangements without undue delay. These preparations may include the following: (1) Notify subordinate officers, and key noncommissioned officers (1st sergeant, mess sergeant, supply sergeant, stable sergeant), of his plans for the march. (2) Make or direct a thorough inspection of all vehicles for condition, lubrication, equipment, and loads. (3) Determine the exact minute for beginning the march so as to join the battalion or squadron when directed. (4) Make or direct a thorough inspection of the feet of the men, including the fitting of shoes and socks. (5) Make or direct a thorough inspection of saddles, packs, and harness for condi- tion, cleanliness, and state of repair. (6) Determine the hour for serving the last meal preceding the march. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 89 (7) Determine the type of food to be carried on the march. (8) Determine the hour when tents will be struck (if necessary) and equipment loaded on vehicles. (9) Determine the hour when animals will be fed, watered, harnessed, or saddled. (10) Determine the type of equipment to be carried and the uniform to be worn. (11) Issue an oral or written warning order to the command embodying all of the above pertinent details. (12) Require canteens to be filled before starting the march. Forming the Column. Units in camp or bivouac are usually somewhat scattered and, when consolidated for a march, must be gathered together with the least practicable loss of time and effort (see Plate 1). Companies, troops, and batteries are usually first consoli- dated into their respective battalions or squadrons, and these are in turn conducted by their commanders to an assembly point of the regiment. For this purpose the battalion or squadron commanders announce an initial point for their units and the time the head of CO A HO CO 1ST BN CO B CO D f CO C YARDS Plate 1. Battalion in Bivouac Prior to a March. the unit will pass that point en route to the regimental rendezvous. It is the duty of each subordinate leader to so time his departure from his own bivouac, to so choose the most direct and practicable route to the battalion or squadron initial point, and to so regulate the speed of his movement as will enable his unit to arrive at the exact moment necessary to join the column without waiting, without countermarching, and without interfering with the movement of other units. To determine these factors, an exact knowledge of road spaces, time length, rates, and time distances is necessary. Marches to the rear to reach the IP are objectionable. Route Reconnaissance. No steps must be left undone to make certain that chance of losing the route is eliminated. The confusion, loss of time, and reduction of morale caused by countermarching to correct an error must he avoided. Whenever it is possible to do so, reconnaissance of routes should be made prior to the beginning of the march. Guides 90 MILITARY MEDTCAL MANUAL may be stationed at points of chance of direction or markers placed to indicate the way. The need for guides is increased during a nieht march. Protection against Air Attack. Troops in march formation are especially vulnerable to attack from the air. Night marches reduce but do not eliminate this hazard. Safety is increased by requiring more distance between units, such as 50 yards between platoons. Units provided with weapons capable of delivering antiaircraft fire should march ready for action. Other units, such as a medical regiment which has no arms, should be pro- tected by a machine gun unit of appropriate size placed nearby. All men should be trained in the methods of antiaircraft defense so that appropriate action may be taken at once upon order or signal. Conduct of the March. Rotation of march unitr. March units within a larger force are rotated daily; that is, the battalion or squadron which leads the regiment today will be the last element in the column tomorrow. Within each march unit companies, troops, and batteries, and within such units, platoons, are similarly rotated, except that the heavy weapons company of the infantry battalion is usually the last element in the column at all times, because of the presence of the company train. Tf the march is being conducted in the presence of the enemy, however, tactical conditions may prohibit this rotation. Under such conditions, the headquarters units habitually march at the head of the march unit, and elements of the heavy weapons company may be distributed through the column. Position of officers. Officers march where they can best control the conduct of the march. At least one should march at the tail of each company, troop, or battery. Eating and drinking. Eating during the progress of the march, except at long halts, is prohibited. Drinking, except water from canteens or containers carried in the trains, is also prohibited. Especial care should be taken that the men do not drink from road- side springs, wells, or streams. The men should he encouraged to drink copiously before the beginning of the march, should he required to start the march with full canteens, and should be cautioned to drink sparingly from canteens during the march. The trained and experienced soldier, except under excessively hot or dusty conditions, will complete the march with water remaining in his canteen, The recruit, unless prevented, will empty his canteen in the first hour. Halts. (1) Intervals. A halt of 15 minutes should be made after the first 45 minutes of marching. Thereafter halts are made for 10 minutes after each 50 minutes of march- ing. Since small units usually march as parts of larger commands, and as these regulate the time of halts in accordance with the hour of starting of the leading unit, the first halt will usually take place in less than 45 minutes from the hour of starting of units in rear. However, each march unit halts simultaneously, at the prescribed time. Since it is desirable to complete the march as early in the day as practicable, halts longer than 15 minutes are not generally ordered, except that one such may be ordered during the hottest period of the day. (2) Conduct at halts. When a halt is ordered the men fall out along the side of the road, remove and adjust their equipment, relieve themselves, and take advantage of the opportunity to rest. The adjustment of saddles, packs, and harness is examined and corrected if necessary. Good march discipline requires men to remain entirely off the road, on the right, to clear the road surface for traffic. (3) Resuming the march. March units resume the march simultaneously. About one minute before the end of the rest period a warning signal is given by each company, troop, or battery commander. Dismounted men sling their equipment and take their places in ranks. Mounted men mount and take their places in ranks. The drivers and other personnel who are carried on vehicles resume their places. At the command of the march unit commander the entire unit resumes the march. March discipline. (1) Straggling is strictlv prohibited. Men are not permitted to fall out without the authority of an officer. The officer who marches at the tail of each company, troop, or battery examines each member of the organization who desires to fall out, and either gives him a written permit to report to the medical officer at the tail of the main column or requires him to continue the march. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 91 (2) Each unit is kept closed up to the prescribed distance from the unit in front. It proper march discipline is maintained no elongation oi the column will result. If for any reason such elongation occurs, that is, should greater than the prescribed distance result, this distance is made up beiore the unit halls. This naturally results in curtailing the rest periods and should be avoided whenever practicable. Duties of officers. In addition to the duties oi oflicers specifically mentioned previously they have the tollowing duties: (1) Entorce all march regulations mentioned in this paragraph. (2) Examine or cause to be examined the backs, shoulders, and hoofs of animals, if any, at intervals during the march. (3) Correct improper adjustment of equipment of the men. (4) At the end ot the day’s march examine the ieet of dismounted men, make necessary adjustments of shoes and socks, require the men to bathe their feet, and have abrasions and blisters treated by medical personnel. Occupation of a Bivouac from March Formation. The commander of a force in march or of its march subdivisions may facilitate the entry into bivouac or assembly areas by pre- liminary instruction ot guides. 1 lc may direct that guid-s trom subordinate units, such as infantry battalions, proceed rapidly in advance ot the column to a point in or near the point of terminating the march. Alter being shown ihc aiea each unit is to occupy they then return to their respective units to guide them directly into the prescribed area. This process eliminates the delay and confusion which may ensue by making these arrange- ments alter units have armed. Unit signs to guide organizations off roads help to prevent confusion and loss ot time. Time of Terminating Marches. Night marches which arc executed for secrecy should be completed at least one hour prior to daylight to allow time for troops to conceal them- selves against observation from the air. Daylight marches should be completed at least one hour prior to darkness so that troops may establish themselves in the new bivouac in daylight as a means of reducing contusion. Large Forces in March. The march of large forces such as the division may be conducted in one column or several columns. The single column is easier to control, but because of the considerable road space which is required the command cannot quickly be deployed for combat upon contact with an enemy. ' When such contact is possible, and several routes are available for use, forces such as the infantry division and larger units will often march in several columns. The lormation used may employ columns moving abreast, columns echeloned to the right (lelt) rear, or other arrangements con- sidered to be best adapted to the tactical situation. The commander of each column is usually made responsible for its own security to the front and often to an exposed flank. This requires each column to be preceded by an advance guard. The order of march of units in each column should be such that entry into combat is facilitated. This requires that the main body be formed with infantry units in advance and supporting artillery immediately in rear. Trains and other components of the column will be farther in rear. SECURITY It is a military axiom that it is unforgivable for a commander to permit his force to be surprised. Surprise results when the onset of the enemy is so sudden that the main body of a force is unable to defend itself on the ground and under conditions of its own choice. Security measures must be taken to protect troops on the march or in bivouac against all hostile capabilities, either by attack from the air, his mechanized units, or other ground forces. Security measures constitute an essential part of all tactical operations, and orders for a march or a bivouac prescribe the measures to be observed. Security is an essential and continuous part of command responsibility. The close-in protection of troops on the march or in bivouac falls to the infantry, which is often supported by field artillery and augmented by other arms. Troops on the march are protected by advance guards, flank guards, and rear guards as may be necessary. Troops in bivouac are protected by the outpost. The discussion of infantry 92 in Chapter II, “Tactical Functions of the Arms,” presents details of this phase of security. Plate 2 shows the reconnaissance areas surrounding a large force as an aid to security. Extent of Security Measures. The commander must determine or estimate the hostile capabilities for interference or contact and provide protection against them. In one case he may need to consider only the possibility of air attack. In another he may limit his security measures to raids by mechanized units and air attack. TTie ultimate case will include protection against action by enemy ground forces as well as mechanized and air threats. MILITARY MEDICAL MANUAL AREA OF MARCHING COLUMNS AREA OF CLOSE t MOTORIZED RECONNAISSANCE AREA OF DISTANT GROUND RECONNAISSANCE HORSE AND MECHANIZED CAVALRY MOTORIZED DETACHMENTS AREA OF AIR RECONNAISSANCE Plate 2. Reconnaissance Areas. The size of the force is a controlling factor in the distances to the front, flanks, or rear to which units in the service of security will be dispatched. Large forces require a con- siderable time to develop for combat because of the large front they occupy in battle forma- tion and the intricacy of their supply, communication, and evacuation requirements. The per cent of a command to which it is reasonable to assign missions in the service of security is subject to very definite limitations The task is hard, dangerous at times, and fatiguing. The principle is that the bulk of a force is protected within an area in which it is free to move and operate with comparative safety. As a basis of comparison a maximum of one-third of the fighting strength of a force may be used on this mission. Only the number of men actually required should be employed. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 93 General Measures for Maintaining Security. It is useful to think of the measures to provide for the security of a command as consisting of two general functions: first, recon- naissance; and second, the positive measures of attack, defense, or delaying action. Reconnaissance combined with a warning service is conducted to discover the presence of an enemy force so th2t its capabilities for interference may be estimated. Observa- tion, aviation, mechanized units, horse cavalry, and motorized units of infantry with artillery support may each be utilized independently or in conjunction with one another on this mission. In addition, the advance guard or outpost executes this task in the proximity of the main force. The goal of these security agencies, insofar as it pertains to reconnaissance, is first to discover hostile groups and then to report their presence in time to permit the commander of the main force to ta\e appropriate action. A small force such as an infantry battalion may require warning of only a few minutes, if posted and alerted in a defensive position, or an hour or more if in bivouac. A large force, such as a corps, if undeveloped for combat, may require several days’ warning. The commander is “surprised” bv enemy action unless his freedom of maneuver is maintained and he is able to take full and complete measures of attack or defense prior to the delivery of the hostile blow. The reconnaissance measures instituted must be adequate to gain the extent of warning which is required. For the most part, all units on security missions execute reconnaissance. The positive measures of providing security envolve combat. If the hostile force is small, units on security missions mav attack to destroy or disperse it. They may defend a key point of terrain which the enemy cannot avoid and attempt to block the hostile action. Thev mav fight a delaying action to reduce the rate of advance of the enemy and thus gain time for the commander to take appropriate action. Delaying action may be executed effectively bv relatively small mechanized units, horse cavalry, or motorized detachments of infantry with artillery support: they may not be able to block a deter- mined enemy advance, but regardless of the enemy strength they can harass, impede, and delay him. Action of Advance, Flank, and Rear Guards on Contact. When any security detach- ment which is protecting a force in march gains contact with an enemy force it takes im- mediate and aggressive action in accordance with its mission. The mission assigned to each of these components may vary. Assume that the advance guard of a column makes sudden contact with an enemy force of unknown strength. The mission of an advance guard, in brief, is to precede, protect, and clear the way for the uninterrupted advance of the main body. The way cannot he cleared unless the hostile force is attacked at once and destroyed or driven hack. Unless this result is accomplished by the prompt development of the maximum offensive power of the advance guard, the main body may be forced to halt or, if it con- tinues to march, come under the fire of the enemy in route march formation—a highly dangerous procedure. Hence, under these conditions the advance guard must attack, else the advance of the main hodv will he delayed. Of course, the enemy force may be too strong for successful attack bv the small force used in the advance guard. But it attacks, nevertheless, and hv this action forces the enemv to disclose his strength, his position, and his intentions so that the commander of the main force may take the action he desires. The action of flank and rear guards is somewhat different. Their mission is primarily that of protection combined with reconnaissance. Tf an enemy force makes contact with a flank guard, the action is rsscntinllv that of blocking so as to prevent interference with the main body in march. Defensive action, in this case, may satisfy the requirements of the mission. A rear guard has a mission analogous to that of flank guards in that it seeks to block an enemy from gaining contact with the rear of a force so that it need not halt its move- ment. Rear guards reach their greatest application in covering a retirement which the enemy may seek to convert to a rout by instituting an aggressive pursuit. Under these conditions the rear guard must block the hostile threat to the main body by executing a series of delaying actions on successive positions. This action envolves deployment on a strong defensive position overlooking the route of advance of the enemy toward th? 94 MILITARY MEDICAL MANUAL rear of the protected main body. Upon his approach Ion# range fires arc directed upon him to force him off the roads, into deployed formations, and to form for an attack. When he has been thus delayed (the main body having gained additional time as well as space), the rear guard withdraws quickly, moves rapidly to a new position, and repeats the process as many times as may be necessary. It cannot defend on one position for to do so would result in being over-run by a strong force, it would be separated from the main body, or the position might be encircled and avoided. A delaying action in successive positions is more in consonance with the nature of the usual rear guard mission. In all of these illustrations it must be remembered that the power of the enemy may be too great for the security elements to control. Reinforcement of the advance guard, flank, or rear guards may be necessary. In an extreme case the employment of the entire force may result. But if this becomes necessary, the security detachments must gain time for the main force to develop and take up battle formations. Missions Appropriate to the Separate Arms and Services in the Protection of Marching Columns. Advance guards, flank guards, and rear guards which are constituted from a force of the combined arms are usually formed from two or more of the separate arms and services, depending upon the size of the detachment, the capabilities of the enemy, and the nature of the terrain. Appropriate functions of the separate arms and services in the service of security for marching columns are as follows: Observation aviation. Observation aviation executes distant reconnaissance to the front and flanks of a large force in march. It seeks to locate large enemy forces, determines their size and components, and observes their movements. It makes a prompt report to other arms on missions of distant reconnaissance, such as cavalry, as well as to the com- mander. It has no offensive mission since it is not equipped to attack ground troops. Cavalry. Cavalry is well adapted for the protection of large columns in march. It can operate over a broad front well in advance of the main force. Bv thorough ground reconnaissance it can search out the hostile forces which may constitute a threat. By the use of its power and mobility it engages in offensive or defensive combat, as the situation may require. It can seize and hold important terrain features until the arrival of the main body or other security elements. It can execute counterreconnaissance to prevent the ground agencies of the enemv from observing the main body. Motorized infantry. Tnfantrv units may be furnished with motor transportation, or they may have it as organic equipment, so that thev may perform missions as described above for cavalry. In fact, thev may operate in coniunctinn with the ravalrv or relieve the cavalry on a part of the perimeter of the zone of security. When these detachments arc formed they are usually reinforced with heavy weapons of the infantry battalion, truck-drawn light artillery, antitank units, an engineer detachment, tanks if available, a signal detachment, and a medical detachment from the division medical service. Tt then becomes a strong, self-sustaining force capable of considerable independent action. Infantry. Columns in march, whether afoot or in motor transport, must be protected with advance guards, flank guards, or rear guards as may be required. The bulk of these units is drawn from the infantry. They provide close-in protection of the columns and protect the columns from aimed small arms fire, as a minimum, and fire from hostile light artillery within effective ranges, as a maximum. Field artillery Security detachments, particularly advance guards and rear guards, may have light artillery support. This adds greatly to the available fire power and enables the enemy to be engaged at long ranges. Engineers. A detachment of combat engineers may accompany security detachments to remove obstructions which may have been prepared by the enemy, assist vehicles over difficult terrain, construct obstacles, and execute demolitions as may be appropriate. Signal corps. A signal detachment may accompany security detachments, particularly those operating at considerable distances from the main body, so that the commander may be informed promptly of changes in the tactical situation and of the needs of the troops. Quartermaster corps. The quartermaster comnonent of the division has sufficient motoi transportation to provide transport for a battalion of infantry. Motorized detachments will obtain trucks from this source. Supply of quartermaster articles must be continuous, and instances may occur where this is extended to units in the service of security. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 95 Medical troops. A detachment from the division medical service will usually be assigned to accompany units in the service of security to provide for collection and evacuation of casualties. Bivouacs and Bivouac Areas. Troops halted for periods of several hours or longer must be protected against attack or interference by an enemy. During these long halts troop units occupy bivouac areas. The simplest form of bivouac is obtained by halting a marching column, movement off the road into suitable adjacent areas along the route of march, and decentralization to subordinate commanders, such as battalion commanders, of the activities conducted during the halt. This method has the advantage in that all units of a long column halt at the same time; units at the tail are not required to continue marching to close into a prescribed area to the front. When the march is resumed, units take their places with only minor rearrangements in the order of march. The disadvantage of the method is that the area of the bivouac is very deep with the consequent difficulty of control; it is especially undesirable in case of attack by hostile ground forces since the command can- not quickly occupy suitable areas in batde formation. Hence, this form of bivouac is unsuited to the conditions which are to be expected when contact with an enemy is possible. COMBAT TEAM COMBAT TEAM OTHER UNITS Plate 3. Diagram of a Bivouac Area. The other form of bivouac consists of closing the columns within an area of suitable size to enclose the entire command. The width of such an area is approximately equal to the front of a force marching in several columns and is therefore somewhat dependent upon the road net. In any event it is wide enough for the force to occupy a defensive position. Its depth is shallower than its width. A war strength infantry division might occupy a bivouac area 7 miles wide and 4 miles deep. Plate 3 is a diagrammatic illustration of such an area. Note that infantry-artillery com- bat teams arc placed together in bivouac; this facilitates entry into combat, if that should become necessary, or the resumption of the march in combat teams. Other units of the division are grouped within the area as shown. The selection of a bivouac area is a function of command. Hostile capabilities must 96 MILITARY MEDICAL MANUAL be considered. The best bivouac area utilizes terrain which has strong defensive possibili- ties, is adequate in size, has obstacles across its front and Hanks, and provides conceal- ment trom hostile observation aviation. Security of Bivouac Areas. Security is provided for units in bivouac under the same guiding principles as for marching columns. Warning of the approach of strong hostile forces must reach the commander of the main force in time to take the measures which are required by the circumstances. The advance of small raiding or reconnaissance parties sent out by an enemy must be blocked so that the main force cannot be observed or suffer interference. See Chapter II. The distance to the front, flanks, and rear of the bivouac area to which protection should be provided varies in accordance with the size of the command, the hostile capabil- ities, and the terrain. As a minimum a force in bivouac should be safe from hostile small arms fire; as a maximum it should be free from hostile artillery fires. Covering and Reconnaissance Forces. A large force in bivouac may be protected by the same covering forces and reconnaissance agencies as described and illustrated for marching columns. In fact, a bivouac of a large unit lor a period of several hours may have no appreciable bearing on the action of these forces since they opeiate at distances which may be equal to several days’ march of the unit protected. Close-in Protection of a Bivouac Area. Just as a force in march protects itself by advance guards, flank guards, or rear guards, as may be required, a force in bivouac provides for its own close-in protection by an outpost, notwithstanding the activities of covering forces consisting of cavalry or motorized infantry. This security measure cnvolvcs the use of a fraction of the combat strength of a command for the piotection of its bulk. The installation of an outpost system is often decentralized by the commander of an independent force to the commanders of his largest combat teams; in this case the com- mander will prescribe the sector of responsibility of each main component, the location of the most advanced elements of the outpost, definite points of coordination between adjacent sectors, and special precautions to be observed such as antimechanized and antiaircraft measures. For example, refer again to Plate 3. The commanding officers of the infantry regiments may each be assigned definite sectors of the outpost. The crosses enclosed by circles indicate the exact location of points where coordination is to be obtained. The action to be taken in case of attack is prescribed. In accordance with these instructions sector commanders assign units of their own forces to form the outpost and appoint an outpost commander. An outpost consists of an outpost line of resistance (OPLR), supports, and reserves. A large outpost may in- clude artillery. Antitank guns are usually included. The troops on the OPL are in small groups, such as a rifle squad, placed on ground with good observation and defensive characteristics. These units may be widely separated, depending upon the visibility to the front and danks. Areas between these small groups arc covered by periodic patrolling, especially at night. Supports are placed in rear of the OPL, so situated that they can move quickly to reinforce any part of the outpost which may be threatened. The re serve of an outpost is held under the control of the outpost commander for use in block- ing or counterattacking a hostile force which penetrates the OPLR in order to prevent it from gaining contact with the main force. See “Infantry in Security,” Chapter II. By this method a force protects itself during the periods when it is halted in bivouac. While the main force should be reasonably tree from attack, if the hazard is great the position may be organized for defense and the men may rest or sleep in or very close to the actual positions each would occupy in case of attack. Action of an Outpost When Attacked. When an enemy attempts to penetrate an OPLR, information of the location and strength of the threat must be communicated quickly to the outpost commander. Thereafter, units of the outpost operate in accordance with their prescribed mission. Small raiding parties and patrols should be blocked by fire. If an attack is made in force, prompt reinforcement ot these small units may be made to enable resistance to be made in the forward areas. In other cases the units on the OPLR may be directed to fall back when forced to do so to a defensive position. In still others these TACTICAL EMPLOYMENT OF THE COMBINED ARMS 97 small units may have fulfilled their mission merely by giving warning of the hostile ap- proach. The latter would be unusual. Thus the action to be taken by an outpost in case of attack should be definitely established in orders. It may be to defend the OPLR, in which case units should be quickly reinforced; they withdraw only on orders of the outpost commander. It may be to tall back when forced to do so into a defensive position outside of the bivouac area. Or the mere giving of warning followed by withdrawal into the bivouac area may suffice. Missions Appropriate to the Separate Arms and Services in the Protection of Bivouac Areas. Observation aviation. Distant reconnaissance to the front and flanks of the force in bivouac. It makes prompt report of hostile large forces, including their composition, size, and movements, to the other arms on missions of reconnaissance, such as cavalry, and to the commander. Cavalry. Cavalry, either horse or mechanized, is well adapted for covering force missions. It executes reconnaissance and counterreconnaissance, and engages hostile forces which are advancing toward the main force. Motorized injantry. Motorized infantry units, reinforced as the situation may require, may perform covering force missions in the same manner as cavalry. Injantry. The bulk of the units on outpost are drawn from the infantry. Field artillery. A large outpost will include field artillery. Some units may be placed in position areas outside of the bivouac so that targets may be engaged at long range. Others are placed within the bivouac area and prepared to fire in close support of the OPLR. Engineers. Engineer units may be used to protect a bivouac area by constructing obstacles, such as road blocks at defiles, and by executing demolitions in areas which will not be required by the future action of the force. For example, flank protection may be increased by destruction of bridges. Signal corps. The signal component of the force will maintain constant contact with units in the covering force and with the outpost commander so that the force commander may know the tactical situation at all times. Quartermaster corps. The quartermaster component of the force will supply addi- tional vehicles for tactical missions. Medical department. Plans must be made to evacuate wounded from the OPLR to the bivouac area in case of attack. OFFENSIVE COMBAT Offensive combat is employed to secure a decision over a hostile enemy force with which contact has been gained or can be gained. The winning of a decision, in its ultimate application, requires the destruction or capitulation of the hostile force. The ends may be gained in a lesser degree by the dispersal of the enemy as an organized military force capable of further resistance, or even by forcing his evacuation from an area if that degree of success is in accordance with the assigned mission. Most wars continue until one force gains a complete mastery over the other to a point, at least, where it is obvious that further resistance can result only in destruction and annihilation. Thus, as a principle, decisive results are obtained by the offensive only, insofar as it pertains to winning the victory on the battlefield. After the initial contact has been gained the commander must make an early decision as to the future action of his force including what it is to do, when, where, and how it is to do it. The decision must be followed by a plan for its accomplishment. If his decision is to attack, it will be coordinated or piecemeal, a penetration or an envelopment. Coordinated Attack. A coordinated attack presumes complete development of the force prior to attack, that each component is in position as the action commences, and the force operates in accordance with a prepared plan as expressed in orders which prescribe a definite objective for the whole force and a definite mission for each of its components. It is in contrast to a piecemeal attack. 98 MILITARY MEDICAL MANUAL Piecemeal Attack. A piecemeal attack is delivered prior to the development of the whole force. Units enter the action successively as soon as each reaches the battle area and with- out waiting to obtain complete coordination. Shortage of time to make a coordinated attack is the usual factor which requires the piecemeal attack. The assigned mission may require completion within such a limited time that no other form of attack can be executed. Or hostile reinforcements may be able to arrive on a front prior to the time a coordinated attack can be driven home. Attack by Penetration. An attack by penetration is a frontal attack directed against an enemy in position which seeks first to pierce his position and then to rupture it entirely. A penetration strikes the enemy where he is known to be prepared to defend, in con- trast to an attack by envelopment which seeks to avoid the hostile defenses (see Plate 4). ENEMY POSITION Plate 4. A Penetration and an Envelopment. Resort must be made to attack by penetration when the enemy occupies a position which offers no flanks for envelopment (obstacles protecting the flanks, protection of units on the flanks, unfavorable terrain), or under conditions where the factors of time and space do not permit attack by envelopment, a more time-consuming procedure. Resort may also be made to attack by penetration when this form offers the best chance of success. A hostile force in seeking to “defend everywhere” may so over- extend itself or fail to hold adequate reserves as to present a weak front inviting pene- tration. Attack by Envelopment. An attack by envelopment consists in attacking both the hostile front (holding or secondary attack) and one or both flanks (main or decisive attack). Attack by envelopment seeks to direct the main attack through an area outside of known hostile organization to an objective behind or on the flank of the enemy position. The flanks and rear of a force are its vulnerable localities. The rear portions of a position contain the command, communication, and supply installations, the supporting artillery, and the formed reserves. Analysis of battles throughout all history indicate that the vast majority of decisive attacks have been envelopments. The Great Captains have each been past masters of the art. The defender will seek to determine the position and location of the main attack so that he may move to block it. He may be deceived and surprised. He may be prevented from taking a desired course of action by the holding attack or the progress of the main attack. Further, attack by envelopment forces the enemy to diverge his fire in two or more directions while the fire of the attacker converges upon him. (See Plate 5). TACTICAL EMPLOYMENT OF THE COMBINED ARMS 99 Attack in a Meeting Engagement. A meeting engagement is a collision between two opposing forces, each of which is more or less unprepared for battle. It may ensue without the collision clement when one or both decide to attack without delay, or when one decides to deploy hastily for defense while the other attacks quickly before this defense can be organized. The element of speed is present on the part cf both forces, whatever their action. The initial combat is between covering forces or advance guards. Advance guards may be quickly reinforced, particularly with artillery. Thus the action may flow from combat between covering forces to advance guard action to development and attack by the entire force. (See Plates 6 and 7). RESERVE ENEMY POSITION HOLDING ATTACK Plate 5. An Envelopment. While this action is proceeding the commander will decide on his future action by weigh- ing his mission, the tactical situation, the terrain, and his own will, the will of the commander. If he decides to attack he will direct the advance guards to coatinuc their attack to dis- cover the enemy’s location, strength, and intentions while he assembles the bulk of the command in an assembly area preparatory to movement to attack positions and launching of the attack. Attack against an Enemy Deployed for Defense. A hostile force which foresees early contact may deploy for defense at once, occupy positions, and attempt to organize them in order to receive the expected attack. The situation presented is of an enemy who has placed his troop units in defense but has not yet completed the organization of the ground or coordination of defensive fires. Given time he will finish this work. The passage of time favors the defender. The attacker who discovers this situation will wish to act quickly. Since his enemy is actually on his defensive position a coordinated attack must be made. Speed is a vital factor. Secrecy with rapidity of movement to attack positions may enable him to obtain surprise. It is often difficult to decide on the proper time for an attack. Assume, for example, that an attack can be launched today over fairly suitable terrain, or that by delaying the attack until tomorrow the main attack force can move to more distant attack positions which arc ideal. The commander will tend to attack today over the less desirable terrain for to delay will allow the defender to carry his organization more nearly to completion. Attack against an Organized Position. An enemy in an organized position has occupied a battle position of his own choice, troop units have been placed after careful study to withstand attack from any direction, his defensive fires have been coordinated and the position protected by an outpost and possibly by covering forces. It may be assumed that he has made the most of his opportunities. 100 Under these conditions the time the attack is made, whether today, tomorrow, or later, becomes a less vital consideration. The enemy may be well able to withstand all but the strongest attack. Reconnaissance must be made to uncover the hostile main position since it is protected, we may assume, by an outpost and by covering forces. These units must first be driven in. The flanks must be explored, their position fixed, and units in flank protection, such as cavalry, driven back. The main position must be studied to determine its areas of greatest strength and greatest weakness. All this will often be necessary before the decision and plan of attack can be made. MILITARY MEDICAL MANUAL HOSTILE FORCE IN MARCH FORMATION A FORCE IN MARCH PRECEDED BY ADVANCE GUARD Plate 6. Attack in a Meeting Engagement. Situation Prior to Contact. It then becomes a matter of concentrating the maximum power of the attacker in the vital area selected. Surprise remains an important advantage to the attacker. The fact that an attack is in preparation may be perfectly apparent. But when the attack will be made, the locality and direction from which it will come, and its intensity will not be disclosed until it is started. Feints, deceptive measures, and secondary attacks will assist the decisive action. It is a power attack in which speed in planning and delivering the blow has a reduced importance. The task presented may be beyond the powers of the unit planning the action. In such a case reinforcing units as may be available or necessary are attached for the duration of the action. In addition, the support of aviation may be provided. Reinforcing units may include all or a portion of the following: observation aviation, light artillery, medium artillery, antiaircraft artillery, heavy artillery, tanks, and chemical units. Attack of an organized position presents the most difficult undertaking which may be assigned to attacking troops. Time must be taken to determine the best course of action, to prepare fully, and, if necessary, secure the services of reinforcing units. Commander’s Choice of the Form of Attack. The commander is concerned first of all, with securing a decisive victory in compliance with his mission and, second, with the TACTICAL EMPLOYMENT OF THE COMBINED ARMS 101 accomplishment of his will in the shortest time with minimum casualties. He will choose the form of attach which, in his judgment, will most surely result in success. Effect of the Mission on the Decision. The employment of military forces in battle, whether large or small, cnvolves the prescription by higher authority of a mission. The nature of this mission may be definite in the extreme as, for example, to attack a hostile position at or before a stated time. Or, in other cases, the mission may be general in nature and the commander authorized to take such tactical action as he deems best to carry out the mission. Illustrative of such a condition, the commander may be required to deny the enemy access to a prescribed area; in the execution of this mission he may elect to defend on one position, to fight a delaying action in several positions, or to attack in order to eliminate the hostile force which threatens him. The mission assigned a separate and independent force may consist of several requirements; it may be required to protect a flank of a larger force, to delay the arrival of hostile reinforcements, and to block a hostile advance beyond a definite line. HOSTILE FORCE HASTILY ORGANIZING FOR DEFENSE BEGINNING OF ADVANCE GUARD ACTION ADDITIONAL ARTILLERY SENT FORWARD TO SUPPORT THE ADVANCE GUARD BULK OF THE FORCE MOVES FORWARD INTO AN ASSEMBLY AREA PRE- PARATORY TO ATTACKING ASSEMBLE AREA Plate 7. Attack in a Meeting Engagement. Advance Guard Action and Preparations for an Attack. Whatever the assigned mission, the commander must satisfy its requirements in arriving at his decision. The latitude allowed him may permit the choice between attack, defense, or retirement. Or, the requirement that he attack being clear, he may have freedom of choice as to timing the attack, such as to attack at once, without delay, at a definite time on the same day, the next day, or at a still more deferred time. In still other cases the 102 MILITARY MEDICAL MANUAL direction from which the attack must be made may be included in the requirements of the mission. Thus it is clear that the conditions which confront a commander with respect to the mission and its accomplishment approach infinity. But there arc two principles which remain: First, within the limits of the means available to him, including his own resource- fulness, skill, and leadership ability, he must accomplish his mission. Second, he must make that decision and plan which, in his own judgment, will most surely result in the accom- plishment of his mission in the least time and with the fewest casualties. Effect of Terrain on the Decision. Only rarely will the nature of the terrain determine whether the commander should decide to attack or defend. In the usual case that is predi- cated upon the mission. The nature of the terrain when studied in connection with the enemy’s known position and organization will determine where the main attack will be made. By choice of the best terrain over which to make the advance the commander seeks to reduce the hazards of the main attack force while increasing the difficulties of the defender. Unfavorable terrain is flat, open country dominated by higher ground occupied by the enemy who must be defeated if the objective is to be reached. Movement in such areas forfeits the vital factor of surprise, exposes the attacker to observation and to aimed fire of all weapons within range. Such routes of advance are usually accompanied by lack of suitable locations from which to observe and adjust the fires of supporting artillery as well as the heavy weapons of infantry. Where there is a choice, avoid areas which can be swept by aimed hostile fire. Favorable terrain, on the other hand, provides at least a measure of concealment from hostile observation, protection from his aimed fire, and points of elevation—hills—from which the fire of his own supporting weapons may be observed and adjusted. Vegetation such as woods or scattered patches of trees provides concealment. The best protection from aimed fire is dirt—hill masses or ridges separating the zone of advance from the known hostile position. The attacker seeks a corridor leading into or towards the objective. A stream valley is a corridor. To be suitable its width must be sufficient to accommodate the frontage of the attacking unit. A corridor serves as a useful check on the maintenance of direction during the advance. When the attacker can retain control of the high ground overlooking the corridor he is able to exclude aimed fires into the flanks of the assault units, a vital factor in a successful attack. Selection of terrain is a matter of the utmost importance. But use of the terrain over which the advance must be made is also a vital factor. Subordinate units will rarely have the choice of the areas of their advance. They must make the best use of whatever ground is allotted to them. This involves selection of routes by subordinate leaders, such as squad and platoon leaders, avoiding areas of greatest danger; the use of formations which reduce the vulnerability of the unit, such as small columns at wide intervals; crawling, if need be, to advance without exposure around or over exposed terrain; crossing of shallow, exposed areas at a run. The commander of the force does his part by selecting the best area over which to direct the attack. But this must be accompanied by skill and resourcefulness in the use of ground by subordinate leaders if the benefits of this selection are not to be nullified. Plan of Attack. The decision to attack will include its form and objective and is accom- panied or followed by a plan of attack or scheme of maneuver. The plan will provide a mission for each component of the force, the sum of which is intended to secure the decision. Included in the plan will be the designation of the units to execute the holding or secondary attac\, the units to execute the main or decisive attach, as well as the units to be placed in reserve. All attacks include provision for these elements with the area in which each is to operate, their mission, their timing and coordination. Holding Attack. The holding or secondary attack seeks to fix to the ground the enemy opposed to it and to attract hostile reserves to its front. Success of the main attack often depends upon the skill and aggressiveness with which it is conducted- TACTICAL EMPLOYMENT OF THE COMBINED ARMS 103 In a meeting engagement the troops in the advance guard, in part at least, will often make the holding attack. After contact is made pressure against the hostile force is maintained by fire action or by fire and movement. If he weakens his position to move troops to other locations the gaps will be exploited. As a further aid to the main attack force, a principal effort is launched in conjunction with the decisive attack or in advance of its delivery. This is a strong attack supported by artillery and is directed towards a definite objective somewhat shallower than the objective of the main attack. OBJECTIVE, MAIN ATTACK - OBJECTIVE/ PRINCIPAL EFFORT OF THE HOLDING ATTACK . HOLDING ATTACK (wide shallow) Plate 8. Diagram of Holding and Main Attack Forces Showing Formations and Depth of Objectives. The importance of the holding attack in its effect upon the outcome is too often mini- mized in practice as well as in study. It is very important. In some ways it requires a greater skill than the delivery of the main attack which, after all, is allotted the bulk of the means. Its action is partly deception and partly power. It is not a weak attack. Units attack on a wide front and in shallow depth; in this way they develop their 104 MILITARY MEDICAL MANUAL maximum power quickly. By attacking on a wide front the depth of their attainable objectives is reduced. It is poor reasoning which leads to a decision to assign a mission obviously beyond the capability of a force to accomplish. The element of deception which is introduced is to make it easier for the enemy to draw erroneous conclusions, a start- lingly easy matter on the battlefield. Aggressive conduct of the holding attack will aid the main attack by confusing the enemy as to the location of the decisive area and by holding in position his troops which have been engaged. If the element of deception succeeds, his reserves may be directed to this front. The strength of the force making the holding attack is usually a minor fraction of the infantry component. In no case should it be stronger than that required for the assigned mission. The bulk of the infantry must be saved for the decisive attack. However, it should be provided with strong artillery support. The remaining combat elements, except one or more battalions in division reserve, would then be available to make the main attack. Further, the holding attack is stripped to the minimum strength commensurate with its mission in order that the bulk of the force may be available for the decisive effort. (See Plate 8). Main Attack. The main attack is planned to he decisive, to win the victory. It is given the bulk (more than half) of the means available to the commander. It seeks to strike the enemy where he is least able to resist effectively. It seeks to mass a superior force against the enemy in the area of the attach in order to drive rapidly to an objective from which the destruction of the hostile force may be completed. Surprise is an important factor in its success. The massing of units to make the attack must be so executed that the enemy will receive the attack before he can move to meet it or before he can prepare completely to meet it. Tt has been pointed out that the holding attack is delivered in shallow depth and great width so that the maximum strength can be developed quickly. The forward movement of the main attack force is on a narrow front and in great depth so that continuity of action may be maintained. As one unit encounters resistance, is blocked, or suffers heavy casualties, a new and fresh unit passes through and continues the forward movement or maneuvers around the resistance to continue the advance. A series of strong blows may then be struck in a manner which will be the most effective. The goal is to concentrate in an area a greater power than the enemy can bring to bear against it. Past experience indicates that time and again the application of this principle has attained the victory, even permitting weaker forces to defeat the stronger. Coordination. Arrangements must be made by the commander to provide for co- ordination of effort between the components of his force. Infantry. Attacking infantry units within adjacent areas require coordination of the time of their advance, the direction, objective, and the zone within which each is free to maneuver. This is obtained by prescribing a line of departure, a time to leave this line, right and left boundaries (flank units do not require an exterior boundary), and a definite objective. (See Chapter II, Infantry.) Artillery. Coordination is required between artillery units, and between artillery and supported infantry. Each artillery battalion is given a definite sector of responsibility within the limits of its range and instructions as to firing restrictions. Battalions are then placed in position areas so that all parts of the battle area may be covered with adequate supporting fires. Contingent zones may be assigned to each battalion equivalent to an overlap of the areas of responsibility of adjacent battalions within which they are to be prepared to fire on call in support of adjacent units. Coordination with the sup- ported infantry units is obtained by liaison detachments, personal contact, and observation. Coordination between Subordinate Commanders and Staff Officers. A vexing phase of operations in the field is the oft-repeated selection by one commander of an area for his use which, all unknown to him, has been selected by another for a conflicting purpose. For example, Hill 106 may be selected as a position for machine guns, as an artillery observation post, and as a location for antitank guns; or the defiladed area in rear of the hill may be TACTICAL EMPLOYMENT OF THE COMBINED ARMS 105 chosen for a command post, an aid station, and as an ammunition distributing point. Unit commanders and staff officers making these selections must adjust these matters, foresee and avoid them, and be ready to accept a prompt give-and-take to the end that all necessary establishments are able to occupy suitable localities with speed and precision. In practice, able commanders and staff officers adjust these conflicts as a matter of course. Movement of Troop Units Prior to Launching the Attack. Prior to the actual delivery of an attack the troop units, particularly of the main attack force, must move to attack positions. Reconnaissance must be completed, orders issued, and coordination of the entire effort obtained. This movement envolves occupation of an assembly position close to the line of de- parture, followed by movement to the line of departure in time to start the attack in correct formation at the prescribed time. The movement must be screened from hostile ground observation and protected from interference. Very often it will be completed at night. Conduct of an Attack. Assault units execute the several phases of attack, including the approach march, the fire fight, the assault, and continuation of the attack aided by the supporting fires of infantry heavy weapons and artillery. The techniques employed by infantry and field artillery in attack are discussed in sufficient detail for the purposes of this volume in Chapter II, “Tactical Functions of the Arms.” Use of Reserves. “Victory is to him,” said Napoleon, “who can put in the last reserve.” It is never possible to foresee exactly how an attack will progress, how the enemy will react, the emergencies which may arise, or the opportunities which may be presented for exploitation. For these reasons a commander will retain a portion of his infantry strength in reserve during the initial stages of the action. He will use this force at the time and in the manner which he decides will have the greatest effect upon the outcome of the battle. Such uses may include the following: the blocking of a hostile counterattack, relief of a unit which has spent its force in action, extension of an envelop- ment to reach the objective, or the exploitation of a success by initiating prompt pursuit. Subordinate commanders retain a portion of their infantry strength in reserve for similar reasons. The commander of the holding attack will require a unit of suitable size with which to deliver his principal effort. The commander of the main attack will em- ploy a narrow front with a portion of his force while placing the remainder in depth. Similarly, assault battalions of infantry may place one or two companies in reserve; a rifle company might hold one or two platoons in reserve. In principle, the smaller units will tend toward early use of their reserve. The commander of the force will wish to retain control of his reserve until the decisive opportunity for its employment is pre- sented. In open warfare, the use of motor transport permits the prompt engagement of reserve units at distant points. Missions Appropriate to the Separate Arms and Services during the Attack. Air force. Attack of ground objectives which will lie of direct assistance to the attacking troops. Protection of the attacking troops against hostile aviation. (See Chapter II.) Observation aviation. The execution of reconnaissance missions, missions for infantry and artillery, and command missions incident to control and communication. Cavalry. Cavalry units attached to an infantry division or corps are available for use in reconnaissance and counterreconnaissance, development of the hostile position includ- ing the driving in of his covering forces and uncovering of his flanks. During the attack they may be used to protect the exposed flanks of the attacking troops, to delay the ar- rival of hostile reinforcements which can reach the battle area before the attack is driven home, and they may be used in the decisive phase of an attack for action, particularly against the hostile flanks and rear. After a successful attack cavalry may be used in exploitation. Infantry. Infantry units, supported by field artillery, will make the holding attack and the main attack. Following a successful attack they will execute the exploitation in con- junction with other units. Field artillery. Light artillery will operate in direct support of designated infantry units, in the usual case. Close contact will be maintained between the artillery unit 106 commander and the commander of the unit supported. Liaison detachments are pro- vided so that fires may be delivered as desired by assault battalions of infantry. Medium artillery operates, for the most part, in support of the light artillery by engaging targets beyond the range or power of light artillery or by increasing the intensity of its fires. Counterbattery fires are executed by medium artillery to neutralize or destroy hostile artillery units whose positions are discovered. An essential part of artillery action is its flexibility and range; it may mass its fires within a wide and deep area, by employing its long range, so that a large portion of a front may be engaged. Combat engineers. Combat engineer units may be directed to stand prepared to as- semble at a designated point within a time limit in order to engage in combat. Signal corps. Units of the signal corps, such as the signal company of an infantry division, establish and operate the message center of the command, install and operate signal communication facilities to the headquarters of the principal subordinate com- ponents and attached units. Antiaircraft artillery. Antiaircraft artillery provides an area defense of installations, troop units, and localities as directed by the commander. Appropriate missions include the protection of the main attack force against air attack, protection of reserve units, the division command post, the railhead, and distributing points. The mission may include protection of essential areas on the line of communications such as bridges, railway junctions, and vital highway intersections or defiles. Quartermaster corps. The quartermaster corps obtains and distributes supplies which are common to two or more arms and services. It provides the stockage of supplies inci- dent to an extensive operation. Its tables of organization include a limited number of laborers to load and unload supplies at the railhead and distributing points. Ordnance department. The ordnance component of a field force is responsible for the delivery of small arms ammunition, and for the repair and replacement of motor transportation and many items of ordnance equipment. The medical department. Regiments of infantry and artillery are provided with medical detachments which function under the direct control of the unit commanders. This personnel operates the aid stations, provides company aid men, and assembles the casualties at aid stations where they are prepared for evacuation by the division medical service. The infantry division has a medical battalion. This personnel is additional to the medical detachments of organizations and operates under the control of the division commander. It establishes collecting stations and evacuates the casualties from battalion aid stations into these installations. From these points the casualties are evacuated by ambulance to the division clearing station. The Force Commander during an Attack. The commander of a field force is responsible for all that his unit does or fails to do. Through his staff he will obtain information of the enemy upon which to base his future action. He will make the decision and announce the plan by which it is to be accomplished. His staff will be utilized to complete the details of this plan with respect to each of its many phases. When the completed plan is approved they will disseminate it to subordinate commanders. After the commander has announced his decision and plan he may visit his principal subordinate commanders to discuss with them the projected operation and make any minor readjustments which this discussion may develop. He should seize each oppor- tunity to visit the subordinate commanders and the troops in order that he may see their operations and be seen by the troops. He will confer with the chief of staff from time to time to apprise him of supple- mentary decisions and inform himself of the progress of the operation as received at the command post. He will plan the future action of the force, seeking to foresee and prepare for all possible developments. He will determine the time, place and mission for the use of his reserve. The commander of a field force should use to the utmost the capabilities of his staff MILITARY MEDICAL MANUAL TACTICAL EMPLOYMENT OF THE COMBINED ARMS 107 and his subordinate commanders. But he is responsible for the decision and the super- vision of its execution. Purpose. Pursuit must follow closely a decisive victory. It contemplates the destruc- tion of the hostile force, for only in this way are the full fruits of victory to be attained. A defeated enemy who is allowed to retire after breaking contact will be able to re- organize, obtain reinforcements, replenish his supplies, and restore his morale. There- after he may again take the field. A defeated force in retreat is demoralized and dis- organized. Prompt and vigorous pursuit by all of a commander’s resources, despite fatigue and hardship, may result in the delivery of the final crushing blow which will bring hostilities to an end. Campaigns arc won by the destruction, dispersal, or capitula- tion of the enemy, not merely by the attainment of a local tactical advantage. Time to Initiate Pursuit. The timing of the start of a pursuit is a difficult command decision. Overconfidence leading to a premature conclusion that the hostile force is def- initely defeated may lead to a serious reverse. When the enemy is decisively defeated pursuit is launched. This state is indicated by the capture of critical objectives, the diminu- tion of resistance, reports from front line units of the capture of prisoners, the abandon- ment of weapons, the cessation of hostile countermeasures. Reports from observation aviation should indicate the attempt to form march columns or movement away from the area of combat, the movement of trains to the rear. These items are indications. The commander must consider the actual information which reaches him as verified by his own observation, and when the instant arrives when he is convinced of the enemy at- tempt to retire he should order the pursuit to start. If he has foreseen this opportunity he will have issued warning orders to the troops so that the launching of the pursuit may proceed without delay. Method of Executing Pursuit. The technique of launching a pursuit consists of ap- plying direct pressure against the front of the defeated force with the early dispatch of encircling forces around one or both flanks to intercept and block the hostile retirement. When this situation is gained the two components of the pursuing force complete the destruction of the enemy. The forces in direct pressure consist of the units in contact with the hostile front. They continue their advance, seeking to overrun the remaining hostile resistance, prevent his reorganization, defeat his covering forces, and prevent the formation of his march columns. The commander will usually decentralize this operation, assigning distant ob- jectives and zones of advance to his principal subordinate commanders. Relentless, con- tinuous pressure is required without regard to hardship, fatigue, or weather for the same factors will beset the enemy. This action continues until the retirement has been blocked by the encircling maneuver whereupon the final destruction of the hostile force is completed or his capitulation obtained. Encircling forces are constituted quickly from available units and dispatched over a route outside the area of hostile resistance to an area in his rear, there to block his con- tinued retirement by seizing important objectives such as bridges, mountain passes, or strong defensive terrain. Components of the Force in Direct Pressure. The force in direct pressure includes all elements of the command, less the units assigned to form the encircling forces. Components of a Force in an Encircling Maneuver. The encircling force must be able to move with speed and be strong in fire power. As it will be separated, perhaps by many miles, from the main force it must be capable of a reasonable degree of sustained action. Bombardment aviation. Bombardment aviation may provide a decisive blow by attack- ing hostile groups and prevent an orderly retirement. Observation aviation. Observation aviation can provide the vital information concern- ing activities in the hostile rear areas, the location of formed columns, and their direc- tion of march. This information is of vital importance in the conduct of the encircle- ment. PURSUIT 108 MILITARY MEDICAL MANUAL Mechanized units. Mechanized units, when available, are especially suitable for en- circling maneuver since the characteristics of their vehicles coincide with the requirements. Cavalry. Horse cavalry is well adapted for the purpose since it possesses mobility and fire power to move in force at a rapid rate to vital positions in rear of the retiring columns. Motorized infantry. Infantry units assigned encirclement missions will be taken from the general reserve since they are usually the most available. They will be provided with motor transportation so that they may move in a motorized column. Truc\-drawn light artillery. The power, long range, and mobility of truck-drawn light artillery make it highly important in an encircling force. Antiaircraft artillery/. An enemy will employ his every resource to avoid encirclement, including attack by his aviation. While the column is en route in march column it re- quires this protection. Antimechanized units. An enemy provided with mechanized vehicles may be expected to use them to intercept the encircling forces. Antitank guns are needed to attack such forces. Engineers. A detachment of combat engineers should accompany the encircling force to assist motor elements over difficult terrain, to execute demolitions, and construct obstacles. Chemical units. The attachment of chemical units to an encircling force provides a means of employing chemical ammunition. Signal troops. A detachment of signal troops, or other communication personnel, is required. Communication may be restricted to use of the radio. Medical personnel. A provisional medical detachment should accompany the force to provide for the collection, treatment, and evacuation of casualties. Summary. While it is altogether unlikely that a commander would have all of the units listed above he will select from the forces available to him suitable components for the mission. He will then appoint a commander and issue instructions, including a definite mission. Conduct of the Encirclement. The orders to form an encircling force will include the point of its assembly or points where units will join the column. The march objective of such a column will be an area in rear of the retiring columns from which further opera- tions will be conducted in accordance with the situation which is found to exist after arrival. The route of the force will be outside of the area of expected hostile interference so that arrival at the objective may not he delayed. Since an encircling force must operate independently it provides its own security measures. After arrival at the march objective, information must be obtained of the location of hostile columns and their direction of march. Observation aviation and the reconnais- sance vehicles of cavalry are especially suited for this purpose. With the delivery of this information the commander of the encircling force will then select and occupy areas where he can best block the hostile retirement. Upon the approach of the enemy he will cause them to be engaged by long range artillery and machine gun fires in order to slow their rate of movement. The position occupied will be held in order to permit the forces in direct pressure to close in and complete the victory. DEFENSIVE COMBAT Introduction. The purpose of this section is to define the essential phases of the defense with special reference to units of the combined arms. Tt is an integral part of campaign. Throughout long periods of action along an extended front, defensive operations will obtain during far longer periods than the offensive. Ability to present a defended front so strong as to be impregnable to quick penetration permits the commander to strip men and guns from many areas and assemble them in another. When this has been accom- plished he mav strike a decisive blow with strong forces, secure in the knowledge that other parts of the area of contact, perhaps lightlv held, will be able to withstand attack. The defense serves to prevent the enemy from gaining the decision, denies him en- trance into certain areas, or weakens the enemy by imposing casualties so as to increase TACTICAL EMPLOYMENT OF THE COMBINED ARMS 109 the possibility of a successful counteroffensive against him. Specifically, the purposes of the defense are as follows: (1) To gam time, pending the development of more favorable conditions for under- taking the offensive; for example, through the arrival of expected reinforcements or sup- plies, or through better weather conditions. (2) To economize troops, and to avoid going into battle at a time when, or place where, a decision is not sought, so that as large a force as possible can be held out tor a main offensive effort at another place and ume. (3) To keep the enemy out of territory that has tactical, strategical, or political im- portance, in order to reduce the freedom with which he can maneuver his forces. There are distinct tactical advantages which he with the defense. The defender may often choose the ground on which he will meet the enemy, lie may then organize his position by selecting the most suitable areas, by held works, by construction of obstacles, by coordination of defensive fires, by the preparation of plans to meet each hostile capa- bility. Communication between the elements of the command is simplified, a vital aid to control. But there are also important disadvantages. He has forfeited the initiative to the at- tacker. He cannot know exactly when, where, or in what strength the enemy may at- tack. There is a hazard in that a long delciise may lower the morale of the troops. 1'hey may lose conhdencc in their own otlensive powers, 't hey may forget that the real goal of battle is the destruction of the enemy force, not merely to delay the time when a more aggressive enemy may impose his will upon them. (Jn the battlefield decisive results are to be obtained only by the ollcnsivc. Types of Defense. There are but two types of defensive operations. They arc differ- entiated only by the purposes for which the defensive attitude was adopted. The passive defense seeks only to hold a specified area against hostile attacks. The mission of the force may be fully accomplished by blocking action. Counterattacks launched in a passive defense are to eject a hostile force which has entered the position or to counter a threat to the position. The counteroffensive on the other hand, foresees the delivery of a strong attack to gain a decision. Ultimate offensive action is the primary consideration. The force may take a defensive position or action which serves to invite attack. By concealing reserves, or by ability to move reinforcements into the area by rapid means of transport, it may deceive the enemy as to the available strength. Then, alter the enemy has developed his force for attack and partially fixed his dispositions, the counterollensive will be struck with all the power, speed, and surprise of which the erstwhile defender is capable. It is an offensive growing out of a defense, even from a delaying action. Unlike the usual offensive action which seeks to strike an enemy where he is weakest, it seeks to attract strong forces to a desired front, even to invite an attack, and then, when the enemy has placed himself in positions and formations unsuited tor defense, to strike the decisive blow. The overly aggressive commander who is prone to minimize or tail to determine hostile capabilities is liable to encounter disaster from such action. Selection of the Defensive Position. The commander will wish to choose the strongest ground on which to base his defense. His selection will be determined by consideration of the requirements ol his mission and the size of the force available to him. Never an easy task, he will make his decision alter consideration of the possibilities of protection of his flanks and front by natural obstacles; of fields of fire lor his infantry; of observa- tion for his artillery to provide tor the adjustment ot their fires; of concealment behind the battle position of his mobile reserves and his artillery; of depth of the position so that a local success on the main line of resistance will not rupture the position. Finally, he must be quite certain that the enemy cannot avoid the position to a degree, at least, which would prevent the defender from making dispositions and countermeasures to block his advance. An interior unit, part of a larger force, will occupy and organize for defense the area allotted or prescribed. An independent force has far greater freedom of choice and accepts greater hazards. MILITARY MEDICAL MANUAL The latter are increased by lack of obstacles to protect the flanks, by absence of dominant terrain, and by a variety of approaches to the position. Flat, open country or gently rolling terrain reduces many of the advantages which otherwise may accrue to the defender. Lacking obstacles to protect the flanks, an independent force will tend to “refuse” its flanks; that is, they will be bent back so that an envelopment will not pass the position so readily. Reserves from behind the battle position may extend the flanks to present a continuous front to a hostile enveloping attack. COVERING FORCE -OPLR MLR RES. RRL BATTLE POSITION • MLR SECTORS ORGANIZED AND FULLY OCCUPIED MLR SECTORS ORGANIZED AND LIGHTLY GARRISONED Plate 9. Diagram of a Division in Defense of a Position with Exposed Flanks. A useful procedure in selecting a battle position is to locate, first, the regimental reserve line, the rearmost part of the battle position. This should be placed somewhat in advance of the dominant observation of the area in order to protect it. The main line of resistance is then located with respect to important terrain localities, elevations which afford good observation and are called “keypoints”; it will be located to provide a depth of the batde position varying from about one-half mile to one mfle. The commander will wish to occupy these strong positions and to defend with fire alone the areas which lie between them. Analysis will then be made of the corridors leading into the position, particularly those which lead toward the key localities, for the enemy may be expected to exploit these avenues of approach. When this study has been completed the commander is ready to decide the portion of his force to be committed to the battle position initially, the “keypoints” each is to occupy, organize, and defend, and the units to be held in reserve. In making these assignments to positions he will assign definite sectors of responsibility. A force of the combined arms, occupying a position with flanks requires TACTICAL EMPLOYMENT OF THE COMBINED ARMS strong reserves to meet and block any hostile threat which may arise. As a basis for further studv of a particular situation, the reserve should include from one-third to one- half the total infantry strength available. Other units (but never artillery) may be held in reserve. This reserve will he used to block the hostile main attack or to launch a decisive counterattack. Its use in driblets to strengthen hard-pressed units on the battle position would be exceptional. Each subordinate unit assigned to the battle position will also have a reserve component: these units are available to block local penetrations, to make local counterattacks, or they may be withdrawn to constitute a portion of the general reserve. Plate 9 (not drawn to scale) illustrates the framework of a defensive position with exposed flanks. Tt shows the battle position, sectors assigned to subordinate units, place- ment of reserves, artillery battalion position areas, and the location of the command post. Tt is schematic onlv and without reference to anv terrain or type of terrain. Each defensive position must he developed after analysis of the mission, the situation, and the actual terrain available for organization. Organization of the Position. Organization of a position includes the initial deploy- ment of the force into the assigned positions and the completion of preparations to resist sudden attack if such action is a hostile capability. This having been accomplished, en- trenchments are dug. gun emplacements completed for infantry heavy weapons, camou- flage prepared, and definite areas of responsibility for supporting weapons assigned, in- cluding lateral coordination with adjacent units. The plan of artillery fires is completed, firing data computed, and coordination obtained with the infantry supporting weapons. Plans are then made for the conduct of the defense to meet each of the several avenues of approach open to the enemy. Obstacles, demolitions, dummy works, observation posts, and communication trenches complete the defensive organization. As soon as the initial organization has been completed it is safe to hold the position with a reduced garrison of manv key points. Accordingly, two. three, or perhaps four battalion sectors on the “nose” of the battle position are fully occupied and a few lightly garrisoned: the remainder mav he unoccupied except for personnel in observation. Units which are not held within the hattle position are located in reserve, some to be released to subordinate commanders when a threat develops: a strong force, such as a complete brigade, is retained hv the commander for use during the conduct of the defense. There is virtually no end to the organization of a position. As soon as the im- mediate requirements of the hattle position are satisfied, organization of positions ex- tending the flanks will he instituted. The depth of the position may then be increased so that if withdrawal becomes necessary because of enemy action the force may occupy new positions in rear and continue the defense. The health and comfort of the troops are important when a defensive position is to be held for an extended period. Drainage of trenches, sanitary arrangements, and pro- visions for shelter to allow men to obtain normal rest are among the important con- siderations. Conduct of the Passive Defense. The defender of the position with open flanks, the most dangerous condition which can confront him, must he prepared to repel a frontal attack, check enveloping attacks, and prevent dangerous movements around the flanks. Such a defense is relatively more mobile than the defense with flanks secure. This demon- strates the reason for committing fewer troops to the position and the holding of strong reserves. The defender must endeavor by all available means to discover the enemy’s intentions and the time and place of his attack. Upon the approach of an enemy he should he engaged hv long range artillery fires; for this fire, positions mav he occupied in advance of the battle position. These may be followed hv fires from infantry weapons. Therefore, when the approach of an enemy can he observed he must advance in the face of defensive fires in addition to overcoming the resistance of natural and artificial obstacles, demolitions, covering forces, if employed, and local security detachments in advance of the battle position. Since assembly areas are usually occupied under the protection of darkness, defensive fires must be delivered from data previously computed. These are schedule fires which can be delivered on call. 112 A strong attack may be delayed or disorganized by this action, but it is not to be expected that it can be stopped prior to contact along the main line of resistance. These positions should be held and local penetrations by the enemy quickly counterattacked by units held for the purpose in each battalion sector or by units from the regimental reserve line. The general reserve (or reserve held by the commander of the force) must be re- tained until the location of the hostile main attack is definitely disclosed. It may then be used to extend the flanks of the position to meet an envelopment, or to counterattack to restore that part of the battle position which has been seized by the enemy. Prema- ture use of this reserve renders the commander unable to meet further developments which may be decisive. When it is engaged a new reserve should be constituted from units on the battle position which are not under hostile pressure. The defense of a position in open warfare with exposed flanks requires the utmost flexibility, strong re- serves, prepared plans, and unerring judgment in estimating the hostile threats. The hostile main attack must be met squarely with strong forces. Conduct of the Counteroffensive. The initial phases of the counteroffensive may be entirely identical with the passive defense. In the one the mission is accomplished merely by denying the enemy the accomplishment of his goal. In the other a sudden shift from the defense to the offense is planned in order to inflict a decisive defeat upon an enemy. It may be regarded as a trap in which an enemy may be ensnared. By definition, the counteroffensive is contemplated when the defensive is assumed. The preservation of a large, intact reserve with which to launch the attack is a requisite. Alluring as this form of attack may seem, and successful as it may have been in past instances, it requires the utmost in advance planning, exact timing in its delivery, and a skillful, cool, and resolute commander to carry it off. Surprise is \ital to success. The ideal time and situation for launching the counterblow is when the attacker has exhausted his forces in the offensive and has consumed his reserves. If the enemy has committed a tactical error, the counterblow should strike before the mistake can be corrected. If the enemv separates his attacking forces widely the counterblow may be directed against one of bis elements while containing the other. Once the counteroffensive is under way, the execution is the same as in an attack. Missions Appropriate to the Separate Arms and Services during the Defense. Air force. Attack of ground objectives in direct support of the defending troops. Protection of the ground forces from attack by hostile aviation. (See Chapter II.) Observation aviation. The execution of reconnaissance missions, missions for infantry and artillery, and tasks for the commander incident to control and communication. Cavalry. Prior to the launching of an attack by a hostile force against the defended position, cavalry units may be utilized as covering forces in protection of the front or flanks of the battle position. During the conduct of a defense, cavalry may be em- ployed on special missions or be held in reserve. Infantry. Motorized infantrv units mav be employed in advance of the battle position as a covering force. Small infantry detachments may be placed in advance of the battle position to constitute the outpost. Within the battle position infantry units will be as- signed sectors for defense or bold positions on the regimental reserve line. Infantry units which are not utilized on the battle position or in the covering forces are held in rear of the battle position as a mobile reserve. Field artillery. The artillery is held “in readiness” or it supports the defense of the battle position by performing direct support missions for designated infantry units or gen- eral support missions for the force as a whole. No artillery is hdd in reserve. Artillery is placed in readiness when its best location cannot be definitely foreseen. In this case, some of the light artillery may be placed in a central location where the road net favors move- ment to the front or either flank: from this position if will be prepared to move on call to occupv any one of several previously prepared positions as soon as the hostile threat has developed. Position areas for artillery are so located that fire can be delivered well to the front and flanks to engage an approaching enemv force at long range. It will be emplaced to cover the front and flanks of the battle position with special reference to favorable corridors of MILITARY MEDICAL MANUAL TACTICAL EMPLOYMENT OF THE COMBINED ARMS 113 approach. Firing data will be computed so that fire may he massed in specified areas, par- ticularly in the protection of exposed flanks. Depth is provided hv placement of battalions, some being placed sufficiently far to the rear to enable fire to be delivered in support of the regimental reserve line. Coordination is obtained by prescribing lines which are to be reached by units and by prescribing the lateral limits of fire. Contingent missions may be assigned which permit artillery firing in support of a particular unit to switch its Ire to assist artillery units on its flanks. Combat engineers. Combat engineers are used to execute demolitions and construct obstacles to delay the hostile approach. They may be employed to lay out a battle position and construct certain of its works. During the conduct of the defense they may be assem- bled in reserve to be available for combat as required. Other units. Defensive operations provide no special tasks for the remaining arms and the services. They continue to perform their usual functions. Summary. The above discussion may be summarized as follows: Defense doctrine. A defensive position is organized: (1) In depth, To guard certain keypoints. With only portions (tactical localities or defensive areas) of the position occupied, with the intervals covered by fire alone. (2) So that the enemy: Blocked in his front by tactical localities, Is forced into intervals, Where he is held by obstacles, and Taken under further fire from the flanks. (3) With the result that the attacker, Suffers heavy casualties. Loses cohesion and control, Is finally brought to a halt, And is ejected by a counterattack. Influence of terrain on the plan of defense. (1) A plan of defense of a sector is prepared after consideration of the following: The mission Width and depth of the sector Strength of units Supporting fires available Analysis of terrain (2) An analysis of terrain takes into consideration: (a) Terrain in general. Corridors leading up to and into the position. Cover, con- cealment, fields of fire, observation, natural obstacles, routes of communication. (b) Influence on the defense. Keypoints within the sector; the selection of weak parts and strong parts of the position. (c) Influence on the attacTerrain features within the defensive area the capture of which will further the enemy attack—the area through which the enemy will probably make his strongest attack. Conduct of the Defense. The defense is conducted so as to: (1) Disorganize the attack in its preparatory stage. (2) Stop the attack by fire in front of the battle position. (3) Repulse the assault by close combat if the attack reaches the battle position. (4) If the enemy succeeds in entering the battle position to attempt first to subject him to such an intense, coordinated fire of all available arms that he will be forced to withdraw; and this failing, to eject him by counterattack, so that the end of the battle will find the position entirely in the hands of the defender. We say, therefore, that there might be three phases in the development of defensive combat, viz: 114 MILITARY MEDICAL MANUAL (1) Defense against enemy preparations for attack of the battle position. (2) The exterior defense ot the battle position. (3) The interior defense of the battle position. The defense, to effect its purpose and to meet the different phases of defensive combat, provides for full and effective employment of coordinated fire power by all arms, and tor movement as well, to meet developments in the defensive battle. The system of fire consists of: (1) Long range artillery fire in localities well forward of the battle position. (2) The combined fire of artillery and infantry weapons in localities in front of the battle position. (3) The fire of infantry weapons alone in localities close to the battle position. (4) The combined fire of artillery and infantry weapons within the battle position. WITHDRAWAL FROM ACTION Purpose. A withdrawal from action is an operation by which all or part of a deployed force executes a breaking of contact with an enemy, particularly an enemy which is attacking or pressing an advantage, in order to initiate some other action. It is classified as a retro- grade movement (movement away from an enemy), and as a defensive maneuver. The immediate purpose may be to rescue a command trom a desperate situation, or to break off an engagement which has already accomplished its purpose or which appears to oiler no further chance of success. It seeks to put space between the opposing torces. Alter contact has been broken the withdrawing force may execute a retirement, occupy a new position for defense, or execute delaying action in successive positions. Classification as to Time of Execution. Withdrawals from action are classified as night withdrawals or day withdrawals, depending upon the time at which they are initiated. A night withdrawal is the preferable method when the commander is free to choose. The movement may be concealed by darkness so that the force may be well started on its next maneuver under the protection of adequate covering and security forces before the enemy discovers the withdrawal. A force in withdrawal is particularly vulnerable until its next operation is well organized and started. The commander of a hard-pressed force will prefer to hold his positions until mghtlall rather than risk the hazards of daylight with- drawal unless to do so will entail a very definite chance of decisive defeat. A daylight withdrawal must usually be executed in the face ot serious enemy pressure. An aggressive enemy upon discovering the rearward movement will seek to convert an orderly withdrawal into a rout, bending his every eilort to block us execution. Cavalry, however, may employ this maneuver with greater salety than a force which includes a large infantry component, especially a cavalry force withdrawing betore infantry. Their greater mobility will gain the space and time so badly needed for the clean breaking of contact. Execution of a Night Withdrawal. Orders for a withdrawal from action at night must be issued sufficiently in advance of darkness to permit reconnaissance, planning, and issue of orders by subordinate commanders. Success ot the maneuver may hinge upon secrecy. The arrival of daylight must find it completed and the next operation well under way. Speed may be achieved only by orderly movement and the maximum use of the best routes, with the avoidance of the mishaps which cause delay, confusion, or discovery. A covering shell protects a night withdrawal. A small traction ot each unit in contact, such as units from infantry and artillery battalions, remains m position until an hour or two before daylight. These units accelerate their firing and activity in order to conceal the departure of the bulk of the force. Under the protection of this shell the bulk of the force completes its withdrawal. A logical order of withdrawal is: service units and installations, artillery, infantry. At the designated time the units in the covering shell assemble, move quickly to prescribed assembly areas, and effect their own withdrawal aided, if practicable, by motor transport to overtake the main force. Dawn should find the position empty and contact completely severed. Execution of a Daylight Withdrawal. Orders for a daylight withdrawal must be issued sufficiently in advance of the start of the maneuver to insure understanding and coordi- TACTICAL EMPLOYMENT OF THE COMBINED ARMS 115 nation within all units. Under hostile pressure, the sight of large units moving to the rear may induce others, whose duty is to remain, to start back unless they have been informed of the plan. Such movements when started are difficult to control. There is no military maneuver which requires a higher degree of discipline of all ranks, or greater capacity for leadership, than a daylight withdrawal executed under strong hostile pressure. Protection is provided by covering forces which operate quite differently than the covering shell described above. In the one case stealth, concealment, and deception are relied upon. But for the other, speed of withdrawal combined with the power of covering forces to hold off pursuit must furnish the protection. Service units and a portion of the artillery must clear the area before infantry units in contact can be withdrawn. At the proper time, upon order, these infantry units break contact by moving straight to the rear, fighting their way back if need be, under the pro- tection of local covering forces placed in position by subordinate commanders for the protec- tion of their own units. A situation which often develops, in practice, is that the most hotly pressed units must be the very last to break contact; for them to withdraw too soon may expose the entire force to envelopment, leading to destruction. During the withdrawal no unit may be permitted to expose the flank of another. The arrival of the shield of dark- ness is often necessary before the organization for the next operation can be completed. General covering forces, designated by the force commander, are formed from the gen- eral infantry reserve with suitable attachments of artillery, and such special units as cavalry, tanks, chemical units, engineers, or antiaircraft artillery. They are formed from units which are available to the commander and are constituted so as to be able to cope with the requirements of the mission assigned. Unlike the covering shell which remains in place to cover a night withdrawal, these units are placed on commanding ground in the rear or on the flanks of the withdrawing units, not on their front, since under the circumstances of a daylight withdrawal under pressure such positions cannot be occupied. They prepare to block pursuit by fire action delivered particularly at hostile units which threaten the flanks. Long range artillery and infantry heavy weapons fires are employed. This fire action is to force the enemy to forego action against the main force and divert his attack to the general covering force or forces in order that the bulk of the command may move with minimum interference. The covering force may counterattack, defend on a single position, or execute delaying action in successive positions, whichever will be the most effective in accomplishing the mission. Under the protection of the general covering force the ensuing action is started. If march columns arc to be formed, as will often be the case following a successful breaking of contact during daylight, a rear guard and flank guards must be formed to provide close-in security. Once contact has been severed the hostile advance must be impeded by all practicable means. Tn addition to the action of covering forces the use of demolitions to destroy bridges and roads, the placing of contact mines, and erection of obstacles will each be desirable. These are functions of combat engineers. The very nature of the conditions inherent to a daylight withdrawal indicates that a commander free to choose will prefer to initiate the movement under the protection of darkness. But where the enemy attack is driving hard upon its objectives, and decisive defeat is a definite expectancy if the hostile advance cannot be blocked or evaded, the com- mander may be forced to accept the hazards of daylight withdrawal in order to preserve his command. It is a difficult decision. Tts orderly execution requires time, careful planning, precise orders. If delayed too long the chance of withdrawal may become forfeit. In that event defeat may become the inevitable consequence. DELAYING ACTION Purpose. Delaving action is an operation executed in order to prevent the uninterrupted advance of a hostile force. Tt seeks to gain time without fighting decisive engagements. The extent of the delay which must he obtained is often definitely announced by prescribing that the enemy must he held beyond a definite line or terrain locality until a certain date and hour. The maneuver may be employed in order to prevent hostile troops from reaching the area of the main forces in contact; a commander may resort to delaying action on a 116 MILITARY MEDICAL MANUAL portion of a front, in preference to defense of a single position, in order to mass a strong torce within a restricted area to launch a decisive attack. Since a strong delaying action may be fought by weaker forces than are required for defense, the commander may elect to cede a minimum of territory so that stronger forces may be assembled in a decisive area. The Factors of Time and Space. The factors of time and space, tyrannical considerations in all military operations, have special importance in delaying action. How much territory may be given up? How long must the enemy be prevented from reaching a definite position? The nature of the action is governed by answers to these questions and an analysis of the terrain. The conditions arc infinite, but a study of time and space will enable reason- able conclusions to be reached. Assume that a hostile force can be intercepted at a certain point, and that it is to be prevented from reaching a line in rear of the point until a definite day and hour. First, determine the time the enemy can reach the prohibited line if his advance is uninterrupted. This will give at once the extent of the delay which must be exacted. Having determined the factor of time, the commander will consider the space available to him through which he is free to maneuver, and the nature of the terrain on which he is to effect delay. If the space is short he may be forced to secure the total amount of delay from a single position, as one extreme, in which case his action is purely one of defense until the mission is accom- plished. But if the space is deep he may utilize a number of delaying positions in order to obtain the delay which is required. This analysis having been completed the commander will formulate his decision and plan. If the delay is to be accomplished in successive positions he will make tentative selections of terrain localities before the operation commences. He will wish to occupy strong terrain, which the enemy cannot avoid, with good observation and long fields of fire. Since he contemplates withdrawal from each delaying position, suitable routes of withdrawal will be factors in his choice. Conduct of Delaying Action. The initial delaying position, at least, having been selected, the force will be moved into the position, formed for combat, and the organization of the position started. Delay in advance of the initial delaying position should be obtained in order to force the enemy to deploy and take action to discover the position. This, in itself, obtains time. It is executed by detachments, preferably those with fire power and mobility, which move forward and engage the enemy with long range fires. Further delay is obtained by harrassing action against the hostile flanks; this may be secured by motorized infantry with artillery support or by cavalry. As soon as the enemy comes within range of the troops on the delaying position he is engaged by fire. This should force him off roads, into deployed formations and assembly areas. The position may be held until he forms for attack, even until his attack is well started. Infantry will prefer to hold a delaying position until darkness, then execute a withdrawal from action and occupy a new position in which to obtain delay during the next day. Cavalry, however, is more free to execute daylight withdrawals. Thus the action is continued. The hostile force must he impeded to obtain the required delay, or the maximum delay if no definite time limit is prescribed. The delaying force must avoid becoming decisively engaged for to do so may result in destruction with failure to accomplish the mission. Small forces are able to delay large and strong ones. The frontage assigned units may be much larger than would be occupied in defense of a position. The time for starting a with- drawal must be closely controlled by the commander. The new position must be designated in advance and known to all. Reconnaissance for routes to the new position and positions to be occupied by each unit should he reconnoitered prior to movement. The necessary arrangements for control and coordination having been made, the actual execution of the withdrawal is properlv decentralized to subordinate commanders. Hostile motor movements around the flanks are especially dangerous. Units with equal mobility which can move to block an envelopment are necessary. Demolitions may be em- ployed to retard enemy movements by motor. Road blocks may he installed over a wide front to prevent hostile movements by motor at night. If the situation is obscure large reserves must be held to meet threats as they develop. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 117 The commander of a delaying force must act promptly and surely in the execution of a mission with infinite possibilities. He must obtain information of enemy movements promptly in order to move to block them. Confronted, as he will be, by stronger forces, he must be alert to every opportunity to obtain delay and avoid every hazard as it develops. Dennition and Purpose. A retirement is a movement away from an enemy, a retrograde movement, in which a torcc seeks to regain freedom of action. Such a movement, to be a true retirement, must be part of a well-dehned plan which has tor its purpose the refusal of decisive combat in an area under the conditions which obtain at the time. The terms retirement and retreat are similar in meaning. A hostile retirement, for psychological rea- sons, may be referred to as a retreat. A logical distinction is that a force making a retreat is unable to retain freedom of action or choice, and the movement is conducted under such pressure that interruption of the movement may result in decisive defeat. A rout may develop after a decisive defeat or the failure to effect an orderly retirement. Units begin to disintegrate; control diminishes and may become non-existent. Panic may ensue. Lee retired after Gettysburg; Napoleon retreated from Moscow, but despite his losses one can hardly say that his force was routed; at Tannenberg many Russian units were routed. It is often a nice distinction. It should be clear that in a retirement the operation must be planned, control must be retained, security measures must be observed and maintained; the enemy must be prevented from regaining contact until the time and place have been reached where the commander is once again willing to resume contact under conditions of his own choice. Conduct of a Retirement. A force in contact with an enemy will necessarily execute a withdrawal from action, in order to sever contact, before the retirement can be started. Once this contact has been broken and the force has moved beyond the zone of effective hostile aruilery fire, road march formations may be taken. The commander must prescribe a march objective and announce the route to be fol- lowed, the number of columns and their composition. He must provide continuous and adequate security measures to protect his command. The security measures which are necessary will certainly include a rear guard; in the usual case a large torcc will require covering forces and flank guards. Covering forces, it employed, must intercept and delay hostile units which seek to strike the flanks or block the retirement by encircling action. 1'hey are especially necessary against hostile motorized or mechanized units. Demolitions are useful in protecting a retirement. The destruction of bridges, culverts, road intersections, and rail facilities will delay pursuit. Obstacles erected on roads, especially those which include contact mines, should be employed; they are especially im- portant in blocking hostile movements by motor at night. The retirement must be conducted in such a manner that the enemy cannot regain contact, or seriously delay the operation, until an area is reached or conditions developed where the commander is again willing to make a stand under conditions of his own choice. RETIREMENT OPERATIONS AT RIVER LINES Importance. Throughout all history river lines have exerted an important influence on military operations. Wide and unfordable rivers are obstacles in attack and natural lines of resistance for defensive and delaying action. Provided the bridges are held or destroyed rivers constitute a useful screen which serve to reduce the extent of hostile reconnaissance. Rivers provide important protection for surprise raids by hostile armored forces. The medical officer serving with troop units will find useful a knowledge of the tactics envolved in attack or defense of river lines because the problems envolved present special difficulties. Reconnaissance. The strength of a river line increases with the width and depth of the stream and the velocity of the current. Other important factors are the approaches to the river (road net and possibility of cross country movement), tribu- 118 MILITARY MEDICAL MANUAL taries to the river, presence of fords, nature of the bottom, topography on opposite bank, and the possibility of ice floes, freshets, and floods. Illustrative of this latter possibility was the experience of the Army of Northern Virginia alter Gettysburg, in July, 1863, when Lee’s defeated army was forced to delay its return over the Potomac for one week because of summer rains. Streams of little significance, appearing perhaps as a thin blue line on a map, may become formidable obstacles alter hard rains. Streams with steep, soft banks, or soft bottoms may constitute serious obstacles to armored or motorized units. The phase of reconnaissance must be thorough in any operation along river lines. Attack of River Lines. A skillful leader will seek a crossing of an important river in an area where he may be unopposed. Reconnaissance, swift movements, and surprise are necessary to achieve such a happy result when confronted by an aggressive enemy. Aerial reconnaissance is especially necessary. Oddly, military history con- tains many examples of such occurrences and the fall of France was hastened in the judgment of many students of the phenomena by failure to present adequate defense of crossings including instances of failure to destroy important bridges. The alert commander will exploit such opportunities to the utmost. When the enemy is in possession of the river line, and his defenses cannot be turned or avoided, a crossing must be forced. Thorough reconnaissance, a carefully prepared plan, assembly of the required equipment, superiority in the air, followed by bold, swift action are necessary for success. Seizure of bridges before they are destroyed is sought. The force making the crossing will often be divided into two or more elements to force a crossing, and a reserve. There may be several determined attacks at separated localities. They will be accompanied by feints and other artifices to increase the chance of deception. The area of the most successful crossing will be exploited, often by using the reserve, The initial action may be executed by parachute troops quickly followed by air- borne troops. The covering forces are sent across the river in motor boats, the several initial crossings coordinated as to time. The immediate purpose is to secure a “toe-hold” on the opposite bank to protect the crossing of the remainder of the command. The initial units to cross, usually infantry and combat engineers, will strive to seize a position from which they may protect the crossing area from small arms fire. Following as quickly as the situation permits will be other units including field artillery and armored units, especially tanks, if available. The second goal or objective is to seize positions which will protect the crossing area from ground observed artillery fire, or a “foothold.” At the earliest appropriate time platoon bridges may be con- structed to facilitate the crossing of heavy equipment. The third objective is selected so as to eliminate all artillery fire from the crossings, or “elbow-room.” When such a position has been gained, the further action continues with minimum effect caused by the river. The attacker has then gained a “bridgehead.” Success depends upon surprise and speed of execution. A few moments may mark the difference between success and failure. Means of crossing include small boats, usually called assault boats; rafts or ferries, footbridges, ponton bridges. Defense of River Lines. The commander must insure the complete destruction of all bridges and fords before the arrival of the attacker. When large forces are avail- able for the defense, the river bank positions may be held in strength and the river be used as an obstacle in front of the main line of resistance. The com- mander who chooses this form of defense with weak forces should encounter defeat. He will either attempt to defend everywhere and be weak everywhere, or so concentrate his forces that they may be readily avoided. However, when the strength to do so is available maximum resistance may be developed by this procedure. In cases where wide fronts must be held, the following procedure offers best chance for successful resistance. The river line is held with relatively weak detachments for TACTICAL EMPLOYMENT OF THE COMBINED ARMS 119 the purpose of reconnaissance, warning, and initial resistance. These units may be regarded as patrols with combat missions. Stronger detachments with local reserves are located at the most probable points of crossing or, strength permitting, at the possible points of crossing. For it must not be forgotten that a good tactician will prefer to undertake a crossing with hard physical obstacles provided he can avoid hostile de- fensive fires during the critical stage of the action. In the Battle of Quebec, for example, the Plains of Abraham were reached by scaling a vertical cliff. However, it is the mission of these detachments to force the enemy to disclose his strength, his supporting fires, and prevent hostile troops from becoming established in bridge- head positions before the arrival and attack of the defender’s general reserve. The defender using this type of defense should hold a strong, mobile reserve. When the commander has determined the area of the main crossing or crossings, he will be expected to launch a counter-offensive to destroy the attacker before he has established himself across the river. Efficient reconnaissance, accurate informa- tion, and a cool head for the commander are essentials. Action delayed too long may enable the enemy to cross in such strength that his defeat is impossible. Action started too soon may find the crossing a feint, and the main force of the enemy to have crossed elsewhere. Characteristics. Success of operations in mountains depends upon correct equip- ment, including clothing, and individual training. Military operations have been con- ducted in mountains successfully throughout all history. Analysis should indicate that mobility is reduced, movement is restricted, firepower and fire effect are reduced, and signal communication and supply are more difficult. Certain regions are inaccessible. Road nets are usually limited, and key terrain features take on great importance. Tactics and technique must be adapted to these special conditions. There are obvious advantages to the defender, but the effect of surprise which is available to the attacker takes added importance since the defender cannot move so promptly to meet an unexpected move- ment. Again, the defender cannot be strong everywhere, and when the attacker finds the weak spots he will exploit that knowledge. Sudden changes of weather are serious considerations and the effect of these conditions may be decisive. Special euqipment, especially individual equipment, is necessary in order to be prepared for these hazards. Conduct of Operations. Tactical operations in mountains are characterized by small units operating independently on a coordinated plan. Infantry is the basic arm. It must rely to a greater extent than operations in open country upon its own weapons for sup- port. Weapons of flat trajectory, as one example, find their usefulness gready reduced. Mortars and howitzers are of increased importance. Combat engineers are vital to the success of operations in mountains. Demolitions of bridges, and hence repair of bridges, are of a greater significance. Offensive action will often be directed down one or several valleys or terrain corridors which lead in the direction of the objective. The advance of the German forces in Nor- way should be recalled. The commander must decide which of his avenues of advance shall constitute his main attack. His reserve will be placed to facilitate this advance. The objective will often be a locality which will improve communications and lateral movement between elements of his force. Small groups with light equipment may make encirclements to seize critical points in rear of the hostile force. The success of the Greeks in opposing the Army of Italy is noteworthy in this maneuver. In winter, ski troops reach high effectiveness in mountain operations. Defense within mountains is often based around control of heights and defiles. Success- ful defense requires an excellent information and intelligence service because movement to block an unexpected advance may be difficult or impossible. The attacker will seek to find and use routes unknown to the enemy, or considered impassable by the enemy. Hard physical obstacles are much to be preferred to hostile fire. The defender can be expected to make maximum use of demolitions and their effect MOUNTAIN OPERATIONS 120 MILITARY MEDICAL MANUAL in mountains may be far greater than in open country. Demolitions covered by defensive fires constitute extremely serious causes for delay. Long fields of fire will be sought, and with the ease of concealment available in mountains the task of the defense is lightened. JUNGLE WARFARE Difficulties. Jungles offer their own difficulties to a war of movement. However, the speed with which the Japanese advanced against the British defenders of the Malay Peninsula indicates that they do not constitute impassable obstacles. Few roads may be expected, and often they may be poorly constructed and narrow. Trails may be numerous. Direction is hard to maintain and control is difficult. Air observation decreases in im- portance, and ground observation is limited. Heat, tropical rains, insects, and unhealthful conditions add to the difficulties. It may be the hardest form of warfare from the view- point of the individual. Special equipment, clothing, and training are essentials. Jungle fighting is largely by infantry. There may be little opportunity to use vehicles, and shoulder weapons or weapons which can be hand-carried reach their highest application. Pack transport is essential and is an excellent form of transportation when motor vehicles lose their effectiveness. Supplies must be moved close to the troops. In fact, the individual should be his own source of supplies for long periods of time. Conduct of Operations. Trail improvement is a constant problem. Leading men in each column should cut the trail. Men following should widen it as they advance. By rotation of the men in the lead the physical strain is distributed. Reconnaissance is difficult and advancing units invite ambush. Small patrols must be utilized for security. Alertness pays added dividends in the jungles. While a knowledge of map reading may be of little avail in dense jungles, an under- standing of terrain may prove to be of vital importance. The main features of terrain must be identified and understood. A drainage net will be present, and there will be ridge lines, however difficult they may be to locate and follow. The compass will be useful, but dense vegetation and short field of vision makes difficult its use. It is easy to become lost in the jungle and all methods of maintaining orientation and location should be used as a check one against the other. No jungle is so dense that there will not be occasional open spaces or clearings. These must be exploited for contact with friendly aviation including dropping of supplies and messages. Small units highly trained in jungle warfare, with individuals thoroughly acclimatized, well equipped, and informed of hostile methods of attack and defense are necessary to obtain success in these operations. DESERT WARFARE Difficulties. While deserts vary widely in their characteristics, their nature gives them points of similarity. Movement is effected by the changing nature of the surface. Loose sand and sand dunes make movement of marching men or motor vehicles very difficult. On the other hand, in areas where the surface is firm, movement may be sim- plified and the direction of maneuver become infinite. Well-defined roads will be few because the difficulties of living will support only a sparse population. The climatic con- dition which creates deserts results in acute shortage of water. Therefore desert warfare is characterized by the dependence of movement and operations upon water supplies. Operations generally are based on the capture and protection of vital water sources. Defeat may be a direct result of destruction or loss of water supplies and water sources. Visibility may be exceptional except during sand storms when it may become almost nonexistent. Long fields of fire and maximum effectiveness of weapons is characteristic. Daylight movement may be difficult to conceal and troops may be especially vulnerable to air attack. Conduct of Engagements. Troops operating in deserts should have a high degree of mobility. The operations in North Africa constitute a series of military epics which military students will analyze for years to come. Armored units reach their greatest TACTICAL EMPLOYMENT OF THE COMBINED ARMS 121 effectiveness, notwithstanding the difficulties they encounter in service. Equipment designed especially for the conditions to be encountered is essential. Victory turns to defeat with disconcerting swiftness in desert warfare and the margin between them is slender. Armored, motorized, and air units should combine in desert operations. By whatever method of organization it is achieved, there must be complete coordination between the several components. The cover of darkness must be exploited for tactical movements to achieve surprise. Night attacks are to be expected. Salvage operations and repair of damaged vehicles and tanks will be conducted at night. Supplies will be moved at night. Wide envelopments or turning movements are to be expected in desert operations. Since each force is dependent upon maintaining its supply lines, encirclements to sever routes of communication and destroy supply bases are frequent. Dispersion must be employed to increase safety. Concealment may be difficult, es- spcially for bodies of troops, or trains. Air power reaches a degree of importance so great that its lack should spell certain defeat. It is used constantly in reconnaissance to detect enveloping or encircling move- ments. It is used to locate hostile concentrations of troops, and supply bases. Movement of supply trains may be detected. With this information combat aviation may launch attacks with more than usual chance of devastating effect. Air superiority enables the attacker to move with maximum chance of surprise action. Definition and Purpose. Ground troops are concerned with the execution of security measures to counteract the ellecis ot hostile attack, trom the air to insure that they may carry out their primary ground missions. An understanding of these security measures is especially important to the commander of medical units. Their hazards are essentially equal to those of other units which operate within the combat zone, and they arc not provided with weapons with which to conduct a defense. Medical units must rely upon passive measures of protection or obtain protection from other troops. The Threat. Bombardment aviation is the principal air threat to ground troops. These airplanes are able to deliver as many as 2400 rounds of machine-gun fire in 30 seconds. They carry fragmentation bombs which break into a large number of frag- ments upon detonation. Bombs loaded with liquid chemicals may be used. Attacking airplanes are usually employed on a single mission in units of at least a squadron. They will seek remunerative targets such as troops in bivouac, in assembly areas, or on the march. These targets will often be located by the hostile observation aviation and reported to attack units; it is considered unwise for attack aviation to fly over a zone in search of suitable targets. They may approach their objectives at low alti- tudes, perhaps only a few feet above the ground, deliver their machine-gun attack from ranges of 1U00 yards or more, then fly over the target to drop their bombs. The speed ot tiight is so great that an attack by a single unit is a matter of a few seconds. The defensive action which is taken must be rapid to provide a hope of success. Active Measures of Protection. Troops armed with weapons suitable for antiaircraft fire are trained to engage prompdy hostile aircraft within range. Rifles, automatic rifles, and caliber .30 and caliber .50 machine guns are suitable for this purpose. With these weapons hostile airplanes within 2000 yards should suffer losses although it cannot be expected that such attacks can be prevented. Infantry and field artillery units are able to provide their own active measures of defense against low-flying hostile aircraft. The effectiveness of their fires depends upon adequate training and provisions for air alarms. Skill in antiaircraft firing can be developed by training. An important part of this training is the development of confidence in the minds of the soldiers so that fire will be delivered with the maximum degree of coolness. The volume of fire which can be delivered quickly by an infantry battalion is very great. It is reason- able to expect that attacks by low flying aircraft against troops trained in this class of firing can be made costly, perhaps so costly as to be unremunerative. Antiaircraft artillery is assigned the mission of attacking hostile aircraft at high alti- tudes. It cannot be expected that this materiel will be available to protect more than the ANTIAIRCRAFT DEFENSE 122 MILITARY MEDICAL MANUAL most vital installations and areas of largest troop assemblies. The characteristics of anti- aircraft artillery are discussed in Chapter II. Passive Measures of Protection. For the purpose of this discussion, passive measures of protection are classified under five headings: concealment, cover, dispersion, security, and speed. Concealment is employed to avoid detection by hostile aircraft. Partial concealment re- duces the chance of detection. The use of wooded areas, movement in darkness and poor visibility, camouflage, and deception by dummy installations arc examples of con- cealment. This means of protection should always be employed for the protection of troops in bivouac, assembly areas, or other massed formations while halted. Cover is sought to minimize the effect of air attack weapons. It is provided by the natural physical objects of terrain such as ground folds, ditches, and reverse slopes. Pro- tective clothing for use in the presence of chemical agents is classed as cover. As soon as the air alarm sounds, ground troops seek suitable covered positions in which to await the approach of the attacking planes. Dispersion is resorted to in order to avoid presenting a remunerative target. It facili- tates concealment, cover, and security. Irregularity in formation and marching in mul- tiple columns arc examples of dispersion while in movement. The effectiveness of air attack is reduced by separating individuals and units so that compact targets are not presented. Security includes the measures which arc taken to give warning of the approach of at- tacking airplanes. This information is obtained and disseminated by all headquarters. The aircraft warning service installed in each theater of operations may provide informa- tion in time to be of use. Close-in warning is provided by air lookouts. They are sta- tioned on the front, flanks, and rear of a force to detect and give warning of the hostile approach. Speed as a defense measure consists in completing operations in as short a space of time as possible in order to preclude the chance of planning and executing an air attack while the troops are in movement or exposed. The preparation and conduct of a march, entrucking and detrucking are especially vulnerable periods. Friendly Pursuit Aviation. When it is available in sufficient quantities, the best pro tection of ground troops is afforded by friendly pursuit aviation. Its use may obtain air superiority so that hostile airplanes are denied an approach to the ground troops. Protection of March Formations. The first step in the antiaircraft defense of a march is the adoption of a formation which promises the greatest cumulative protection by the ap- plication of active and passive measures and which is appropriate for the road net, terrain, and the logistics and tactics of the ground situation. A suitable formation which facilitates rapid deployment laterally and the delivery of defensive fires is the primary consideration. In order to enable troops to effect further quick dispersions from march formations, it is preferable to divide columns from front to rear, rather than a method whereby alternate units move laterally to opposite sides of the road. A formation which is rigidly applicable to all marching situations is not possible. The danger to marching troops from attack aviation is greatest when troops are forced by limiteJ time, a poor road net, terrain pre- venting cross country movement, and tactical considerations, to make a daylight march in mass along well defined roads in normal route column formations. Marches under such adverse conditions should be protected by offensive air operations against the hostile avia- tion and by antiaircraft artillery. Machine-gun units should be attached, by platoon, to rifle companies and march by section when tactical requirements permit. It is highly desirable for motorized machine-gun sections to move by bounds from one selected position, 250 or more yards ofT the road, to another, with priority on roads where neces- sary. Machine guns in such positions generally will be outside the effective zone of the air attack. Against an enemy using gas, this machine-gun fire will constitute a very important defensive measure. A formation which may be feasible in many cases is a single file of foot troops on each side of the road, with vehicles which must accompany the foot troops moving by bounds between and following the files of foot troops. Action When Attacked on the March. When the air attack alarm is sounded, or an actual attack is launched, all men with shoulder weapons, and other individuals not otherwise engaged, rapidly deploy off the road, seek what cover is immediately available, and open fire on the attacking planes. Ditches, gullies, small depressions, trees, and walls offer some cover from bomb fragments and grazing machine-gun fire. The fire of the suitable weapons in the rifle units, supported by the fire of the motorized machine-gun units from positions outside the effective attack zone, directed accurately toward low- flying planes, even for the few seconds of time available, may be expected to inflict losses on hostile planes and pilots. If animal-drawn units are present, the animals are moved off the road and tied to trees, fences, or telegraph poles, if the time permits. In many cases the animals will have to be held on or near the road. In all cases every effort must be made to prevent runaway animals, with the resultant confusion and injuries. The best time for riflemen to get in a few shots at the hostile planes is between the passage of the machine-gun fire and the detonation of the bombs. When bombs are released, all men TACTICAL EMPLOYMENT OF THE COMBINED ARMS 123 Plate 10. Air Attack on Ground Troops. within their effective radius of burst cease firing and quickly lie prone under whatever cover is available. After the bombs dropped in the close vicinity of a unit have detonated, preparation is made to fire at the planes in case they circle, or to fire at any succeeding elements in the air attack. All commanders down to include squad leaders exercise such supervision as may be practicable in the time available. If the enemy has initiated the use of chemicals, marching troops put on their gas masks at the first warning of air attack, and immediately follow with the action as outlined above. Thereafter the troops are promptly moved out of the gassed area and given such first aid measures as may be directed. Night Marches. Night marches are usually less exposed to observation and attack from the air than by day. Passive measures alone can be taken by troops when they can- not see to fire on the enemy’s planes. Even at night, marching troops should never remain standing at the halt for any length of time. When attacked at night, marching troops move off the sides of the road and throw themselves flat on the ground. When flares or other sources of illumination make hostile planes visible, all troops within range open 124 fire unless concealment is more important than fire, in which case troops refrain from looking upward. Movements by Motors. This discussion includes the movement of motorized trains as well as troop movements by motor. Entrucked troops base their own protection against low-flying aircraft principally on passive measures. As meager a target as possible is presented for as short a time as possible. Nevertheless, the maximum fire is directed at attacking planes, although circumstances often greatly lower the efficiency of such fire, and sometimes preclude it. To prevent riflemen from shooting each other in a lurching truck, only men whose weapons can be supported (used with a rest) are designated to fire. It is not practicable to mount machine guns on all trucks carrying troops. Motorized machine-gun sections (infantry or antiaircraft artillery) may be dis- tributed throughout an entrucked troop column. Generally, by day, vehicles of small columns move individually at varying distances up to several hundred yards and at the fastest practicable speed. Massing of troops and transportation and the closing up of trucks in one column are kept to the minimum at entrucking and detrucking areas, and during such activities an area machine-gun defense should be established. An area defense is also desirable to protect traffic jams. Every effort must be made to avoid traffic jams, or the closing up of trucks when halted. Motorization of infantry units is relatively new in our army. With this limited experience, opinion as to the conduct of entrucked infantry when attacked from the air has not crystallized. There are some who believe that entrucked infantry on good roads in daylight should engage attacking planes in a running fire fight. The obvious objections to this are that the attack aviation has the advantage in both speed and fire power, and accidents to disabled trucks introduce added danger. Others maintain that trucks should halt on or off the road when attacked from the air, and that the occupants should jump out and take cover if time is available, otherwise they should remain in the trucks. When attacked at night, such attacks usually being in the nature of harassment by single planes, the greatest protection may be secured by keeping in motion, particularly on dark nights or on roads that are not well defined to air observation. Defense of Bivouac Areas. General. Troops in bivouac rely principally upon passive measures for their protection against air attack. If well dispersed over the terrain with good cover and concealment, bivouacked troops do not offer a very remunerative target to combat aviation. In open terrain with little or no facilities for natural cover and con- cealment, the plan for antiaircraft defense must be based upon defensive fires, dispersion consistent with effective fire defense, and the construction of shallow trenches and fox holes for protection against air attack weapons. There are several historical examples where deceptive concealment such as false lighting and false camp sites have been of value. MILITARY MEDICAL MANUAL Individual fox holes, trenches or small depressions afford protection against the flat trajec- tory of the fragments of bombs, and machine-gun fire. Plate 11. Protection Afforded by Fox Holes. Selection of bivouac areas. The antiaircraft defense of a bivouac area begins with the selection of that area. On terrain which affords ample concealment, cover, and area for dispersion, fire defense is secondary in importance. Troops should not be bivouacked too close to landmarks, such as prominent hills or the junction of roads and streams. Attack- ing planes may use such landmarks for orientation; hence the route of attack may follow the general direction of these terrain features. In general, however, with modern aides to air navigation available in the plane itself, the route of approach of an air attack may not be limited to any particular direction. In some situations, an air attack may be launched from under cover of suitable terrain features or the early or late sun, and certain directions may appear more likely than others. Probable avenues of approach should be TACTICAL EMPLOYMENT OF THE COMBINED ARMS 125 taken into consideration in assigning bivouac areas to subordinate units and in the estab- lishment of the fire defense. Passive defense measures. Tt is generally necessary to resort to camouflage to sup- plement the amount of natural concealment available. The importance of camouflage and other passive measures increases with the time an area is to be occupied. Every pre- caution should be taken to avoid discovery. Movement within the area should be kept to a minimum, and roads and trails avoided by day. Existing roads and trails should be travelled at night in preference to forming new ones. New trails formed during the night should be camouflaged by daylight. Troops discovered moving into a bivouac area or attacked while in bivouac, should move to a new area, when practicable, as soon as the move can be made secretly. In locations liable to be attacked by aviation, troops should not bivouac in the same area for extended periods of time. The best use should be made of natural protective cover which serves as protection against air attack weapons. A considerable dispersion of units, and elements and individuals within units in bivouac, is always desirable, even where ample concealment is available. Air lookouts and air observers should be posted so as to detect the approach of hostile aircraft from all direc- tions, and to transmit warnings, particularly to machine-gun fire units. Troops should not halt or countermarch during the occupation of the area, and should not be formed unnecessarily early when moving out. Defensive fires. Provision should be made so that elements of an infantry unit are capable of mutually supporting defensive fires. This applies particularly to the establish- ment of a ring of mutually supporting mochine-gun units, usually platoons, around the bivouac area so that enemy planes approaching from any direction are met by an effective volume of fire before they arrive within bomb or gas sprnving range of the defended area. One or more machine-gun units should be emplaced within the bivouac area as a precau- tion against possible diving attacks and to fire at planes which cross the fire zone of the outside ring. When enough machine guns are available, best results will be obtained by emplacing machine guns in platoon units. This will generally be practicable when an infantry regiment is part of a larger force, the normal case, and part of the periphery around the regimental area is covered by the fire of adjacent units. In other situations it may be necessary to dispose the machine guns by sections. To be mutually supporting, and to give a uniformly effective fire power around the defended area, the machine-gun units should not be more than 1,000 yards apart, and emplaced so that their all-around fire is not masked by obstacles. All weapons suitable for antiaircraft fire should be kept loaded and at hand. Units without weapons for defending themselves should he biv- ouacked so as to receive incidental protection from the fires of other units. Antiaircraft Defense in Combat. Defense of assembly areas. Assembly areas are generally occupied for a shorter time than bivouac areas. The tactical situation may limit the degree to which passive antiaircraft defensive measures can be applied. The time element usually limits the degree of organization of the antiaircraft defense. Within these limits, the defense of troops in assembly areas against enemv aircraft is similar to the defense of bivouac areas. One point usually requiring consideration is the relative merit of fire or concealment as the most appropriate counter-measure against hostile ob- servation aviation. If assembly areas are attacked with effective concentrations of per- sistent gas, the troops must move without delay to new areas. General comments. Units deployed for combat, especially entrenched troops, ordinarily offer a comparatively unremunerative target to combat aviation. Nevertheless, troops must be prepared to meet air attacks during the progress of a ground battle. Ordinarily, troops engaged with the enemv on the ground take cover from an air attack and direct the fire of all suitable weapons against hostile aircraft. The short time that fire is directed at hostile planes will usually have no appreciable effect upon the ground situa- tion. Tn some cases, it may be necessary to designate certain weapons for antiaircraft fire. Troops should not fire on enemv planes not attacking them when such fire is less im- portant than secrecy. An extensive use of air guards is impracticable for troops actually engaged with the enemy on the ground. In the defense. Troops in the forward part of a battle position will offer a poor target to the enemy’s combat aviation because of their concealment, cover afforded by 126 MILITARY MEDICAL MANUAL entrenched positions, and dispersion. Troops on the forward position should never fire on enemy planes not attacking them, if such fire would disclose their positions. Units whose positions have undoubtedly been discovered should hre on all enemy planes within range. The commander of a battalion sector is the lowest commander to authorize such fire. When so authorized, the opening ot antiaircraft hre then becomes the responsibility of local commanders of small units. Reserves in defense will ordinarily be more vul- 1 Seot.M.G. 1 Sect.MG. 1 Squad R. Air quara well dispersed Rifle Cc> 12Squads ) R- < rHeavyWeaponsi Co. I Tgss Dels. Ai 0 Air guard Rifle Co ;2 Squads -R / l Sect M.G. Trains tse&ms) .Airquard ’ 1 Squad P. Seat.M.GN Plate 12. Infantry Battalion in Bivouac with Area Defense Against Air Attack. ncrable to air attack for the following reasons: they are usually held more concentrated; they are vulnerable during movement to places ot employment; and they may not have the cover afforded by entrenched positions. Therefore, reserve units should make the utmost use of all practicable passive measures and defensive fire. In the attac\. Troops advancing the attack take cover and direct the fire of all avail- able weapons against attacking planes. Troops in the attack ordinarily fire at all types of hostile planes within range, as the progressive antiaircraft fire by small units will be drowned out by the general firing in the ground engagement. Because of irregularities TACTICAL EMPLOYMENT OF THE COMBINED ARMS 127 of terrain, extended troop deployment, and difficulties of control, effective action against hostile aviation is usually the responsibility of small unit commanders. Antiaircraft Defense of Trains. Passive measures. There is no reason, in most situa- tions, for unit trains to move during the day. Trains must ordinarily depend upon such passive measures as are practicable, with incidental protection from fires of other nearby combat elements. Trains depend upon concealment, dispersion, and fires, in the order named, tor protection against enemy aircratt. Concealment is secured by the use of overhead cover such as trees and buildings, by camouflage, and by absence of movement during good visibility. Dispersion should be sufficient to result in offering only unremunerativc targets to enemy aircraft. Defensive fires. Defensive fires for the trains may be furnished: by organized anti- aircraft troops; by attached infantry troops; by weapons organically a part of the trains; incidentally by fire from units having other missions at the time. The first method is the most effective when available, however, the movement of trains cannot be made with impunity when such a defense is set up. The second, though effective, is objectionable when it results in the diversion of fire power from the accomplishment of the primary combat mission. The number of organic weapons in infantry trains is not sufficient to provide an adequate fire defense, therefore negative measures must be relied upon. In- cidental hie defense by troops engaged with enemy ground forces is uncertain. ANTIMECHANIZED DEFENSE Importance. It has been definitely established that tanks and other mechanized fight- ing vehicles constitute a serious threat on the battlefield as long as they can operate under favoring conditions of weather and terrain. These vehicles have definite limitations. They are sensitive to steep slopes, to marshes, to rivers and streams, to forests with large trees. But in open country their speed and power present a threat to all but the strongest defensive measures. See Chapter II. Commanders of all forces must be alert to the possibility of mechanized attacks and raids. Their positions will be selected to reduce this hazard to the greatest degree at- tainable. They will seek natural obstacles to guard their front, flanks, and rear. Time permitting, they will increase the difficulty of tank operation by improvement of natural obstacles, by the use of barbed wire, by mine fields and other measures. Those areas which cannot be fully protected by such obstacles must be protected by the fire of anti- mechanized weapons. The speed with which such attacks are made requires that defense arrangements be made in advance and constantly maintained. The means available for antimechanized defense are active and passive. The active means include antitank guns, artillery, attack aviation, armored vehicles, mines, and, in emergency, any firearms and explosives in the hands of the troops attacked. The passive means include natural barriers; road blocks; wire rolls; demolitions, and other artificial obstacles; buildings; and organized localities. Usually, active and passive means are used in combination. A barrier or obstacle loses its defensive value unless protected by fire. An extensive use of passive means on less critical fronts permits an economy of active means in order to concentrate the bulk at the decisive place. Means Other Than Weapons. Natural obstacles. Whenever and wherever possible the enemy should be denied favorable routes of approach, or his advance should be materially impeded by maximum use of some or any of the following natural obstacles: unfordable water, marshes, thick woods with large or strong trees, large boulders closely strewn, tree stumps that may belly a tank, deep steep-sloped gullies, precipitous slopes, and deep mud. Artificial obstacles. For the reasons just stated, the maximum use should be made of any or all of the following artificial obstacles: antitank trenches, large shell craters, canals, walls, tank barriers, tank traps, and mine fields. It is essential to remember that obstacles, either natural or artificial, must be so located with reference to the defensive position that they can be effectively covered by small arms fire. Antitank trench. If trenches are to be specially constructed or adapted for block- ing tanks, the type of tank against which they are to form a nrotection must be con- 128 MILITARY MEDICAL MANUAL sidered. Antitank trenches should preferably have steep walls, a width somewhat greater than half the length of the tank they are intended to stop, and a sufficient depth. (2) Antitanmines. Antitank mines are usually of the contact type. They are buried in the ground or scattered on its surface. To be reasonably effective, mines must be placed where enemy tanks can be expected to operate. The ends of underpasses, bridges, culverts, road defiles, fords, and defiladed ravines are semi-obligatory passages. In addition many other areas such as clumps of light woods and ground depressions will be indicated to the eye of anyone familiar with tank methods. Mine fields should be combined with obstacles so that in avoiding the obstacles, tanks will run over the mines. To prevent the enemy from locating and destroying or avoid- ing the mines they must be carefully camouflaged from both ground and air observation. Edges of woods, wire entanglements, and shell-torn areas make good places to conceal mines from aerial photography. To form a real barrier, mines are usually laid checker- board fashion in two or three rows, with mines and rows of mines from 3 feet to 6 feet apart. Oftentimes it is impossible to assemble and plant such a quantity of mines, and an inferior mine field has to be accepted. The more fuses there are, the more effective the mine field. Extensions of fuses are often made. To give a broader danger area, camouflaged timbers may be laid between fuses. A mine containing 5 pounds of TNT will stop a light or medium tank upon direct contact. Within a position, it is often possible to do more with mines than can be done in front of it or on its flanks. Finally, the location of mines must be known to all of our own troops—particularly those operating any sort of vehicles. All mines must be recovered when our troops advance. Also, warning signs should be taken up from mine fields within the position, if a with- drawal is made. Agencies other than infantry assisting in antitan\ defense. (1) Divisional artillery may provide gun fire by either indirect laying with concen- trations on tank bivouacs, assault positions, areas through which tanks must pass to reach their objctives, and assembly points, or else by direct laying with the individual pieces used as antitank guns. (2) Engineers may prepare demolitions, assist in the preparation of barriers and ob- stacles or furnish material therefor, and provide antitank mines. (3) Observation aviation, mechanized cavalry, and all other reconnaissance agencies are means that may be used to obtain information of hostile mechanized movements. Attack aviation may intervene in emergencies to disrupt the hostile operation. (4) At times, chemical troops may assist by the use of smoke or gas. (Gases are used only in reply to an enemy who initiates their use.) (5) Because they are essentially instruments of the attack, our own tan\s are not well adapted to assist in the defense except where they can be employed aggressively, as in counterattack. Should our counterattack be of such size as to warrant the use of tanks, they may be of great assistance in expelling the enemy. They may operate effectively against foot troops following hostile tanks, or, under certain conditions, such as when our antitank defensive means are inadequate, they may operate with success against the hostile tanks themselves. Favorable opportunities for the latter would occur when hostile tanks have broken through our front line but have not yet reached their objective, or have become disorganized. (6) With all due credit to the value of these arms in providing antimechanized protection, much of the close-in defense of infantry against armored vehicles must be provided principally by infantry itself. The weapons found within the infantry regiment are its primary means for this defense. Weapons and Means Within the Infantry Regiment. The infantry’s small arms and machine guns, when loaded with armor piercing ammunition, are effective weapons with which to attack mechanized vehicles. The |ienetrative capability of caliber .30 armor- piercing ammunition is not only of consequence against lightly armored mechanized ve- hicles but its bullet splash through cracks and vision slits is effective against more heavily armored mechanized vehicles. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 129 Our yi-mm antitank gun is a powerful and effective weapon. It is low silhouetted, easily manipulated, and is capable of disabling any modern tank except very heavily armored tanks, with one hit. Other expedients that have been used with minor success in the past are: grenades tied together and thrown at a tank track or under a tank; any sort of destructive means like a rifle barrel or crowbar run through a track mechanism to throw it or break it; gasoline or petroleum thrown in glass containers against tanks and ignited by incendiary bombs or grenades; brush or dry grass or gram set afire in order to drive out or destroy attacking vehicles. Such means, however, are crude makeshifts, well worth knowing and using in emergencies but not to be considered in planning organized defense measures. They are last resort measures to be used by troops lacking more effective means. Purpose and Importance. Standing operating procedures consist of methods of per- forming many recurring phases of troop movement or employment so as to reduce normal operations to routine. These methods are built up through practice and experience. Be- tween large units such as the infantry division a considerable degree of variation is to be expected. Upon joining an organization, especially one which has performed extensive field operations as a unit, prompt inquiry should be made as to the exact nature of any standing procedures which are in use. The advantage of the method lies in the increased simplicity and brevity of orders which must be issued for activities which recur frequently. Smoothness and efficiency of execution are increased. Time is saved and confusion may be avoided or reduced. Procedures can be built up and used with confidence in those large units which work together during an extended period without important or frequent changes of personnel. Their use has the additional advantage that they serve as a test of new methods which, after thorough proving, may find their way into training manuals issued by the War Department for the use of all. There is present the possibility that the good idea may be carried too far. They can succeed only when all commanders understand exactly what is required of them and of their units by each standing procedure because detailed instruc- tions are omitted from routine orders. Changes occurring among the senior commanders, staff officers, or large personnel changes among the subordinate commanders present an immediate need for instruction, coordination, and practice. It can be overdone. Standing operating procedures should be regarded as tools to be used and exploited when conditions favor their employment and rejected when they may not apply. The medical officer on duty with a force, such as an infantry division, must adjust and adapt the operations of his unit to the procedures of other organizations and the force as a whole. He must inform himself of the exact nature of the special procedures which are in use. He must provide instruction and practice for his own unit to enable it to function smoothly and confidently in accordance with these adopted procedures. Recognizing the limitations of the system, he may be able to develop worthwhile methods for a few of the recurring tasks which pertain solely to his own organization. Medical units are an integral part of the tactical structure. They must be able and ready to func- tion as a part of a combat team in the same manner as all other units. The Combat Team. Increasing use is being made of combat teams of relatively fixed composition. Basically, a combat team consists of an infantry regiment and a field artil- lery gun battalion which is habitually teamed with the same infantry regiment. Com- manders of medical units should anticipate that certain units of the division medical battalion (or regiment), such as the collecting platoons, may be incorporated into combat teams. When this is done greater coordination is developed because commanders of all components become acquainted with one another, learn to work with one another, and gain a greater understanding of joint problems. Combat teams are designated by the number of the infantry regiment; hence, a combat team including the 1st Infantry would be designated as Combat Team No. 1. In many instances orders would issue to the combat teams as units, and the commander would not issue separate instructions to the com- ponents of the teams. STANDING OPERATING PROCEDURES 130 MILITARY MEDICAL MANUAL The March Group. A march group is a column consisting of a combat team, with attached units if any. It is commanded by the infantry regimental commander. Standing Operating Procedures for Movement. Within the division, the commander may prescribe the components of each march group which will include the several units or detachments which constitute the force. Command of the march group passes to the infantry regimental commander when the movement is ordered and continues until march conditions cease or other orders are received. In the usual case the division com- mander warns the units sufficiently in advance of the contemplated movement to permit the necessary preparations to be made. As soon as practicable or desired after the warning, the division commander orders the movement, except possibly the time of starting. Representatives of units and de- tachments report to the commander of the march group to which assigned as early as possible after receipt of orders for the movement, with information of positions of units or detachments, and time when they will be ready to move. The representatives then return to their units with instructions from the march group commander. When the march group is ready to start, or the time of readiness is known definitely, the march group commander reports to the division commander “March Group (No.) ready at (hour).” As soon as the march groups have reported ready, the division commander orders the time of starting. Ordinarily it is practicable and desirable to form the march group as it moves and without assembling it beforehand. This saves time and may avoid unnecessary marching. Elements of the march groups remain in their initial positions, such as bivouac areas, as long as practicable in order to rest the troops and perfect preparations. A march group includes foot troops and motor vehicles loaded with personnel, equip- ment, and supplies. In the movement, motor vehicles move by bounds of the greatest practicable length. March group commanders report to division headquarters the position of the head of their respective groups excluding the security detachment as of the hour. The position is defined by the distance in miles from the initial point. For example: “March Group 2—10.” Unless tactical conditions dictate otherwise, it is particularly important that the time length and road space of motor columns be reduced to the minimum. In executing motor movements the leading vehicle moves at the prescribed speed, so far as practicable, but never exceeds it. Every vehicle of the column is kept closed on the vehicle ahead to the limit of safety, but this distance is not fixed in yards; rather, it is based on safety and the judgment of the driver himself as a result of training, experience, and supervision. In halting, the leading vehicle halts at the proper time; others close on it to two yards, tactical conditions permitting. Standing Operating Procedures for Development for Combat. The division may be assembled preparatory for combat, the units moving into assembly areas, or it may be committed to action directly from march columns. When the division is to assemble, on call of the division commander, guides from the march groups go ahead to the assembly area or other designated point, where assembly areas are assigned by the division commander. The march groups follow—without halting if possible—and are met by the guides and conducted to the assembly area. Every effort should be made to clear the roads for units in rear. A plan of traffic circulation is de- vised and traffic guides posted. Until otherwise prescribed by the commander, march groups remain intact during assembly. Communication between division headquarters and major units is established at once. Standing Operating Procedures Appropriate for Medical Units. On the march a col- lecting platoon may be attached to each march group for march collection. In combat, unit commanders of regiments, battalions, and similar units are responsible for the initial treatment, collection, and evacuation of the casualties of their units to unit aid stations. The medical battalion (or regiment) is responsible for gaining and main- taining contact with the aid stations and evacuating their casualties. Collecting platoons, usually one in support of each combat team engaged, establish their normal installations. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 131 In moving situations, the collecting platoon commanders establish and advance the col- lecting platoons on their own initiative (unless otherwise prescribed), reporting promptly their locations to the division surgeon. Reinforcing units are requested from corps when necessary. The command post of the medical battalion is usually established at the site of the clearing station. CHAPTER V COMMAND AND STAFF PROCEDURE The staff which serves the troops best, serves the commander best. Medical officers are assigned in large numbers to duty with tactical organizations, such as medical battalions or regiments, and as attached medical personnel with units of the arms, such as the infantry regiment. In the execution of these tasks they may serve as commanders or staff officers of medical units, or as a staff officer, in addition to other duties, of a unit such as the infantry regiment or division. The duty envolved in either capacity requires the medical officer to function in accordance with the prin- ciples evolved for the control of military units in command and staff procedure. Command Responsibility. The commander alone is responsible to his superior for all that his unit does or fails to do. Me cannot shift this responsibility to his staff or to subordinate commanders. All orders from a higher to a subordinate unit are issued by the commander of the higher unit to the commander of the subordinate unit. If it is impracticable to comply with the orders received, due to an emergency or a change in the situation, the subordinate commander should so report to his superior. If it is impracticable to report, the subordinate commander should act according to his judgment and the policy of the commander, and report at the earliest practicable time the action so taken. In order to expedite the execution of orders and to promote teamwork between units, a commander may authorize his staff officers to communicate directly with the staff officers of other units as to the details of orders issued or received. Interstaff com- munication, when used, should be arranged preferably by the commanders concerned. Definition and General Functions of the Staff. The staff of a unit consists of the officers who assist the commander in his exercise of command. (See Plate 1.) The staff secures and furnishes such information as may be required by the com- mander, prepares the details of his plan, translates his decision and plan into orders, and causes such orders to be transmitted to the troops. It brings to the commander’s atten- tion matters which require his action or about which he should be informed, makes a continuous study of the situation, and prepares tentative plans for possible future con- tingencies for the consideration of the commander. Within the scope of its authority, it supervises the execution of plans and orders and takes such other action as is neces- sary to carry out the commander’s intentions. The staff officer should have a thorough knowledge of the policies of his com- mander and should be acquainted with subordinate commanders and their units. A staff officer should be an active, well-informed assistant to the commander and a help- ful adviser to subordinate commanders. Classification of Staff Officers. The staff of a division or larger unit may be sub- divided into two main groupings: A general staff group organized so as to include all functions of command and composed of officers of the General Staff Corps and officers detailed as their assistants. A special staff group, consisting of all staff officers assigned, attached, or who have duties at the headquarters and are not included in the general staff group. It includes certain technical specialists and heads of service. In units smaller than a division, the same officer frequently performs duties of both general and special staff nature; consequently there can be no definite subdivision of such staffs into general and special staff groups. Pensonal staffs or aides as authorized by law for certain general officers perform the duties prescribed by the general officer to whom assigned. They may be assigned to additional duties with the unit staff. They may be directed to keep the chief of staff or executive informed of the commander’s whereabouts and of the general content of any oral instructions he may have issued during an absence from the command post. Liaison officers. Organization. Basis. The organization of a staff is based upon the duties of the commander. The general distribution of personnel to staff sections is shown in Tables 134 MILITARY MEDICAL MANUAL COM MANDEB PERIsONAL RTIAFF G ENE RAL ST AFF AIDES CHIEF OF STAFF DEPUTY CHIEFl OF STAFF* — -—ii J SECRETARY OF THE GENERAL STAFF # G-l G-2 G-3 G-4 LIAISON OFFICERS | ((toM .’0TH£R ‘W131 I I AIR OFFICER jANTIAIRCRAFT OFFICES j ARTILLERY OFFICER j CHEMICAL OFFICER - JC== ENGINEER y - ■: -ic= jHEADQUARTERS ) COMMANDANT { ORDNANCE OFFICER i provost'MARSHAL —.nf- { SIGNAL OFFICER ll — — [surgeon J COMMANDERS OF 1 ATTACHED TROOPS \ ADJUTANT GENERAL \ CHAPLAIN \ FINANCE OFFICER {INSPECTOR GENERAL JUDGE ADVOCATE ' ' li I OFFICES IN CHARGE (OF CIVIL AFFAIRS * ' -_-ii : {QUARTERMASTER SPECIAL STAFF TROOPS (COMBAT 8. SERVICE) IN CERTAIN UNITS WHEN NOT REPRESENTED ON SPECIAL STAFF. COMMAND CHANNEL (DOWN) ROUTINE CHANNEL FOR- ADVICE AND RECOMMENDATIONS (UP) COORDINATION (DOWN) COOPERA T/ON INFORMATION OCCASIONAL CHANNEL FOR ADVICE AND RECOMMENDATION (UP) INFORMATION Plate 1. Command and Staff Procedure. of Organization. The detailed allotment of personnel to sections, particularly in the general staff group, will be made by the commander. (1) The duties of all commanders can be divided into four principal functional groups as follows: Personnel. Military intelligence. Operations and training. Supply and evacuation. (2) These 4 subdivisions of command duties, under a coordinating head, exist in the staffs of all units. In the staffs of the smaller units of certain arms or services the duties of two or more of these subdivisions may be performed by one staff officer. The coordinating head is the chief of staff in the division and higher units (executive in brigades and smaller units). He is responsible directly to the commander. Division into two echelons. For convenience of operation it is necessary frequently to divide the staff into two echelons. The forward echelon consists of the elements required immediately by the commander for tactical operations; and the rear echelon, of the remainder of the staff required for administrative activities. The composition of the forward and rear echelon of various headquarters is contained in the discussion herein of the general staff and special staff. In addition to the designated general and special staff officers, liaison officers from other units and the commander’s personal staff (aides) may be with the forward echelon. Cooperation. Teamwork is essential within and between staffs and between staff and troops. It is assured by cooperation and collaboration within and between all sections of the general and special staff groups, between the staff and troops, and between the staffs of subordinate, higher, and adjacent units. Prompt dissemination of essential information and of decisions and orders within and between groups is vital to the efficient functioning of a command. The general staff group should consult the special staff officers as to the ability of their respective arms and services to execute contemplated missions, and give the special staff timely warning of operations in order to permit preparations. Conferences of the staff including available subordinate commanders are often helpful. At other times individual personal contact is a more effective and practical procedure. Authority. A staff officer as such has no authority to command. All policies, decisions, and plans whether originating with the commander or with the staff must be author- ized by the commander before they are put into effect. When a staff officer by virtue of delegated authority issues an order in the name of the commander, responsibility remains with the commander even though he may not know of the order. The dual functions of certain officers who are unit commanders as well as special staff officers are presented herein. A Guide for Staff Officers. A new commander is apt to assume that everything is running smoothly and satisfactorily if too many complaints and appeals from decisions of his headquarters do not crop up. Having confidence in his staff, he is prone to let these officers decide for themselves what matters should be brought to his attention. Such a hit-or-miss system may result in a staff-run organization or in the commander being swamped under a mass of trifling details which his staff should handle. The memorandum 1 which is reproduced below was placed in effect by Major General Frank S. Cocheu with a view to exercising command without infringing on any of the duties and prerogatives of staff officers, and is said by him to be the product of many years of experience. MEMORANDUM: For the Staff. 1. The following will be brought without delay to the attention of the Commanding General: a. Subjects of importance which require prompt action and are not covered by existing policies and instructions. b. Disapprovals from higher authority. c. Errors, deficiencies or irregularities alleged by higher authority. d. Communications that allege neglect or dereliction on the part of commissioned per- sonnel. e. Correspondence or proposed correspondence conveying even a suggestion of censure. /. Appeals from subordinates frem decisions made at this headquarters. g. Subjects which affect the good name or reputation of an officer or organization. h. Subjects involving financial or property irregularities. i. Serious accidents involving personnel of the command. COMMAND AND STAFF PROCEDURE 135 1 Reproduced with permission of Maior General Frank S. Cocheu, U. S. A., Retired, 136 2. The following will be presented to the Commanding General for final action: a. Requests and recommendations to be made to higher authority. b. Suggested disapprovals. c. Communications that contain a suspicion of censure. d. Communications that involve the good name of an officer or organization. e. Reports of financial and property irregularities. /. Letters to civil authorities in high positions. g. Endorsements on efficiency reports. h. Correspondence concerning war plans. /. Communications of exceptional information. 3. A copy of these instructions will be kept exposed at all times upon the desk of each staff officer of this headquarters. Liaison. A staff officer should visit subordinate units to acquaint them with condi- tions which cannot be explained in orders, and to obtain information for the use of the commander and his own staff section. The procedure for officers on liaison missions should be followed. MILITARY MEDICAL MANUAL THE GENERAL STAFF Duties. The general statutory duties of the general staff with troops are to render professional aid and assistance to the general officers over them; to act as their agents in harmonizing the plans, duties, and operations of the various organizations and services under their jurisdiction; to prepare detailed instructions for the execution of the plans of the commanding general; and to supervise the execution of such instructions. This subdivision of activities is intended only as a guide in assigning duties to the general staff sections. The unit commander may and should make such adjustment of duties as best meets operating conditions. The general staff group is responsible for preparing and issuing all combat orders except those orders issued by the commander in person. The general staff group supervises the execution of orders to insure understanding and execution in conformity with the commander’s will. Organization; Designation. Divisions and higher units. The general staff group of divisions and higher units is organized in 4 sections corresponding to the functional sub- divisions of command. The group includes the necessary coordinating personnel. The chiefs of sections are designated as assistant chiefs of staff, G-l, G-2, G-3, and G-4. The organization includes: Coordinating personnel—chief of staff, assisted by— Deputy chief of staff (in army and higher units). Secretary of the general staff (in army and higher units). Staff sections. Personnel section (G-l). Military intelligence section (G-2). Operations and training section (G-3). Supply and evacuation section (G-4). In some divisions the general staff group consists of the chief of staff and three sections. The chiefs of sections are designated as assistant chiefs of staff, G-2, G-3, and G-4. Units smaller than division. In units smaller than the division, to include the bat- talion (or equivalent unit), duties corresponding to those of the general staff group arc assigned to officers listed below. Staffs of many smaller units are of such limited size that one staff officer is charged with the duties of two or more staff sections. (1) Chief of staff—the executive officer. (2) Personnel section—the adjutant (S-l). (3) Military intelligence section—the intelligence officer (S-2) COMMAND AND STAFF PROCEDURE 137 (4) Operations and training section—the plans and training officer (S-3). (5) Supply and evacuation section—the supply officer (S-4). Forward and rear echelons. The forward echelon of the headquarters of a unit usually includes all of the officers whose duties are of general staff nature. Representa- tives of G-l (S-l) and G-4 (S-4) may be at the rear echelon. Flexibility of Operation. Although the general staff group is organized into 4 sections there is much overlapping of duties; coordination and prompt interchange of informa- tion between sections are essential. In addition, general staff officers may be required to assist, or to take over temporarily, one or more other sections. This condition frequently exists in divisions and corps, especially when the headquarters of these units are operating on a 24-hour basis. It is of vital importance in smaller units. Chief of Staff (executive in brigades and smaller units.) The chief of staff or executive is the principal assistant and adviser to the commander. He may transmit the decisions of the commander to appropriate staff officers for preparation of the necessary orders, or transmit them in the form of orders to those who execute them. He is the principal coordinating agency of the command. He performs the following specific duties: Formulates and announces policies for the general operation of the staff. Directs and coordinates the work of the general and special staff in respect to: (1) Activities of the sections within the general and special staff groups. (2) Relations between the general and special staff groups. (3) Relations between the general and special staff groups and the troops. Keeps the commander informed of the enemy situation, the situation relative to adjacent and supporting units, and the situation of the command as to location, strength, morale, training, equipment, supply, evacuation, and general effectiveness. Represents the commander during his temporary absence or when authorized to do so. (In certain small units the second in command is designated by Tables of Or- ganization as executive, hence succeeds automatically to the command when the com- mander ceases to function.) Receives decisions from the commander and takes the following action: (1) Makes such additional decisions as may be directed by the commander and gives necessary instructions to the staff in furtherance of these decisions. (2) Allots the detailed work of preparing plans and orders and when time permits coordinates the resulting drafts and submits them to the commander for approval. Takes steps to insure that all instructions published to the command are in accord with policies and plans of the commander. By personal observation, and with the assistance of the general and special staff sections, sees that the orders and instructions of the commander are executed. Makes a continuous study of the situation with a view of being prepared for future contingencies. Assembles the routine staff section reports and after their approval by the com- mander forwards required copies to higher headquarters. Deputy Chief of Staff (in army and higher units only). The relations of the deputy chief of staff to other members of the staff and to the troops are similar to those of the chief of staff. The deputy chief of staff assists the chief of staff and acts for the latter in his absence. Secretary of the General Staff (in army and higher units only). The secretary of the general staff performs the following duties: Acts as executive officer for the chief of staff and deputy chief of staff. Maintains an office of temporary record for the chief of staff and deputy chief of staff. Routes papers received in the office of the chief of staff to their proper destinations. Forwards correspondence to its destinations in the headquarters and establishes a follow-up system to insure prompt action on and return of papers. Receives officials visiting headquarters for the purpose of conferring with the com- mander, the chief of staff, or deputy chief of staff. Collects statistical data for the commander, chief of staff, and deputy chief of staff. Personnel (G-l) Section. The personnel section is charged with the formulation of 138 MILITARY MEDICAL MANUAL policies and the supervision of the execution of administrative arrangements pertaining to personnel of the command as individuals, civilians under supervision or control of the command, and prisoners of war. In divisions in which there is no provision for a G-l section, the supervision of activities listed below will be assigned to the G-4 section, or as may be directed by the division commander. The specific duties of the personnel section may include the planning for and super- vision of activities concerning— (1) Procurement, classification, reclassifications, assignment, pay, promotion, trans- fer, retirement, and discharge of all personnel. (Coordination with G-3 in assignment and transfer of personnel.) (2) Replacement of personnel. (Coordination with G-3 for priorities.) (3) Decorations, citations, honors, and awards. (4) Leaves of absence and furloughs. (5) Rewards and punishment. (6) Internal arrangement of headquarters. (Coordination with G-4 for construc- tion.) (7) Religious, recreational, and welfare work; supervision of military and non- military agencies devoted to such work. (Coordination with G-3 for allotment of time for recreational and morale work.) (8) Army postal service. (Coordination with G-4 for movement; G-2 for censor- ship.) (9) Strength reports and graphs, casualty reports, prisoner of war reports, station lists, and other personnel statistics. (10) General regulations and routine administration which especially concern indi- viduals, or routine administration not specifically assigned to another general staff section. (11) Furnishing the commander advice on morale. (12) Collection and disposition of stragglers. (13) Collection and disposition of prisoners of war. (Coordination with G-2 for identifications and questioning; G-4 for transportation and for location and con- struction of prisoner of war enclosures.) (14) Recommendations as to provisions for shelter for the command and ad- ministration of quartering areas. (Coordination with G-3 for location of areas; G-4 for construction.) (15) Sanitation. (Coordination with G-4.) (16) Relations with civil government and civilians in the theater of operations, including initial establishment and operation of military government or martial law. (FM 27-5.) (Coordination with G-4 for transportation for civilians to be evacuated and feeding of civilians; G-3 for evacuation of civilians as it affects operations; G-2 for censorship.) (17) Maintenance of law and order within the command. (18) Graves registration service, including burials. (Coordination with G-4 on acquisition of cemeteries.) (19) Supervision of matters concerning members of our forces who are prisoners in enemy hands. (20) Preparation of such parts of administrative plans and orders as relate to activities under the supervision of the personnel section. (Coordination with G-4.) Military Intelligence (G-2) Section. The military intelligence section is charged with the planning and preparation of orders and to some extent with operations pertaining to the collection, evaluation, interpretation, and distribution of information of the enemy and with counterintelligence activities. Its primary function is to keep the commander and all others concerned informed regarding the enemy’s situation and capabilities. Operations and Training (G-3) Section. The operations and training section is charged with those functions of the staff which relate to organization, training, and combat operations. It is responsible for tactical and training inspections, as directed by the commander (AR 265-10). COMMAND AND STAFF PROCEDURE 139 The specific duties of the operations and training section may include: (1) Preparation and coordination of plans for and supervision of: (a) Mobilization of the command. (b) Organization and equipment of units. (Coordination with G-4 for allocation of equipment.) (2) Preparation and coordination of plans for and supervision of training of units and individuals, including: (a) Preparation of training directives, programs, and orders. (Coordination with G-2 for combat intelligence training.) (b) Selection of training sites and firing and bombing ranges. (Coordination with G-4 on preparation of sites and ranges.) (c) Organization and conduct of schools. (3) Operations, to include, in general: tactical and strategical studies and esti- mates; plans and orders based thereon; supervision of combat operations; and future planning. Specific duties relative to operations may include: (a) Continuous study of the tactical situation, as affected by: 1. The enemy situation. (Coordination with G-2.) 2. Instructions from higher units. 3. Actions of adjacent or supporting units. 4. Location, morale, and capabilities of the troops. (Coordination with G-i for morale matters.) 5. Needs for replacements and reinforcements. (Coordination with G-l for replacements.) 6. Terrain and weather conditions. (Coordination with G-2.) 7. Status of equipment and supplies. (Coordination with G-4 for priorities of replacement of materiel and allocation of supplies.) (b) Preparation of estimates, reports, and recommendations based on the tactical situation. (c) Preparation of plans for and supervision of activities concerning: 1. Reconnaissance and security measures. (Coordination with G-2 for intelli- gence missions of combat troops.) 2. Troop movements. (Coordination with G-4 for movements requiring trans- portation in addition to organic transportation and for routes.) 3. Tactical employment of units. (Coordination with G-4 for influence of supply and evacuation on operations; G-2 for capabilities of enemy; G-l on morale of troops.) 4. Defense of administrative installations and lines of communication. (Co- ordination with G-4.) 5. Tactical measures to preserve secrecy and effect surprise. (Coordination with G-2.) (d) Preparation and authentication of field orders and operation maps required to carry out the tactical plan, and their transmission to units and staff officers con- cerned. (Coordination with G-2 for maps and for paragraphs and annexes dealing with enemy information, reconnaissance, and counterintelligence measures; G-4 for para- graph dealing with administrative matters.) (e) Maintaining contact with the commanders of subordinate units; observing or supervising troop movements and tactical operations as directed by the commander. (f) Establishment of liaison with adjacent, higher, and subordinate units. (g) Supervision of signal communication. (h) Preparation of tentative plans for subsequent phases of a tactical operation and for future tactical operations. (Coordination with G-2 for enemy capabilities; G-4 for practicability of operations from a supply point of view.) (4) Recommendations to the commander of priorities for assignment of personnel and equipment. (Coordination with G-l for assignment of personnel; G-4 for allocation of equipment.) The organization of the operations and training section in each unit will vary with the personnel available and the work to be accomplished. In corps and higher units, 140 MILITARY MEDICAL MANUAL separate subsections pertaining to administration, organization, training, operations, and troop movements may be organized. Supply and Evacuation (G-4) Section. The supply and evacuation section is charged with the preparation of policies for, and the supervision of execution of arrangements for supply, evacuation, transportation, and other administrative matters related thereto. It is responsible for advising the commander relative to the extent of the administra- tive support that can be given to any proposed strategical or tactical line of action, and for recommendations as to the necessary decisions concerning supply and evacuation. It is further responsible for the development of those details of the administrative plan which pertain to its functions, the preparation of the necessary orders, and the super- vision of their execution. The specific duties of the supply and evacuation section may include the planning for and supervision of activities concerning: (1) Procurement, storage, and distribution of all supplies including animals. (Co- ordination with G-3 for priority of allocation of supplies.) (2) Location of supply, evacuation, and maintenance establishments. (3) Transportation of supplies by land, air, and water. (4) Construction and maintenance of roads and trails, docks, and airdromes. (5) Maintenance of equipment. (Coordination with G-3 for priorities.) (6) Recommendations for allocation of small arms ammunition and antitank mines. (Coordination with G-3.) (7) Traffic control. (Coordination with G-3 for tactical plan and secrecy.) (8) Construction, operation, and maintenance of utilities and other facilities relat- ing to supply, shelter, transportation, and hospitalization, but exclusive of fortifications. (9) Evacuation and hospitalization of men and animals. (10) Assignment and movement of supply, medical, technical, and labor troops not employed as combat troops. (Coordination with G-3 to avoid conflict with tactical movements.) (11) Salvage. (12) Collection and disposition of captured supplies, equipment, and animals. (Coordination with G-2 for examination of materiel.) (13) Recommendations concerning protection of lines of communication and rear establishments. (Coordination with G-3.) (14) Recommendation as to location of rear boundaries. (15) Recommendation as to location of rear echelon of headquarters. (Coordina- tion with G-l.) (16) Property responsibility. (17) Funds and priority of expenditure. (18) Construction, operation, and maintenance of military railways. (19) Operation of inland waterways. (20) Recommendations as to new types of equipment. (Coordination with G-3.) (21) Procurement of real estate, shelter, and facilities, including their leasing, repair, maintenance, and disposition. (22) Acquisition and improvement of airplane bases. (23) Preparation, authentication, and distribution of administrative orders, both fragmentary and complete. (Coordination with G-3 for details of tactical plan; G-l for details pertaining to the activities supervised by the personnel section.) The organization of the supply and evacuation section in each unit depends upon the personnel available and the work to be accomplished. In corps and higher units, separate subsections pertaining to administration, construction, evacuation, supply, and transportation may be organized. General. General junctions. The special staff operates with the general staff under the policies prescribed by the unit commander. The general functions of the special staff group include: THE SPECIAL STAFF COMMAND AND STAFF PROCEDURE 141 (1) Technical and tactical advice and recommendations to the commander and his general stall. (2) Preparation of plans, estimates, and orders in order to relieve the general staff of routine duties. (3) Coordination with the general staff sections of their tactical and administrative plans and activities. Dual junctions. In certain cases, special staff officers are also commanders of troops or heads of technical, supply, or administrative services and as such have the usual functions of command or control over such troops or services; for example, the com- mander of the artillery troops of an infantry division is also the division artillery officer. There two functions of staff and command, although vested in a single indi- vidual, are separate and distinct in that each involves different responsibilities and duties, and the exercise of one should not be confused or permitted to interfere with the exercise of the other. On the contrary, this dual function of certain officers has many advantages in facilitating the proper discharge of both staff and command duties of the oificers concerned. Relations With Subordinate Units. While certain of the duties charged to special staff officers apply to the unit as a whole, the unit commanders are primarily responsible for all phases of planning, training, and execution of all activities of their com- mands; and directions or instructions issued subordinate units must be transmitted through the proper channels of command and not directly from one special staff officer to the corresponding special staff officer in a subordinate unit. Within the limits and in the manner prescribed by the division or higher commander a special staff officer’s duties may include: Technical and tactical supervision, coordination, and inspection of subordinate units of his arm or service not commanded by him. Appropriate technical inspection of all subordinate units. Handling routine reports directly from corresponding staff officers of subordinate units. Composition. Divisions and higher units. The special staffs of divisions and higher units include such of the following officers as are assigned to the unit: (1) Air olficer. (2) Antiaircraft officer. , (3) Artillery officer. (4) Chemical officer. (5) Engineer. (6) Headquarters commandant (combined with provost marshal in certain units). (7) Ordnance officer. (8) Provost marshal (combined with headquarters commandant in certain units). (9) Signal officer. (10) Surgeon. (11) Commanders of attached combat units having no special staff representative. (12) Liaison officers. (13) Adjutant general. (14) Chaplain. (15) Finance officer. (16) Inspector general. (17) Judge advocate. (18) Officer in charge of civil affairs (initially in GHQ and other territorial commands, when required). (FM 27-5.) (19) Quartermaster. Sections. Special staff sections are shown in Tables of Organization. They arc headed by the special staff officers shown above. The title may be followed by the designation of the unit when necessary, thus: Financial Officer, II Corps. Brigades and smaller units. In addition to the staff officers corresponding to the chief of staff and the four general staff sections in larger units (executive, S-l, S-2, S-3, 142 MILITARY MEDICAL MANUAL and S-4), the staffs of brigades, regiments, and battalions, corresponding to the special staffs of larger units, include such ot the iollowing as may be assigned to the unit: (1) Communication officer. (2) Gas officer. (3) Liaison officer(s). (4) Reconnaissance officer. (5) Surgeon. {6) Commanders of attached combat units not represented on the staff. (7) Chaplain. (8) Motor officer (designated as maintenance officer in some units). (9) Munitions officer (armament officer in Air Corps units). (Duties frequendy combined with those ot S-4.) Forward and rear echelons. In divisions and higher units the headquarters usually are divided so as to include the special staff officers assigned to the units and listed above in the forward echelon, and in the rear echelon. In certain units a special staff section at the rear echelon may have a representative at the forward echelon. Duties. The duties of the several special staff officers, as listed herein, are intended as a guide. The commander may and should adjust duties to meet operating condi- tions. In the performance of their duties, special staff sections are ordinarliy subject to supervision and coordination by appropriate general staff sections. Certain of the special staff officers whose duties are listed have both command and staff functions. Only those duties pertaining to their functions as staff officers are listed in this chapter. Air Officer. Adviser to the commander and staff on air matters. Preparation of plans for the use of air units, including recommendations for their allotment to subordinate units. Administrative responsibility through subordinate air base commanders for the air units operating under theater control (air officer, theater of operations, only). Coordination, within limits prescribed by the commander, of the utilization of all air units of the command. Determination of requirements, procurement, storage, and distribution of aircraft ammunition and air technical supplies. Furnishing information as to the status of aircraft ammunition and air technical supplies. Obtaining and disseminating meteorological data for use by the command, except that obtained by the field artillery and other units for their own use. Examination of captured aviation equipment. Antiaircraft Officer. Adviser to the commander and staff on all antiaircraft matters, including passive defense measures. Determination of requirements and recommendations for apportionment of anti- aircraft artillery ammunition. Planning for coordination of all means of active defense against air operations in cooperation with the unit air officer. Recommendations as to missions for antiaircraft artillery including recommendations for allotment to subordinate units. Artillery Officer. Adviser to the commander and staff on field artillery matters. Supervision of the training of the field artillery of the unit. Preparation of plans for the use of field artillery, including recommendatoins for its allotment to subordinate units. Coordination of the survey system within field artillery units. Supervision of observation, signal communication, and liaison within the field artillery. Supervision of supply of meteorological data for the field artillery. Determination of requirements, recommendations for apportionment, and supervision of distribution of field artillery ammunition. Furnishing information as to status of ammunition supply. Coordination of fires of the field artillery of subordinate units. COMMAND AND STAFF PROCEDURE 143 Plans for artillery missions to be performed by observation aviation. Collection and dissemination of information pertaining to hostile artillery and other targets through artillery intelligence agencies. Chemical Officer. Adviser to the commander and staff on all chemical matters, in- cluding the use of chemicals by the various arms. Preparation of plans for the use of chemical troops, including recommendations for their allotment to subordinate units. Supervision of the operations of chemical troops not assigned to subordinate units. Supervision, within limits prescribed by the commander, of all chemical training, including inspections. Supervision, within limits prescribed by the commander, of collective protective meas- ures, including gas-proofing of inclosures, and the decontamination of gassed areas, equipment, and vehicles. Examination of captured chemical equipment, and collection and evaluation of other information concerning means and methods of utilization of chemicals by the enemy and our own troops and the results obtained. Determination of requirements, procurement, and distribution of chemical equip- ment and supplies for all units, and chemical munitions for chemical troops. Operation of chemical storage, maintenance and repair facilities, and rehabilitation of salvaged chemical material. Technical inspection of supplies, equipment, and ammunition, stored and issued by the Chemical Warfare Service. Supervision of the filling of such chemical munitions as may be prescribed to be performed in the theater of operations. Estimation of requirements and recommendations for apportionment of chemical muni- tions to chemical troops. Furnishing information as to the status of chemical warfare service ammunition supply. Engineer. Adviser to the commander and the staff on engineer matters. Preparation of plans for the use of engineer troops, including recommendations for their apportionment to smaller units. Determination of requirements, procurement, storage, and distribution of engineer equipment and supplies, including camouflaging materials. Construction, maintenance, and repair of camps, cantonments, warehouses, hospitals, and other structures, including incidental installations (except signal communications) of roads and trails, and all means of river crossings, of docks, and of airdromes and landing fields. Supply of all fortification materials, and the construction of such defensive works as may not be assigned to other troops. Construction, repair, maintenance, and operation of railways, portable and fixed electric light plants, water supply systems, and all other utilities of general service not otherwise assigned. Military mining, demolitions, and the construction and removal of obstacles. Surveys, mapping, and the procurement, production, and distribution of maps. Engineer reconnaisance. Recommendations as to traffic regulations on roads and bridges as may be required by their physical condition. Preparation and posting of signs for marking routes. Supervision, within limits prescribed by the commander, of engineer and camouflage activities in subordinate units, including such work performed by troops other than engineers. Development within the unit of measures for camouflage of personnel and installation; preparations of instructions concerning camouflage, use of camouflage material, and protective coloration of all equipment except aircraft. Examination of captured engineer equipment. Headquarters Commandant. Local security of the headquarters. Internal administration and arrangements for moving headquarters. 144 Detail of orderlies and messengers. Supervision of headquarters mess. Messing and quartering of casuals. Reception of visitors at certain headquarters. Ordnance Officer. Adviser to the commander and staff on ordnance matters. Preparation of plans for use of ordnance troops not assigned to subordinate units. Collection and evaluation of information concerning means and methods of utilization of ordnance materiel and ammunition by the enemy and our own troops, and the results obtained. Procurement, storage, and distribution (in accordance with apportionments as ap- proved by the commander) of ammunition and of other ordnance supplies and equip- ment. Operation of ordnance storage, maintenance, and repair facilities, including salvage and repair of ordnance materiel. Technical inspection of ordnance equipment. Supervision, within limits prescribed by the commander, of ordnance activities in subordinate units. Provost Marshal. Adviser to the commander and staff on matters pertaining to the duties of the military police. Enforcement of traffic control regulations. Apprehension and disposition of stragglers, absentees, and deserters. Collection and custody of prisoners of war. Enforcement of police regulations among members of the military forces and in areas occupied by troops. Cooperation with civil authorities on plans including those for police protection, black-outs, antisabotage activities, and the like. Control of the civil population, including circulation of individuals and mass move- ments of refugees, when circumstances require. Supervision of installations for refugees and the feeding of noncombatants, when necessary. Criminal investigation activities and custody and disposition of offenders. Coordination, within limits prescribed by the commander, of military police in subordinate units. Recommendations as to location of straggler line and collecting points for prisoners of war. Signal Officer. Adviser to the commander and staff on signal matters, including the location of command posts. Preparation of routine and combat orders relating to signal communication. Planning, installation, and supervision of the aircraft warning net, when so directed. Preparation, publication, storage, accounting for, and distribution of codes and ciphers. Determination of requirements, procurement, storage, and distribution of signal equipment and supplies. Procurement and operation of signal maintenance and repair facilities. Technical inspection of signal equipment, within limits prescribed by the commander, and recommendations relative to its care and utilization. Technical supervision, within limits prescribed by the commander, of signal opera- tions of the command, including coordination of the employment and of the training of signal agencies of subordinate units. Supervision of the installation, maintenance, and operation of the signal system, including the message center of the unit. Supervision of such activities pertaining to the signal intelligence, pigeon, and, except in Air Corps units, photographic services as affect the unit. Examination of captured signal equipment. Surgeon. Adviser to the commander and staff on all matters pertaining to: (1) Health and sanitation of the command and of occupied territory. (2) Training of all troops in military sanitation and first aid. MILITARY MEDICAL MANUAL COMMAND AND STAFF PROCEDURE 145 (3) Location and operation of hospitals and other medical establishments and of the evacuation service. Supervision, within limits prescribed by the commander, of training of medical troops, including inspections. Determination of requirements, procurement, storage, and distribution of medical, dental, and veterinary equipment and supplies. Supervision, within limits prescribed by the commander, of the operations of ele- ments of the medical service in subordinate units. Preparation of reports and custody of records of casualties. Examination of captured medical equipment. Commanders of Attached Combat Units Having No Special Staff Representative. Com- manders of attached combat units having no special staff representative act as advisers to the commander and his staff on tactical and technical matters relating to their units. Adjutant General. Handling all official correspondence, except that pertaining to combat orders and instructions, in accordance with regulations and approved policies. In cases for which no policy has been established, he initiates action to secure a policy covering such cases. Authentication and distribution of all orders and instructions, except those pertaining to combat operations. Maintenance of the office of record for the headquarters. Operation of the Army postal service in the unit. In divisions and certain higher units upon mobilization, a postal section is organized and operated by a designated postal officer under the supervision of the adjutant general. Establishment of the Prisoner of War Information Bureau prescribed by the Hague Convention (GHQ and theater of operations). Operation, in accordance with approved policies, of activities at the headquarters pertaining to: (1) Classification of all individuals joining the command, their subsequent assign- ment, reclassification, and reassignment, their promotion, transfer, retirement, and discharge. (2) Procurement and replacement of personnel. (3) Decorations, citations, honors, and awards. (4) Leaves of absence and furloughs. (5) Education (exclusive of tactical and technical). (6) Recreation and welfare and all other morale matters not specifically charged to other agencies. Custody of the records of all personnel belonging to the command which are not kept in some subordinate unit. Preparation and distribution of the station list. Preparation and submission of reports on strength, casualties, captured materiel, prisoners of war, and incidental returns. Supplying of blank forms, publications, and instructional matter furnished by the Adjutant General’s Department. Operation of office procedure as regards administrative matters, including recommen- dations as to similar arrangements in headquarters of subordinate units. Chaplain. Adviser to the commander and staff in religious and moral activities of the command. Supervision of the spiritual welfare of the command. Conduct of religious services, including funerals. Spiritual ministrations to the sick and wounded. Correspondence with relatives of deceased personnel. Coordination of the religious work of the various welfare societies. Supervision and coordination, within limits prescribed by the commander, of the training and work of the chaplains of subordinate units. Recommendations as to assignments and transfers of chaplains. 146 MILITARY MEDICAL MANUAL Providing the services of chaplains for units requiring them. Preparation of estimates and allotment of funds for religious activities not specifically charged to other agencies of the command. Preparation of reports relative to the religious and moral activities of the command. Finance Officer. Adviser to the commander and staff on fiscal matters. Payment of the command, and payments for hired labor, for supplies purchased or requisitioned, and for damages or claims. Custody of financial records. Custody and disbursement of all Government funds, including such special funds as the commander may direct. Inspector General. Inspections and investigations as the commander may direct. For sphere of inquiry see AR 20-5, 20-10, 20-30, and 20-35. Inspection of all commands, units, systems, transportation, installations, accounts, and nonmilitary agencies as required by the commander. Judge Advocate. Adviser to the commander and staff, and to other members of the command in proper cases, on questions of law. Supervision of the administration of military justice within the command. Review and recommendation as to the action to be taken upon charges preferred for trial by, and records of trial of, military courts. Officer in Charge of Civil Affairs (GHQ and other territorial commands when re- quired). Adviser to the commander on matters pertaining to the administration of civil affairs in the theater of operations (FM 27-5). Supervision of such agencies as may be established for the required control of civil affairs in occupied territory. Quartermaster. Adviser to the commander and staff on quartermaster matters. Determination of requirements, procurement, storage, and distribution of quarter master equipment and supplies, including vehicles. Procurement and disposition of real estate and facilities, including leasing. Procurement and operation of quartermaster utilities, storage, maintenance, and repair facilities. Operation of: (1) Remount service. (2) General service pool of labor. (3) Salvage service. (4) Graves registration service. Transportation of troops and supplies by land, water, and commercial air means, except such as may be allocated to another arm or service. Technical inspection of motor and animal transportation, and supervision of quarter- master activities in subordinate units within limits prescribed by the commander. Examination of captured quartermaster equipment. Special Staff Officers of Smaller Units. In brigades and smaller units, general and special staff duties merge into each other, and one staff officer frequently is charged with duties of both general and special staff nature. In some units the same officer performs the duties of more than one of the staff sections. STAFF RECORDS, MAPS, AND REPORTS Staff Records. A system of staff section records is essential in order to have informa- tion available for: (1) Command decisions during operations. (2) Higher headquarters. (3) Historical rerord (AR 345-105). The refinement of the svstem of making and keeping unit or staff records will vary with the factors of available time, opportunity, and personnel. Office of Record. The office of record is that of the adjutant general or adjutant. Staff sections temporarily retain copies of documents needed in their current work, returning them to the office of record when no longer needed. COMMAND AND STAFF PROCEDURE 147 Journals (Sec Plate 2). A journal is a chronological record of events affecting the unit or staff section. The amount of detail recorded in journals will vary with the personnel available in the staff section and the nature of the operations being conducted. The minimum detail necessary to fix the time or other facts concerning important events is the ideal. Important incidents are recorded as they occur, such as time of receipt or transmission of important messages, visits of higher commanders and staff JOURNAL Journal1 Organization From: (Date and hour) To: (Date and hour) Place Time * Senal No. Time dated * Incidents, messages, orders, etc. Action taken In Out Plate 2. Form for Unit Journal. NOTES 1. The journal is the daybook of the section or unit. It contains briefs of important written and oral messages received and sent and notations of periodic reports, orders, and similar matters that pertain directly to the section or unit. Copies of messages and other data pertaining to the section or unit and furnished by it for purposes of information to other sections or units are not entered in the journals. The journal is supplemented by the journal file; this file contains copies of all messages, orders, and other documents arranged in the order of entry in the journal. A brief synopsis of the contents of oral messages or orders should be entered in the journal proper. 2. Refers to time of receipt or sending in this office. 3. Refers to time information originated, and thus calls attention to age of the information. 4. Following symbols may be used: M, noted on situation map; S, standard distribution at CP; T, information furnished troops. officers, and absences from the command post of the commander or section chief. A brief synopsis of written messages or orders should be entered in the journal and the originals filed in the journal file. Oral messages or orders should be entered in full when practicable. In corps and higher units and in divisions when the personnel of the staff section is adequate, each staff section keeps a journal of its activities. The assembled journals 148 MILITARY MEDICAL MANUAL of the staff sections should form a complete picture of the operations of the unit for a given period. In divisions, when the personnel of the staff sections is inadequate, two or more section journals may be combined. In brigades and smaller units, a combined unit journal is usually sufficient and should be kept by the adjutant or plans and training officer or as directed by the unit com- mander. In highly mobile units such as armored units, it may be necessary for each staff section to keep its own journal. The journal is closed daily or at the end of a phase or period as determined by higher authority. The journal is a permanent record of the operations of the unit and is annexed to reports after action against the enemy (AR 345-105). Original entries should not be altered but supplemented when necessary by later entries. Situation Maps. In corps and higher units, and in divisions when the personnel of the general staff sections is adequate, each general staff section keeps a situation map posted to date showing the dispositions and activities that concern the section. Data should be posted on the map as soon as received, after which the items should be entered in the journal. In divisions, when the personnel of the general staff sections is inade- quate, a joint G-2—G-3 situation map and a joint G-l—G-4 situation map may suffice. (1) In most brigades and smaller units, a combined situation map kept under the supervision of the unit executive is usually sufficient. (2) In highly mobile units such as armored units, each staff section keeps its situation map up to date even while moving. Situation maps showing the situation at a particular time are often prepared as appendixes to special or periodic staff reports to permit the written contents of reports to be reduced to a minimum. Operation, Administrative, and Circulation Maps. Operation maps are prepared and issued by the G-3 (S-3) section. Administrative and circulation maps are prepared and issued by the G-4 (S-4) section. Reports. The character and scope of staff and unit reports will vary with the re- quirements of the commander or the higher headquarters at the time the reports are called for. The merit of a report is not measured by its length. A concise presentation of im- portant points usually is <»il that is required. In divisions and higher units, each staff section prepares and submits such periodic or special reports pertaining to its activities as may be directed or required. In brigades and smaller units, a single unit report prepared under the supervision of the executive is usually sufficient. Reports on the situation or events will be of maximum usefulness to the commander, other staff sections, and higher headquarters when made as of a particular hour. Such a time might be toward the close of the day’s heaviest fighting, as a basis for the com- mander’s decision for night dispositions and a renewal of operations the following day, or whenever a change in the situation indicates that new decisions and new plans will be necessary. The number of written reports required from subordinate units should be held to the minimum. Wherever possible, personal or telephone conferences should replace written reports. Commanders may require reports from subordinate units at certain times; for ex- ample, a report may be required at a time in the early morning, noon, and near night- fall, regardless of the information available. Negative information may be valuable. COMMAND AND STAFF PROCEDURE 149 LIAISON General. Liaison is the connection between units or other elements, established by a representative—usually an officer—of one unit who visits or remains with another unit. Its purpose is to promote cooperation and coordination of effort by personal contact. Types. Liaison may be established between supporting and supported units; between adjacent units (lateral liaison); from subordinate to higher headquarters; and from higher to subordinate headquarters. Between Supporting and Supported Units. Liaison between supporting and sup- ported units, if established, is the function of the supporting unit. Field artillery habitually establishes liaison with supported units for the primary purpose of obtaining information as to the needs for supporting fire. For example, liaison is established by direct support artillery battalions with the supported front line battalions and also with the regiment. (FM 6-20). Liaison between other supporting and supported units is established when desirable. Between Adjacent Units. Liaison between adjacent units in combat is established when desirable. If used, it may be directed by a higher commander or established on the initiative of adjacent commanders. From Subordinate to Higher Headquarters. A subordinate unit may be directed to establish liaison with higher headquarters. Such liaison may be made routine by prescribed standing operating procedure. From Higher to Subordinate Headquarters. The usual purposes of liaison from higher to subordinate headquarters are to obtain information, transmit orders, clarify the existing situation and orders, and receive and transmit requests for assistance. This liaison is maintained when authorized by the higher commander. Selection of Liaison Officers. The maximum effectiveness of liaison missions will be secured if the officer selected for this duty: a. Has the confidence of his commander. b. Is favorably known, either personally or by reputation, by the commander and staff of the unit to which sent. c. Has a sound and comprehensive knowledge of tactics. d. Posseses tact. e. Has had experience or training as a liaison officer. Duties of Liaison Officers. Prior to departure the liaison officer should: (1) Become familiar with the situation of his own unit and so far as practicable with that of the unit to which sent. (2) Ascertain definitely his mission. (3) Insure that arrangements for communication (signal and transportation) are adequate. (4) Obtain credentials in writing unless obviously unnecessary. On arrival at headquarters to which sent, the liaison officer should: (1) Report prompdy to the commander, stating his mission, and exhibiting his directive or credentials, if in writing. (2) Offer his assistance to the commander, if appropriate. (3) Arrange for the transmission of messages he may be required to send. (4) Arrange to obtain information required by his mission. (5) Familiarize himself with the situation of the unit to which sent. During his liaison tour the liaison officer should: (1) Further harmonious cooperation between his own headquarters and the one to which sent. (2) Accomplish his mission without interfering with the operations of the head- quarters to which sent. (3) Keep himself informed of the situation of his own unit and make that infor- mation available to the commander and staff of the unit to which he is sent. (Such action is of special importance to liaison officers of attached or supporting units.) (4) Keep an appropriate record of his reports. (5) Report on those matters within the scope of his mission. 150 MILITARY MEDICAL MANUAL (6) Advise the visited unit commander of the contents of reports to be sent to his own headquarters. (7) Make prompt report to his own headquarters if he is unable to accomplish his liaison mission. (8) Report his departure to the visited unit commander on the completion of hxs mission. On return to his own headquarters the liaison officer should: (1) Report on his mission. (2) Transmit promptly any requests of the commander from whose headquarters he has just returned. Duties of Sending and Receiving Headquarters. The commander of the headquarters sending a liaison officer should: (1) Give the liaison officer definite and detailed instructions, in writing if appro- priate, as to the liaison mission. (2) Inform the liaison officer of the commander’s plans, especially as they affect the unit to which he is to be sent. (3) Insure that adequate facilities are available for communication (signal and transportation means) between the liaison officer and the sending headquarters. The commander of the headquarters receiving a liaison officer should: (1) Give the liaison officer all assistance possible, compatible with the normal operations of the headquarters. (2) Keep the liaison officer informed as to the plans for future employment of the unit visited. (3) Give the liaison officer free access to those staff sections or troops having data pertinent to the liaison mission. The contact established by liaison officers does not relieve commanders from the re- sponsibility of keeping the next higher, lower, and adjacent commands informed of the situation through normal channels. CHAPTER VI SUPPLY AND EVACUATION OF LARGE UNITS Scope. This chapter deals with the problems of supply and evacuation of large units within the combat zone. The system of supply of small units is presented in detail in Part III, of this volume. The vast problem of procurement of supplies and adequate provisions for the mobilization of materiel and industrial organizations essential to wartime needs is made the specific function of the Assistant Secretary of War, under the direction of the Secretary of War, by the provisions of the National Defense Act of 1916, as amended. The purpose of this chapter is to define and illustrate this vital phase of military operations as it must be accomplished in the field with sufficient detail to enable the reader to visualize the problem and its methods of accomplishment. The modern army is dependent to an amazing degree upon a multitude of mechanical devices, motor transportation, highly specialized arms and equipment. An army con- sumes vast quantities of supplies of many kinds such as food, gasoline, and ammunition. Its equipment is subject to destruction in battle, to unusually severe wear and tear, to loss from many causes. Notwithstanding these obvious difficulties, the army must enter upon a campaign without shortage of essential equipment. During combat the vital re- quirements must be replaced substantially as rapidly as they arc consumed. When the battle is over the army must be refitted. These operations provide a tremendous problem for the supply services. The enormity of the undertaking may be better visualized by considering the supply and evacuation requirements which confront a war strength reinforced corps as they are now estimated for the first day of attack of a position. Tons of rations required 359 Tons of small arms ammunition required 730 Tons of all other ammunition required 3768 Tons of Class 11, 111, IV supplies required 898 Casualties to be evacuated 3400 Considering the factor of tonnage alone, six trains hauling approximately 1000 tons each must be brought into the corps area and unloaded; the supplies have to be placed in depots, other supply points, or distributing points so that they will flow forward to the troops as they are required. The components of these tons and trainloads must be visual- ized as a multitude of separate items, each of which must be forwarded in the neces- sary quantities and must reach the unit for which intended in time to meet its require- ments. Modern armies have been able to attain this objective. It requires training of supply specialists, the development of the necessary facilities, and understanding by the using services of the system adopted so that they may supply the necessary information in time to permit the service of supply to operate efficiently. Perhaps the greatest requirement is foresight so that future needs arc properly anticipated. Not the least important factor in this foresight is appreciation of the scope and importance of the basic problem. It is a principle that the necessary supplies must be made available to support the com- mander’s tactical plan. If this cannot be accomplished for any reason whatever the com- mander must be informed of the fact as it must affect his further actions. It requires careful estimate of the requirements well in advance of a projected, large-scale operation. The supplies must be obtained and placed in depots for distribution. As required by the troops, they must be forwarded and distributed. Breakdown in the supply service may have a disastrous eflect upon the outcome of battle. General Principles Governing Supply and Evacuation. Each commander of a unit in the chain of supply is responsible for providing adequate supplies and replacements (men and animals) for its own next subordinate units at the time and place needed. Anxiety as to supplies must not divert the attention of the troops from their tasks as concerns action with the enemy. For example, the division commander is responsible that his 152 MILITARY MEDICAL MANUAL infantry regiments, artillery battalions, and other organic or attached units are furnished with their requirements. Thus the impetus of the movement of supplies and replace- ments is said to flow from the rear to the front. The same principle applies to the evacuation of sick or wounded men and animals. The higher unit assumes responsibility of relieving the next lower unit of its casualties. Combat units must be free from the burden of excessive supplies. Stockage of supplies must be echeloned in depth to provide against shifting tactical situations and interruptions in the rate of delivery. Whatever the actual system of supply adopted in a particular situation, it must be flexible. The conditions of batde are subject to constant change. The fact that a division occupied a certain location under a known situation at the time the request for supplies was originated does not mean at all that the location or situation will necessarily be the same at the time of delivery. The method adopted must be flexible so that these changing conditions will not stop the flow. Supplies must find the troops, not the troops find the supplies. Further, the plan must be simple. This much overworked term is subject to various interpretations as the easy way to accomplish any task is not usually apparent to the unskilled or the novitiate. Certainly the plan must avoid complexities. Operation of the Supply System. The commander of a military unit is responsible for the operation of his system of supply just as he is responsible for all other phases of its operation. In the execution of this responsibility he is assisted by the heads of the supply services within his organization and by the G-4 section of his general staff. In the infantry division the following officers of the special staff are operating agencies for supplies pertaining to their own branch: The Division Quartermaster. The Division Surgeon. The Division Signal Officer. The Division Chemical Warfare Officer. The commander of the artillery of the division. Other representatives of supply arms or services who may be provided. The G-4 section of the general staff, among other allied responsibilities, is charged with making certain that the plan of supply proposed by the operating agencies will be adequate to the commander’s tactical plan; that the operating agencies are coordinated among them- selves as to location of installations, priorities on delivery, and use of means of transport and labor; the section makes certain that the necessary adjustments are made in the basic plan to meet changing situations. Finally, the G-4 of a command is responsible to the commander that needs are foreseen and provided for and that the system “works.” Classification of Supplies. For purposes of convenient reference, supplies required by troops in the field are classified as shown below. It will be noted that items furnished by two or more supply services may be placed in the same classification. Class 1. Those items such as rations, forage, and illuminants which are consumed at an approximately uniform daily rate irrespective of combat operations or terrain and which do not necessitate special adaptation to meet individual requirements. These supplies are usually forwarded on an automatic basis (see definitions below). Calls for Class I supplies are made by the daily telegram. The depots make up the shipment as required. It is loaded on the daily train and dispatched through the regulating station to the proper railheads. At the railhead distribution is effected by the quartermaster. Class 11. Those authorized articles of equipment which, though consumed at an approxi- mately constant rate, are for the personal use of the individual and necessitate special arrange- ments to meet individual requirements; examples are clothing and gas masks. These items are usually made available in the form of credits in designated depots on which units may draw as required. Unit supply officers submit approved requisitions to the proper supply service of the next higher echelon in the chain of supply where, if available, they are filled from stock. If requisitions are filled from the depot, shipments are made up and dispatched through the regulating station to the proper army supply establishment as outlined above for Class I supplies. Also those authorized articles of equipment for which allowances are established by SUPPLY AND EVACUATION OF LARGE UNITS 153 Tables of Organization and Tables of Allowances, such as arms, and engineer, medical, ordnance, quartermaster, and signal equipment, including motorized and animal-drawn vehicles. Delivery is made on the same basis as that described for Class I supplies. Class 111. Motor fuels and lubricants (air and ground). Class IV. Those articles of supply which are not covered in Tables of Allowances and the demands for which are directly related to the operations contemplated or in progress, such as fortification materials, construction materials, and machinery. These supplies are furnished on a requisition basis as Class II supplies. Class V. Ammunition. Definitions. An understanding of the terms defined below is necessary for the further study of the system of supply. Theater of war. Areas of land and sea which are or may become directly involved in the operations of war. The part of this area under the control of each belligerent is usually divided into a zone of the interior and one or more theaters of operation. Zone of the interior. That part of the national territory not included in the theater of operations. The functions of the several agencies of the zone of the interior, in time of war, arc to supply the commander of the field forces with the means necessary for the accomplishment of his mission. Theater of operations. That part of the theater of war in which operations are con- ducted. It is divided for the purposes of combat and for decentralization of administration into a communications zone and a combat zone (see plate 1). Communications zone. That portion of the theater of operations containing the prin- cipal establishments of supply and evacuation, lines of communication, and other agencies required for the continuous service of the forces in the theater of operations. Combat zone. The forward area of the theater of operations. Each army, corps, and division area covers the zone of operations of the unit to which it pertains and is under the control of the commander thereof. Automatic supply. A process of supply under which deliveries of specific kinds and quantities of supplies are moved in accordance with a predetermined schedule. Daily automatic supply means that certain supplies are dispatched daily to an organization. Rations are usually delivered in this manner. The daily telegram is the basis for determin- ing quantities to be delivered. Daily telegram. A report of strength made by a division or higher unit which serves to determine the unit’s daily requirements of Class I supplies. Credit. An allocation of a definite quantity of supplies, placed at the disposal of the commander of an organization for a prescribed period of time, on which he may draw as required. The amount of the credit is an important factor in determining the extent of operations in which a unit may engage. It is futile to undertake an extensive military operation unless the required supplies in the form of credits are available to draw upon as needed. Requisition. An authoritative, original demand for supplies required. The quantity called for in a requisition should be considered in connection with the credits and future requirements. Call or draft. A demand for the delivery of supplies under the terms of a credit. Priorities. Definite rulings which establish, in the order of time, the precedence of ship- ments and the movements of rail, road, and water transport. Ammunition, for example, may be forwarded ahead of all other supplies because of the urgency of tactical require- ments. Day of supply. A yardstick used by the higher echelons of the staff for determining levels, credits, and transportation requirements. It expresses collectively, in pounds per mon per day, the estimated average expenditure of the various items of supply, per day, in campaign.1 The amounts are determined by experience, the size and composition of the forces involved, the character of the operations, the nature of the enemy, and prevail- ing climatic conditions. 1 According to newspaper accounts of the movement of the British Army to France at the begin- ning of World War II, It was necessary to move per man per day across the to serve the expected requirements of the expedition. 154 MILITARY MEDICAL MANUAL ARMY COMBAT AREA"' COMBAT ZONE ARMY SERVICE AREA SECOND COMMANDER OF THE THEATER OF OPERATIONS FIRST THEATER OF OPERATIONS ■ SECRETARY OF WAR- 'advance SECTION GHQ ADVANCE SECTION 'GHQ- ■COMMUNICATIONS ZONE GHQ- BASE SECTION BASE SECTION -GHQ- ZONE OF THE INTERIOR, WAR DEPARTMENT' Plate 1. Schematic Diagram of the Organization for Supply in a Theater of Operations. SUPPLY AND EVACUATION OF LARGE UNITS 155 Day of fire. An arbitrary unit of measure for ammunition expenditure expressed in rounds per piece. The character of the operations is the basis of this estimate. It is subject to change according to experience. Depots and depot classifications. A depot is an establishment for the reception, storage, classification, issue, or salvage of supplies or for the reception, classification, and forward- ing of replacements. The designation of a depot is that of the unit establishing it, followed by the kind of supplies stocked. For example: “First Army Ammunition Depot No. 1”; “Communications Zone General Depot No. 3”; “First Army Replacement Depot”. A general depot affords accommodations for the operation of two or more supply arms or services. A branch depot pertains to a single supply arm or service. General or branch depots may be base, intermediate, or advance depots, depending upon their loca- tion in the communications zone. Army depots are branch depots located in the combat zone under the jurisdiction of the army. A corps operating independently will usually find it necessary to establish branch depots similar to army depots; these are designated corps depots. Regulating station. This is a traffic-control agency established on the lines of com- munication through which movements of supplies arc directed and controlled by the com- mander of the theater of operations. Usually, one is provided for each army or similar command. In an emergency, motor transportation will supplement rail transportation, and the regulating officer must be prepared to substitute motor service if ail transport is disrupted. Lines of communication. These include the network of railways, waterways, and roads which lead into the combat zone from the supply and evacuation establishments located in the communications zone and the zone of the interior. Railhead. A point on a railway, designated as such, which provides rail accommoda- tions for the supply of troops whom it is designated to serve. It marks the forward limit of rail transportation within the combat zone. It must be located convenient to the troops served, beyond the maximum effective range of enemy artillery, and have sufficient siding capacity to accommodate at least one unit section of the daily train. Generally not more than two divisions, or one division and corps troops, should be served from any one railhead. Truc/{ head and navigation head arc similar terms. Daily train. The railway train arriving daily at the railhead with Class I and other supplies for the troops whom die railhead serves. A unit section is made up for each division. It is dispatched from the regulating station. It should arrive at or before midnight to allow time for unloading and delivery under the cover of darkness. Supply point. A generic term used to include depots, railheads, distributing points, air bases, and dumps. The term “refilling point” is no longer in use. Distributing point. A place at which supplies are distributed to trains of the troops. Separate distributing points are usually established for Class I supplies and small-arms ammunition. Distributing points for other supplies, such as artillery ammunition, water, and engineer supplies, are established as required. Distributing points for Class I supplies, water, and small-arms ammunition must be convenient to the troops served but should be beyond the range of hostile small arms in a location with concealment and cover. Dump. A temporary stockage of supplies within the area of corps, divisions, or smaller units. Dumps are designated by the identity of the unit establishing them and the class of supplies therein; such as, “1st Infantry Ammunition Dump” or “1st Division Class I Supply Dump.” Control point. An agency established by a unit at a convenient point on the route of its trains where information and instructions are given and received to facilitate and regulate supply. Train. The train of a unit is that portion of the unit’s transportation with its ac- companying personnel which operates under the immediate orders of the unit com- mander in supply, evacuation, and maintenance. The designation of a train is the same as that of the unit, as “1st Infantry Train.” A train may be subdivided according 156 to the service in which it is engaged; for example, “Ammunition Train, 1st Infantry,” “Kitchen Train. 1st Battalion, 1st Infantry,” or “Medical Train, 1st Battalion, 1st Field Artillery.” Straggler line. A line usually located close in rear of the light artillery positions along well defined terrain features. On or in rear of this line military police are stationed to apprehend stragglers moving to the rear. A straggler collecting point is a location on the straggler line at a place which is likely to be used by stragglers. They are returned to their organizations from this point. Prisoner of war collecting points. A place where prisoners of war are delivered by organization guards and turned over to the military police for custody. Prisoner of war enclosure. A place for safe-keeping and confinement of prisoners war pending their evacuation to the rear. Traffic control post. A critical point on a highway at which one or more men are stationed to regulate traffic. Traffic patrol. One or more men mounted on horses, bicycles, or motorcycles for the purpose of patrolling roads between traffic control posts. Officers’ control station. One or more officers and a detachment of military police detailed to control and regulate traffic within a critical area, such as a town, defile, or multiple road intersection, where immediate action by a responsible authority is necessary. Evacuation. The process of clearing the combat zone of battle casualties in both men and animals. Collecting station. A place at which casualties are assembled from unit aid stations, frequendy by litter carry, where they are examined, given the necessary treatment, fed, and sorted for return to their units or removal to the hospital station (or clearing station). Its distance from the front line wi*’. usually vary from 1500-3500 yards. It should be on the natural line of drift of wounded, be protected from hostile small-arms fire and obser- vation, and on a practicable ambulance route. Water, wood, and shelter should be available. Clearing station. The division medical installation where sick and wounded are assembled from collecting stations, sorted, treated if necessary, and turned over to the army for further evacuation. (Formerly called “hospital station.”) Evacuation hospital. A hospital through which all casualties pass in their transit from the combat zone to the communications zone. They are established in groups of two or more behind each corps at from 10-16 miles in rear of the battle tront along railroads leading to the communication zone hospitals and along roads which lead forward to the division areas. Casualties are moved by ambulance from the hospital stations of divisions to the evacuation hospital. Surgical hospital. A hospital assigned to the immediate support of division hospitals, from which the more serious cases or non-transportable cases arc received. Hospital train. A train which is specially equipped and supplied for the purpose of moving patients from evacuation hospitals to the communications zone. Reserve supplies. Supplies which are accumulated in depots in excess of immediate needs for the purpose of insuring continuity of an adequate supply under any condition of campaign. The stockage of depots for future needs and the level of supplies of all categories to be maintained are important questions of decision. These supplies are classified as base, battle, unit, and individual. Base reserves. Supplies accumulated and stored in depots, for the purpose of estab- lishing a general reserve, under the control of the commander of the theater, for the theater of operations as a whole. Battle reserves. Supplies accumulated in the vicinity of the battlefield in addition to unit and individual reserves. They are often accumulated in anticipation of a particular operation. If these supplies are left on freight cars so as to be quickly moved they are sometimes referred to as rolling reserves. Unit reserves. The prescribed quantities of supplies carried as a reserve by a unit. Unit reserves of rations, ammunition, and gasoline are maintained as regular procedure. They insure supply during minor emergencies when for any reason the supply service is interrupted. MILITARY MEDICAL MANUAL SUPPLY AND EVACUATION OF LARGE UNITS 157 Individual reserves. Supplies carried on the soldier, animal, or vehicle for his or its individual use in an emergency. "Rolling” reserves. The prescribed load of supplies carried on trains of the corps, division, and subordinate units. These supplies may be placed in dumps to obtain re- lease of transportation for other purposes. Also reserves stocked on railway trains. The Division as a Link in the Supply System. The division is the basic supply unit for combat troops. The field army is the principal administrative (and supply) unit in the combat zone. The army corps, when part of an army, is not a link in the chain of supply, evacuation, and replacements for its divisions except requisitions for and allocations of ammunition and personnel. In accordance with the principle that each commander is responsible for the supply of the components of his force, the impetus coming from the rear, the division receives and distributes the supplies which are forwarded to it by the supply agencies under the control of the field army commander. Plate 1 illustrates in diagram the location and nature of these supply agencies. The division commander is responsible for the administration, supply, and evacuation of his force to the same extent as for its action in battle. The delivery and distribution of supplies within a division whose trains are motorized are effected by hauling either in regimental or divisional transportation from army supply points to the using troops. Normally, supplies are not transferred to other trucks or placed in dumps from the time they are received from the army supply points until they are delivered to the using troops. Based upon consideration of the tactical situation, the reserves carried, the probable expenditure rate, the distances envolved, the routes available, and the restrictions imposd by higher authority, the division commander determines the degree of responsibility that will be placed on subordinate commanders for effecting resupply with their own transportation. The division com- mander must insure that the requirements placed on subordinate units for the utiliza- tion of their transportation in effecting resupply are not excessive. That part of the hauling requirement which is not delegated to subordinate commanders must be exe- cuted by transportation of the division quartermaster battalion or quartermaster regi- ment (in the square type division). On the other hand, the transportation of the division quartermaster unit constitutes the division reserve, which is inadequate to meet in full the requirements for resupply of the division during a protracted period. The reader should understand that the division commander may prescribe that sub- ordinate commanders will provide for resupply with their own unit train; or that re- supply will be handled in its entirety by trucks of the division quartermaster unit; or that it may be done by unit trains, in part, and by the quartermaster unit, in part. Pooling of Truck Transportation. While certain trucks are assigned prescribed loads, it does not follow that their use is limited to transporting such loads. Except for motor vehicles issued as an aid to the movement of active weapons, such as prime movers or weapon carriers, all of the trucks of a unit are considered by commanders as a pool of transportation to be used as required. By this means maximum flexibility and capacity are obtained. Replenishment of Gasoline and Oil. The modern military force of large size requires huge quantities of gasoline and oil. It is obvious that the consumption rate per day must vary within the widest limits, depending upon distances moved, distance to supply points, and the total truck-miles of transportation required. Accordingly, no fixed quantity can be specified as a day of consumption of a unit. A reserve of gasoline and oil in containers is carried in each unit. As far as prac- ticable, initial distribution of this reserve is made to each vehicle. This constitutes the entire division reserve. Each vehicle sent to an army supply point replenishes its supply en route at some convenient gasoline supply point established by the army. Vehicles remaining in the forward areas are resupplied by exchanging empty containers for full ones brought forward by regimental or divisional transportation. Procedure to Obtain Class I Supplies (Rations, Forage, and Illuminants). The fol- lowing rations are prescribed for field service (Circular 88, War Department, November 7. 1939). 158 Field Ration A: Corresponds to the garrison ration and is perishable. Field Ration B: Same as A but with nonperishable components. Field Ration C: Previously cooked ration; 6 cans per individual ration, 3 of meat and vegetables, and 3 of crackers, sugar, and coffee. Field Ration D: Three 4-ouncc chocolate bars per individual ration. The A ration will normally be issued daily from Class I railheads to all divisions and other units not actively engaged with the enemy. In batde, one of the nonperishable rations or combinations will usually be issued to the units engaged. Class I supplies are usually furnished on an automatic basis. Daily strength reports are submitted by each company and battery to the regiment where they are consolidated and forwarded to the division headquarters. The sum of these reports is the strength of the division and is the number of officers and men, and animals, for whom Class I supplies are to be received. The division quartermaster prepares and sends a daily telegram stating the strength to the army quartermaster. This information from all the components of the army is then furnished by telegram to the quartermaster supply officer at the regulating station. This officer notifies the appropriate depots in the communication zone or zone of the interior to forward the required supplies. The depots make up the required shipment as required, based solely on the strength reports, forwarding ration components and other Class l supplies according to definite schedules. It is noteworthy that mess officers in the field have no choice whatever of the ration components they will receive; rations are sent forward sufficient for the number of men reported in the strength report. Balancing the diet and variations in the ration com- ponents are determined at the point of origin of the shipment. The shipment starts for- ward, usually by rail, from the depot and passes through the regulating station en route to its final destination. At the regulating station cars are assembled into unit sections, one section, for example, being made up for each division. This section becomes the daily train. It is dispatched from the regulating station in time to permit arrival at the division railhead at a pre- arranged hour. This time of arrival is usually after dark and before midnight so that the train can be unloaded and the supplies distributed to the troops before daylight. At the railhead the daily train is unloaded and the supplies are distributed by the division quartermaster service. This may be accomplished by different methods. Unit distribution consists of loading the supplies for a unit, a regiment for example, on trucks of the division train; they are then hauled to the distributing points for Class T supplies estab- lished for the particular units concerned. A regiment of infantry may secure its supplies from the same distributing point, which is usually located at the bivouac of the unit trains. At each distributing point the trucks are unloaded, the supplies separated for each subordinate unit such as a company and loaded into trucks of the unit train for final delivery. Rations are sent directly to the kitchen sections. Railhead distribution is a second method. In this method the railhead becomes the distributing point and supplies are not moved in trucks of the division train. The supplies are unloaded at the railhead, separated into loads for each subordinate unit, and secured at that point by the unit trains. Delivery to the troops is then accomplished. Combinations of these methods may be used, some subordinate units being supplied by unit distribution while others use railhead distribution. The distance of the railhead from the troops and the availability of transportation are determining factors in the selection of method. Reserve Stockage of Supplies. The ideal flow of supplies, if it were possible of at- tainment, would place in the hands of troops today the things they will consume today. With such an arrangement the slightest interruption or miscalculation would result in immediate shortages with the troops. A reserve of supplies is necessary to provide against interruption in delivery, such as might result from enemy bombing operations, and to provide available supplies in quantities beyond the hauling capacity of a unit during an operation. The quantities of supplies held in reserve stockage depends upon the nature and extent of the proposed tactical operation, the capabilities ox the enemy to interrupt the MILITARY MEDICAL MANUAL SUPPLY AND EVACUATION OF LARGE UNITS 159 normal bow of supplies, the distance to supply depots, and other factors. The amount and kind of reserve supplies are decisions to be made by the commander. If too little a reserve is maintained hardship may result, as a minimum, and disaster as a maximum. On the other hand, if too great quantities are stocked the unit loses flexibility in move- ment, excessive manpower is consumed in loading and unloading vehicles, and in the event of a sudden withdrawal under hostile pressure large quantities of valuable stores must either be destroyed or abandoned to the enemy. The ration reserve to be carried by individuals and on unit trains as a prescribed load is announced by the division commander. The rations within a division would rarely exceed three in number. For example: one ration issued to the kitchens with which to prepare the next three meals, one ration in reserve, transported on unit trains; and one ration retained under the control of the division quartermaster. The reserve of gasoline and oil, as discussed above, is carried by each vehicle in extra cans. The reserve of ammunition is provided by issue of complete loads to combat units and vehicles, by dumping of loads of certain ammunition-carrying vehicles in areas conven- ient to combate units, and the return of these vehicles thus emptied to army supply points for additional quantities. The problem of estimating the kind and quantity of supplies required for an ex- tensive operation of a large force is a responsibility of the commander. He must reach the decision by a far-sighted analysis of all the factors which may confront his sub- ordinate units. The supply of small-arms ammunition is a responsibility of the division ordnance officer. Using transportation and labor from the division quartermaster regiment or battalion, ammunition is obtained from supply points established by the army or independent corps. It is then transported to small-arms ammunition distributing points, usually estab- lished in rear of each brigade and conveniently located with respect to the positions of troops. The trains of units secure loads at these points as they are required. Units with motorized trains may secure ammunition direct from the supply point. Issue of ammunition to the troops becomes a responsibility of regimental commanders as soon as it has been turned over to them at the distributing points. This phase of delivery is a function of battalion or regimental supply sections. Supply of artillery ammunition is a direct responsibility of the commander of the di- vision artillery. He lias an ammunition train for the purpose. Ammunition is obtained from artillery ammunition supply points which are established by the army or independent corps. It may be delivered direct to the batteries, or distributing points may be established in convenient locations where unit trains obtain it as required. Anticipation of quantities of ammunition required for a projected operation is a vital consideration, Battle reserves may be built up in anticipation of peak needs at depots and at supply points. Extra ammunition may be issued to the troops, ammunition carry- ing vehicles may dump their loads in convenient locations and then be refilled. Foresight is required to anticipate the requirements and to provide the necessary stockagc in advance depots so that delivery to the troops may be accomplished rapidly. In this phase of planning considerable use is made of the units established by the day of fire and day of supply of ammunition and other supply requirements, respectively. While these computations are valuable chiefly in determining tonnage, depot capacities, and number of trains required, they arc important for large units. These figures are subject to constant revision to accord with experience. Procedure to Obtain Other Supplies. Other supplies are obtained on approved requi- sition through unit supply officers. Heads of supply services of the division either fill the requisition from their own restricted stockage or forward it to higher headquarters. After approval, the requisition is then sent to the appropriate depot or supply point where it is handled by the unit concerned. Engineer distributing points may be established in loca- tions convenient to the troops for distribution of large quantities of tools or materials. Medi- cal supplies are procured by the service company of the medical regiment or battalion from medical depots of higher echelons and distributed to medical units, including 160 MILITARY MEDICAL MANUAL attached medical personnel with the regiments. Water, where practicable, is obtained locally and chlorinated as a matter of protection. Whenever necessary because of inadequate local supplies of potable water, water distributing points are established and operated by the division engineer regiment or battalion. From these points water con- tainers of units of the division are filled. Reinforcing units to the division are supplied by the division, responsibility resting upon the division commander to the same extent as for his organic components. Procedure for Evacuation of Casualties. Casualties are first assembled at aid stations of the regiment or battalion, by litter if necessary, by medical personnel attached to regi- ments. From the aid stations, after the administration of the immediate requirements of medical care, they are transported to collecting stations by litter, by ambulance, or by walking. From the collecting stations they are moved by ambulance to the division clearing station. Division clearing stations are evacuated (cleared of patients) by medical units of the army of the independent corps. CHAPTER VII LEADERSHIP1 The Individual in War. Man is the fundamental instrument in war; other instruments may change but he remains a constant factor. Unless his behavior and elemental attri- butes are understood, gross mistakes will be made in planning operations and in troop leading. The conduct of the average man in battle is governed more by instinct than by reason. By instinct he is gregarious and prefers to fight in the group. He is beset with fear of the unknown, especially at night and when, alone, and therefore seeks security in the group. He readily accepts symbolic ideals implanted by tradition and national culture and will fight for these ideals when he is aroused. His instinct of self-preservation will induce him to flee from danger but he is deterred from flight by the disgrace he feels in the eyes of his comrades. He wants to earn their respect and esteem as measured by the standard of military conduct accepted by the group. In the training of the individual soldier, the essential considerations, therefore, are to integrate the individual into a group and to establish for that group a high standard of military conduct and performance of duty. War places a severe test on the moral stamina and physical endurance of the indi- vidual. It is not sufficient that he be well armed and equipped. Not only must the individual soldier be physically hardened, but he must be qualified to march, to use his weapons, and to care for himself and his transportation in the field. The individual soldier must be fortified by discipline which is based on a high ideal of military conduct. This disciplne must cause every man to have a horror of the disgrace that will be visited upon him and his unit if he succumbs to fear and endangers his comrades. An endeavor to dominate the instinct of self-preservation by the fear of a greater terror is resorted to only in extreme cases and then primarily for its salutary effect on the members of the group. As a rule it is far better to dominate demoralizing influences by inculcating in the individual a proper sense of duty, a conscious pride in his unit, and a feeling of mutual obligation to his comrades in the group. In spite of the advances in technique, the worth of the individual man is still decisive. His importance has risen due to the open order of combat. Every individual must be trained to exploit a situation with energy and boldness, imbued with the idea that success will depend upon his action. The dispersion of troops in battle caused by the influence of modern weapons makes control more and more difficult. Modern combat, therefore, requires more than ever a strong cohesion within a unit in order to give it a sense of unity. This cohesion is promoted by good leadership, pride in the accomplishments and reputation of the unit, and by mutual confidence and comradeship among its members. Troop Leading. Troop leading in combat, regardless of the echelon of command, calls for cool and thoughtful leaders with a strong feeling of the great responsibility imposed upon them. They must be resolute and self-reliant in their decisions, energetic and insistent in execution, and unperturbed by the fluctuations of combat. Example of Leadership. Troops are strongly influenced by the example and conduct of their commissioned and noncommissioned leaders. Will power, self-confidence, initiative and disregard of self will enable a leader to master the most difficult situation. A bold and determined leader will carry his troops with him no matter how difficult the enterprise. Mutual confidence between the leader and his rr.en is the surest basis of discipline in an emergency. To gain this confidence, the leader must find the way to the hearts of his men. This he will do by acquiring an understanding of their thoughts and feelings, and by showing a constant concern for their comfort and welfare. Combat Value of Units. The combat value of a unit is determined by the soldierly qualities of its leader and members and its “will to fight.” An outward mark of this combat value will be found in the set-up and appearance of the men, in the condition, care, and maintenance of their weapons and equipment, and in the readiness of the 1 The Officer’s Guide, Military Service Publishing Company, has abundant material on this subject. MILITARY MEDICAL MANUAL 162 unit for action. Superior combat value will offset numerical inferiority. The greater the combat value of the troops, the more powerful will be the blow struck by the com- mander. Superior leadership combined with superior combat value of troops constitutes a reliable basis for success in battle. Importance of Discipline. A hastily or poorly trained unit is likely to fail in a critical moment due to demoralizing impressions caused by unexpected events in combat. This is particularly true in the first engagements of a unit. Therefore, training and dis- cipline arc of great importance. Every leader is obliged to take energetic action against indiscipline, panic, pillage, and other disruptive influences. Discipline is the cohesive force that binds the members of a unit and its strict enforcement is a benefit for all. Its constraint must be felt not so much in the fear of punishment which it evokes as in the moral obligation it imposes on the individual to heed the common interest of the group. Relations of the Commander with His Troops. A commander must live with his troops, and share their dangers and privations as well as their joys and sorrows. By per- sonal observation and experience he will then be able to judge their needs and combat value. A commander who unnecessarily taxes the endurance of his troops will only penalize himself. The expenditure of combat strength must be in proportion to the ESSENTIALS OF TROOP LEADING 1. Ability to reach a logical decision and sound plan. (Estimate of the Situation.) 2. Ability to transmit his decision and plan to his subordinates in the form of clear and simply expressed orders. (Issue of orders.) 3. Possession of the strength of character and knowledge of human relation- ships to force the execution of his orders. (Supervision.) objective to be attained. Impossible demands only undermine the morale of troops and destroy their confidence in the leader. Comradeship among officers and men is to be fostered by every available means. The strong and the capable must encourage and lead the weak and less experienced. On such a foundation, a feeling of true comradeship will become firmly established and the full combat value of the troops will be made available to the higher commander. Acceptance of Responsibility. A willingness to accept responsibility is the foremost trait of leadership. This willingness should not, however, manifest itself in a disregard of orders on the grounds of probably having a better knowledge of the situation than the higher commander. Independence must not be confused with personal caprice. Officers and men of all grades are expected to exercise a certain independence in the execution of tasks assigned to them and to show initiative in meeting situations as they arise. Every individual from the highest commander to the lowest private must always remember that inaction and neglect of opportunities will warrant more severe censure than an error of judgment in the choice of the means. Morale and Unity. A wise and capable commander will see that the men assigned to the component groups of his unit are compatible and the composition of the groups is changed as little as possible. He will provide each group with a leader in whom its members have confidence. He will so regulate the interior economy of the unit that all groups perform the same amount of work and enjoy the same amount of leisure. He will see that demonstrated efficiency is promptly recognized and rewarded. He will set before all a high standard of military conduct and apply to all the same rules of discipline. Good morale and a sense of unity in a command cannot be improvised; they must be thoroughly planned and systematically promoted. They are born of just and fair treatment, a constant concern for the soldier’s welfare, thorough training in basic duties, comradeship among men, and pride in self, organziation, and country. The establish- ment and maintenance of good morale arc incumbent upon every commander and arc marks of good leadership. The Decision. All commanders must reach their decisions by a logical process of thought. The process is called the “estimate of the situation.” Prior to contact, or the beginning of a planned operation to be executed at a later time, there may be oppor- tunity for a lengthy, time-consuming, painstaking analysis in which is considered all of the factors which can affect the outcome. A commander will compare each possible action which he can adopt, within the sphere of his mission, with each enemy reaction. Finally he will arrive at his decision which will include what the command as a whole will do, when, where, and how it will do it. Illustrative of a decision is the following: “To attack without delay enveloping the hostile south flank from the vicinity of Joncs- ville to seize the high ground east of Smithton. “Line of departure: Highway 22. “Boundary between brigades: •***•* *.” There is no room for vacillation, for hunches, for “snap” judgment. All of the fac- tors must be determined, weighed, analyzed, and accepted or rejected. It culminates in the decision. In the heat of battle, commanders will rarely have time for such a detailed process prior to announcing the action to be taken. But the necessity for a thorough estimate is in no way reduced. Under these conditions each officer and man “lives” with the situation. The commander must be aware of the location and situation of his units. He must obtain and evaluate information of the enemy. He must be alert to each possible hostile threat and eager to exploit each enemy weakness. Foreseeing all possibili- ties he must have in mind tentative plans in constant development to meet each change in the situation. Under these conditions the announcement of a decision and plan to meet a sudden threat or exploit an opportunity is a matter of a brief period, perhaps a few minutes, even a few seconds. See Chapter VII, Part III. The Plan. After the commander has reached his decision he must evolve the plan by which it is to be executed. It will direct the essential tactical operations to be under- taken and make disposition of the major combat elements. It includes the basic tactical decision, supplementary decisions regarding unit tactical missions, intelligence and secur- ity measures, and administrative matters necessary to give effect to the decision. Definite missions are assigned to the principal components of the force. In an attack, for example, the plan may include the designation of the units to make the holding attack, the main attack, and the reserve with its initial location. Many other details may be included, depending upon the desires of the commander, the state of training of the troops, the skill of his staff and subordinate commanders, and the degree of teamwork which has been developed between the components of the force. The commander who has no staff must of necessity prepare all of its details. But when a trained staff is available he may utilize it to develop it in final and complete form. When this process is followed the commander issues a directive to the staff, or to his chief of staff, in which he states the decision and outline of his plan. The staff will then complete it and, subject to approval of the commander, prepare and issue orders to the components of the force. Orders. The will of the commander as expressed in his decision and completed plan is transmitted to subordinate commanders in the form of orders. They may be issued as written field orders, they may be dictated to the subordinate commanders of prin- cipal units, issued orally, in complete form or fragmentary form. Whatever the method of issue, there are two requirements which must be met: f irst, they must reach the subordinate commanders, even of the smallest units, in time for them to make their own reconnaissance, their plans, issue their orders, and place their units in the required posi- tions; second, they must be so clearly expressed as to eliminate any chance of misunder- standing or confusion. Under many conditions of combat, especially where speed in execution is required, time may be saved by having the phases of planning and execution proceed simultane- ously, each step being started as soon as it is decided upon. It may start, for example. LEADERSHIP 163 164 THE LOGICAL BASIS OF THE COMMANDER’S ESTIMATE OF THE SITUATION MILITARY MEDICAL MANUAL Par. 1 OBJECT With the MISSION as the guiding consideration Par. 2 CALCULATION Estimation and Calculations of the CONSTANT FACTORS of the situation (Relative Combat Power, Time and Space, Terrain, etc.) in combination with all appropriate methods of TACTICAL ACTION leads to DEDUCTION of their EFFECT (preventing, hindering, favoring) to LIMIT the ACTION of the VARIABLE FACTORS YOUR FORCE to all reasonable and practic- able lines of action open to you to accomplish your mis- sion. (1, 2, etc.) ENEMY FORCE To all physical capabilities of the enemy to hinder the ac- complishment of your mission. (1, 2, 3, etc.) Par. 3 VISUALIZATION ANALYSIS of the lines of action and capabilities of the VARIABLES (WHAT WILL HAPPEN IF) OWN LINES OF ACTION OPPOSED BY ENEMY CAPABILITIES etc. Leads to determination of the ADVANTAGES & DISADVANTAGES of your own lines of action. Par. 4 SELECTION COMPARISON of the advantages and disadvantages of your OWN LINES OF ACTION leads to Par. 5 DECISION DECISION with a warning order that the command will attack. As soon as units are designated for the holding attack, main attack, and reserve they may move to attack positions. Thus at times it is practicable to start the execution of a plan before all of its final details have been determined. Clarity in expression is extremely important. There is no known substitute for simple, clearly expressed, concise, grammatical English. Verbosity, omission of essential details, use of “canned language” which may not be clear to the reader, with words or phrases capable of double meanings, are each to be studiously avoided. The form and contents of orders must also be tempered by the personalities of the subordinates who are to execute them. To an aggressive, skillful, dependable leader, mission type orders may be given which leave to the subordinate great latitude in the selection of method. Such methods are appropriate within organizations which have developed mutual understanding by long association in combat. We may forget, in im- personal studies, that individuals are something far more than identical machines; they are men, all are different, and relationships must be based upon full appreciation of these human equations. General Lee achieved his greatest successes by skill in diis very factor. At Chancellorsville his orders are military models for he was supported by Jackson, a corps commander who reached his greatest effectiveness when allowed latitude in decid- ing his actions in detail. But at Gettysburg, Lee may have suffered his greatest failure for allowing others of his subordinates to function under the same type order which worked so well with the [by then] deceased Jackson. Stuart with Lee’s cavalry failed to maintain contact with the main force; this denied Lee the information on which he depended. Ewell failed to exploit a success by misinterpreting an order. Longstreet delayed the execution of two attacks either by misunderstanding, inability to dispose his forces in time, or willful disobedience. In any event, there was a lack of clear-cut orders suitable for the personalities with which he dealt, however adequate they might have been for Jackson. An order “which can be misunderstood will be misunderstood.” Supervision of Execution. The commander will fail who lacks the strength of charac- ter, the courage, the energy to supervise the execution of his orders, bending and alter- ing them to meet new situations, directing and leading his men in the execution of the mission. It requires contact with his subordinate commanders at which time he may confer with them, explain his desires, hear their reactions, adjust conflicts, watch the execution. He must see with his own eyes the work of his men, even in advanced posi- tions, so that he may know their problems and supply their needs. In this process he must be seen by his men. They must know their commander, recognize him, be con- vinced that he knows their situation and will take prompt action to aid them in their hazardous undertakings. It cannot be done from a command post. Nor can it be done through visits of inspectors or staff officers or by any other impersonal process. This is a task which must be executed by the commander in person. The great military leaders of history have been masters of this phase of the art of leadership. Each visit must reinforce their morale, their confidence, their willingness to accept sacrifice. Repeated time and again the day may come when the commander is given the personal respect of his men which may later develop into admiration, even to love. When that spirit is developed the force which he commands can sustain reverses and, having sustained them, can still go forward and win victories. The size, complex nature, and speed of operation of the modern military unit make it difficult to control. The commander is likely to be unduly tempted to remain at the com- mand post, to supervise each step in the work of his staff, to inform himself of each minor change in the situation. While his responsibility includes all of these matters, even the most trivial, he cannot permit himself to be separated from his greater responsibilities. He must surround himself with subordinate commanders and staff officers in whom he has confidence, who are able to execute this multitude of details, even important ones, in a manner which will obtain the required results. As time passes this desirable state is enhanced by training, by shift of personnel, and adjustment of methods. Finally unity of effort, coordination, mutual trust, and respect may each be developed. When that time comes the commander is free to exercise the personal control and leadership on which the success of military operations is based. LEADERSHIP 165 CHAPTER Vm DEFENSE AGAINST CHEMICAL WARFARE GENERAL CONSIDERATIONS The Medical Officer and Chemical Warfare. The use of chemicals in warfare presents a problem of peculiar importance to members of the Medical Department. Theirs is the task of treating and evacuating gas casualties, in itself a dangerous task. They are as sub- ject to becoming gas casualties while in the execution of their mission, except for advanced infantry units, as other arms and services. Hence, the medical officer requires a consider- able knowledge of the chemicals used in war to execute his professional responsibilities, and he will need this knowledge in order to instruct the soldiers under his control for their own protection. All personnel present in an area where chemicals are employed are equally subject to its hazards. A word of caution is in order about chemical warfare. The German introduced the use of toxic gases in World War I. Thus far, he has not chosen to do so in World War II. It is questionable that his reasons are humane. It is safer and wiser to assume that he will use it ruthlessly when he chooses to do so. The medical officer must pre- pare himself to be ready instantly to meet the medical situation such action would present. The medical aspects of chemical warfare are presented in Chapter VIII, Part II, of this volume. Chemical Warfare Defined. Chemical warfare is the tactical employment of substances which are capable, after their release in the field, of acting directly through their chemical properties to cause bodily injury or irritation, produce an obscuring smoke, or set fire to combustible material. Such substances are called chemical agents. The munitions em- ployed to disseminate them are referred to as chemical weapons. Chemical agents, employed for their physiological effect, generally arc disseminated in the form of gas which renders the atmosphere at the target dangerous to breathe and necessitates the use of gas masks or other protective equipment. Origin of Chemical Warfare. Crude devices for generating noxious fumes to wear down the resistance of an enemy were employed in sieges by the ancient Greeks as far back as the 5th Century B.C. Such means continued to be used against walled cities until well into the Middle Ages. But as warfare became more open, these primitive devices, being no longer of general value, fell into disuse. The employment of incendiary substances in war is considered by many military historians to be as old as organized warfare. The deliberate use of screening smoke as an aid in battle is largely a recent addition to military art, although history records some instances of its employment in early times. In essence then, chemical warfare is not new. However, as an application to war of modern science and industry, it was inaugurated in the World War. World War Development Modern chemical warfare dates from April 22, 1915, when the Germans carried out an attack with chlorine gas against the Allies in Flanders. For this attack the Germans emplaced thousands of cylinders of liquefied chlorine in their front-line trenches. When the valves were opened the chlorine vaporized as it was released, forming a gigantic, suffocating cloud which was swept by a favorable wind for several miles before the gas was finally dissipated. Some 20,000 casualties resulted. The Allies were soon to retaliate and from then on until the close of the war gases, smokes and incendiary materials came to be used extensively. The cylinder attack gave way largely to the use of projectiles to release chemicals directly upon the target, thus making chemical operations less dependent upon wind conditions. Chlorine was soon superseded by more deadly gases, notably phosgene. In 1917 the Germans introduced dichloro-ethyl sulphide, a skin blistering substance, given the name mustard gas by British soldiers. It caused more casualties than all other tvpes of gases used. Hand in hand with offensive developments came the provision of gas masks and other protective means. While these were constantly improved as the war progressed, gas, 168 MILITARY MEDICAL MANUAL nevertheless, caused a tremendous number of casualties although comparatively few cases were fatal. More than one-lourth of the battle casualties of the American forces engaged in the war were due to gas. Among the immeasurable difficulties imposed by gas attacks were the interruption of normal activities, lowering of morale, and extra work in providing gas shelters and cleaning contaminated installations and equipment. In pursuit of means for chemical warfare, each belligerent set up an elaborate research and development. In addition to the extensive use ot artillery tor chemical operations, separate tactical units of troops armed with special chemical weapons were provided. Development Since World War. Aircraft were not used in the World War as a means of delivering gas attacks. But gas bombs and devices for use on airplanes to spray liquid chemicals have since been developed, so that gas attack from the air is now recognized as highly practicable. Another post World War development is the improvement of chemical mortars which, with motor transportation, make possible the conduct of chemical operations of considerable magnitude by ground torces in open warfare. There unques- tionably has been much improvement since the World War in gas protection. However, if gas is employed in future war, the utmost precautions against surprise and a high state of gas discipline will be required. Treaty Prohibitions of Toxic Gas. The resort to toxic gas in the World War was gener- ally condemned by the Allies as a violation of certain provisions of The Hague Convention of 1899 on rules of warfare. Accordingly, the Peace Treaty of Versailles, and a number of subsequent treaties, contain clauses amplifying The Hague rules more to definitely prohibit toxic gas as a weapon. None of these treaties, however, has been ratified by all of the military powers. Meanwhile, all such powers have continued to maintain establish- ments for chemical warfare research, and provision, at least, of gas-protective equipment. General John J. Pershing, in his final report as commander in chief of the American Expeditionary Forces in the World War, sums up tersely the gas-protective problem, stating: “Whether or not gas will be used in future war is a matter of conjecture, but the eflect on the unprepared is so deadly that we can never afford to neglect the question.” The United States is not a party to any treaty, now in force, that prohibits or re- stricts the use in warfare of toxic or nontoxic gases, or of smoke or incendiary materials. Objects of Gas Defense Training. The objects of training in gas defense are to minimize casualties and present hostile chemical attacks from causing undue interruption to or interference with normal military activities. Defense is predicated upon knowledge of the weapons which an enemy may employ, their capabilities and limitations, and the methods of their use. In this respect, chemical warfare is no exception. To defend against chemical attack we must not only have special equipment and understand its use, but we must know the characteristics of chemical agents and weapons and how and when they can be employed most effectively. Responsibility of Commanders. Although the chemical casualty is the responsibility of the medical officer it is the responsibility of the infantry, artillery, armored force, in fact all line officers to see that the gas casualties are kept to the absolute minimum. If the troops are well equipped and well trained “gas” will be a comparatively in- effective weapon. The individual soldier must be taught to put his gas mask on at once and to apply the protective ointment immediately. He can not wait until he gets to the medical officer for first aid care because the damage will be irrepairably done. In fact there will be no need to evacuate these trained soldiers as they will seldom become casualties. “Organization commanders are responsible for the proper train- ing of their respective commands in defense against chemical attack and, within the means available to them, they are responsible for taking proper measures for the care and maintenance of protective equipment, and for the protection of their troops, equipment and supplies against gas.” The Chemical Warfare Service. The Chemical Warfare Service of the American Army was organized in the World War as the result of experiences indicating the need for centralizing chemical warfare activities in a single agency. Following the war, in the revision of the National Defense Act, Congress made provision for this branch as a part. of the permanent military establishment. The duties of the Chief of the Chemical War- fare Service, stated in the Act, include chemical warfare research and experimentation, procurement, manufacture, or supply of chemical warfare equipment, and supervision of training in chemical warfare. This supervised training is conducted through the Chemical Warfare School at Edge- wood Arsenal, Md., chemical warfare instructors at other service schools, chemical officers on the staffs of corps area; department and division commanders; and unit gas officers of regiments and battalions of the various arms. DEFENSE AGAINST CHEMICAL WARFARE 169 CHEMICAL WARFARE AGENTS AND WEAPONS, AND FORMS OF CHEMICAL ATTACK Classification of Agents, a. General. Chemical agents comprise three classes of sub- stances: gases, smokes and incendiaries. (1) The term gas is here used in a broad sense as applying to a chemical agent which can be disseminated in the air to produce a powerful physiological effect. (2) A smohj: is a chemical agent whose principal eilect is to produce an obscuring cloud. (3) An incendiary is a chemical agent whose principal purpose is to cause destruction of materiel by fire. b. Physical state. Chemical agents may be encountered in gaseous, liquid, or solid form. All chemical agents, brought to the battlefield loaded in explosive shell or other containers, are in cither a liquid or solid state. Some of them vaporize at once upon their release, forming gas or smoke clouds; some tend to remain as liquids or solids but vaporize grad- ually; some require the application of considerable heat for their dissemination and hence are used in burning-type munitions. c. General types o) gases. Gases consist of two principal types, toxic gases, or those which may cause severe injury or death, and irritant gases, those which may have severe incapacitating effect but, in concentrations which can be produced in the field, will not cause death. (1) Toxic gases present two distinct types, non persistent and persistent. (a) A nonpersistenl gas is one whose effectiveness is dissipated generally within 10 minutes after release. Most agents of this class are true gases which arc liquefied under pressure for loading in containers. Upon release they quickly revert to their normal gaseous state. (b) A persistent gas is one whose period of effectiveness extends beyond 10 minutes. Such substances are normally liquids or solids but they vaporize slowly after release. (2) Irritant gases may be persistent or nonpersistent but in their case, persistency depends largely upon the method of dissemination used. d. Physiological action. Chemical agents are classified according to their most pronounced physiological effects as: (1) Lung irritant, an agent which, when breathed, causes irritation and inflammation of the lungs. (2) Vesicant, an agent which blisters the skin with resultant inflammation, burns, and the destruction of tissue. It also has a corresponding effect upon the lungs and eyes. (3) Sternutator (irritant smoke), an agent which acts upon the mucuous membranes of nose and throat, causing sneezing, coughing, and headache. (4) Lacrimator, an agent which causes a copious flow of tears, and intense, though temporary, eye pains. Screening smokes, as used in the field, generally have no injurious effects. Incendiary substances, in contact with the body, cause sevexe heat burns. 170 MILITARY MEDICAL MANUAL e. Tactical use. Chemical agents are further classified according to their tactical use, as: NORMAL GENERAL TYPE PERSISTENCY PHYSIOLOGI- CAL ACTION TACTTCAL EXAMPLE USE (Name and Symbol) PHYSICAL STATE Lung Irritant Casualty j Phosgene (CG) Gas 'Nonpersistent Chlorine (CL) Gas -Toxic * Mustard Gas (HS) Liquid 'Vesicant Casualty -j Lewisite (Ml) Liquid Ethyldichlorarsine (ED) Liquid GAS - .Lung Irritant Casualty Chlorpicrin (PS) Liquid Sternutator Harassing Adamsite (DM) Solid Depends on Sneeze Gas (DA) Solid means of dissemination Chloracetophenone (CN) Solid Harassing Tear Gas Solution (CNS) Liquid Tear Gas Solution (CNB) Liquid SMOKE Burning or White Phosphorus (WP) Solid functioning time of the Negligible Screening HC Mixture (HC) Sulphur Trioxide Solid munition „ Solution (FS) Liquid Thermite (TH) Solid INCENDIARY Burning time Heat Burns Incendiary Solid Oils Solid White Phosphorus (WP) Solid CLASSIFICATIONS OF CHEMICAL AGENTS DEFENSE AGAINST CHEMICAL WARFARE 171 (1) Casualty agent, an agent used to produce casualties which require evacuation. (2) Harassing agent, an agent used to iortc masking, thereby reducing the efficiency of troops. (3) Screening agent, an agent used to produce obscuring smoke. (4) Incendiary agent, an agent used to set lire to enemy material or supplies. /. The relationship of these various classifications is shown in the accompanying chan. In ordinary military writing and parlance with reierence to chemical agents, the following broad classification is generally used: Gas nonpersistcnt, persistent, or irritant Smoke Incendiary. CHARACTERISTICS OF PRINCIPAL CHEMICAL AGENTS LUNG IRRITANTS Name and Symbol Chlorine (CL) Phosgene (CG) Chlorplcrin (PS) Odor Disagreeable, pungent Disagreeable, pungent, Ike new cut hay or cut corn. Sweetish, like fly paper. Color and state In field Greenish yellow gas First white, changing to colorless gas. Oily liquid changing slowly in open to color- less gas. Effects on body Lung Irritant. Causes choking and coughing smarting of eyes, and discomfort in chest. A 2-minute exposure to an average field concentra- tion produces a casual- ty. Effects begin Im- mediately. Lung Irritant. Choking, slight coughing, hurried breathing, pains i n chest due to irritation of lower lungs. Approxi- mately nine times more toxic than chlorine; a few breaths in average field concentration pro- duce a casualty. Effects are delayed 1-12 hours Lung Irritant and lacri- mator. Lacrimation, coughing, nausea, vom- iting, lung irritation, approximately one-half as toxic as phosgene. First-aid care and Absolute rest, keep Absolute rest, keep Same as phosgene, ex- emergency treat- warm, sedative (bar warm, hot drinks, seda- cept withhold oral ment bituates), oxygen when available, remove to pure air. Do not give morphine, alcoholic drink or arti- ficial respiration. tive (barbituates), oxy- gen when available, venesection In blue stage. Pure air. Do not give morphine, alcoholic drinks, artifi- cial respiration, cardiac stimulants, intravenous fluids, adrenalin or venesection in the grey fluids because of nau- sea; In addition wipe splashes of liquid off skin with sodium car- bonate solution or al- coholic sodium sulfite solution. Persistency Vaporizes almost Im- mediately under field conditions. Drifts as gas with the wind but being heavier than air clings for some time in trenches, shell holes, woods, and other low or protected places. stage. Vaporizes almost imme- diately under field con- ditions. Gas remains considerable time in low or protected places. 1 to 12 hours. Action on food and Dry supplies; any tern- Dry supplies; same as Can be removed from water porary effect wlil pass off after the cloud dis- perses and the food will for all practical pur- poses be unharmed. Foods of high water or fat content; the flavoi stro ngly changed through decomposition of fats. Cannot be made edible. for chlorine. Some slight deteriora- tion may occur with prolonged exposure to a relatively high concen- tration of phosgene. foods of low water con- tent by energetic ven- tilation. Foods of high water content are rendered inedible. Foods of high fat con- tent; decontamination impractical if not im- possible. Action on metal Dry, none; wet, vlgorl- ous corrosion. Dry, none; wet, vigorous corrosion. Slight tarnish only. How used For casualty effects. In cloud gas attacks as substitute for phosgene or mixed with phosgene or chlorplcrin in cylin- ders or Livens projec- tors. For casualty effects. In cloud gas attack. In cylinders. pro jectors, medium artillery, mor- tars, and aviation bombs. For harassing and cas- ulty effects. In shell, bombs, or airplane spray as substitute for other agents; in like manner mixed with CN; in cloud attacks mixed with CL. protection required Gas mask. Gas mask. Gas mask. VESICANTS Name and Symbol Lewisite (Ml) Mustard (HS) Odor Like gernniums. then biting. Like garlic or horseradish. Color and state in field Dark brown liquid changing Dark brown liquid, changing slowly Into a colorless gas. slowly into a colorless gas. Effects on body Vesicant, blisters skin. Skin Vesicant, blisters skin. Symp- shows slight irritation in 15 toms delayed 2 to 4 hours. If minutes, followed by grayish exposed, eyes burn and inflame. discoloration and blisters In 30 Skin in contact with gas or minutes to 1 hour. Systemic liquid, discolors, followed by poisoning; vomiting, if breathed. blisters and sores. If breathed, powerful lung irritant effects hoarse cough develops, followed within >/2 hour. If unprotected by severe pain in chest and in- Immediate irritation of eyes. flammation of lungs. Approxi- Approximately six times as toxic mately four times as toxic as as phosgene. phosgene. First-aid care and emergency When possible remove from When possible remove from area treatment contaminated area. and remove contaminated cloth- 1. Apply protective ointment ing, otherwise, leave clothing (M4) immediately. Repeat 2 oi on. Small area of clothing con- 3 times and remove. taminated, cut it away and 2. Remove excess with dry cover the skin with protective cloth. Use solvent alcohol, ether ointment. benzene, gasoline. Use soap and 1. Apply protective ointment water. Use 8% Hydrogen perox- immediately. Repeat 2 or 3 Ide 2 or 3 times, saturate cloth times and remove. and leave on wound. 2. Remove excess HS with dry Open blisters at once. cloth. Use solvent, alcohol, Eyes 2 or 3 drops of (Ml). Eyr ether, gasoline. Wash soap and solution in each eye. Do noi water. Apply Dichloramine “T" repeat. In Triacetin Inhale from wide Do not use Hydrogen peroxide mouthed bleach bottle. in eyes, rub or bandage eyes. Eyes irrigate with water, bland oil (castor oil), 2% butyn or pontocalne compound ointment. Do not use Ml Eye Solution, bandage eyes, or rub eyes. Do not use cocaine in eyes. Persistency Dispersed as liquid which slowly Dispersed as liquid which slowly changes to gas. Rate of vapor- changes to gas. Rate of vapor- ization depends on temperature Ization depends on temperature. vegetation, and method of dls- vegetation, and method of dis- persion. Rapidly destroyed b persion. Summer: 4 to 5 days water. Summer: 24 hours ir in open; l week in woods. open; 2 or 3 days in woods Winter; l week or more. Winter: Several weeks. Action on food and water Food which has come in contact All foods contaminated with the with these gases, whether vapoi liquid form must be viewed or liquid, should not be eatei with suspicion. Fatty foods because of the great danger oi (milk, cream, butter, cheese, arsenical poisoning. The salvag- fatty meats, eggs, etc.) con- ing of foods exposed to this gas taminated either by vapor or depends on the degree1 of con by liquid will almost certainly tamination and the suitabilitj be highly dangerous and should of such food for consumption be destroyed. Slight contamina- should be passed on only b\ tlon with mustard gas vapor qualified experts after a thor- may affect palatabillty but, ex- ough chemical examination. Very slight. cept for fatty foods, the ma- terials should be edible after 48 hours’ airing and cooking. Action on metal Very slight. How used For casualty effect or to deny For casualty effect or to deny ground through threat of cas- ground through threat of cas- ualties. In artillery shell, mor- ualties. In artillery shell, mor- tar shell, airplane bombs, air- tar shell, airplane bombs, air- plane spray, and land mines. plane spray, and land mines. Protection required Gas mask and protective cloth- Gas mask and protective cloth- ing. ing. LACRIMATORS Name and Symbol Chloracetophenone (CN) Tear Gas Solution (CNS) Odor Like apple blossoms. Like fly paper. Color and state in field Bluish gray smoke from burning type munition; colorless from shell. A colorless liquid, changing to colorless gas. Effects on body Piercing irritation of eyes caus- ing profuse tears. Effective in extremely low concentrations. Piercing irritation of the eyes, profuse tears, followed by nausea and vomiting. First-aid care and emergency treatment Wash eyes and skin with water. Use 2% sodium bicarbonate so- lution. 2% butyn for eye pain. Calomine lotion on skin. Pro- tect eyes from light. Do not rub, bandage or use cocaine in eyes. Same as Chloracetophenone. Name and Symbol Chloracctophcnone (CN) Tear Gas Solution (CNS) Persistency Cloud from burning mixture drifts with wind. Will remain in low and protected places for some time. Shell or solid CN may remain several weeks. Summer: l hour in open; 2 hours in wods. Winter: 6 hours in open; 1 week in woods. Dispersed as liquid which changes to gas. Action on food and water Gives unprotected food disagree- able odor. Contaminates. In some cases may be removed by ventilation and heating. Action on metals Tarnishes steel slightly. Tarnishes steel slightly. How used For harassing effect. In gren- ades. For harassing effect. In artillery shell, mortar shell, airplane bombs, and airplane spray. Protection required Gas mask. Gas mask. IRRITANT SMOKES (STERNUTATORS) Name and Symbol Adamsite (DM) Sneeze Gas (DA) Odor Color and state in field Not definite, slightly like coal smoke. A yellow smoke cloud. Grayish smoke cloud. Effects on body Immediate sneezing followed by Sneezing and burning sensation First-aid care and emergency headache, nausea, and vomiting. Temporary physical debility. Ef- fective in low concentrations but is delayed about 5 to 10 minutes. Remove to pure air, aspirin for of the nose and throat. Slight lacrimation followed by occa- sional nausea, headache, and temporary debility. Immediately effective. Same as for Adamsite. treatment Persistency Action on food and water headache, rest, keep warm, withhold fluids by mouth, in- hale from bleach bottle. Irri- gate nose and throat with 2% sodium bicarbonate solution. Clean and reapply mask after vomiting. While burning, drifts with the wind, will remain in low and protected places for some time. General, 5 minutes in open. Poisons unprotected food and While burning, drifts with the wind, will remain in low and protected places for some time. General, 10 minutes in open. Poisons unprotected food and Action on metals water; cannot be made safe for use. Very slight. water; cannot be made safe for use. Vigorous corrosion on steel. How used Protection required For harassing effect. In candles or generators. Gas mask with a good filter. For harassing effect. In candles or shell. Gas mask with a good filter. SCREENING SMOKES Name and Symbol Sulphur Trioxide Solu- tion (FS) IIC Mixture White Phosphorus (WP) Odor state in Acid or acrid. Acrid, suffocating. Like phosphorus matches. Color and field Dispersed as liquid which changes to white smoke upon contact with air. White smoke pro- duced by burning munitions only. Dispersed as solid which rapidly changes to flame and white smoke on con- tact with air. Effects on body Mild prickling sensation to skin; non-injurious. None. Smoke, none; particles produce severe fire burns which heal very slowly. First-aid care and emergency treat- ment Wash with copious amounts of water, then with sodium bicarbonate and treat as for ordinary burns. None needed. Keep part under water, use saturated wet cloth. Apply 2 to 5 percent cop- per sulfate solution to form a coat over the particles and prevent oxi- dation. Pick out solid particles and treat like ordinary burn. Action on water food and Liquid renders food and water unfit for use; smoke gives disagreeable odor. Smoke gives dis- agreeable odor. Smoke gives disagreeable odor; solid is poisonous. Action on How used metal Vigorous corrosion in presence of moisture. Screening smoke. In air- plane spray for screening; in artillery shell, mortal shell, and cylinders for training to simulate cloud gas. None, if dry. Screening smoke. In smoke pots or candles, for train- ing only. None. Screening smoke and in- cendiary. In artillery shell and mortar shell, primarily for smoke ef- lect; also used in same munitions and airplane bombs for casualty effect and incendiary action. Protection required None. None. For smoke, none; for burning particles, none provided. 174 MILITARY MEDICAL MANUAL SYSTEMIC POISONS Name and Symbol Hydracyonic Acid (IICN) Arsine (AsIIs) Odor Color and state in Held Bitter almonds. Colorless and volatile liquid, Garlic-like odor. Colorless, inflammable gas. Effects on body First-aid care and emergency forming a colorless gas when released from container. Giddiness, headache, convul- sions, unconsciousness, and death. Inhale armyl nitrate, artificial Shivering, weakness, giddiness, nausea, vomiting, headache, ar- remia, anuria, uremia. Absolute rest, evacuate in prone treatment Action on food and water respiration, sodium nitrate, so- dium thiosulfate, or methylene blue introvenously. Liquid renders food and watei position, force fluids, carbohy- drates, blood transfusion, pro- mote diuresis. Arsenic makes food and water Action on metal How used Protection unfit for use. Slight. Casualty producing agent when used in a confined space. 3as mask if worn at time gas is laid down. unfit for use. With large stores, degree of contamination to be etermined by analysis. None. Casualty producing agept when used in a confined space. Gas mask if worn at the time gas is laid down. g. Symbols. Brief lettered symbols are commonly used to designate chemical agents, particularly in identification markings on chemical munitions; e.g., C G is the symbol for phosgene. Concentration and Time of Exposure. The degree of injury produced by a gas depends, not only upon its inherent properties, but upon the amount by weight of the substance present in the air, (referred to as the concentration), and the length of the period of exposure. The action of most gases is cumulative; the longer the exposure, the more severe the injury. In general, exposure to a low concentration lor a long period will produce the same results as brief exposures to a high concentration. Characteristics. During and since the World War, many thousands of chemical com- pounds have been studied for their military possibilities. Of these but a dozen or so are considered of great value. New and more potent agents will undoubtedly be discovered in the future. However, it is believed that the characteristics of any new agent will, in the main, conform to those of some one of the known types. Hence, the practical information about representative agents, contained in the accompanying table, should be of considerable val le in meeting any gas-protective problems that may arise. Objects of Chemical Attack. Chemical attacks are made with one or more of the follow- ing objects in view: a. To inflict casualties. b. To deny ground by contaminating it with persistent gas. c. To contaminate material and supplies. d. To harass by forcing the use of gas masks. e. To lower the morale ol troops. /. To interfere with observation by smoke. g. To destroy material and supplies by burning. Tactical Principles in Use of Gas. a. Nonpersistent gas. Surprise is essential for ap- preciable casualty effect, hence, when this gas is used in projectiles fire is sudden, rapid and intense, but usually of short duration. Successive bombardments, at varying intervals of time, are suitable. Massed troops in stationary position, particularly troops asleep, are the most profitable targets. b. Persistent gas. In an offensive this type of gas is used only on areas which the attack- ing troops will avoid in their advance. It may be used extensively by a defender. Fire to deny ground may be slow, but fire against personnel for casualty effect should be executed rapidly. c. Irritant gas. Harassing agents are useful, particularly against troops at work on their position or engaged in bringing up supplies. These agents are effective in very low con- centrations and therefore are economical in ammunition expenditure. d. Smoke. Smoke is used to blind hostile observation and for deception. In attack, smoke is placed directly upon the defender’s forward positions to prevent aimed fire upon DEFENSE AGAINST CHEMICAL WARFARE 175 advancing troops. It is also used against rearward observation points. In defense, the use of smoke is limited so as not to obscure the defender’s own field of fire. e. Incendiaries. These agents are used primarily for destruction of material. Weather and Terrain Influences, a. Weather. Gas and smoke clouds travel with the wind, spreading and thinning out as they travel from their source. The rate of width increase is about 15 °/o of the distance traveled. Winds of more than 12 miles per hour velocity tear chemical clouds apart and disperse them rapidly. Sunshine, especially in warm weather, is conducive to rising air currents (convection) which rapidly dissipate chemical clouds by causing them to rise. In the case of persistent agents, warm weather accelerates their evaporation. Rain may destroy or partially destroy gas or smoke by beating it out of the air, draining it away, or by chemical action (hydrolysis). Cool, cloudy weather with wind steady at low velocity, is favorable for the use of non- persistent gas. On the other hand, warm weather is generally more suitable for persistent gas because a higher concentration is then developed than when the weather is cool. Mus- tard gas solidifies in freezing weather, remaining inert until the temperature rises sufficiently to melt it. Lewisite is effective in cold weather but is destroyed by moisture. b. Terrain. War gases, being heavier than air, tend to hug the ground, flow downhill and collect in depressions, remaining effective in such places for a considerable time after the open, high areas are clear of gas. In woods, rising air currents are generally absent or less pronounced, and wind velocity is retarded. Hence, low-lying woods are the best target area for gas. Ground covered with dense undergrowth is especially suitable for use of vesicant agents, since men, moving through such areas, will brush off the chemical on their clothing. DIA. 75 MM SHELL diameter 4.2” CHEMICAL MORTAR SHELL DIAMETER IS5 MM HOWITZER SHELL Plate 1. Chemical Shell Bursts. Chemical Mortar and Artillery Shell Attacks, a. The chemical mortar is a light, mobile cannon, designed for rapid high-angle fire of large capacity shell. Within its maximum range, generally less than 3000 yards, mortars may be used to put down and maintain high concentrations of persistent or nonpersistent gas, fire smoke, or incendiary agents. Both light and medium field artillery pieces may be similarly used, though the light gun is not suitable for fire of nonpersistent gas shell. b. Danger areas. A chemical shell contains sufficient explosive to break it open upon impact and disperse the chemical (see illustrations). The danger area is not only that over which the chemical is thrown upon explosion, but extends for some distance downwind therefrom. In the case of nonpersistent gas, this danger distance varies from 200 to 300 yards for a single shell, to several miles for a heavy concentration over a wide front. In the case of explosion of persistent gas shell, a part of the chemical changes immediately 176 MILITARY MEDICAL MANUAL to gas; part of it is so finely atomized that it, too, travels with the wind, while the remainder, in liquid form, is distributed over the ground and slowly changes to gas. Thus, downwind from the point of burst, there continues to be a danger area until vaporization of the chem- ical is complete. The depth of this area varies from about 200 yards, for a single shell, to 1000 yards, or possibly more, in the case of a heavy concentration on a wide front. A chemical shell containing a liquid can ordinarily be distinguished from other shells by the peculiar intermittent, whirring noise it makes in flight and by its low detonation. Chemical Projector Shell Attacks. The projector is a simple mortar of large bore, which fires one shot per installation. It has a comparatively short range, the maximum being usually about 1500 yards. For employment, projectors, generally in large numbers, are emplaced close together in the user’s front line, and discharged simultaneously by an electric current. By this means gas in very high concentration can be released suddenly upon a target. SHELLS VISIBLE IN FLIGHT ENEMY FORWARD POSITION GAS IN HIGH CONCENTRATION RELEASED SUDDENLY UPON THE TARGET LIVENS EMPLACEMENT — RANGE — 450 TO 1450 YDS. LOUD NOISE; BIG FLASH UPON DISCHARGE OUR POSITION WIND Plate 2. Livens Projector Attack—Diagrammatic Illustration. GENERAL DIRECTION Projector attacks are likely to be followed shortly by infantry attack. An enemy may fire two salvos, first one of high explosive, for tremendous blasting effect on targets above ground, and then one of non persistent gas to reach targets in trenches and dug-outs. An enemy on the defensive may use persistent gas with projectors. Projectors are generally emplaced at night, for fire that night or early the following morning. Their installation may sometimes be discovered by aerial observation. The metallic sounds usually made in emplacing them, possibly may be heard in our lines. In large scale gas operations, the danger area extends several thousand yards downwind of the impact zone. When fired, the brilliant flash of discharge may be seen, or the loud noise of same heard, in time to enable troops in the target area to adjust gas masks before the shells fall. Chemical Attacks from Aircraft. Either bombs, or apparatus for spraying persistent gas or smoke, may be used in chemical attacks from aircraft. Small bombs containing persistent gas, or white phosphorus, may be dropped from high or low altitudes. Large bombs weighing 100 pounds or more, containing nonpersistent or persistent gas, may be employed by bombardment aviation. Persistent gas may be used in conjunction with demolition bombs to hamper, or prevent the repair work. Incendiary bombs, both large and small, are also applicable. Persistent agents, such as mustard gas or Lewisite, may be sprayed from airplanes in DEFENSE AGAINST CHEMICAL WARFARE 177 attacks upon ground troops or used to contaminate ground or supplies. The persistency of such agents when sprayed from airplanes is considerably less than when fired from shell, owing to the small size of the drops and consequent increased surface area of the liquid exposed to the air. Attack aircraft flying at 50 to 1000 feet can lay a belt of per- sistent gas approximately one mile long, the width of the belt depending upon the altitude of the plane and the wind velocity and direction. A plane flying at 100 feet elevation, with a cross wind of 10 miles per hour, can gas an area one mile long by 100 yards wide. Troops in column present a particularly favorable target for such attack. LEAO WIRES To ELECTRIC EXPLODER ■ ' puze A//1-7- &. burster tube: GROURD L//VE BARREL CHEMICAL SHELL PROPEL L tA/G CHARGE base plate: PULL SUPPPCE SET UP Plate 3. Livens Projector MK1. At the beginning of World War No. IT the French and British proved the feasibility of high altitude airplane spray of a vesicant agent, particularly mustard. They proved that mustard could be sprayed from altitudes of at least fifteen thousand feet. The vesicant mist so formed would not reach ground for some fifteen or twenty minutes after the passage of the plane and therefore this type of attack would be very insidious since fine droplets of the vesicant agent would probably be in the eyes by the time the odor was detected. Since the capitulation of the French it is possible that they passed on this information to the Germans and that they are conducting experimenta- tion along this line. CHEMICAL SPRAY STRIKES TARGET IN FORM OF SMALL DROPLETS—PLANES FLY AT ALTITUDE OF ABOUT 100 FEET. WIND PERPENDICULAR TO TARGET MOST FAVORABLE FOR THE ATTACKER. MOST FAVORABLE TARGET- COLUMN OF TROOPS. Plate 4. Airplane Chemical Spray Attack. N0ZZLE,MI~ -VALVE, MI EDUCTION TUBE CONTAINER, MU -CARRIER, MIA2 FILLING Plate 5. Portable Cylinder with Nozzle and Firing Device. DEFENSE AGAINST CHEMICAL WARFARE 179 Until chemical is sprayed or bombs burst, there is no way for troops on the ground to determine whether chemicals, other means, or both will be used. Conscquendy, upon warning of the approach of hostile aircraft, particularly low-flying airplanes, gas masks should be adjusted. Cloud Attacks With Cylinders or Candles. Cylinders filled with nonpersistent gas which vaporizes upon release by opening valves, or candles for generating clouds of irritant smokes by a burning process, may be employed by an enemy when the wind conditions are such as to carry the chemical cloud from his position to that of the target. Such weapons are applicable, primarily, to stabilized situations. Cloud attacks usually are conducted on a large scale to effect an area extending for several miles downwind from the place of release of the chemical. These attacks are generally made at night, or during the early morning, with a view to surprise effect. The gas cloud is normally white from condensed water vapor, but the actual position and width of the front of attack is likely to be disguised by smoke. At the moment of discharge of gas cylinders the hissing noise made as the gas escapes may be heard in time to give warning. ENEMY'S POSITION OUR POSITION GAS CLOUD CYLINDER EMPLACEMENT WIND Plate 6. Gas Cloud Attack with Cylinders—Diagrammatic Illustration. Use of Chemical Land Mines and Bulk Chemicals. An enemy organizing a position for defense or engaged in a retrograde movement, may make use of mines filled with persistent chemicals to contaminate roads, or other important areas, to deny their use. For such pur- poses, persistent gas may also be liberated from containers carried on tanks or other vehicles. Gas, thus employed by these means, is highly persistent. It can be detected by odor and visible splashes. Use of Chemical Grenades. Hand grenades filled with irritant gas, or white phosphorus, may be used in local operations, particularly to force personnel to evacuate dug-outs or other inclosed spaces. Hand grenades can be thrown about 35 yards. PROTECTIVE EQUIPMENT AND PROCEDURE Classification of Protective Measures. Protection against chemical attack involves both technical and tactical measures, a. Technical protection is passive in character. It consists of (1) individual protection, or the equipment and measures applicable to the individual, and (2) collective protection, or the unit equipment and measures applying to a group. b. Tactical protection has to do with active measures of security against hostile chemical operations. 180 MILITARY MEDICAL MANUAL The Army Gas Mask. a. Description. The principal item of individual protection is the Army gas mask. This mask consists of a facepiece, hose tube, canister, and canvas bag carrier. A mask is carried at all times in the field by each soldier. It is adjusted upon sounding of a gas alarm, or whenever the individual detects the presence of gas. When the mask is worn, all inspired air is drawn through the canister, where war gas or smoke is removed. Exhaled air passes out through a valve connected to the facepiece. Protection depends upon a properly fitting mask, free of leaks, and a serviceable canister. SKETCHES OF GAS MASKS //V i/S£ Dt/K/LVG WORLD WAR BRITISH R/RST BEACH VEIL BRITISH HYPO, P.or PH HEL MET In vac . ek/rf bo Honed i/nofer tome. . FRENCH NT -<2 MASH /TAL/AH MASH GER MAN MASH BRITISH HTPO, P. „ PH HEL MET Skewing e//te/. BRITISH SMAU BOX RESPIRATOR FRENCH TISSOT -RUSSIAN MASK amcR/cam r/jsor Plate 7. World War Gas Masks. b. Limitations. The Army gas mask is designed for protection against war gases only. It is unsuitable for use in fighting fires, fumigation work, or any activity in which toxic gases, such as carbon monoxide or ammonia gas, may be encountered. For such cases, special canisters should be used. Another important limitation is, that being solely an air filter, the Army mask does not protect against atmospheres deficient in oxygen. c. Service life. After considerable use, the filter components of the canister may de- teriorate, or become saturated. However, before a canister becomes dangerous, it gives warning of its deterioration by admitting a minute quantity of gas which can be smelled. Periodic inspection of masks issued to troops should be made by officers. d. Training. A gas mask impairs the efficiency of the wearer by resistance to breathing and limitation of vision. The handicap is, in part, psychological. It can largely be over- come by training, gradually increasing the periods of wear. Fitting of gas masks, gas mask drill, and use of the gas chamber pertain to field training and hence are not dealt with here. Protective Clothing. Protective clothing, which is designed for the protection of the body against gases of the mustard type, will be issued in time of war. It may be impervious or impregnated clothing. Protective Ointment. A tube of protective ointment is issued to each soldier. This package will not only contain the ointment but material for applying and wiping it off and, in addition, an ampoule of M-l eye solution for use against lewisite con- DEFENSE AGAINST CHEMICAL WARFARE 181 tamination of the eyes. Each individual must be taught that he is responsible for his own decontamination in case of contamination by any of the vesicant agents. The protective ointment if promptly and efficiently applied to contaminated areas will prevent the individual contaminated with the vesicants from becoming a casualty. Particularly in the case of lewisite contamination, the protective ointment should not be used after the skin becomes erythematous. Identification of Gases. No practicable apparatus for identification of gas in the field has been devised. Soldiers must depend on their sense of smell to detect and identify gases by their distinctive odors. AIR DEFLECTED AGAINST EYEPIECES BEFORE INHALATION -FACEPIECE DEFLECTOR ■AIR expelled; HERE / HOSE" CARRIER' MECHANICAL FILTER AIR PASSAGE' CHARCOAL AND SODA LIME — AIR ENTERS HERE CANISTER Plate 8. United States Service Gas Mask. First Aid. Every soldier should be thoroughly familiar with the first aid treatment of injuries from chemicals as set forth in the table, Characteristics of Agents. In rendering first aid treatment to gas casualties, a gas mask and protective gloves should be worn. Gas Discipline. The prompt and orderly adoption of proper protective measures by a command, when it is subjected .o a gas attack, is evidence of good gas discipline. Such discipline comes through knowledge and training. With respect to the individual soldier gas discipline means that he has no unreasonable fear of gas; has confidence in his pro- tective equipment; upon detecting gas, he at once shouts “GAS,” and then holds his breath until his mask is adjusted. 182 MILITARY MEDICAL MANUAL Gas-Proof Shelters. A gas-proof shelter is an inclosed space rendered gas-tight. It should have a double doorway in the form of an air-loci( to prevent gas from penetrating the en- closure as men enter or leave it. In areas subjected to gassing for long periods, gas shelters are needed as places where men may cat, sleep, and rest. They arc desirable especially for command posts, telephone exchanges, and aid stations. Non-ventilated shelters are usually suitable for use for several hours, if necessary. Collective Protector. A collective protector is a device for ventilation of a gas shelter. It consists of a motor-driven, or hand-operated blower, and a large canister to purify the air drawn into the enclosure. Gas Alarms. Where a large force is involved a gas alarm system, applicable to a wide area, should be provided. Steam whistles or siren horns, if available, may be employed. Frequently, means of rapid communication will have to be depended upon. As local alarms, Klaxon horns, and other similar devices which make a distinctive sound may be used. Degassing and Decontamination. Following gas attacks, it frequently will be necessary to carry out rather elaborate measures to get rid of the gas. Even gasses of the nonpersistent type tend to collect and tend to persist in trenches and dug-outs. The problem here is one of ventilation. Fanning, and the building of fires to create drafts, should be resorted to. Clothing and equipment which smell of the gas should be exposed to wind and sun; metal equipment, especially if damp, should be cleaned and re-oiled to prevent corrosion; and food and other supplies which have been exposed should be examined for evidences of damage or poisoning. In the case of an attack with a persistent agent, such as mustard gas, neutralizing chemi- cals must be employed. The cleaning processes involved are referred to as decontamination. Men engaged in this work must wear gas masks and protective clothing. Decontamination materials usually available are water, earth, soap, kerosene or gasoline, and chloride of lime. A supply of the latter is part of the field equipment of combat units. Water, unless hot, has little effect on mustard gas, except that, when applied with pres- sure, it may drain off some of the chemical. Water destroys Lewisite as such, but a toxic solid residue is left. This gives off no vapor, but is dangerous to touch. Wherever pos- sible, sodium hydroxide should be used to neutralize Lewisite. Kerosene and gasoline do not destroy vesicant agents, but dissolve them, hence they are useful in cleaning contaminated articles. Chloride of lime destroys mustard gas. However, when used for this purpose, it should be mixed with water, or earth, to prevent a violent heat reaction and consequent driving off of gas in high concentration. Chloride of lime is corrosive to metal and should not be used to decontaminate working parts of guns or machinery. a. Ground. It is impracticable to decontaminate a large area of ground with chemicals. Sometimes an area may be decontaminated by burning it off. During the burning friendly personnel should keep away from the downwind side of the area. Small areas, such as a few mustard gas shell holes, especially near an important installation, can and should be decontaminated by covering them with a 3-inch layer of one part dry chloride of lime to about three parts of earth. b. Concrete. Contaminated concrete installations should be covered with a paste made of chloride of lime and water. This should be left on for at least 24 hours, then washed off, and the surface covered with sodium silicate (water glass) to seal in any of the agent which may remain. c. Wood. It is practically impossible to decontaminate wood permeated with persistent gas. Wood buildings and objects so contaminated, which constitute a source of danger, should be burned. d. Metal. Metal equipment, including guns and ammunition, in so far as practicable, should be protected by paulins, or placed in gas shelters. If contaminated, such equipment should be swabbed with kerosene or gasoline, then with chloride of lime if practicable. They finally should be washed with hot water and soap, and re-oiled. Vesicant agents are readily absorbed by ordinary paint, hence are difficult to remove from painted articles, unless they are treated at once. DEFENSE AGAINST CHEMICAL WARFARE e. Vehicles. Vehicles splashed with gas may be partially decontaminated by hosing them down with water, preferably hot, but as soon as possible treatment with neutralizing chem- icals should be undertaken. f. Clothing. Persistent gas can be removed from clothing and fabric by steaming the articles for about six hours. This process may be reduced to two hours, if the articles arc first exposed, for one hour, to chlorine. g. Leather. Harness and other leather equipment, which has been sprayed or splashed with liquid vesicants must be treated at once, if permeated by chemicals, such equipment should be burned or buried. -Protection of Food and Water. Whenever practicable food, forage, and water sup- plies should be kept in a gas tight containers until used. The possibility of con- tamination of food stuffs by chemical agents makes it highly important for the medical officer to remember that: Chemical agents are highly penetrative. Food stuffs are often highly absorbent particularly foods of high water and fat content. Packaging materials may be absorbent and may permit the passage of the chemical agent. Where air can penetrate so can “gas” (gas mask excepted). Any material which will soak up oil or water will absorb and eventually permit the passage of chemical agents. Ventilation may be helpful but also provides a means for the entrance of “gas”. It is not necessary to discard all food stuffs contaminated by chemical agents. Whether or not the food can be salvaged and rendered fit for human consumption is dependent upon the type of chemical agent, the degree of exposure, the kind of food, the manner in which it is packaged, and the way it has been protected. All chemical warfare agents contaminate food either by going into solution in the water or fat present in the food or by being absorbed on the solid surface. In either case chemical reactions may occur which will result in some decomposition of either or both the chemical agent and the food. If hydrolysis takes place the chemical agent loses its original properties and, generally speaking, becomes innocuous. Warning. No such beneficial action will occur with those agents containing arsenic especially lewisite, ethyldichlorarsine, or arsine. Even though the original properties of the chemical agent are destroyed the hydrolysis products remain toxic due to the presence of arsenic. Many of the decomposition products which result from hydrolysis may be somewhat unpleasant tasting but not toxic, and the only action would be to render the food unpalatable. A comparable action does not occur in foods of high fat content when contaminated by the vesicant or arsenical agents, and such food must be considered unfit for human use. The water in shell holes or small ponds should in no case be used. Any supply of water contaminated with arsenical agents must not be used because the hydrolysis products are sufficiently soluble to be dangerous in a water supply. These soluble arsenious oxides can not be removed by ordinary water purification processes. Mustard gas is soluble in water to the extent of 800 p.p.m. at 20° C. When water is contaminated by mustard it is distributed into a surface film, a water soluble frac- tion, and any in excess of this settles to the bottom. The undissolved mustard may remain unchanged for several weeks in the bottom of the water. Water containing 500 p.p.m. or more of mustard gas can not be treated so as to be safe for human con- sumption. With less than 500 p.p.m. the water may be treated that the following procedures are employed: Treatment with unusually large doses of activated carbon followed by coagulation and settling. The settled water must then be filtered and chlorinated beyond the break point. Caution. If the filtered water has a five minute chlorine demand or more than 5 p.p.m., water is still unsafe for use. Bathing and Re-Clothing Units. In the World War mobile units, consisting of trucks provided with shower bath equipment and supplies of fresh clothing, were employed for 184 MILITARY MEDICAL MANUAL the protection of troops exposed to mustard gas. These measures will be required when similar chemicals are used in the future. Protection of Animals. Horses and mules are much less susceptible to gas, generally speaking, than man. These animals, however, arc highly susceptible to injury by gases of the mustard type. Animals working in gassed areas should be protected by gas masks, and also by gas-proof boots, if the area contains a vesicant substance. They should be washed at once after exposure to a vesicant agent. Pigeons should be protected during gas attacks by gas-proof loft covers, or should be released. Gas Protective Organization. Organization commanders have on their staffs specialists in gas protection who supervise the execution of protective measures under the authority of the commander. In the division, corps and army, these specialists are officers of the Chemical Warfare Service, referred to as chemical officers. They handle the supply of gas protective equip- ment, conduct schools in gas defense, make inspections, carry on chemical warfare intelli- gence and reconnaissance activities, and advise the commander on all matters pertaining to chemical warfare. Each unit below the division, down to the battalion, details an officer as the unit gas officer. He is directly concerned with gas defensive training of troops, inspection and maintenance of protective equipment, gas reconnaissance in battle, and supervision of degassing and decontamination work. Each company, troop, or battery, details a gas noncommissioned officer to assist the company commander in his gas protective duties. Gas Sentries. Each combat unit provides its own gas sentries. Their principal duty is to detect the presence of gas in their areas, give the alarm when gas is so detected, and awaken sleeping men in their areas in time for these men to adjust their gas masks before being dangerously exposed. The number of gas sentries to be provided depends upon the number of men to be protected, and the size of the area over which the men arc distributed. Gas sentries should be intelligent, alert and active, and possess keen senses of smell and hearing. They should sound their alarms only when they actually detect gas in their areas. To sound an alarm merely because an alarm in another area is heard, might result in needless disturbance of sleeping troops. Standing Orders. Standing orders for defense against chemical attack are general orders issued by each army, corps, division, or smaller force, if acting independently, which pre- scribe definite and uniform training and procedure in the protection of the command against gas. They are issued upon mobilization, and are modified from time to time as necessary. Tactical Protection. Tactical protection includes such activities as chemical warfare reconnaissance and intelligence, consideration of the influence of chemical warfare on selection of routes of march and battle positions, maneuver to avoid gassed areas, and offensive action to limit or disrupt hostile chemical attacks. Chemical Intelligence. Military intelligence, pertaining to chemical warfare, is derived and disseminated generally by the same agencies providing other intelligence. However, by reason of its technical nature, officers, having special training in chemical warfare, usually are depended upon to secure it. War Department chemical intelligence pertains to the enemy’s chemical warfare policy, training, and capability. Chemical combat intelligence deals with information of the chemical warfare activities, preparations, and intentions of the enemy forces in the field. Gas Indications. It may be expected that an enemy will seek to vary his use of gas so as to conceal his intentions. It is unsafe, therefore, to depend on gas indications alone in estimating the enemy’s future action. However, in the main, chemical operations will con- form to well established tactical principles. An attack with nonpersistent gas is likely to be followed shortly by an attack by infantry or by a repetition of the gassing. Such attacks may be masked by smoke. On the other hand, the gassing of an area with persistent gas is a good indication that the enemy does not intend to send foot troops through that area. DEFENSE AGAINST CHEMICAL WARFARE 185 BLANKET DETAIL PROJECTING ENTRANCE LATHS ON INSIDE OF BLANKET TO BE 2" SHORTER THAN WIDTH OF FRAME OPENING. BLANKET OVERLAPS FRAME IN CASE OF— PROJECTING ENTRANCE. FASTEN BLANKET TO TOP OF FRAME WITH A STRIP OF WOOD. WEIGHTS -PROTECTIVE COVER SHELF WEIGHTS HORIZONTAL GALLERY Plate 9. Gas-Proofing Dugouts. BLANKET EXACT WIDTH OF EN- TRANCE FRAME BLANKET WHEN ROLLED UP MAY v BE KEPT IN PLACE BY A STRING \\ AND LOOP ATTACHED TO A HOOK OR 7/S. BY A SHELF. SEE DETAIL ABOVE. -BLANKET ROLLED BLANKET UNROLLED ARRANGEMENT OF GAS BLANKETS FRAMES NOT CLOSER THAN 4 FEET AT TOP. FOR MEDICAL STATION - 8 FEET. SLOPE OF DOOR FRAME 3 ON I. -WEIGHTS BLANKET ROLLED SHELF DETAIL SEE THAT ALL JOINTS ARE CLOS- ED AND THAT THERE ARE NO OPENINGS. -shelf' 186 MILITARY MEDICAL MANUAL Chemical Reconnaissance, a. Chemical reconnaissance on the march. (1) Distant recon- naissance. Aviation, motorized, or mounted elements are looked to for early information bearing directly, or indirectly, upon protection against gas. Maps and air photographs will show critical areas, such as defiles, which favor the use of chemicals by the enemy; alternate routes, which may be used to avoid such areas; and suitable localities for halts. For gas protection, a bivouac area should be on high ground devoid of dense undergrowth, but containing sufficient trees for concealment. It should be large enough to accommodate the force without crowding. Water supply should be convenient. (2) Close reconnaissance. The composition of advance guards should include one or more unit gas officers. In case a gassed area is encountered, a gas officer should determine its extent, and seek a means of avoiding or passing through it with the least possible delay or danger to the column. Guides or signs should be posted as necessary to inform the main body of these gassed areas and the alternate routes to take in order to avoid them. An advance guard should be equipped to deal at once with minor gas situations as encountered. When the main body deploys for advance on a broad front, unit gas officers, assisted as necessary by gas noncommissioned officers, should reconnoiter for gassed areas in the path of the advance, and inform their commanders of the localities. b. Contact. After contact is gained, and throughout batde, unit gas officers are engaged continuously in chemical reconnaissance. They should study the terrain in the unit areas, note suitable localities for use of gas by the enemy, and be prepared to make recommenda- tions for the disposition of the unit for gas protection. They should inspect gassed areas and inform their commanders of the kind of gas used and the danger involved. Passage of Gassed Areas. Troops, upon encountering a gas-contaminated area, should, if possible, pass around it on its upwind side. If the passage must be made on the down- wind side, it should be carried out quickly and gas masks should be worn. When it is impossible to pass around such an area, steps should be taken to insure maximum safety in passing through it. If there is a road, it usually will be desirable to use it. If there is no road, and the area is covered with underbrush, lanes should be cut through the area to enable troops to avoid contact with contaminated vegetation. Terrain Considerations. High, open, bare ground is generally the safest from the view- point of gas protection. But low, wooded ground is that which provides concealment and cover from fire. The relative importance of these conflicting factors will vary in different situations. In many cases, in selecting positions for battle installation, some compromise, using reverse slopes of hills, may be practicable. While gas clouds travel generally with the wind, their movement is affected materially by terrain. Woods and broken ground retard them. Deep valleys and ravines cause eddy- ing air currents, which divert gas clouds from a straight path. Small woods, which an enemy may well suspect of being occupied, are likely to be heavily gassed. Chemical Attack From the Air. There do not appear to be any tactical measures for protection against chemical attack from the air, other than those which apply equally to other forms of air attack. Such general measures are concealment by night marches; use of concealed bivouac areas; such separation of units as is practicable, avoidance of main high- ways; provisions for warning of the approach of hostile aircraft; deployment; and anti- aircraft fire. Upon warning of the approach of hostile low-flving airplanes, gas masks should be ad- justed promptly. Tn case of a chemical spray attack, such vertical and overhead cover as available should be taken. A raincoat, paulin or shelter-half, if it can be thrown over the body in time, will give immediate protection, but, if contaminated, it must be discarded after the attack is over. Troops in covered vehicles are protected from such spray, provided they wear gas masks. When the hostile planes have passed, troops should be moved out of the gassed area and first aid and decontamination measures taken at once. Trees provide verv little protection from chemical spray. Plans of Protection. A force in bivouac, where it is subject to chemical attack, or occupy- ing a defensive position, should prepare plans for gas protection for that locality. These plans provide a coordinated scheme for occupation of an alternate position by each unit in case its original position is rendered untenable with persistent gas. The plans must insure against selection o£ the same alternate position by two or more units, and avoid movements which might jeopardize the safety of the force, or interfere with the accomplishment of its mission. An important area should be evacuated only when it is certain that the enemy is employing persistent gas in such quantity as to render the area unsafe to occupy, and not merely for harassing purposes. Offensive Action. Hostile preparations for chemical operations, such as installation of Livens projectors or other chemical weapons, whenever discovered, should be disrupted by fire or such other offensive action as is practicable. Action During and After Gas Attack. When the gas alarm is sounded, or a hostile gas attack is launched, troops adjust their masks and take such cover as is afforded. The doors of gas shelters, if provided, are closed; any fires for heating same are put out to avoid drafts; and supplies and equipment, in so far as practicable, are covered to protect them from gas. Troops in forward positions prepare to resist an attack by hostile infantry. Unit gas officers note the intensity of the enemy’s fire, identify the kind of chemical used, and if necessary, obtain samples of the agent and forward them to the rear for examination. If a persistent vesicant agent is used, unit gas officers determine and report the extent of the gassed area, estimate the danger of continued occupation of the unit’s position, and, where necessary, make recommendations to their commanders for the removal of the troops to another posi- tion. After the gas attack is over officers guard against any lelaxation of vigilance in their commands, since one gas bombardment is likely to be followed by another. As soon as practicable, casualties are evacuated, and such degassing or decontamination measures as are required are undertaken. DEFENSE AGAINST CHEMICAL WARFARE 187 CHAPTER IX MAP READING INTRODUCTION Map Reading for the Medical Officer. Map reading is an essential subject for the officer of the Medical Department. It is vital for officers assigned to duty with medical detachments of regiments of infantry, cavalry, or field artillery, or to the medical regiment or squadron of infantry or cavalry divisions. During marches, in campaign or battle, as well as in maneuvers and garrison service, the personnel of the department must provide continuous and adequate medical care, in whatever trying circumstances may be presented, in order to accomplish the important missions with which it is charged. This service must be taken to the troops. Medical units must move with the same facility, by the same general means, and for the same reasons. They must move and displace to new locations as the tactical situation changes and as the troops advance or retire. The statement, “Terrain is a tyrant,” applies to the medical officer, in the execution of his field duties, to the same extent as to the officer of the arms and for the same reasons. Maps picture terrain. The location and nature of roads and railroads, of cities and villages, of streams and the ridge lines which control their flow, of woods and forests, and cultivated fields are all shown on military maps. The nature of the terrain will usually determine the exact location of any tactical installation. The map is a primary fighting instrument of the officer. A knowledge of map reading is necessary in order to understand orders which are re- ceived. The width and depth of the areas utilized in action by the infantry or cavalry divi- sion may extend over several miles. The single factor of time will usually preclude that com- plete and definitive terrain reconnaissance which would be necessary if maps were not used. Immediately the medical officer receives the commander’s tactical plan he will start the preparation of the medical plan to support it. Map study will facilitate his under- standing of his task. It will indicate areas which should be visited in order to make a wise choice of locations for medical installations, as it will also enable him to eliminate from consideration entire areas which are thus disclosed to be unsuitable. His own order is likely to be issued with reference to a map. He must not permit himself to rely entirely on maps to the exclusion of ground reconnaissance. But he must use the one to supplement the other. On the battlefield the officer of any arm or service who lacks adeptness in the use of maps will be of doubtful value as a leader. This knowledge need not, however, include all of the phases which are necessary for the officer of engineers, for example, nor as required by the infantry or field artillery officer who uses the map for purposes of fire control or adjustment. He will need to develop pro- ficiency in the following specific map reading tasks: (1) Knowledge of conventional signs and special military symbols. (2) Location and coordinates, especially grid coordinates. (3) Measurement of map distances. (4) Direction and azimuth. (5) Elevation, relief, and terrain structure. (6) Use of the compass. (7) Practical application of map reading in the field. Military Maps. While the militarv will use any and all maps, including aerial photo- graphs, that come to hand, to the full extent of their capabilities, experience has indicated that certain types of maps are best suited to military needs. Therefore, maps constructed by the military will usually fall within one or another of the following classifications, as will maps of probable military use made by other government agencies: a. The strategic map. A small scale ('1:500,000) map, one sheet of which covers several hundred square miles. It is used by the commanders of major units, such as corps and larger. b. The tactical map. A topographical map of a scale of about one inch to the mile (1:62,500). Sheets are produced, covering an area of 15 minutes of latitude by 15 minutes 190 MILITARY MEDICAL MANUAL of longitude, or about 20 miles on a side, by the U. S. Geological Survey. Such sheets are often called “quadrangles.” This is the type of map expected to be most available and most useful in time of war. It is, therefore, considered the standard type for tactical opera- tions within the division. c. The terrain map. A large scale (1:20.000) topographical map showing the terrain in great detail. It is not expected that such maps will be available in quantity for field operations, and their present use is intended for indoor tactical instruction when it is impractical to utilize the terrain itself. Conventional Signs. The purpose of a map is to convey to the reader accurate information concerning the various terrain features occurring in the area under study. The body of the map consists of signs or symbols, each representing some terrain feature occurring in that area. These are arranged on the body of the map in the same horizontal relationship, one to another, that the features themselves hold to each other on the ground. The symbols by which the ground features are represented are called Conventional Sipns. These have been standardized and are published in FM 21-30. The map shown in Plate 1 contains most of the standard conventional signs used on both military and civilian maps. Conventional signs have been so devised that they picture or suggest the feature CONVENTIONAL SIGNS SHOWN ON PLATE 1, Numerical Key. 1. Good motor road, paved. 2. Telephone or telegraph line. 3. Double track standard gauge railroad. 4. Stream or creek (blue on a four-color map.) 5. Fenoe, smooth wire. 8. Trlangulation point or primary traverse station. 7. Corn field. 8. Fence, barbed wire. 9. Tall tropical grass. 10. River (blue on a four-color map.) 11. Woodland (deciduous trees.) 12. Tone trees. 13. Buildings In general. 14. Orchard. 15. Railroad crossings, railroad beneath. 16. Fence of any kind. 17. Schoolhouse. 18. Cultivated field, sugar cane. 19. Grass-land In general. 20. Dam. 21. Electric power transmission line. 22. Church. 23. Cemetery. 24. City, town or village. 25. Bridge, suspension. 26. Railroad crossing, railroad above. 27. Fill. 28. Bridge, steel (S). 29. Cut. railroad. 30. Bridge, truss or girder, for standard gauge RR. 31. Narrow-gauge railroad. 32. Bridge, highway, general. 33. Railroad, single track, standard gauge. 34. Mine or quarry of any kind (or open cut). 35. Accentuated (every fifth) contour. 36. Wire entanglement. 37. low or portable entanglement. 38. Trenches (dotted when proposed). 39. Demolitions (Ruins). 40. Ford, general symbol for vehicle ford. 41. Good pack trail or foot path. 42. Bridge, foot. 43 City, town or village (generalized). 44. Intermittent stream. 45. Worm fence. 46. Stone fence. 47. Tank trap. 48. Emiestrian ford. 49 Road poor motor or private, unpaved. 50. Marsh in general. 51. Head of small stream. 52. Bench mark, Elev. 555 ft- Alphabetical Key. P<»Tich mark 52 foot .!!!!!!!!!!!!!!! 4a Brifiore. highway, general .!!!!!!!!!!! 32 Brirtcre. highway, made of steel (8)""!!!!!!!! 28 B-ldge. truss, or girder 30 Bridge, susnenslnn 25 Buildings In general 13 City town or village (generalized) 43 Combination showing city, town or village 24 Crossing, railroad (RR above) 28 Crossing, railroad (RR beneath) 15 Cemetery 23 churrh 22 Accentuated (every fifth) contour 35 Cultivated field, corn 7 Cultivated field, sugar cane 18 Cut 29 Dam 20 Demolition* (ruins) 39 Electric power transmission line 21 Fence of anv kind (or board fence) 18 Fence, barbed wire 8 Fence, smooth wire 5 Fence, stone 46 Fence, worm 45 Fill 27 Ford, enuestrlan 48 Ford, for vehicles 40 Grass-land In general 19 Grass, tall tropical 9 Marsh In general 50 Mine or quarry of any kind or open cut) 34 Orchard 14 Pasture or grass-land In genera] 35 Railroad, double track, standard gauge .... 3 Railroad, narrow gauge 31 Railroad single track, standard gauge 33 River (blue on a four-color map) 10 Road, good motor, paved 1 Road, poor motor or private, unpaved 49 Schoolhouse 17 Stream or creek. Intermittent 44 Stream or creek, perennial (blue on a four- color map! 4 Stream head of 31 Tank trap 47 Telephone or telegraph line 2 Trail or foot path 41 Trees, lone 12 Trees, deciduous 11 TYenches (dotted when proposed) 38 Triangulation point or primary traverse station 8 Wire entanglement 36 Wire entanglement (low or portable) 37 Woodland (deciduous tree*) W Plata 1. Conventional Signs. 192 MILITARY MEDICAL MANUAL that they represent. Further to increase their value and ease of identification, the standard maps are printed in four colors, as follows: a. Black( for the works of man, names, and the grid. b. Blue for water. c. Green for woods and other vegetation. d. Brown for contours and other torms of relief portrayal. Marginal Information. The following items of marginal information usually appear on standard military maps: a. Harriman index number of the map and the location in the Harriman index of the quadrangle shown on the map sheet. The Harriman index system is explained in TR 190-7. b. Name of the state or states within which the mapped area lies, and the name of the quadrangle or area. c. Its scale, showing both the representative fraction, and mile and yard graphic scales. d. Its orientation with the local magnetic declination and probable annual change. e. Explanation of any symbols appearing that have not been adopted as standard. /. The contour interval. g. Name of the organization which issued the map. h. The date of issue or revision. *. The names of the organizations executing the surveys, date of surveys, and any com- pilation sources. The projection used. The horizontal datum. /. The vertical datum. m. zone of the military grid, including reference to overlap zone, if any. n. The designations of the geographic grid lines. o. The designations of the military grid lines. p. The names of adjoining map sheets. q. An index of the adjoining map sheets (sometimes). r. The filing name. Special Military Symbols. The map is used as a plotting board upon which to record the dispositions and locations of the enemy and our own troops, and upon which to plan the details of operations. For this purpose a series of symbols have been devised. These are known as Special Military Symbols and by means of them the size, identity, and desig- nation of the various units and installations, the location and type of auxiliary weapons, and the various lines and boundaries involved in an operation can be indicated. See Plate 2. Symbol indicating size Airship mooring mast Airport (landing field) (a) Smaller unit Basic symbol Superior unit Airport (landing field advanced) .. Example: 1st Battalion. 2d In- fantry Autogiro Symbol indicating size Ammunition Arsenal Symbol of arm or service (b) Company, troop, battery, flight Weapon Division. brigade. regiment. separate battalion. separate company. Arsenal (gas generating) Balloon, ascension point Balloon bed Balloon barrage ascension point ... Example: Battery E. 62d Coast Artillery, Antiaircraft. Machine Gun Barrage Blue [ (size indicating the extent, and notation indicating type) Symbol indicating size Demolitions . . (c) Army or corps Depot (supply point) Example: Second Army (Temporary depot in combat zone) LIST OF BASIC SYMBOLS.—To indicate pur- pose or character of activity. Military post or station; command post or headquarters Debarkation or embarkation point.. (lower end; of staff terminates at location of establishment repre- sented) Dugout: Isolated Troop unit (On large-scale maps where troop units can be shown to scale, this symbol may be modified as fol- lows so as to show area occupied by units in column or line and direction in which they are facing: In trench system Gas-proof Entanglement Wire Concealed ... Gas: Area to be avoided I Line Column Area blanketed by smoke (time effective) Airdrome Area probably affected, by gas cyl- inder cloud Airship hangar Area to be gassed, nonperslstent General hospital Point, any located (suitable descrip- tion) Laboratory, experimental station, or proving ground Point, distributing: Leader gear r* (An energized cable which may be provided to aid the safe pilotage of vessels through free passages in mine fields. Symbol is used on chart to show exact location.) For class I supplies .... Ammunition Artillery ammunition Message center Mines: Small-arms ammunition Individual (layout shown if prac- ticable or area included) .. q 0 Water Prisoners of war Chemical land mine Contact mines _0. (This symbol is used to indicate the actual number of mines and their locations. The ara- ble figures indicate the con- templated number of mines in each line ) Procurement district, headquarters.. Railway center Railhead Controlled mines (This symbol indicates one 19- mine group, and a separate symbol is used for each group. As it appears here, the upper edge of this page is assumed to be seaward: and on charts the symbols should be corre- spondingly placed. The length of a mine group being 1800 feet, the symbol is drawn to scale. Its position represents the contemplated disposition of the mine group.) Reception center Replacement training center School, commonly used Found occasionally on old maps .. Mobilization point or area (capacity in figures) Supply. (See Depot.) Ammunition, all classes Net: Torpedo net (with gate) Ammunition, artillery Antisubmarine net (with gate) Ammunition, small arms Class I Obstacle: Individual Gas and oil Water Road block Bridge out Trains (supply, motor): Post: Observation Animal-drawn Fixed underwater listening Pack • Visual signal Railway Searchlight Cavalry: Horse Sound locator Horse and mechanized Mechanized Signal: Radio station Chemical Warfare Service Direction-finder station (radio compass) Coast Artillery: Antiaircraft Intercept station Harbor Defense Railway Switching central Tractor-drawn Switching central (located at com- mand post) Engineers Test station or cable terminal .. Infantry Motorized Wire on ground Parachute Traffic: One-way Medical Corps Two-way > Military Police ' Ordnance Department Tank : Barrier — Trap Quartermaster Corps Trench for one squad (For each additional squad add one traverse.) Bakery Class I supplies Weather station Gasoline and oil only To indicate arm or service or its activity.— These symbols are placed within the symbols shown above when appropriate, except when otherwise noted. Remount Service Signal Corps Signal Corps (aviation) Tank Destroyer Air Corps Transportation Corps Airship Balloon Veterinary Corps To indicate size of unit.—These symbols are placed above the symbols shown above, or are used for indicating boundaries as shown below. Balloon (motorized) Squad Armored Force Section (When used with arm or service symbol, indicates mechanized unit.) Platoon Artillery Company, troop, Pattery, or Air Corps flight Battalion, Cavalry squadron, or Air Corps squadron Division Corps Regiment or group Army Brigade or Air Corps wing Corps area, department, or section of communications zone Division or air force Corps Communications zone Army Rear boundary of theater of op- erations Service Command, department, or section of communications zone . Front line . Communications zone Limit of wheeled traffic by day General Headquarters Limit of wheeled traffic by night Air Force Combat Command Line beyond which lights on vehicles are prohibited Soldier Outpost line Automatic rifleman Assistant leader, or second in com- mand Main line of resistance Regimental reserve line Leader Limiting point Squad leader Line of communication To indicate boundaries and lines. Bombardment aviation, light (limit of radius of action) oo> Line of departure GHQ reconnaissance aviation (limit of zone of reconnaissance) Straggler line Prisoner of War Inclosure, IV Corps. Observation aviation (limit of zone of reconnaissance): Weapons. Rear limit, army aviation Automatic rifle (Dotted when emplacement is not occupied, thus) Rear limit, corps aviation Air force reconnaissance aviation (limit of zone of reconnaissance) Machine gun (Arrow points in principal direc- tion of fire. When used alone it indicates machine gun, water- cooled, cal. .30.) (Machine-gun symbol under sym- bol of unit of any arm indicates machine-gun unit of that arm ) Pursuit aviation (limit of radius of action) Squad — Antiaircraft Section Antitank gun (specify caliber) .. Platoon Antitank gun in position, show- ing principal direction of fire (indicate caliber by numeral) Company or similar unit Battalion or similar unit Antitank gun emplacement with principal direction of fire Regiment or similar unit Brigade .... Caliber .50 Light APPLICATION OF SPECIAL SYMBOLS—The following examples show the use of special sym- bols as applied to various military organizations and activities. These examples are intended to illustrate the method of combining basic symbols and abbreviations in order to show the desired information. These are only a few of the possible combinations. Many are more complete than necessary. Often the number of a unit, to those familiar with it, will indicate its activity. Machine gun (single gun) (Arrows indicate sectors of fire; shaded portion shows danger space when fire is placed on final protective line.) Machine-gun section (two guns) .. Gun Air Corps. Gun battery .. | Howitzer or mortar 3d Air Force Open when em placement is< unoccupied, thus Howitzer Or mortar batt'ery- 444 701st Air Base Group 901st Transport Squadron 4.2-in. chemical mortar -4-4.2 7th Observation Squadron Livens projector Mines, chemical land (individual) .. 88th Reconnaissance Squadron Special symbols for use in hasty sketches and on operations maps. 101st Balloon Squadron Area occupied by a unit (2d Bat- talion. 3d Field Artillery) 1st staff Squadron Area occupied by corps troops (III Corps) 301st Balloon Group 701st Bombardment Wing (Light) Brush Cultivated land 532a Pursuit Group (Interceptor) Second Army Aviation . Stream 203d School Squadron Woods Roads.—Suggested road classification is shown below. This classification will not apply in all cases. When additional types are indicated suit- able identification should be made by improvised notation or legend. Headquarters Company, 1st Armored Division Hq Armored Force. Military Police Platoon, Headquar- ters Company, 1st Armored Divi- Slon MP Hard surface i Transportation Platoon, Headquar- ters Company, 1st Armored Divl- Sl°n TH, Graded and improved Graded, not improved 1st Reconnaissance Battalion / Poor road Trail Rifle Company, 1st Reconnaissance Battalion Weapons platoon, 1st Reconnais- sance Battalion Wpn 0 Motorcycle Platoon, 1st Reconnais- sance Battalion Mtcl A 1st Reconnaissance Squadron I Armored Company (Light), 1st Re- connaissance Battalion C 1st Cavalry Division 1st Armored Brigade Command Post, 5th Cavalry Communication Platoon, Headquar- ters Company, 1st Armored Bri- gade Com Hq [ Observation Post, 9th Cavalry Park, mechanized units of horse cavalry regiment Park, Motor Transportation, 3d Cav- alry * Headquarters Company, 1st Armored Regiment (Light) Hq Maintenance Platoon, Service Com- pany, 1st Armored Regiment (Light) Molnt Sorv [ Chemical Warfare Service. 2d Platoon, 1st Chemical Company, Service Aviation • • • Reconnaissance Company, 1st Ar- mored Regiment (Light) Ren | 10th chemical Company, Mainte- nance ..' r~T Machine Gun Company, 1st Ar- mored Regiment (Light) Company B, 2d Separate Chemical Battalion _ r 1 1 3d Battalion, 901st Chemical Regi- ment , Company A, 1st Armored Regiment (Light) A 69th Armored Regiment (Medium) Chemical Warfare Service Distri- buting Point, IV Corps 70th Tank Battalion, GHQ Reserve Chemical Warfare Service Depot, First Army Cavalry. Light Machine-gun 'Platoon, Troop A. 2d Cavalry Coast Artillery Corps. 55th Balloon Barrage Battalion ... Scout Car Platoon. 2d Cavalry .. Searchlight Platoon, Battery A, 104th Coast Artillery ' 1st Platoon, Troop E, 8th Cavalry .. Machine-gun Platoon, Battery E, 102d Coast Artillery i 1st Platoon, Special Weapons Troop, 14th Cavalry ( Sp W| 1st Platoon, Antitank Troop, Cavalry Division 37-mm Platoon, Battery F, 202d Coast Artillery 2d Battalion, 2d Coast Artillery, Harbor Defense 2 Mortar Platoon, Weapon Troop, Cavalry Brigade V 912 Coast Artillery (Railway) 1st Platoon, Troop A, 4th Cavalry Horse and Mechanized I 57th Coast Artillery (155-mm gun) 2d Platoon, Troop G (Motorcycle) 4th Cavalry (Horse and Mech- anized) ? 77th Separate Coast Artillery Bat- talion (Antiaircraft, 37-mm) .. .r Headquarters Troop, 3d Cavalry Brigade 4th Battalion, 241st Coast Artillery, Harbor Defense, Type C . HrS Troop A (Scout Car), 1st Reconnais- sance Squadron g. ft Command Post. Battery E, 248th Coast Artillery, Harbor Defense, Type B i—i Special Weapons Troop, 3d Cavalry Troop E (Scout Car) 6th Cavalry (Horse and Mechanized) Corps of Engineers. Company A, 2d Engineers (combat) 12th Engineer Battalion (Triangu- lar Division) . Reconnaissance Troop (Mechanized) 9th Division Ren I 8th Engineer Squadron (Cavalry Division) Battery B, 1st Field Artillery Obser- vation Battalion _ f— B L 302d Engineer Battalion (Separate) Headquarters Battery, 1st Division Artillery (Triangular) 301st Engineer Battalion (General Service) .... Tank Destroyer Battalion 905th Engineer Battalion (Heavy Ponton, Motorized) .... One squad, 2d Platoon, Company G, 117th Infantry 2 Infantry. 2d Platoon, 70th Engineers (Light Ponton. Motorized GHQ Reserve) 2d Heavy Machine-gun Section, Company D, 2d Infantry Engineer Depot No. 2. First Army .. 1st Platoon Company B, 2d Infantry Engineer Park, II Corps p Headquarters Company, 3d Infantry Bridge Company, 16th Engineer Bat- talion 8 3d Machine-gun Platoon, Caliber .50, Company M, 120th Infantry 1st Antitank Squad (Antitank Com- pany), 1st Infantry ( 2d Platoon, 391st Engineer Company (Depot) pii: Service Platoon. Company C, 801st Engineers (Water Supply) Command Post, 2d Battalion, 323d Infantry g 2d Platoon, Company B, 28th Engi- neers (Aviation) , • • Automatic Rifle Squad, 2d platoon, Company A, 1st Infantry Factory Platoon. Shop Company, 84th Engineers (Camouflage) -j. Intelligence Platoon, Headquarters Company, 22d Infantry | n t H Field Artillery. 1st Light Machine-gun Squad, Com- pany F, 309th Infantry I F Symbol may also be used to show artillery position area Mortar Section, Company C, 18th Infantry Battery F, 2d Field Artillery Ammunition Train, 2d Battalion, ■ 3d Field Artillery (Horse) . Service Platoon, Headquarters Com- pany, 105th Antitank Battalion . • Headquarters Battery, 2d Battalion. 4th Field Artillery (Pack) ... Hq 2 Weapons Platoon, Company E, 6th Infantry (Armored) Wpn 3d Platoon, 205th Military Police Company 3 Gasoline Section, Service Battery, 54th Field Artillery Regiment (105-mm, Howitzer. Armored) -T S«n 1st Battalion, 8th Field Artillery .. 501st Infantry Battalion (Parachute) Headquarters and Headquarters Bat- tery , 11th Field Artillery Brigade 8th Infantry (Motorized) 1st Infantry Train 2d Battalion, 18th Field Artillery (Composite) * rt Service and Ammunition Battery, 1st Battalion, 79th Field Artillery (240-mm Howitzer, Motorized) .. Kitchen Train, 2d Battalion, 3d Infantry «i Observation Post, 81-mm Mortar Platoon, Company D, 30th In- fantry 4 2d Section, Battery B, 71st Field Artillery Battalion, Horse-drawn ... Maintenance Section, Battery C, 98th Field Artillery Battalion (75-mm Howitzer, Pack) Molnt C [ Medical Detachment, 5th Infantry . 1st Battalion Section, Medical De-. tachment, 175th Infantry .gn C Medical Department. Veterinary troops Company B, 19th Ordnance Battal- ion (Armored) Headquarters and Service Company, 1st Medical Regiment HC Headquarters and Supply Section, 105th Ordnance Company (Medium Maintenance) • • Clearing Company D, 8th Medical Battalion Service Platoon, 73d Ordnance Com- pany (Depot) 1st Platoon, Company E (Ambu- lance), 105th Medical Regiment | £ 462d Ordnance Company (Aviation, Bombardment) | L_ Station Platoon, Company G (Clear- ing 105th Medical Regiment | q 694th Ordnance Company (Aviation. Pursuit) 1—. 3d Platoon, Collecting Company, 47th Medical Battalion Armored 3 721st Ordnance company (Aviation Air Base) L_ Clearing Platoon, Veterinary Troop, 1st Medical Squadron 3 v Quartermaster Corps. First Army Medical Depot Light Maintenance and Car Battal- ion, 119th Quartermaster Regi- ment Battalion Aid Station, 1st Battalion, 4th Infantry j Company C, Truck Battalion, 105th Quartermaster Regiment Ambulance Loading Post Company A (Truck), 13th Quarter- master Battalion (Armored) Collecting Station, 1st Division Shop Headquarters and Supply Pla- toon, Company C, 56th Quarter- master Regiment (Heavy Mainte- nance) r' - \ co* 11th Evacuation Hospital 2d Platoon, company K, 48t.h Quar- termaster Regiment (Truck) r Clearing Station, I Corps . Hospital Train Pack Troop, 16th Quartermaster Squadrons, 1st Cavalry Division 681st Quartermaster Battalion (Steri- lization and Bath) —i I Veterinary Clearing Station, First Army xxxx Service Platoon, Company A, 203d Battalion (Gasoline Supply) . ,-r-u 5th Platoon, 12th Veterinary Com- pany Company D, 94th Quartermaster Battalion (Bakery) l 901st Veterinary Evacuation Hospi- tal GMQ Transportation Platoon, 252d Quar- termaster Company (Air Base) Ordnance. 1st Ordnance Company, Medium. Maintenance I Second Army Quartermaster Depot No. 1 (Gasoline and Oil) * 2d Ordnance Company, Heavy Main- tenance (Army) i Third Army Quartermaster Depot No. 2 (Motor Transport) .... Railhead for Class I Supply. 2d Divi- sion 3d Ordnance Company, Heavy Main- tenance (Tank) i Service Section, 28th Ordnance Com- pany (Medium Maintenance) • ■ Ill Corps Quartermaster Park . . . . p, Truckhead Class l Supply. 2d Divi- sion x. Magazine Platoon, 51st Ordnance Company (Ammunition) . Signal Corps. 3d Platoon, 95th Ordnance Com- pany, Maintenance Railway Artil- Jefy - - 59th Signal Maintenance Company (Aviation) ,_L_ [cSc MAP READING 201 Intercept Section Headquarters Pla- toon, 3d Radio Intelligence Com- Pany HaVl 5th Signal Battalion, Construction 317th Signal Company, Air Wing f 1st Signal Company, Photographic jl Signal Company, Operation (Radio) 59th Signal Battalion, Armorer Corps Opn (R< Operating Platoon, 1st Signal Troop, 1st Cavalry Division Headquarters Platoon, 701st Pigeon Company • Signal Company, Operation (Wire) 59th Signal Battalion, Armore< CorPS Opn (Wi Operation Company, 62d Signal Bat- talion 0| 1st Signal Company, Depot Construction Platoon, 30th Signal Company Coi 2d Signal Company, Repair 7th Aircraft Warning Section,. 2d Aircraft Warning Company .... 1st Signal company, Construction Separate r-H 21st Signal Company, Operation Separate r~_—1 Telephone and Telegraph Section. 313th Signal Company (Aviation) 3d Radio Intelligence Company ct 1st Signal Platoon (Air Base) Point on axis of signal communi- cation, 1st Division Position-finding Section 1st Platoon 3d Radio Intelligence Company . Point on axis of signal communi- cation, 1st Armored Division Plate 2. Special Military Symbols. LOCATION AND COORDINATES Names. The naming of any named feature is the simplest and fastest method of identification. The names of cities, towns, rivers, lakes, mountains, woods, and similar features are invariably shown on maps. Military maps endeavor to show the names of all named features, particularly roads, hills, woods, and even farm houses, when known, further to facilitate identification and location. Because of their military importance the accurate identification of hills and of road junctions is especially desirable. On military maps, hills and road junctions are often given numbers for identification. The numbers so selected are the elevation of the feature in feet, and thus serve the dual role of identification and of conveying topographical information. Location by Polar Coordinates. To indicate any specific location on a map it is sufficient to name the feature at the desired location, if it has a name. When the feature in question has no identifying name or number itself, it may be identified by giving its distance and direction from some close-by feature that is named. Thus (see Plate 1) it is sufficient to say, “Road junction one-half mile south of MILLDALE,” or, “Orchard just east of R. WILLIAMS, JR.,” to identify the features in question. If greater accuracy is needed be- cause of difficulty in describing the feature, the distance may be accurately measured in yards and the direction given in terms of azimuth. This is called the “polar coordinate” method of indicating location. Location by Grid Square. To facilitate the reading of military maps a grid system is printed thereon. The grid is a series of horizontal lines (known as the x-grids) and vertical lines (known as the y-grids) spaced 1000 yards apart. These lines arc numbered in one scries from left to right, and in another series from bottom to top. The combina- tion of these horizontal and vertical lines is known as the “military grid,” and they divide the map into 1000-yard squares. Any square can be indicated by giving the numbers of the two grid lines that form the beginning (west edge and south edge) of the square. The left-to-right reading is always given first, and the bottom-to-top reading last. In 202 MILITARY MEDICAL MANUAL Plate 1 the vertical grids arc numbered at the top and are 40 to 42, inclusive; the horizontal grids arc numbered on both sides of the sheet and are 15 to 19, inclusive. To indicate location of features on maps of unfamiliar territory, much time is saved by indicating the feature and the grid square in which the feature is found. This reduces the amount of searching to an area 1000 yards square. The road junction and the orchard identified by polar coordinates in the preceding paragraph could have been identified, as follows, by the grid-square method. “Road junction (41-17).” “Orchard (42-19).” Plate 3. TDstaff the "L” Shaped Coordinate Card. The coordinates oX point “P” are (43.63 —13.77). Location by Grid Coordinates. It is frequently necessary to give the location of some feature with great exactness, or to indicate a point on the side of a hill, or in an open field. This is done by indicating the exact position within its proper grid square at which the point occurs. For example, the road junction in Plate 1, used in previous examples of location, appears to be about nine-tenths of the distance across its grid square, reading toward the right from the 41 grid, and about five-tenths of the distance up from the 17 grid. Its grid coordinates therefore would be expressed (41.9—17.5). Coordinates are always written as two figures, separated by a dash and inclosed in parentheses as above. The left-to-right reading is always given first, followed by the bottom-to-top reading, which can be remembered through the key phrase, “READ RIGHT UP.” The interpolated figures showing position within the grid square arc shown as decimals, following their key grid (as .9 follows 41, and .5 follows 17, above). They can be read to tenths or to hundredths, according to the accuracy desired. Since the squares measure 1000 yards MAP READING 203 on a side, a reading to tenths (one decimal) gives location to a 100-yard accuracy, while a reading to hundredths (two decimals) gives an accuracy of ten yards. When the grid line numbers run into several digits, it is customary to drop all but the last two digits of the x and the y grids. For example, grid number (1941—2117) ordinarily would be writ- ten (41—17). The Coordinate Card. The reading or plotting of grid coordinates is greatly facil- itated by the use of the coordinate card. This card is, in effect, a double scale that can be placed on the map and by means of which both the horizontal and the vertical inter- polations can be made at one time. There are two types of coordinate cards in general use. One of them is “L” shaped, and the other is rectangular. The manner of using the cards is similar and is shown in Plate 3 and Plate 4. Plate 4. Using tlie Rectangular Coordinate Card. The coordinates of the point “P” are (43.63 —13.77) In both cases, the sides of the cards must be parallel to the grid lines when used. The cards are divided into tenths, and when read to the nearest graduation will give a reading to one decimal, or to a tolerance of 100 yards. When readings to two decimals, or to ten yards, are desired, the graduations arc further subdivided into tenths, by inspection. Coordinates on the 5000-Yard Grid Maps. The smaller scale maps, such as the tactical map (1:62,500), often show every fifth grid line only, thus dividing the map into 5000-yard squares. In indicating location by the “grid-square” method it is sufficient to indicate the squares as they appear on the map. To indicate exact location by the grid coordinate method, however, it is necessary to allow for the intermediate 1000-yard grids that are omitted from the map. For this purpose a special coordinate card is used, dividing the 5000-yard unit into five 1000-yard divisions for the missing intermediate grids, and further subdividing each of these 1000-yard units into tenths (or 100-yard units). Such a coordinate card and its method of employment is shown in Flatc 5. 204 MILITARY MEDICAL MANUAL DISTANCE AND TIME The Graphic Scale. One of the most important uses of the map is to determine distances between points on the ground. This is done by means of a map scale, thus the basic data found on all military maps includes a scale, which consists of one or more lines divided into equal divisions, and each division marked with the distance which it represents on the ground. These are the graphic scales and arc used for the measurement of distances. There will be one such scale graduated into mile units for use in computing data needed for marches and movements. There will be another such scale graduated to permit direct measurements in terms of yards for the computation of ranges, depths, and frontages. (See Plate 6). On many maps, an additional graphic scale will be shown graduated to permit The coordinates of point “P” are (43.7 — 87.3). Plate 5. Reading Coordinates on the 5000-Yard Grid. readings in kilometers and meters (an aftermath of having fought the World War in Europe). Each scale consists of a primary scale divided into convenient major divisions of ground distance, and an extension at the left consisting of one of the major divisions subdivided into tenths or other appropriate fraction. Measuring Distance on the Map. The graphic scales are a printed portion of the MAP READING 205 map, and therefore cannot be moved around on the face cf the map, as a ruler would be for example. A straight distance on a map is measured by laying the edge of a strip of paper along the line to be measured, and marking thereon or short straight marks opposite the two points that form the limits of the line. The distance between these ticks corresponds to the map distance between the points. To determine the ground distance carry the marked paper down to the proper graphic scale. Place the right-hand tick accurately on that division of the primary scale which forces the other tick to fall within the extension. Read the total number of the primary divisions at the right end, and add Yards ►Extension Primary Scale Plate 6. A Graphic Scale (or Measurements in Yards. the number cf extension graduations shown at the other end. The combined reading will be the ground distance of the line measured. The distance between the two houses (center to center) in Plate 7 is 3000 yards of primary scale plus 4*4 divisions of the extension, a total of 3425 yards. Measuring Distance by Road. Road distance between two points, because of the bends and turns of the road, seldom can be measured in one operation as explained above. It is necessary to break the route to be measured into a succession of straight parts, commonly called legs, plotting them in sequence direct from the map onto the edge of a strip of paper. (See Plate 8). The combined distance, so plotted, is then measured on the graphic scale (always in miles for marches and movements) as described in the preceding paragraph. distance - (strip of paper -distance- Yards Plate 7. Measuring a Distance on a Map. The Representative Fraction. The scale of a military map is indicated on the map not only by the graphical scale but also by a fraction called the "representative fraction” or "RF". This fraction or symbol expresses mathematically the relation which distances on the map bear to the distances on the ground. Thus in the case of a map bearing the symbol 1/20,000, any distance measured on the map is one-twenty thousandths of the same distance on the ground; or, any distance on the ground would be twenty thousand times the same distance on the map. It (1/20,000) is also in effect, a statement that one unit of distance on the map corresponds to 20,000 units of distance on the ground. In the absence of any graphic scales, a ground distance can be determined from the representative fraction by 206 MILITARY MEDICAL MANUAL multiplying the map distance by the denominator of the RF of the map. Various maps have different scales, such as 1/10,000, 1/63,360, etc. Any representative fraction is a statement of the ratio of size between corresponding map and ground dimensions. Determining the Representative Fraction. If the representative fraction is not shown on the map, due cither to omission or to mutilation, it can be determined in the following manner. Select a line on the map that can be accurately located on the ground. Measure the line on the map and then measure the same line on the ground by tape, chain, pacing, or any acceptable method. We now have two measurements both pertaining to the same -road distance (strip of paper) Plate 8. Measuring Road Distance. line—one on the map in inches and one on the ground in yards or miles. Reduce the ground measurements to inches, so that both measurements are in the same unit and there- fore can be compared. Reduce the equation so that the map side thereof is 1. For example, the distance between two houses measured on the map is 2.82 inches and measured on the ground is 1580 yards. Map Ground 2.82 inches on the map=: (Reduce to common term*) 1,580 yards on the ground 2.82 inches on the n.ap— 56,880 inches on the ground (Reduce to a map value of “1") 1 inch on the map = 20,170 inches on the ground (or) 1 = 20,170, the RF of this particular map. If other maps of the same area are available, the ground distance could be secured from them instead of by measurement on the ground itself. Words and Figure Scales. Scales may be expressed in words and figures, such as: “One inch equals one mile,”'which means that one inch on the map represents one mile on the ground. Such a scale can be converted to a representative fraction by reducing both sides of the equation to common terms. The above scale would then be “1 inch= 63,360 inches,” and its RF would be written: 1:63,360. Representative fractions are always written with the numerator (map side of the equation) expressed as unity. Therefore a further conversion step may be required in cases such as the following: “Three inches equals one mile.” 3 inches=63,360 inches 1 inch =21,120 inches 1 :21,120 (RF) Constructing a Graphic Scale. For the purpose of determining distance data from a map, the graphic scale is the only type scale that is convenient to use, and for this reason is often called the reading scale. If such a scale does not appear on the map in con- venient units, much trouble is saved by constructing one immediately. A graphic scale can be constructed for any map whose representative fraction is known or can be de- termined. For example, assume that a map shows no graphic scale, but shows a represen- tative fraction of “1:20,000.” It is desired to construct a graphic scale to make readings in terms of yards. The 1000-yard unit is the most convenient to use. 1000 yards equals 36,000 inches. Our problem can be stated, “Since 1 inch on the map is known to represent 20,000 inches on the ground, then how many inches on the map will it take to represent 36,000 inches on the ground.” The above can be worked out as a problem in ratio and proportion, as follows: 1 : 20,000 : : X : 36,000 20,000 X = 36,000 X = 1.8 A line of convenient length is then drawn, and divided into divisions of 1.8 inches each, each of which will represent 1000-yard units of ground distance. The left division should be subdivided into tenths, by any convenient method, for the extension of the scale. Converting Distance to March Time. The computation of the time required for troop movements is an essential item of military information obtained from maps. The rates of march of various types of troop units is known from experience. Foot troops are habitually computed as traveling, by road, by day, at a rate of 2/2 miles per hour. The distance to be marched, divided by the rate of march, will give the time required for the movement. Example: A dismounted unit is to march from A to B. How long will it take? Points A and B are located on the map, and the road distance measured. It is found to be 11.4 miles. The rate of march is 2 XA mph. 11.4-^2.5=4.56 The march will therefore require 4.56 hours. March time is always expressed in hours and minute*. All fractional parts of a minute are carried to the next full minute. Four and 56/100 hours (X 60) equals 4 hours and 33.6 minutes. Therefore the above march will require 4 hours and 34 minute* travel time. Converting March Time to Distance. The distance that troops can move during a, known elapsed time is an item that must frequently be determined. The time in hours multiplied by the rate of march will give the distance. Example: A dismounted unit left A marching toward B at a known time. Where is the unit now? The rate of march is 2 mph. and the troops have been marching for 3 hour* and 15 minutes. 3 hours 15 minures= 3.25 hours 3.25 (elapsed time) X 2.5 mph (rate)=8.125 miles (distance). The unit would be 8.125 miles from A. This distance is plotted on the edge of a strip of paper by means of the miles graphic scale, and is then scaled off along the road from A toward B. Time-Distance Scales. When much work in determining distance and time of marches and movements must be done, it is of great convenience to construct a time-distance scale. Such scale is in reality a graphic scale divided into time units instead of into dis- tance units. Such a scale for use in connection with movements of foot troops (2x/2 miles per hour) could be constructed as follows. From the miles graphic scale of the map draw a line to represent 2/2 miles which will therefore represent one hour of travel. Divide the line so drawn into twelve equal parts, each of which will then represent the distance covered in five minutes of travel time. To measure any given time-distance, use it exactly as a graphic scale, the full divisions representing full hours, and the subdivisions indicating the number of minutes of travel time. The scale might be divided into sixty parts, each representing one minute of travel. A time-distance scale for any other rate of travel could be constructed in a similar manner. MAP READING 207 DIRECTION AND AZIMUTHS Direction, General. The established geographic terms, north, south, cast, west, and northeast, southwest, etc., are used by the military to indicate general direction. Also the relative terms right and left, front and rear, are sometimes used in the field when they will serve the purpose. They are used in their generally accepted sense, except that the relative terms are based upon the direction that the unit is facing, rather than the in- dividual: and. in combat, the direction of the enemy is always front. When a more accurate designation of direction is necessary the azimuth method is used. The Azimuth Circle. The azimuth method is the established method of indicating direction in military map reading. The observer, or the point from which the direction is initiated, is presumed to be at the center of an imaginary horizontal circle (see Plate 9). NORTH WEST EAST Plate 9. The Azimuth Circle. The azimuths of A, B, C, D, and E are 72*, 78*, 135*, 240*, and 313\ respectively SOUTH Plate 10. Map Reading1 Protractors. A—Semi-circular Protractor. B—Rectangular Protractor. LINE EXTENDED TO CUT PROTRACTOR SCALE TO FACILITATE READING. LINE EXTENDED TO INTER5ECT VERTICAL GRID. Plate 11. Measuring Map Azimuths. The azimuth of the line A — B la 83*; of C — D, 296* BASE LINE CONSTRUCTED ■THROUGH P PARALLEL TO VERTICAL GRIDS. INITIAL POINT FROM WHICH AN AZIMUTH OF 115° IS TO BEN PLOTTED. •POINT PLOTTED FROM PROTRACTOR SCALE LINE DRAWN FROM P THROUGH P/ Plate 12. Plotting an Azimuth (115°) On a Map. 210 MILITARY MEDICAL MANUAL This circle is divided into 360 units of circumference measurement, called degrees. The degrees are numbered in a clockwise direction, the zero point being at the north, which automatically places the 90°-point exactly east, the 180°-point south, and the 270°-point west. The 360°-point will coincide with the 0°-point and be north. Direction by the azimuth method is expressed by giving the number of the degree on the circle at which a line drawn from the initial point through the point desired will pass. The Protractor. Map azimuths are read with a protractor. Two standard types of protractors, semicircular and rectangular, are shown in Plate 10. Each protractor repre- sents one-half of an azimuth circle. Two scales are usually shown, one reading from 0° to 180° for reading azimuths in the first half of the circle, and another showing read- ings from 180° to 360° for azimuths in the second half of the circle. Measuring a Map Azimuth. To measure the azimuth of a line on a military map, extend the line to be measured, if necessary, until it crosses a vertical grid. (See Plate 11). Place the central index point of the protractor upon the intersection of the line with the vertical grid and register the base line of the protractor accurately on the grid line. If the direction of the line to be measured is to the east of the grid line, the reading is taken from the O°-180° scale. If the direction of the line is to the west of the grid, the pro- tractor is inverted, and the reading made on the 180°-360° scale. Plate 13. Back-Azimuths. Plotting an Azimuth On a Map. To plot an azimuth on a map, construct a vertical base (zero) line through the point at which the azimuth originates. On a gridded map such a line would be parallel to the vertical grid lines. Register the protractor with its base line superimposed on the plotted line, and with its central index on the point at which the azimuth originates. Mark the point opposite the proper reading on the pro- tractor scale and draw the line as shown in Plate 12. Back-Azimuth. Every line has two azimuths, depending on the direction in which the measurement is made. On Plate 13 the azimuth of the line O-A is 60°. The azimuth of the same line measured from A back toward O (A-O) is 240°. This is the back azimuth of O-A. It is also the same as the azimuth of the line O-A', which is the extension of the line A-O. The back-azimuth of any line varies from its direct azimuth by exactly 180°, and so whenever the azimuth or the back-azimuth of a line is known its other azimuth MAP READING 211 can be determined by subtracting or adding 180°. It is essential in dealing with azimuths always to indicate the direction of the measurement (O-A or A-O) and to specify azi- muth or On Plate 13 the azimuth of the line O-B is 290°; its back- azimuth is 110°. Intersection and Resection, a. An unknown point can be located by its azimuth and distance from some known point. (Sec polar coordinates.) A point can also be located if its direction from two points is known. For example, a new house has been built, and it is desired to enter it on the map. (See Plate 14.) The azimuth to the house is deter- mined from the road junctions 482 and 516, and found to be 112° and 30°, respectively. These azimuths are then plotted on the map and their intersection is the location of the house. This is known as intersection, and is very useful when swamps, woods, or defiladed areas make measurement of distance impracticable. HOUSE Plate 14. Intersection and Resection. The azimuths from the road junctions to the house being known, their plotting gives the location of the house. Or the azimuths from the house to the road junctions being known, they can be converted to back-azimuths and plotted with the same result. b. An observer who does not know his location can locate himself if he can get azimuth readings to two known points. In the above example presume the observer to be at the house, taking readings to the road junctions. In this case the readings would be 292° and 210° respectively. These readings toward the road junctions are then converted, mathematically, to their back-azimuths, which give the azimuth readings from the road 212 MILITARY MEDICAL MANUAL junctions, and so can be plotted as in a above. This is known as resection, and is the same process as intersection, except that the original readings are taken at the unknown point, and must be converted to back-azimuths before they can be plotted from the kjiown points. The Mil. Fire direction of artillery, machine guns, and other auxiliary weapons requires greater accuracy of direction than is possible with degree readings. For this purpose the military have devised an azimuth circle divided into 6400 units of measurement known as mils. (See Plate 15). Protractors and-compasses are provided graduated in mils so that readings can be made direct in mil units without necessity for conversion. The method of reading and plotting azimuths in mils is the same as when using degrees. NORTH WEST EAST Plate 15. The Mil Azimuth Circle. The azimuth of A is 2140 mils. SOUTH Declination. Direction is read on military maps by means of the grids, and such read- ings are called grid azimuths. Direction in the field is read with a compass whose mag- netized needle points toward the north magnetic pole, and such readings are called magnetic azimuths. The grid north and the magnetic north do not coincide with the true north, nor with each other, except in very rare instances. It is necessary, therefore, to make an adjustment in order to use in the field azimuth data secured from the map, and vice versa. Military maps show the direction and the amount by which the grid north and the magnetic north diverge from the true north. These are known as the grid declination and the magnetic declination respectively. Plate 16 shows a typical orientation symbol as found on military maps. The following declination data is shown by this symbol in Plate 16: Magnetic declination: 6* 40' West (in 1935). 6* 52' West (in 1939). Grid declination: 2* 25' East. The Grid-Magnetic Azimuth Adjustment. The three lines, grid north, true north, and magnetic north may occur in any one of several arrangements. The amount and direction by which the grid north varies from the magnetic north is the correction data MAP READING 213 needed in map reading. The amount of this adjustment may be the sum of the declinations, or in other cases may be the difference of the declinations. Both the amount and the direction can be determined from the diagrammatic plotting of the orientation symbol, and the values given thereon. First study the symbol and determine the mathematical amount of the variation between the grid and the magnetic north lines as shown. (See Plate 17). Then note whether the magnetic arrow lies inside (right) or outside (left) of a clockwise azimuth measurement from the grid line. If it lies inside a clockwise measurement, the magnetic azimuth will be less than the APPROXIMATE MEAN DECLINATION 1935 ANNUAL MAGNETIC CHANGE INCREASE 3'. Plate 16. Map Orientation Symbol. grid azimuth by the amount determined. If outside (left), it will be greater than the grid azimuth. Plate 17 shows a diagrammatic method of determining the grid-magnetic adjustment for three separate instances. ELEVATION AND RELIEF Relief. Relief, or topography, are terms used to designate the vertical irregularities of the ground, such as the hills, ridges, valleys, and depressions. The presence or absence of such terrain features, and their location, size, and arrangement are very essential items of military information because they greatly affect the disposition of troops and the tactical plans of the commanders. Therefore, a military map must show the relief of the area, and a commander rpust be able to secure this information from his map. Since the map itself is flat, special devices arc necessary to show relief. One system is to color the high ground with various shadings of color to indicate different layers of elevation. ADJUSTMENT 11° "ADJUSTMENT 5° ADJUSTMENT 2° -GRID AZIMUTH .MAGNETIC AZIMUTH GRID AZ. - X# MAG. AZ. = X+ II GRID AZ. = X° MAG. AZ. = X-5 GRID AZ. = X° MAG. AZ. = X + 2 Plate 17. Determining the Grid-Magnetic Adjustment. (Angles exaggerated) PROFILE STEEP SLOPE GENTLE SLOPE Plate 18. Contour Arrangement. MAP READING 215 This system is used on the air navigation maps, and on some small scale maps. Another system is to use hatchures or small fine lines to picture the ridges and hills. Neither gives reliable elevation data for specific points on the terrain. The system now used on all our standard topographic maps is the contour system. Contours. Contours are a map device for depicting the relief of an area by means of lines drawn on the map. Each contour line represents a given elevation or is a line joining all points of the same elevation. The elevation that each contour represents is shown thereon (sometimes on every fifth contour only), the elevations being based on mean sea level. The seashore line itself would be tbe base contour line. Thereafter there would be a separate contour for each successive gain of elevation of 10 feet or of 20 feet, depending on the scale of the map and the contour interval (vertical interval or VI) The top figure is a sketch of the ground. The bottom figure shows how this ground would i ble* indicated on a contoured map. Plate 19. Contours of Ground Forms. selected. Each contour follows the line that would be the new shore line if the water le\el were raised to its particular elevation. The following are some of the characteristics of contours: a. A contour cannot begin or end. It must eventually close upon itself. b. A contour cannot join or cross another contour. (Exception in vertical and overhang- ing cliffs.) 216 MILITARY MEDICAL MANUAL c. All points on a contour have the same elevation, and only points on the same contour have that elevation. d. In order to “cross” a ridge, a contour must pass around the outer end of the ridge (like a road of 0 grade passing around a hill) and in so doing it assumes a “U” trace or shape. e. In order to “cross” a valley, a contour must follow up the valley, cross the stream, and then come back again on the opposite side, and in so doing it assumes a characteristic “V” trace or shape. /. The steeper the slope, the closer the contours; and conversely, the gender the slope the wider apart the contours. g Evenly spaced contours occur on uniform slopes. Irregularly spaced contours occur on uneven slopes. RIDGE SADDLE NOSE •HILL TOP VALLEY SPUR ORAW Plate 20. Contours of Characteristic Ground Forms. h. Closed contours indicate hilltops (sometimes depressions—rare). i. A contour always runs at right angles to the direction of the steepest slope. j. In map reading it is presumed that the ground between two adjacent contours has a uniform slope, though this may not be true in fact. Determining Elevation, a. Of a point on a contour. To determine the elevation of a point on a map that happens to fall on a contour, search along the contour line for its stated elevation. This will be the elevation of the point. On most maps every fifth con- tour is accentuated for convenience, and often only every fifth contour is numbered. In such cases, note the vertical interval ihown on the map, the elevation of the nearest num- bered contour, and the number of intervening contours, and compute the elevation of the required contour. The elevation of point A on Plate 21 is 580 feet. b. Of a point on a slope between contours. To determine the elevation of a point on a slope between contours, first determine the elevation of the two contours between which the point lies. Then note the relative position of the point with respect to these two con- tours, and along the line of the steepest slope, which is the line perpendicular to the con- tours. Interpolate the distance in terms of elevation. Point B on Plate 21 is 594 feet. c. Of a point above the top contour. In the case of a point falling within the top contour of a hill or ridge, only an approximation is possible. The elevation of point C on Plate 21 must be greater than 600, and must be less than 620 feet. Since the top of the hill MAP READING 217 itself cannot be as great as 620 feet (or the 620 contour would appear), and the point “C” is obviously not at the top of the hill, its elevation would be estimated as roughly between 605 and 610 feet. Terrain Structure. The relief of the ground is, with rare cxcepdons, due to water erosion, or weathering. During the course of geological ages the streams and rivers wash away portions of the earth’s surface thereby forming valleys. The more resistant portions do not wash away as rapidly, and remain as hills and ridges. Through the natural work- ing of this process the streams seek and follow the lowest ground available to them, and therefore the drainage net, as shown on the map, is the pattern of the low ground of the area. Between any two adjacent streams there will always be found a ridge or crest, its direction generally bisecting the angle between the streams, and usually centrally located. The tops of the ridges are usually irregular, the high points constituting hills or peaks, Plate 21. Determining Elevation. and appearing on maps as a succession of dosed contours. The basic terrain structure consists of a drainage system, following a characteristic pattern, and a ridge system which conforms to and complements the drainage system. The best way to study the terrain structure of an area is to trace out the drainage system, and then to trace out the ridge system. The exact location and trace of the drainage system is shown on maps by the proper stream conventional signs. The exact location and trace of the ridge system can be determined by tracing along the line established by the hills and ridges as shown by the contours. Profiles. A valuable method of visualizing the details of relief is by profiling a selected line on the map. The profile gives a cross-section view of die terrain as it would appear on a vertical section through the line being profiled. The vertical scale is greatly exagger- ated in most profiles, in order that the details of the relief can be more easily studied. Assuming the scale of the area shown in Plate 24 to be 1:10,000, the relief in the profile has a vertical exaggeration of about ten to one. To construct a profile, a working space (see Plate 23) is first constructed consisting of equally spaced horizontal lines, each line to represent the elevation of a contour, and the spaces between the lines representing the difference in elevation between two contours. The number of spaces must be sufficient to accommodate the total number of contour intervals between the lowest and the highest point involved in the profile. Lines are numbered in sequence to conform to the contour lines involved. MILITARY MEDICAL MANUAL Plate 22. Basic Terrain Structure. MAP READING 219 The working space is placed on the map, lines parallel to the line to be profiled. Perpen- dicular lines are dropped down into the working space from each point where the line (O-P on Plate 24) crosses a contour, a stream line, or a ridge line. This method main- tains the proper horizontal spacing of these points, which is essential to the accuracy of the profile. The contour crossing points are plotted on their appropriate elevation lines of the work space. The elevations of the stream and the ridge crossing points are determined by interpolation and plotted accordingly, in Plate 24 they are (reading from O to P) % (at O), 1/3, 2/3, 1/3 and /i of a contour interval, respectively. The profile is completed by connecting, by straight lines, the points thus plotted. Plate 23. Profile Working: Space. Visibility, a. By profile. Reiiablc knowledge of the visibility, or lack of visibility of points or areas is very essential to commanders. It greatly affects the location of ob- servation posts, the siting of weapons, selection of targets, and may determine the suit- ability of combat positions. The profile is the most reliable and useful means of determin- ing visibility, because it gives accurate information of what points are and are not visible, the location and the extent of invisible (defiladed or dead) areas, and from it the 220 MILITARY MEDICAL MANUAL actual amount of vertical defilade can be computed for any point. On Plate 24, assume an observer to be standing at O, eyes five feet above the ground, looking toward P. The profile indicates that there are two areas invisible to the observer, and their extent can be plotted back on the map from the profile. The amount of vertical defilade at the second stream can be computed in terms of the vertical intervals of the working space, and found to be approximately 50 feet. The profile also shows that the nearest point to O from which the first stream can be seen (military crest of the east slope of hill O) will be at the 320 contour line (indicated on the profile by an arrow). Plate 24. Profile. The visibility of entire areas, such as the field of view from an observation post, can be plotted on a control map by profiling each of a scries of radiating lines and completing the outline of the invisible portions by inspection. (See Plate 25.) b. By hasty profile. When speed is essential, and rhe visibility of specific points, only, is at issue, the necessary information can be quickly determined by plotting on the work- ing space only the points involved. Such points would be the observer, the probable masks, and the points whose visibilities are to be determined. In Plate 26, assuming the visibility MAP READING 221 of points A and B, only, are at issue, the plotting shown is sufficient to determine that A is visible and that B is not visible from O. c. By computation. The visibility of any single point can be determined by calcula- tion. The line of sight from an observer to any point would follow a straight line (if uninterrupted) which would be the hypotenuse of a triangle, the other sides being the distance, and the difference of elevation. These data can be determined by measurement and by calculation. The visibility of point B on Plate 26 could be determined in the follow- ing manner (see Plate 27). Measure the distance O to B and O to M in any common Plate 25. Visibility of Areas. unit of measurement (in this case the measurement was made in inches). Determine the difference in elevation between O and B. Stated in simple terms we now know that the line of sight has dropped 87 feet in 3.40 inches of map distance. We can easily determine how much this line of sight will drop in the 2.24 inches of distance from O to the mask, by applying the law of similar triangles: 3.40 : 2.24=87 : X X = 57.3 Therefore, the line of sight from O to B will have dropped 57 feet by the time it reaches the mask, and will have a theoretical elevation of (375—57) 318 feet. The actual eleva- tion of the mask as shown by the contours is about 332 feet. Therefore, the mask is too high (by 14 feet) to permit observation from O to B. d. By inspection. Most visibility problems can be solved by inspection. If the inter- vening mask is higher than both the observer and the point, then there can be no visibility. If it is lower than both the observer and the point, then obviously the point can be seen. Hie line of theoretical sight, being a straight line, will drop (or rise) one-half the total drop (or rise) in half the distance, one-tlurd in one-third of the distance, three-quarters in three-quarters of the distance, etc. Therefore, by noting the amounts of the differences in elevation of O-P and O-M, and comparing their relation with the relative location of the mask between O and P, one can by inspection classify visibility cases as visible, not visible, and doubtful. The visibility of the doubtful cases must be determined by one of the methods described above. Plate 28 shows a case of a mask approximately Plate 2G. Visibility by Ilasty Profile. Plate 27. Visibility by Computation. MAP READING 223 one-half the height of the difference of elevations O and P. It shows that only when such a mask is located approximately half way between O and P, would there be any doubt as to the visibility of P. MAP READING IN THE FIELD General. The map is the only means available for studying distant or inaccessible terrain. Even when the terrain is accessible, the map is still most valuable as a source of names, and a convenient means by which to find one’s way about. The officer should always take his map with him into the field, and refer to it constantly. When operating over unfamiliar territory he should keep his movements plotted on his map, verify his location at every opportunity, and from his map learn the names of the terrain features encountered. Plate 28. Visibility by Inspection. Terrain Feature Terms. The standard terrain terms, such as hill, ridge, stream, crest, and the like, are used in map work and in the field. For use in the field to identify more readily the special and the minor terrain features, a large number of less common terms are used. Those most frequently encountered are shown in Plate 29. Distance. The determination of distance in the field presents many difficulties. Dis- tance can be measured by pacing or by tape, but this method is slow, tedious, and often impracticable. Long road distances can be measured by the odometer of an automobile. Visible areas can be measured by estimation by eye. This requires a certain amount of skill and experience, and is not successful in the dark, in woods, over long distances, or in broken country. Two other methods of handling distance in the field are the landmark method, and the travel-time method. For example, a patrol is directed to proceed two miles down a road and take up a position in observation. The patrol leader could take a map, scale off two miles, study the map and select some recognizable feature in that vicinity. He would then march until he reached the feature. On the other hand, if no map were available, he might calculate that the two miles would require forty minutes of marching. He would march forty minutes and then take position. The Compass. Direction in the field is measured with the compass. There are two types of hand compass issued in the service, known as the prismatic compass and the lensatic compass. They are shown in Plate 30 and are similar in design, construc- tion, and employment. Each compass consists of a case containing a magnetic dial bal- anced on a jeweled pivot, a hinged cover with a glass window, an eye piece containing a prism or a lens for reading the finer graduations jf the dial, and a holding ring. The glass cover has an etched line which is used like a front sight, and the eye piece has a slot which can be used as a rear sight. The dial is fixed to a magnetized needle, rotates with the needle, and is graduated for a full azimuth circle. Compasses are provided graduated •I' DIRECTION ■ or FLOW N" MESA STEEP SLOPE ROAD JUNCTION BLUET I SADDLE KNOLL SKYLINE MILITARY CREST I ARROYO on. — GULLY Plate 29. Military Features of the Terrain. TOPOGRAPHICAL CREST ROAD CENTER Evergreens PAVED ROAD •PASS OR. GAP - Culvert VALLEY i SMALL VALLEY OR. DRAW CONCAVE SLOPE I NOSE „ OP SPUR. i r CROSSROADS PEAK CONVEX SLOPE CLEARING MAP READING 225 The Prismatic Compass The Lensatic Compass Legend. A. Front sight. B. Index mark on case. C. Movable index on crystal (luminous). D. Rear sight. E. Prism mounting. F. Clamp for compass card. G. Holding ring. A. Cover. B. Front sight. C. Index markings on case. D. Holding ring. E. Lens. F. Level. G. Compass card or dial. H. Xylonite indicator. Plate 30. Types of Military Compasses. A. Case. B. Compass card or dial. C. Cover. D. Rear sight E. Front Sight. F. Holding ring. H. Movable index on crystal (luminous) I. Dial needle. Plate 31. The Prismatic Compass Open. 226 MILITARY MEDICAL MANUAL in degrees, in mils, and in both. There is an index mark inside the body of the compass near the hinge at which point azimuth readings of the dial are made. The cover can be used upright for taking field azimuths, or opened flat for use on the map. The dial is locked by closing the cover, and must be unlocked manually after the cover is opened. The line passing through the slot in the eye piece, the center of the dial, the index mark, and the hair line of the cover is known as the axis of the compass. The compass needle Plate 32. Using the Compass In the Field. is affected by the presence of iron, steel, or electricity, and will not give accurate readings near an automobile, tank, field piece, machine gun, or power line. A steel helmet, rifle or pistol on the person of the observer may influence the needle and make readings inaccurate. Measuring Azimuth With the Compass. To read the azimuth of a point on the terrain (distant hill, house, etc.) proceed as follows: Raise the cover and the eyepiece ano unlock the dial. Hold the compass to the eye and sight the compass at the object. Hole. LUMINOUS MARK SET BY THE NIGHT MARCHING SCALE SO HELD THAT LUMINOUS ARROW ON DIAL POINTS TO LUMINOUS MARK. Plate 33. Compass Set for Night Marching. the compass steady until the dial comes to rest. Read the azimuth figure on the dial at the index point. This will be the magnetic azimuth of the line from the observer to the object. See Plate 32. To establish a given azimuth on the ground, proceed as follows: Raise the cover and lens and unlock the dial. Permit the dial to come to rest. Hold the compass to the eye and watch the dial, facing the entire body about until the desired azimuth figure on the dial is at the index point. Holding die compass in this position, Plate 34. Orienting the Map by Compass. 228 MILITARY MEDICAL MANUAL look through the sights of the compass and pick up some ground feature on the line of sight. The line determined by this feature will be the azimuth desired. Marching by Compass, a. By day. Orders to troops may direct them to attack cross- country in a prescribed direction given in terms of azimuth. Groups or individuals selecting cross-country routes from the map may compute the azimuth of various legs of the trip to prevent the possibility of getting lost. In any such case, map azimuths must be converted to magnetic azimuths before they can be used with the compass. To march by compass, the commander rotates the compass until the dial reads the required azimuth. He then sights along the axis of the compass and selects some hill, house, tree, or other feature on this line. He then marches toward the above feature until he reaches it, or it becomes invisible. He then repeats the operation, selecting a new feature on the line of the re- quired azimuth upon which to guide the march. This is continued until the goal is reached (the compass is not in use while actually marching). The compass is used to select successive features on the required line, and the actual marching is always conducted toward such visible features. The more distant and prominent the feature the easier the procedure. b. By night. For use in marching at night, the compass is equipped with a movable luminous marker on the top of the case, and with a night-marching azimuth scale on the outside of the case near the base. To set the compass for night marching on a pre- determined azimuth, rotate the ring on the top of the case until the luminous mark is at the proper azimuth on the night-marching scale. Hold the compass in the hand with the dial free and turn the entire body until the luminous arrow of the dial points to the luminous marker. The direction of march is now the line of the axis of the compass. Select some features such as a low star, skyline hilltop or saddle, or other recognizable feature on this line and march in the direction of the feature selected. Repeat the operation as often as necessary and make frequent checks of the direction while en route. The setting of the night-marching mark on its correct azimuth must be done before going into the field, or by flashlight screened from enemy ground and aerial observation by an overcoat, shelter- half, or other means. Orientation in the Field. Whenever the map is studied in the field, it should be oriented to the ground. A map is “oriented” when the directions on the map arc parallel to the corresponding directions on the ground. If any one direction on the map can be made parallel to its corresponding ground direction, all other directions will automatically be- come parallel to their corresponding ground directions also, and the map will be oriented. An individual in the field is said to be “oriented” when he knows his location, both in the field and on the map, and also knows the cardinal directions on the ground. Orienting the Map in the Field, a. By compass. In unfamiliar territory, when the individual is not sure of his location, and when accuracy of orientation is desired, the fastest and best method of orientation is by compass. Place the map on a level surface. Place the compass, opened and with the dial free, upon the map so that the axis of the compass (etched line on the glass cover) is accurately superimposed on and in coincidence with a vertical grid line of the map. The cover of the compass must be toward the top of the map. Revolve the map and compass together until the needle is in the same relation to the grid line as is shown for the magnetic north arrow in the orientation symbol on the map. (See Plate 34.) b. By inspection. When traveling by road, and when the reader knows his approximate location on the map, the map may be oriented as follows: Lay the map in the road. Rotate the map until the road as shown on the map is pointing down (is parallel to) the road itself. Any trail, stream, ridge, or other line identifiable on both the map and the ground can be used in the same manner. c. By ground feature. An individual in the field who knows his location, but who may not have a compass available, and who does not know the cardinal ground directions, can orient the map as follows: Study the ground and the map and select some distant feature recognizable both on the map and on the ground. On the map draw a line from the known map position to the above feature. Revolve the map until the line so drawn points toward the feature itself. The map will then be oriented. Sighting is facilitated by laying an alidade, straight edge, or pencil on the line. MAP READING 229 Plate 35. Orienting the Map by Inspection. Locating Oneself on the Map. a. By inspection. When an individual knows his ap- proximate location on the map, he studies the visible terrain for distinctive features, and the map to locate and identify these features. He estimates the distance and direction to the features on the ground and notes the corresponding distances and directions on the map. Location by inspection is greatly simplified if the map is oriented to the ground. Plata 36. Orienting Map by Gronnd Feature. 230 MILITARY MEDICAL MANUAL POSITION OFN OBSERVER— Plate 37. Locating Position on the Map by Inspection. CHURCH POSITION OF v OBSERVER Plate 38. Locating Position on the Map by Single Point. MAP READING 231 b. By single point. To locate one’s position on the map while traveling a known road, proceed as follows: Orient the map. Select some distant feature of the terrain that can be located and identified on the map. Place a pin through the feature on the map. Take an alidade, pencil, or any straight edge, hold it against the pin and turn it until it points at the feature on the ground. Draw a line on the map along the edge from the pin toward the road. The point where this line intersects the road is the location of the position. Check the results by studying the near-by terrain features and comparing them with the map. HOUSE HILL TOP MAP ORIENTED BY COMPASS -POSITION OF OBSERVER Plate 39. Locating Position on the Map by Resection. c. By resection. To locate one’s position on a map in the field by resection proceed as follows: Orient the map accurately. Select a distant visible feature of the ground, and locate and identify it on the map. Place a pin in the feature, place an alidade or any straight edge against the pin, and turn it until it points at the feature on the ground. Draw a ray on the map from the pin toward your position. Select a second feature, at as nearly a right angle as possible from the first feature. Repeat the operation. The inter- section of the two lines is the desired map location. During the entire procedure the map must remain oriented. Identifying Features in the Field. Features, such as hills and woods, arc shown on the map in their horizontal plan. In the field, one secs these features in profile instead of in plan, and their characteristic sizes and shapes may not be apparent. An officer directed to proceed to “SMITH HILL” may sec several hills to his front, all of similar appearance, and be in doubt as to which one is “SMITH HILL.” Or again, an officer in the field in unfamiliar territory may wish to report some activity noticed in one of several clumps of woods of indefinite and indistinguishable identity. The map is a source of names and therefore of identification. The use of the map for this purpose is one of its most important military uses in the field. a. To identify on the ground a feature shown on the map. Orient the map. Locate own position on the map and place a pin in this position. Locate the feature on the map and place another pin in its position. Lay a straight-edge against both pins and sight along the straight-edge. The ground feature will lie on this line of sight, and at the distance indicated by the map. h. To locate or to identify on the map a feature seen on the ground. Single ray method. Orient the map. Locate own position on the map and place a pin in this position. Lay a straight-cage against the pin and sight the straight-edge at the ground feature, keeping the straight-edge in contact with the position pin. Draw a ray (line) on the map on the pin side of the straight-edge. Estimate the ground distance to the feature, and scale this distance off along the ray. This point will be the map location of the feature. e. To locate on the map a feature seen on the ground. Intersection method. Orient the 232 MILITARY MEDICAL MANUAL map. Locate own position thereon, and place a pin in this position. Lay a straight-edge against the pin and sight the straight-edge at the ground feature. Draw a line on the pin side of the straight-edge. Proceed to some other location from which the feature is visible, and repeat the operation from this point. The intersection of the two lines will be the map location of the feature. CHAPTER X INTERPRETATION OF AERIAL PHOTOGRAPHS USES OF THE AERIAL PHOTOGRAPH Introduction. Aerial photographs are very useful military instruments. They were first used extensively during the World War, it being estimated that the American forces alone during the first four days of the Meuse-Argonnc offensive produced and used more than 56,000 prints. Since that time there has been improvement in equipment and in technique, and at the present time our air force is well able to perform extensive photo- graphic missions. Commanders in the field may reasonably expect to be provided with ample aerial photographs in the future. Uses of the Aerial Photograph, a. Intelligence. During a campaign the enemy positions and rear areas are photographed and the photographs carefully studied for indications of his organization, and for possible artillery and bombing targets such as supply points, assembly areas, command posts, and artillery positions. These features may sometimes be recognized directly from the photograph through their appearance. More often their appearance is carefully disguised, and their presence and identity must be deduced from miscellaneous indications such as converging paths, regularity of outline or arrangement, grass worn away or trampled down, muzzle-blast marks, and other similar dues. Important enemy areas are rephotographed from day to day and the latest photograph compared with earlier ones. Trees, bushes, and other detail on today’s photograph that may appear entirely natural, may not appear at all on previous photographs of the same area, thereby disclosing their artificial nature. The comparative study of roads may show indications of abnormal traffic during the night, thus giving warning of the location of impending attacks or withdrawals. The study of the aerial photograph for the purpose of deducing enemy infor- mation is known as interpretation. It is a highly specialized subject requiring special experience and training, and is not the primary interest of the combat officer. b. Map making. The aerial photograph is very valuable as a basis for the construction of maps. Ground surveying for map making purposes is slow and laborious, and is never possible in the case of territory that lies in the hands of enemy forces. The aerial camera records such features of the terrain as roads, railroads, towns, houses, streams, woods, and cultivated areas, and shows them in their proper size, shape, and relation to each other. From rectified photographs these features may be traced and maps con- structed. Machines have been developed (the “multiplex” and the “acrocartograph”) which work on the stereoscopic principle and by which contours may be plotted direedy from overlapping aerial photographs. This use of the aerial photogiaph is a specialistic one, and is not the concern of the combat officer. c. Tactical. Any commander needs detailed and reliable information concerning the terrain over which he must fight. Formerly, this information could only be obtained through personal reconnaissance and from maps. The aerial photograph gives an ad- ditional source of information regarding the terrain. Its great value in this respect is obvious in situations where personal reconnaissance is impracticable and when maps arc not available. Even when maps are available, it is probable that there will have been many changes since their compilation. Old roads are often abandoned or resited, and new roads constructed, woods are cut down, and fields formerly cultivated are found grown up into brush and woods. Maps show these features as they existed at the time the data was compiled, which may have been years before. An aerial photograph, however, shows the terrain exactly as it is. The photograph is, therefore, a very valuable source of information with reference to the terrain, in that it gives reliable, up-to-the-minute information. It is in this connection that the aerial photograph is of great importance to the tactical officer. Terms. An aerial photograph taken with the camera pointing straight down is called a vertical, and shows the ground in its horizontal plan similar to that shown by a map. A photograph taken with the camera pointing sideways is called an oblique, and shows the 234 MILITARY MEDICAL MANUAL ground as a landscape picture. Obliques are usually taken with the camera axis depressed about 30 degrees below the horizontal, though this is not a fixed requirement. Two or more verticals taken in succession at the same altitude and each overlapping the other may be fitted together to form a larger picture called a mosaic. If the mosaic follows along a single line, such as a road or a stream, it is called a strip mosaic. A 60 percent overlap in successive prints is desired in taking verticals for the purpose of making mosaics. This permits accurate registration, and also facilitates the use of the prints for stereoscopic study. If a mosaic is constructed by matching the details of the adjacent prints by inspection it is known as an uncontrolled mosaic. In mosaics of this type a certain amount of error occurs, and this error tends to become cumulative toward the outer edges of the mosaic. To con- struct an accurate mosaic a ground control based on ground surveys is first plotted, and the individual prints are then registered to this basic control. Such a mosaic is called a controlled mosaic, and its error does not exceed that of the individual print. Photographs taken by the multi-lens cameras are called composites since they consist of both verticals and obliques. Plate 1 shows a relative plotting of a vertical (1:10,000) and an oblique (5000 feet) for shape and area. Tlate 2 shows the characteristic shape of a five-lens composite. VERTICAL 1:10,000 ORI IQUF AOOO FFFT Plate 1. Comparative Plotting of a Vertical and an Oblique. Sizes. The standard single-lens camera (K-3 type) produces a print 7" x 9". Photo- graphic sections are equipped with laboratory equipment that is capable of producing prints up to 20" x 24" in size. Individual prints may be enlarged to this size when so desired. Also, a mosaic may he rephotographed either as a whole or in sections and repro- duced in sheets 20" x 24" in size. The multi-iens cameras take pictures of other sizes. They are used primarily for mapping projects and it is seldom that the line officer will encounter them in their original print form. The amount of ground area shown in any individual print depends on the type of camera used (focal length) and the altitude from which the picture was taken. Plates I, II, and III are vertical photographs of the same area made from different altitudes and over a period of years. {Note. Plates referred to in Roman numerals, numbered serially from 1 to XII, are photographic plates and are to be found in INTERPRETATION OF AERIAL PHOTOGRAPHS 235 this section. They should not be confused with the plates with Arabic numbers.) The relative area of ground included in each photograph is shown by the plotting on the map in Plate 15. Study carefully the relation of the altitude upon the recorded area in each case, and also the relation of die altitude upon the amount and clarity of the minor detail recorded. Distortion, a. Tilt. A true vertical photograph of a flat surface will show all features thereon in their proper relation as to size, shape, spacing, and direction. Should the axis of the camera be tilted from the perpendicular at the time the picture is taken the result tends toward an oblique. In such circumstances the ground shown at one edge of the photograph is farther from the camera than that at the other edge, and therefore the detail shown registers smaller. Thus, a scale used in connection with one edge of the photo- graph would not be true for the other edge, and for this reason it is said to have distortion due to tilt. The tilt in the average vertical produced by our air service, however, is so negligible that distortion due to tilt can he disregarded as having no effect upon the tactical use of the photograph. The plotting of Plate 1 upon the plot map of Plate 15 shows such a distortion, and it is about the maximum distortion likely to be encountered. b. Relief. Where the ground being photographed is extremely rugged, the higher portions are nearer to the camera and for this reason will be recorded slightly larger than their proper relative size. Also, the tops of any high points will be displaced outward from and the low points displaced inward toward the center of the photograph. Such distortion, however, is practically unmeasurable on average terrain photographed from 10,000 feet or higher, and can be disregarded for our purposes. In photographing average terrain the distortion due cither to lilt or to relief will never be sufficient to cause the reader to get an incorrect conception of the nature of the terrain, or of its individual features. Plate 3 demonstrates the manner in which relief causes distortion. The plate shows an imaginary, huge vertical cylinder toward one side of the area. The camera would Plate 2. Five-lens Composite (rectified). 236 MILITARY MEDICAL MANUAL show the top of the cylinder to be relatively larger than its base (because it is closer to the and also would show the top to be displaced outward because of para- lax. This illustration contains great exaggeration. The small vertical line toward the left of the diagram is drawn to scale (.034 inches) and represents the relative height of ACTUAL LOCATION AND SIZE OF CYLINDER TOP RECORDED LOCATION AND SIZE OF CYLINDER TOR a 100 foot hill on a 1:15,000 vertical. The displacement of the top of this line could scarcely be detected and would approximate die average displacement encountered in verticals of this nature. Plate 3. Distortion Due to Relief. THE RECOGNITION OF FEATURES Orientation, a. Map. When the photograph is being used in conjunction with a map the photograph should be oriented to the map. Maps are constructed with the north of the map at the top, and all the lettering and figures are entered on this basis. Photo- graphs, on the other hand, are not necessarily taken on a north-south axis and the original prints do not show any lettering for orientation. Therefore, it may be necessary to study INTERPRETATION OF AERIAL PHOTOGRAPHS 237 the photograph from all angles to find some feature by which its location on the map may be determined. Once its general map location has been determined, the photograph should be placed so that its features are oriented to the map features. b. Shadow orientation. Ground shadows recorded cm aerial photographs are of tre- mendous importance in their effect upon the manner in which the mind of the reader interprets appearance. Plate III has especially fine shadow values that cause the relief of the area to stand out clearly. The finger-type drainage lines in the lower center with their pronounced valleys and separating dome-shaped spurs are very apparent, as are also the two clcarcut gully-type drainage lines at the left of the photograph. Face toward the light and invert this photograph so that you are looking at it upside down. From this position the relief will appear to have reversed, the former valleys now appearing as encircling ridges, and the former spur ridge now appearing as an amphitheatre. The gully-type PHOTOGRAPH COORDINATE CARD Plate 4. Using the Photo Coordinate Card. (The coordinates of “P” are (6.4-E.9) ) drainage lines, now on the right, will appear extruded; and even the woods will have an unnatural pockmarked, crater-like appearance. Nothing has changed in the photograph itself. If there is any change it is in the mind of the reader. It is a form of optical illusion. Nevertheless, it exists, and must be given full consideration. For this reason it is necessary that a photograph be correctly oriented for light when it is being studied for the recog- nition of minor detail, especially relief detail. It is correctly oriented when the shadows on the photograph fall toward the reader. It is best to face toward the source of the light so that the light falling on the face of the photograph coincides with the direction of light as it fell on the ground. The direction of light can be determined from the shadows of buildings, lone trees, or the edges of woods. All the photographs in this text have been oriented for shadow, which, unfortunately, causes them to be upside down with regard to map orientation. 238 MILITARY MEDICAL MANUAL The Photo Coordinate Card. It is difficult to indicate the location of obiects on an aerial photograph because of the lack of names and of a grid system. Location is therefore indi- cated by means of a coordinate card especially designed for use with aerial photographs. The method, in general, of handling the card is the same as that for using the coordinate cards in map reading. The card is divided into inch divisions, and each division is sub- divided into tenths. The horizontal divisions are given numbers, and the vertical divi- sions are identified by letters. This is done in order not to confuse them with map co- ordinates. The left-to-right reading is always given first, followed by a dash and the bottom-to-top reading. The combined figure is inclosed in parenthesis, as in map co- ordinates. Plate 4 shows the proper use of a photo coordinate card, the coordinates of point “P” being (6.4-E.9). Aerial photographs reproduced by the lithographic process as photo-maps often have a coordinate control in tenths of inches printed around the margin. In the absence of a coordinate card photograph coordinates can he read with any ruler graduated into inches and tenths. Measure the distance across from the left edge, and then the distance up from the bottom, expressing the major divisions of the last measure- ment in letters. Legend. A legend giving necessary identification information is placed on the lower edge of photographs beginning at the lower left-hand corner. The following is a typical legend: (V-43-740C-16 OBSN) (12-21-36-9:32A) (12-15000) The legend as shown above indicates that the photograph is a vertical, that its serial number is No. 43, and that it was taken of area 740C by the 16th Observation Squadron. It also indicates that the picture was taken on the 21st of December, 1936, at 9:32 in the morning, and that it was taken with a camera having a 12-inch focal length lens from an altitude of 15,000 feet. The name of the most important terrain feature, or the map co- ordinates of the center of the photograph are often added when known. In the case of a series of photographs taken for mosaic purposes this legend may appear on the first and last print of the series, the others showing their serial numbers only. Recognition of Features, a. Recognition and identification of features. The recognition and identification of features on an aerial photograph are easy. One sees familiar things, and sees them as they actually appear. Unlike the map, which resorts to artificial signs or symbols to represent ground features, the photograph literally provides a picture of the feature itself. For this reason, in order to read photographs skillfully and accurately, the reader must he familiar with the appearance and characteristics of original ground features. The photograph, being taken from above, shows features in their horizontal plan only. This is excellent for showing cities, roads, woods, fields, streams, and all the natural ground features. In the case of a feature whose special identifying characteristic is its vertical profile, such as a church steeple, factory chimney, silo, or water tank, its identity may not he apparent directly from the photograph. However, shadows, when present, often outline its profile on the ground and thus disclose its identity. Shadows by their relative lengths often disclose the relative heights of buildings and trees. On the other hand, when the buildings or trees arc known or suspected to he of uniform height, the relative lengths of shadows cast indicate the direction and amount of ground slope, if any. b. The part played by color. The eye is very sensitive to color. Therefore, color plays an important part in our daily recognition of features. The aerial camera on the other hand does not record color, hut evaluates the things that come within its focus in terms of their light reflecting properties. Light colored objects usually reflect more light than dark ones and therefore appear lighter on photographs. Rut all colors do not reflect light in the degree that one might expect, and the texture of a surface may have a greater effect upon its light reflecting properties than its color. Shadows reflect almost no light and therefore show up black on photographs and are very prominent for this reason. c. Roads. Exposed earth reflects light well, and therefore roads, paths, construction work, and cultivated fields appear white on aerial photographs. Improved roads may be recognized by their greater and more uniform width, and their more regular curves. Primary gravel roads usually appear wider and often lighter than paved roads. Rail- roads are usually darker, and narrower than highways, with long straight tangents and INTERPRETATION OF AERIAL PHOTOGRAPHS more gentle and accurately engineered \curves. Plates I, VI, VIII, and IX contain various types of roads and the last two contain railroads. d. Details revealed by the camera. Woods may usually be identified as such by their characteristic tree composition. They usually apjiear as dark patches, not only because they are of a darker color, but because each branch and leaf is casting shadows on lower or adjacent branches, leaves, or the ground itself. Though the camera may not record the individual shadows, it, nevertheless, is sensitive to the reduced light reflection of the area as a whole caused by the general prevalence of shadows. For this same reason tall grass with its longer shadows appears darker than short grass, even though to the naked eye there is no perceptible dillerence ot color and the shadows themselves may escape notice. The camera is so sensitive to light that it records the dillerence in the amount of light falling on reverse slopes as compared to forward slopes, even though the sun is shining directly on both. This is the case with the finger-type drainage area noted on Plate 111. A realization that the camera records all detail in terms of light reflecting properties greatly facilitates understanding aerial photographs. Plate VI1, center, contains patches of thick woods, thin woods, scattered trees, grass land, and areas partly devoid of grass due to sur- face erosion. Plates X and XI also show various types ot woods. In Plate VII, bottom, there appear some dark areas that are not woods but are the shadows of small clouds. e. Water is revealed by the camera. Clear water does not reflect light and therefore shows dark on photographs (Plate VII, center), but if the water is muddy the dirt par- ticles in suspension tend to reflect light, and the water will appear grey and at times quite light. The trace of streams that cannot be directly seen may be identified by their char- acteristic pattern and by the more luxuriant vegetation along their courses. Plate VII, top, shows a winding stream with sandbars at the bends. It also shows a primary highway and bridge. Plate X shows a characteristic drainage pattern. Plate XI shows minor drainage of various types. In the upper left are minor drainage lines through cultivated ground; in the left center one can see a small stream bed Dating through grass land, probably a pasture; in the right center are wooded stream lines passing through a lightly wooded area; at the upper right are artificial drainage ditches in a cultivated stream bottom. Incidentally, the upper left corner ot this particular photograph shows with unusual clarity the terracing of cultivated slopes. Such terraces are to prevent soil loss through erosion, and they run at right angles to the direction of slope. Thus they have the char- acteristics of contours, and as such clearly indicate ground forms. /. Minor details. The identification of minor detail depends primarily upon personal familiarity with the characteristics of the original features. On Plate IV the military reader would easily identify as such the trench system in the center of the plate. He would also quickly recognize the four light spots at (0.75-B.60) to be an artillery firing position, because of the arrangement of the spots. The guns themselves cannot be de- tected but the four white spots are peculiar to bare earth exposed by the muzzle-blast of field pieces. Likewise, the dark objects at (2.6-A.3) arc characteristic of motor vehicles halted off the road. A good reading glass brings out a wealth of detail and is a great aid in studying photographs. 239 SCALES AND AZIMUTH Scales. The aerial pljotograph shows the features of the ground such as the roads, streams, woods, fields, and villages in their relative sizes, distances and directions one to the other. In this respect the photograph may he considered as a map and all the data re- garding size, distance, and direction obtainable from maps can be secured from the aerial photograph by applying the methods and procedure normal to map reading. How- ever, the photograph as at present issued to the using services frequently docs not show scale and orientation data. It is, therefore, necessary for the user to determine these basic data for himself before the photograph can be used conveniently, or to the full ex- tent of its capabilities. Scales arc usually expressed as a representative fraction. A rep- resentative fraction is the mathematical relation of a unit of map (photograph) measure- ment to the corresponding ground measurement, expressed as a ratio of similar units. Determining Scale, a. By jocal length and altitude. The triangle formed by the negative 240 MILITARY MEDICAL MANUAL and the lens within the camera is similar to the triangle formed by the lens and ground area included in the exposure. Since these are similar triangles the relation of the two bases (the size of the photograph as compared with the ground area) will be the same as the relation existing between the bases of any two similar triangles. (See Plate 5.) The third group of data shown in the legend usually appearing on individual prints gives the focal length in inches of the camera used and the altitude in feet at which the picture was taken. Therefore, the ratio established by these figures is the same ratio as that of the photograph to the ground, or of any portion of the photograph to the corre- sponding portion of ground. Accordingly, it constitutes a photo-to-ground ratio and needs only to be reduced to common units, and to unity, to be the representative fraction of the photograph. FILM OR PHOTOGRAPH •LENS ■HEIGHT GROUND Plate 5. The Scale (RF) of a Photograph Is the Ratio of the Focal Length to the Height. In the case of a photograph showing the legend data, “(12—15,000),” its representative fraction is determined as follows: “(12—15,000)” 12 inches : 15,000 feet 1 foot : 15,000 feet I : 15,000 (RF) INTERPRETATION OF AERIAL PHOTOGRAPHS 241 The two cameras most frequently used have focal lengths of 12 inches and 8.25 inches respectively. The representative fraction of a photograph taken with the latter camera, and showing the following data, “(8.25—13,000)” would be determined as follows: “(8.25—13,000)” 8.25 inches : 13,000 feet 8.25 inches : 156 000 inches 1 inch : 18,909 1 : 18,900 (approximate RF) With cameras of any other focal length the representative fraction is determined in a similar manner, using the focal length and height data given in the legend. The scales determined by the method shown above arc only approximately correct. The altitude as set forth on the photograph is often the altitude of the plane above sea level. Should the mean ground level be considerably higher than sea level the height of the plane above the ground should be determined and used in the calculations. The height of the plane is its altitude above sea level minus the mean elevation of the ground area. b. From the map. When a map of the area is available the scale of the photograph can be easily determined. It is ascertained by finding the ratio existing between the length of any line on the photograph and the corresponding distance on the ground. The photo distance is measured on the photograph with a ruler. The ground distance is determined by normal map reading methods. For example, we wish to determine the scale (RF) of Plate II, using the map in Plate 15 for data. The line from the CR at BM 346 (16.2-19.3) to the nearest water tank on EBBERT HILL (18.8-19.7) is selected for the datum line. This line measured on the map by means of its graphic scale is found to be 2660 yards or 95,760 inches of ground distance. The same line located and measured on the photo- graph measures 6.70 inches. We find that 6.70 inches on the photograph equals 95,760 inches on the ground. Therefore, 1 inch on the photograph equals 14,293 inches on the ground and the scale (RF) of the photograph is 1:14,300. PLATE TL FJUtie ti. Determining the Scale (KF) of a Vertical Photograph by Means of a Ground Distance Secured from a Map. Datum lines selected for the purpose of making scale computations should be as long as possible, and preferably should pass through the center of the photograph rather than along an edge. When accurate results arc desired two or more different lines should be used and computed, and the average of the separate computations determined. 242 MILITARY MEDICAL MANUAL c. From the ground. The scale (RF) of an aerial photograph can be determined from the ground itself whenever a map is not available. The scale of the photograph shown in Plate I would be determined in the following manner. The main road from the crossroads at (7.20-A.53) to a point at (1.31-A.28) where the small curved trail joins the road is selected for the datum line. Measured on the ground by means of an auto- mobile odometer, it is found to be 2.61 miles. The same distance measured along the road on the photograph in inches is found to be 7.34 inches. Therefore, 7.34 inches on the photograph equals 2.61 miles, or 165,369.6 inches, on the ground with the result that 1 inch on the photograph equals 22,530 inches on the ground. The scale (RF) of the photograph would therefore be expressed 1:22,500. The ground measurement could have been determined by pacing, by using a tape, or by any other means. PLATE I Plate 7. Determining the Scale (RF) of a Vertical Photograph. The Ground Distance Was Determined by Measurement on the Ground. d. Maying a reading scale. A scale expressed in representative fraction form is of little value in making measurements of distance. For the purpose a graphical reading scale is more serviceable and should he constructed. A reading scale of 1000 yard units is the most convenient. The scale of the photograph in Plate II was determined (in b above) to be 1:14,300. This means that one inch on the photograph equals 14,300 inches on the ground. One thousand yards is 36,000 inches. 1:14,300 = x : 36,000 14,300 x = 36,000 x = 2.52 A line is drawn on the margin of the photograph and divided “into 2.52-inch divisions, each of which represents 1000 yards of ground distance. The left division is then sub- divided into tenths to represent 100-yard distances. A photograph coordinate card, divided into inches and tenths of inches, provides a con- venient reading scale based on inch units. In the case of plate II whose scale (RF) was determined above to be 1:14,300, this would be done as follows: 1 : 14,300 1 inch = 14,300 inches 1 inch = 399—j- or 400 yards The above having been determined, the coordinate card may be used both for location and also for distance measurements, INTERPRETATION OF AERIAL PHOTOGRAPHS 243 Direction and Azimuth, a. Orientation. An aerial photograph, unlike a map, is not automatically reproduced on a north-south axis. It is convenient to know the correct orientation of the photograph when using one and this knowledge is necessary when azimuths arc to be secured from it for marching or fire control purposes. An approximate north orientation can be made based on the shadows, when the date and time of day at which the picture was taken are known. An accurate orientation can be made when a map or the ground itself is available. Since the photograph is usually used in conjunction with the ground itself, it is preferable to determine the magnetic, rather than the true or the grid orientation, and to use magnetic azimuths for all computations. b. Determining a base azimuth. When a map is available a line is selected that can be accurately located on both the map and the photograph. The grid azimuth of the line is measured on the map and converted to magnetic azimuth. This will be the magnetic azimuth of the same line on the photograph. The protractor is placed on the line on the photograph so that it reads the proper azimuth. A line drawn along the base of the pro- tractor will be the magnetic north or zero line for orientation. For example, in Plate 15 the line from the CR at BM 346 (16.2-19.3) to the nearest water tank on EBBERT HILL (18.8-19.7) has a grid azimuth of 81 /i degrees as read from the map with a protractor. Based on the orientation symbol of the map this is a magnetic azimuth of 81 degrees (to the nearest half degree). The same line is drawn on the photograph and the protractor placed thereon, reading 81 degrees. (See Plate 8). The magnetic north will be the line of the base of the protractor, and is so drawn and labeled. It may be plotted at any desired point along the datum line. In the absence of a map, two inter-visible features are selected PLATE n Plate 8. Determining Magnetic North. (Diagram Oriented to the Photograph.) on the ground that can also be identified accurately on the photograph. The magnetic azimuth of the line thus determined is read on the ground with a compass. The north line of the photograph can then be determined from this data in the same manner as de- scribed above. c. Maying azimuth measurements. Once a zero azimuth line has been determined and plotted, the azimuth of any line can be measured by normal map reading methods. Pro- long the line whose azimuth is to be determined until it intersects the zero azimuth line, and read the azimuth directly with the protractor. If the zero azimuth line is incon- veniently located, another can be plotted at any location desired, either by drawing it parallel to the original line, or by re-basing it on the datum line. It is not necessary that there be a zero line in order to make azimuth readings. Whenever a line intersect* another 244 MILITARY MEDICAL MANUAL line the azimuth of which is already known, the protractor can be correctly oriented by placing it with its proper reading on the known line and then reading the azimuth of the unknown line directly from the protractor scale. Plate 9. Measuring Photo Azimuths. (Diagram inverted to Approximate North Orientation.) Plate 10. Plotting Photo Azimuths. d. Methods illustrated. Plate 9 demonstrates various methods of making azimuth readings. A datum line of 81 degrees azimuth (and therefore 261 degrees back azimuth) has been determined and plotted, and a north line plotted therefrom. (1) w. The azimuth of the line A-B is 144 degrees determined by constructing a new north line through A and orientating the zero of the protractor thereon. INTERPRETATION OF AERIAL PHOTOGRAPHS 245 (2) x. The azimuth of the A-B is 144 degrees determined at the intersection of A-B with the datum line. The protractor is orientated by placing its 81-degree mark on the datum line. (3) y. The azimuth of the line C-D is 229 degrees determined at the intersection of C-D with the datum line. The protractor is oriented by placing its 261-degrec mark on the datum line. (4) z. The azimuth of the line C-D is 229 degrees determined by extending it until it intersects line A-B, whose azimuth has previously been determined to be 144 degrees, hence back azimuth of 324 degrees. The protractor is oriented by placing its 324 degree mark on the line B-A. e. Plotting azimuths. In order to plot an azimuth it is necessary to have for a base a line of known azimuth at the point from which the new azimuth is to originate. A north (zero) line can be erected through the point by orienting the protractor to a known datum line and sliding it along the line until its base line, extended if necessary, passes through the point. Or, a line can be drawn into the point and its azimuth determined as in c and d above. The azimuth or the back azimuth of this line will then serve for orienting the protractor. Plate 10 demonstrates various methods of plotting photo azimuths. A datum line of 81 degrees azimuth and a north line based thereon has been determined and plotted. (1) An azimuth of 40 degrees is to be plotted from A. A zero base line is con- structed through A by sliding the protractor along the datum line with a reading of 81 degrees until its base line passes through A. The protractor is then moved to and oriented at A and an azimuth of 40 degrees is plotted. (2) An azimuth of 252 degrees is to be plotted from B. A line is drawn from any convenient point on the datum line to B, and the azimuth (123 degrees) and back azimuth (303 degrees) of this line determined by methods previously covered. The protractor is moved to B and oriented by placing its 303-degree mark on this line, and the desired azimuth of 252 degrees is then plotted. MILITARY TERRAIN FEATURES AND STEREOSCOPIC RELIEF Military Terrain Features, a. General. A successful commander is the one who most skillfully utilizes the favorable features of the terrain, and who also knows the unfavorable features so that he can make proper plans to avoid them or to minimize their effect. In general, the most important military features of the terrain are the road net, the wooded and open areas, and the basic tactical relief. A good military map shows all these features. However, with regard to the first two, they are constantly changing. Old roads are im- proved or abandoned, and new roads put in. Woods arc cut down for lumbering purposes or converted into cultivated land. Land formerly cultivated is often abandoned and soon grows up into brush and woods. A good map shows these features as they were at the time of the compilation of the map, but many important changes may have occurred since its compilation. Fortunately, these two types of features, roads and woods, are clearly and unmistakably shown on aerial photographs, being the most easily read features on them. Therefore, in the items in which the map is least trustworthy, the photograph is especially clear. The photograph does not show relief quite as clearly or in such detail as does a topographic map. However, the relief of an area is not subject to pronounced change over a period of years. Accordingly, in the one item in which the photograph is weak the map can still be depended upon. The map and the photograph, used in conjunction with each other provide a most reliable means of studying the terrain. The map furnishes names and relief data, while the photograph provides up-to-the-minute data on existing roads, woods and open areas. b. Roads are very prominent on aerial photographs, and the details of the road net are quite apparent. From a military point of view more must be known about roads than their location and pattern. Information concerning the nature of the road itself is desirable. Improved roads are generally wider than unimproved roads, and their curves are more regular and gentle. Main improved gravel roads are usually wider than paved roads. Oiled or tarvia type roads show darker than those made of concrete or gravel. Old con- 246 MILITARY MEDICAL MANUAL crcte roads arc darker than dirt or gravel roads because of the oil drip from the motor traffic, and in low photographs the double oil drip streaks of the two traffic lanes can often be detected. Unimproved roads are narrow and irregular in width and follow a much more erratic course than improved roads. This is due to the necessity of avoiding steep grades in their construction. They often follow slopes in an angular fashion and pass around hills, spurs, and draws. Plate IX shows several highways and a railroad converging toward a city. The roads at the lower left and lower center of the plate are obviously old roads as they show many houses along their route. The road across the center is a wider road and for this reason probably a main highway. Tt is very recent because as yet it has practically no houses along its course. From its general trace it appears that it must be a re-routing of the older road. The road across the top is also wide, probably a main primarv road, and from its numerous houses is not a new road. Plate VIII also shows several roads, both primary and secondary, and also the darker course of a railroad. The unusually wide road at the top center with its “fuzzy” edges suggests that the cuts and fills, the borrow pits and waste piles, and perhaps the ditches along the side are still bare earth and not vet grown over with grass or weeds. It is probably a very recently completed improved dirt or gravel road, and in fact, may still be under construction. Incidentally, it is in a valley following along a stream line while all other roads in this area seem to follow the tops of ridges. On Plate I at (2.35-A.55) the “needle eye” formation is characteristic of a place in a road so poorly con- structed that, on occasions, traffic must detour, thus forming by-passes. Such detail is invaluable in disclosing the nature of roads. From this one item one can deduce that this road may at times be very bad, and that it should be reconnoitered before being used. Such information can never be secured from maps. c. Woods arc important military features. Woods in front of positions obstruct fields of fire of the defense, and offer covered avenues of approach for the attack. Woods in the rear areas afford concealment for reserves, supply points, command posts, train parks, and similar installations. Therefore, the location and the extent of the wooded area is essential military information. Tt is also desirable to know the nature of the woods. Woods consisting of mature trees so closely spaced that the branches interlock (Plate ITT, right center) have vastly different military value from woods whose trees are so spaced that much of the ground is clearly visible (Plate Til, lower right and lower left center). Maps do not generally show this distinction, but it is clearly evident on aerial photographs. d. Relief. Relief is not as easily read from aerial photographs as from topographical maps. Nevertheless, aerial photographs contain much information regarding the basic relief of an area. Good shadow values often picture the relief of the area directlv, as is the case with the finger drainage on Plate TIT, and also in portions of Plate TV. Also, the relative lengths of shadows of buildings and trees of similar height often disclose the direction and the amount of slopes. Terracing, when present, is a clue to relatively rugged country, and can often he seen in photographs as in Plates VTTT. TX. and XT. To all intents and purposes they can he considered as form contours and serve as such for indicating relief. Bends in the routes of unimproved roads where thev pass arottnd ridges, spurs, and draws, are likewise valuable clues to relief. The most valuable source of information regarding relief, however, is the drainage net. which ran he clearly followed on photographs. Relief, that is, the valleys and the ridges, is the result of water erosion. The streams carve out the valleys, and every stream line discloses the location and the direction of a valley. Between any two adjacent streams there must he a ridge line, and its location and direction must conform to the two streams between which it lies. Streams, or drainage lines, follow definite natural laws and for this reason have easily recognizable conventional patterns. Plate X shows a tvpiral drainage pattern. Plate XI shows various types of minor drainage and their characteristic patterns in various tvpes of background terrain. Tn both cases the patterns of the drainage lines are clearly marked by the more luxuriant vegetation along their courses. Thev can be traced out on the photograph, or on an overlay, and will furnish the pattern of the low ground of an area. By placing a form ridge between each two adjacent stream lines, its location approximately centered, and its direction conforming to the stream lines, one will have a pattern of the INTERPRETATION OF AERIAL PHOTOGRAPHS 247 ndge framework. Such a framework will not perhaps be exactly true to the ground in all details, but the picture it presents of the general location, direction, and extent of the ridges with their lateral spacing will be a reliable picture of the basic terrain structure of the area. The location, direction, size, and extent of the terrain corridors and cross-compartments thus disclosed can be relied upon for planning tactical operations. On Plate VIII it is easy to see that the drainage lines all run away from the village. From this it is evident that the village is situated on high ground. Further study of the stream lines shows the village to be on a ridge, and that the main transverse highways and railroad follow along this ridge. The tactical significance of such information is valuable. The higher buildings of this village should offer good observation points and overlook much of the surrounding territory. Also, the roads, being on a ridge, can prob- ably be seen from quite a distance, and troop movements thereon by daylight could be observed by the enemy. Plate 11 shows a tracing of the drainage system of Plate XI. Plate 12 shows the ridge lines added, based on the drainage system. The combined plotting dis- closes the basic terrain structure of the area. It does not show the details of the minor relief nor the relative heights of the ridges and hills. This data, if needed, can be determined through stereoscopic study. Plate 11. Basic Terrain Structure (Drainage lines traced from the photograph.) Stereoscopic Relief. When a person looks at an object or a landscape both eyes do not register identical images. Because of the lateral spacing between the eyes each eye sees each object from a slightly different angle. The mind takes these two sight impressions and combines them and produces from them a single picture which contains the perception of depth or of the third dimension. This is possible only because of the two separate and slightly different views presented. In photographing an area for the purpose of constructing a mosaic, the pictures are taken so that there will be considerable overlap. This insures that there will be no gaps, and assists in fitting the pictures together. An overlap of about 60 percent in adjacent pictures is standard procedure. Therefore, on any two adjacent pictures there will be a large part of the area common to both pictures. Moreover, since the plane will have flown some distance between the exposures, the second picture will be from a different position and therefore a different angle from the first. Each picture is considered to be the view that each of the eyes of a person would register if the eyes were at the altitude of the plane, 248 MILITARY MEDICAL MANUAL and the spacing of the eyes were the many hundreds of yards of horizontal distance be- tween the two exposure points. By causing one eye to see one of these pictures only and the other eye to see the other picture only, the result will be similar to that experienced in normal vision, and will permit a perception of depth, thereby disclosing relief. This is done by the aid of an instrument known as the stereoscope. By means of mirrors, prisms, or lenses, it directs the sight of one eye to one picture, and of the other eye to the other picture, and the result gives clear perception of tbe relief of that portion of the area common to the two pictures. In fact, due to the great distance between the points from which the successive pictures were taken, the relief disclosed by the stereoscope is usually quite exaggerated, and one must evaluate it accordingly. Plate 12. Basic Terrain Structure. Ridge lines added by inspection based on the drainage traced in Plate 11. The stereoscope itself is not necessary for stereoscopic vision. It is only a convenience. Stereoscopic effect is obtained when one eye sees one picture only, and the other eye sees the other picture. Plate XII shows a stereoscopic pair, or pictures of the same area cut from the overlap portion of successive prints, and arranged and spaced for use without instruments. Place the plate on the desk about 14 to 18 inches from the eyes. Hold a piece of cardboard vertically between the two pictures so that each eye can sec only its respective picture. Permit the eyes to relax somewhat, do not concentrate or stare. Continue to look at the pictures and the stereoscopic effect will develop. Some persons may have to try several times before they get the knack, but nearly everyone attains it with practice. The same effect can be attained with no aids whatever. Focus the eyes on some distant point, 20 feet or more away, and relax them (day-dream). Move the plate into the line of vision without permitting the eyes to look directly at it or to focus upon it. Rather, look through the plate in a dreamy manner. After several tries the stereoscopic effect should develop. Summary. A reasonable knowledge and proficiency in Aerial Photograph Reading, to meet the needs of the tactical officer, involve the following: a. A knowledge of the various types of aerial photographs, and the ability to classify any individual print. b. A basic conception of the effect of altitude upon detail registration and amount of area. c. An understanding of the data furnished in a legend. d. An understanding of the use of the photo coordinate card. INTERPRETATION OF AERIAL PHOTOGRAPHS 249 e. The recognition and the correct evaluation of roads and road nets. /. The recognition and the correct evaluation of various forms of vegetation in so far as they may afford cover and concealment, or affect fields of fire. g. The ability to plot the outline of a photograph onto a map by inspection, that is, the recognition or terrain detail along the edges. OVERLAP AREA COMMON TO BOTH PHOTOS AND USED FOR STEREOSCOPIC STUDY Plate 13. Successive Prints of a Mosaic, Showing: Overlap Area Which can be Used For Stereoscopic Study. h. The ability to compute the scale (RF) of a photograph by any of the following means: (1) Focal-length and altitude. (2) Ground data secured from the map. (3) Ground data secured from the ground. i. The ability to construct a graphic reading scale. /. The ability to secure azimuth orientation data and to perform azimuth computations. The ability to trace out the drainage system, and to form therefrom a reliable con- cept of the basic terrain structure. l. The ability to compare the photograph and the map as to essential military features, and to detect any such data appearing on one that is not substantiated by the other. m. The knowledge of the operation, capabilities, and limitations of the stereoscope. A direct comparison of a map with aerial photographs of the same area is often useful under field conditions for the one may clarify that which is omitted or obscured on the other. The process is especially useful in developing a knowledge of the aerial photograph. Plate 15 is a map which has overprinted thereon the boundaries of aerial photographs shown in Plates I, II, III and V which follow. 250 The following work is recommended as an aid to study. Compare each of the plates with the map of the same area with regard to: (1) The road net. (2) The wooded areas. (3) The drainage system. (4) The works of man. (5) Trace out on a sheet of overlay paper the drainage system (stream lines) of Plates IV and X, and compare with the map. (6) Plot the ridge structure of Plates IV and X and compare with the map for batic terrain structure. MILITARY MEDICAL MANUAL Photo by Air Corps, U. S. Army Plate I. Vertical Photograph 1:22,000. Photo by Air Corps, U. S. Army Plate II. Vertical Photograph. 1:14,000. Photo by Air Corps, U. S. Army Plate III. Vertical Photograph. 1:8,000. Photo by Air Corps, U. S. Army Plate IV. Vertical Photograph. Photo by Air Corps, U. S. Army Plate V. Oblique Photograph. 3000 feet. Photo by Air Corps, U. S. Army Plate VI. Oblique Photograph. 5000 feet. Plate VEL Photo by Air Corps, U. I. Army Photo by Air Corps, U. S. Army Plate VIII. Photo by Air Corps, U. S. Array Plate IX. Photo by Air Corps, U. S. Army Plate X. Typical Drainage System. Photo by Air Corps, U. 8. Army Plate XI. Types of Minor Drainage. Plate XII. Stereoscopic Pair. Photo by Air Corps, U. S. Army declination 1932 annual magnetic change 7“ (DECREASE) Plot Map of Photographs Shown in Plates I, II, III and V. CARE AND OPERATION OF MOTOR VEHICLES CHAPTER XI INTRODUCTION Definition. The term “motor transport,” as used in the military service, applies to motor-propelled vehicles used for transporting military personnel weapons and supplies. . Employment. Uses. Military motor transport is used for the movement of troops, materiel, and supplies in both strategic and tactical operations. All types of movements are included, from those of small units by organic transport to those of large forces by the army motor pool. Supplementary transportation. When commercial motor vehicles are used for emer- gency troop movements, special consideration must be given to their nonuniformity. Motor Transport Pools. In general it will be found that a pooling of effort in the use of motor transport will give the most efficient and economical results (AR 850-15). Administrative pool. Ordinarily, when motor transport is pooled, it is done ad- ministratively. In this type of pool, the vehicles and personnel remain with the organiza- tions to which they are assigned and operate from the organization motor parks. Physical pool. In some cases the actual forming of a physical pool of vehicles and personnel is advisable. This is normally confined to the pooling of motor transport units and on rare occasions to tactical vehicles, although a large pool of vehicles will be as- signed for army use in actual combat. Requirements for Efficient Operation. Assignment of drivers. A driver and, if author- ized, an assistant driver should be assigned to each motor vehicle. Except for instruction, inspection, or other like purposes, the vehicle should not be operated by other drivers if it can be avoided. Vehicle abuse. Vehicle abuse is the chief cause of mechanical failures, excessive op- erating and maintenance costs, and general unsatisfactory performance of the motor vehicle and its component parts. The following forms of vehicle abuse should be prohibited: Improper use of controls, particularly gear shift, clutch, brakes, and choke. Racing engine, especially when cold. Overspeeding, particularly over rough roads and across country. Improper lubrication. Deferred maintenance, including lack of proper servicing and adjustments. Lack of systematic inspection and follow-up. Overloading and improper loading. Speed limits. The caution plate mounted on a motor vehicle indicates the maximum safe speed for which the vehicle is designed. In no case should this speed be exceeded. Fast driving over rough, slippery, or congested roads should not be permitted. Applicable speed limits set by State or local regulations should not be exceeded. Regulated governors, when installed, should be set and sealed at the maximum speed considered safe and not to exceed that indicated on the name and caution plate. Tanks and combat cars will be driven habitually by the tachometer in an appropriate gear and at not over the prescribed speed in engine revolutions per minute. In motor marches which contain tanks or combat cars, the pace will be set by a leading vehicle at such a rate as will insure that all tanks or combat cars in the column can keep up without exceeding the prescribed economical speed in engine revolutions. When passing through towns and villages, a proper reduction in speed will be directed by the column commander, who should control the march in such manner as to insure the safety of spectators and civilian traffic and to prevent prolonged operation at low speeds in a low gear. Factors affecting operation. Factors which materially affect the service rendered by motor vehicles should be impressed on all operating and command personnel who are concerned with the supervision, operation, maintenance, and inspection of motor transport equipment. These factors are: 252 MILITARY MEDICAL MANUAL Proper selection, training, and discipline of operating and maintenance personnel. Strict supervision and control of operations by commissioned personnel. Organized maintenance with adequate repair facilities and the performance of routine maintenance and inspection functions. Serviceable mechanical condition of vehicles. Recognition of the capabilities and limitations of all types of vehicles in operation. Careful reconnaissance of routes to be traveled. Recognition of the capabilities and limitations of the drivers. Training and experience of the commissioned and noncommissioned personnel. The necessity for control, for constant and intelligent supervision, and for proper selection, training, and discipline of the operating and maintenance personnel cannot be stressed too forcibly. The discipline required of personnel in organizations operating motor vehicles is that discipline which will guarantee strict adherence to the instructions received in training and will result in the proper operation and maintenance of motor transportation. Selection and training of personnel are covered in subsequent chapters. Vehicle Units and Assemblies. There are many methods of grouping vehicle units and assemblies, but it is usual to have two primary groupings, the chassis group and the body group. These may be divided into subordinate units, assemblies, and acces- sories according to functional use, unit or assembly to which attached, or customary automotive practice. Chassis Group. This primary group consists of the units and assemblies briefly described below under the major assemblies, running gear, and power plant, with their respective units. Running gear. This consists of frame, springs, axles, wheels, braking system, and steering mechanism. Some vehicles may also use torque tubes or torque arms and radius rods. The frame is the structural unit about which a motor vehicle is assembled. It main- tains proper relation between component parts of the vehicle and distributes the weight to various points of support. Springs are flat or coiled flexible support units mounted between the frame and axles. They are designed to absorb shocks due to vehicle movement over irregular road surfaces. Axles may be either dead (nondriving), or live (driving). The dead axle is usually represented by the solid front axle of a vehicle, all axles of trailers, and the axles of a chain sprocket driven vehicle. This type of axle usually has no moving parts other than those necessary to turn and stop the vehicle. The live axle contains the final driving mechanism that moves the vehicle. It normally consists of a housing, differential gear, and two axle shafts. Wheels support the vehicle and are the means for moving it over the highway. Bracing systems are designed either to slow down or to stop a vehicle. When parking brakes are applied they prevent vehicle movement. A vehicle usually has brakes on at least 2 rear and 2 front wheels. However, any combination may be used. Steering mechanism connects the steering wheel in the operator’s cab (or compart- ment) to the front wheels and provides a means for directing the vehicle. Torque tubes or torque arms and radius rods may be attached to or made a part of the axle housing and frame or the frame members. They resist the force from propeller (drive) shaft or from any brake action which tends to rotate the axle. Power plant. This assembly consists of engine assembly, clutch, transmission, and transfer mechanism (the latter usually on heavy duty vehicles), propeller shaft or shafts with universal joint or joints, and differential and final drive units. Engine assembly is the source of motive power. It converts heat units into mechanical power by the internal combustion of a fuel. The clutch unit engages or disengages the engine from the transmission. When engaging, it permits the load on the engine to be “picked up” gradually. It may also be disengaged so that none of the developed engine power is transmitted to the driving (or live) axles. Transmission and transfer mechanisms, by use of gear trains, allow the power de- CARE AND OPERATION OF MOTOR VEHICLES 253 veloped in the engine to be applied to the driving (live) axles according to the speed, hill-climbing ability, and pulling capacity required. Propeller shafts are used to transfer power from the transmission to the transfer case and to the driven axles. In order to provide angular (up and down or side) motion of the axle with respect to the frame, one or more universal joints may be used with the shafts. Universal joints are capable of transmitting power through angles within fixed angular limits of the joints. Differential and final drive units are incorporated in the live axle units and combine to change direction of the power transmission from the propeller shaft to the axle shafts, as well as to adjust the amount of rotation between the right and left wheels on any one driven axle. Plate 1. Cargo Vehicle Showing Engine Compartment, Cab and Body. Body Group. (Plate 1). This primary group consists of the units and assemblies briefly described below. The cab assembly is the compartment usually provided for the driver of the vehicle. Controls and instruments required for the operation of the vehicle are usually located in the cab and on an instrument panel mounted on the dash. Cargo body or platform provides space for the payload. Sheet metal housing (fenders, hood, cowl, and similar metal parts) reduces wind resistance by “streamlining” and protects vital parts from the weather. Accessories. These are units which, depending upon custom and practice, are not considered necessary for the proper functioning of a unit or assembly but which are often desirable. They usually include oil filters, air filters, and other special equipment. Electrical System. For convenience, automotive electricity should be considered under the single heading “electrical system”, without specific regard to individual units or as- semblies with which it functions. AXLES Axles. The principle function of the axle is to carry the weight of the vehicle to the wheels. An axle which performs this function only is a dead axle (Plate 2). It may be of tubular or I-beam construction. Live axles. These axles carry the weight of the vehicle and also transfer power (or driving force) to the wheels. They are of tubular construction. The outer shell carries the weight of the vehicle and forms a housing for the driving axle shaft and the 254 MILITARY MEDICAL MANUAL differential units. In addition to these functions, the outer ends of axles usually carry the fixed parts of the braking system and absorb the forces resulting from brake ap- plications. Front driving axles correspond to rear driving axles except that provision must be made for steering. Parts. The rear axle assembly consists of the housing, the shafts, the bearings, the gas\ets, and the oil retainers. Plate 2. An I Beam Type Front Axle (Dead, Nondriving) and Attached Steering Parts. The housing is of steel, malleable iron, or aluminum, either forged, pressed, or cast. The housing provides a seat for the other parts of the axle, serves as a container for lubricant, and furnishes brackets for the attachment of springs, shock absorbers, radius or distance rods, brakes, and ride stabilizers. It is subjected to various stresses and strains in the transmission of weight and driving or braking torque. The axle shafts are steel forgings, the inner ends of which are squared or splined to fit into the side gears of the differential; the outer ends have a means for attaching the 1. Spring seat. 2 Axis housing. 3. Wheel end bearing. 4. Axle shaft. 5. Wheel spoke. Plate 3. Semifloating: Axle. 6. Differential bearing. 7. Differential case. 8. Side gear. 9. Axle-shaft retaining “C” ring. 10. Spacer and thrust block. The gaskets and oil retainers are especially important parts of the rear axle, since they must retain the lubricant and prevent water or dirt reaching the moving parts. Lubri- cant which escapes at the end of the axle usually ruins the brakes. Types. Depending upon the manner in which the above parts and the necessary bearings are assembled to take care of the various stresses, live axles are classified as plain and floating axles. The plain live axle is distinguished by the fact that the axle shaft is mounted in bear- ings within the housing, and the hubs and differential are carried by this shaft. The axle shaft therefore carries weight, is subjected to bending stresses, must deliver driving CARE AND OPERATION OF MOTOR VEHICLES 255 torque, and must withstand compression and tension stresses. Braking torque is car- ried by the housing. This type of axle is obsolete. Floating axles are classed as semi-, three-quarter-, and full-floating axles. In all of them, the differential, rather than the inner end of the axle shaft, is mounted on bearings inside the housing. If the outer end of the axle shaft is mounted in a bearing (Plate 3) and also has the hub mounted only on the shaft, the axle is semifloating. The shaft then carries the load, resists bending, and delivers torque. If the wheel hub is mounted on a radial bearing on the exterior of the axle housing (Plate 4) and is also splined to the shaft, the axle is three-quarter floating. Load is transferred to the housing and then to the hub, but the shaft carries bending and torsional forces. Where the hub is mounted entirely on tapered bearings on the exterior of the axle housing (Plate 5) and the axle shaft merely drives the wheels, the axle is full floating. Plate 4. Three-quarter-floating Axle. 1. Hub flange. 2. Axle housing. 3. Bearing (on exterior of housing). 4. Axle shaft. 5. Bearing retaining nut.. OIL SEAL , OIL SEAL GASKET GASKET OIL SEAL THRUST BLOCK SCREW GASKET STRADDLE MOUNTING HOUSING I GASKET - AXLE SHAFT RING GEAR Plate 5. Full-floating Rear Axle. Front axles. These axles incorporate a portion of the steering mechanism in addi- tion to carrying the load. In many instances they provide power transmission, especially in tactical vehicles. Independent springing. Where “knee action” or similar methods of independent springing are used, the center section of the axle, as well as the entire axle structure, is sometimes eliminated. The load is passed from the frame to the wheel spindles by means of two or more flat or coiled springs and transverse linkages. 256 Shoc\ absorbers. Shock absorbing devices are used to control the action and reaction of the springs between the axles and the sprung load. These may be either single or double acting. The single acting shock absorber acts only on the rebound of the spring, while the double acting acts on both compression and rebound movements. Shock ab- sorbers are normally used on all four wheels of passenger cars, but only on the front wheels of commercial vehicles. MILITARY MEDICAL MANUAL WHEELS, TIRES, BRAKES AND STEERING Wheels and Tires. The wheels of a motor vehicle must be light, yet strong enough to transmit driving power from the axles to the tires, carry the load, and resist side strains caused by skidding and rapid turning on curves and at corners. Wheels are made of wood, pressed steel, or of cast metal. The hub in the center of a wheel is the means by which the wheel is mounted on the spindle or axle shaft. Rims secure the tires to the wheels. They are usually of the demountable, quick detachable, or drop center types. Tires may be either solid, cushion, or pneumatic. Solid and cushion tires are still used to some extent on motor vehicles. Their principal use is on interior plant vehicles. Tread Under Cover Breaker Strip Liner of Carcass' Cushion Side Wall ■Inner Tube TimStrig Chafing Strip Demountable Tim_ Bead; Piano Wire Rim Lug Metal Felloe ■Inner Tube Valve Stem Tim Lug Bolt 'Valve Stem Lock Nut J)irt Cap 'Valve Cap Plate 6. Tire Construction. Penumatic tires are used almost exclusively on modern motor vehicles. (Plate 6). They vary from the wide, thin wall, and low pressure balloon type on passenger cars to the heavy, thick wall, high air-pressure type used on commercial vehicles and heavy trucks. Air is confined to the inside of the tire by an inner tube which, when inflated, conforms to the inside contour of the tire and rim. Puncture resistant tubes have been developed with inner air chambers or layers of special rubber, which seal punc- tures and control escaping air in case of tire failure. When the traction provided by the regular tread of a tire is not sufficient under certain weather and terrain conditions, chains and mud cleats may be added or the vehicle may use full or half track laying mechanism. (See War Department instructions on detailed care of tires.) Braking Systems. General. Brakes retard and stop a motor vehicle by acting on the wheels and in some cases on the transmission main shaft. CARE AND OPERATION OF MOTOR VEHICLES 257 In order to stop or retard a moving vehicle, friction is developed between the brake drums and brake shoe linings. The heat resulting from the friction is dissipated by air currents that surround the brake drums. The brakes are applied by use of the hand lever or the brake pedal. This forces the brake shoes against the brake drum, and the resulting drag tends to stop the rotation of the wheel. In a two-wheel braking system the rear wheels only are provided with brakes. In a four-wheel braking system all four wheels are equipped with brakes. The propeller shaft brake is usually known as a hand (or parking) brake. -BRAKE RODS- BRAKE HAND * LEVER FRONT WHEEL BRAKES' BRAKE "PEDAL CAM LEVERS- FULCRUM (-CROSS SHAFT (SUPPORTEDIN FRAME) ' OVERRUNNING SLOTS J -REAR WHEEL BRAKES Mechanical Brake System with Single Cross Shaft. BRAKE PEDAL — BRAKE HAND LEVER OVERRUNNING y SLOTS FULCRUM -REAR CROSS SHAFT FRONT CROSS SHAFT- INTERCONNECTlNC ROD Mechanical Brake System with Two Cross Shafts. Plate 7. Linkage and Controls for Mechanical Brake Systems. Braking action is usually initiated by operation of the foot pedal or hand lever by the driver. The pressure of the driver’s foot on the brake pedal moves levers, rods, and cables in mechanical braking systems; a column of liquid (braking fluid) from the master cylinders in hydraulic braking systems; or air pressure from tanks in air-brake systems. Booster devices are frequently used to increase initial braking pressures. Many combinations of braking systems are available. Hydraulic brakes are commonly used on light motor vehicles; air brakes on many heavy duty vehicles. The hand lever usually operates a parking brake. Brake types based on location and action of the braking surfaces may be classified as external contracting or internal expanding. The contracting type is seldom used as wheel brakes on modern motor vehicles because it is open to dirt and water. Mechanical bra\es employ cables or rods to distribute the braking effort to the wheels. Pressure applied by the operator at the brake pedal is multiplied by the ratio of the lengths of the various brake arms before it is transmitted to the operating shafts. Most mechanical systems equalize the braking action on each wheel by a device known as an equalizing cross shaft or arm. Mechanical brake arrangements are shown in Plate 7. Hydraulic bra\es are extensively used an passenger cars and light or medium weight trucks. Use of the brake pedal develops pressure in a master hydraulic cylinder. By hydraulic principles this pressure is increased and applied to each of the wheel 258 cylinders through a system of brake tubes. The wheel cylinders are fitted with operating pistons that convert the hydraulic pressure into the mechanical power which expands the brake shoes. As soon as the pedal pressure is released, the return springs of the brake shoe act against the wheel cylinder pistons, forcing the brake fluid back into the master cylinder. Plate 8 shows a hydraulic braking system. MILITARY MEDICAL MANUAL Compensating Port ■To Front v Brakes Stop-light Switch Master Cylinder -Supply Tank Brake Pedal -To Rear Brakes Plate 8. Lockheed Hydraulic Brake System, (Bragg-Kiesrath). “Adjustment Cams -Shoe Adjusters > 0 ID Jz <£ Brake Release Springs Frame Air bra\es are used primarily on buses and heavy-duty trucks. Air pressure for operating an air brake system is supplied by an air compressor equipped with pressure governor (regulator) and driven by the vehicle engine (power plant) or by a separate compressor. Compressed air is stored in a suitable tank (reservoir) equipped with a safety valve. Air is piped from the storage tank to a brake chamber at each wheel through a brake (control) valve. Plate 9 shows an air brake system. CARE AND OPERATION OF MOTOR VEHICLES 259 AIR COMPRESSOR AIR STRAINER AIR PRESSURE GAGE EMERGENCY LINCTAG auich RELEASE VALVE RELAY VALVE 5ERVICE LINE TAG WHEEL CHAMBER? WHEEL CHAMBER5 SAFETY VALVE BRAKE VALVE Plate 9. Diagrammatic Arrangement of an Air-operated Braking System. RESERVOIR Steering Wheel- Front Wheel- Steering Column Steering Gear Case Steering Worm- Axle Center Steering Gear Arm- Steering Gear Connecting Rod.-, -Steering Kr.uckje hnuc,hje Arm- 'Wheel Spindle ■Kpuchte Gear Rod Arrrv Steering Worm Gear Roller -Tie Rod Arm (left) ■ Steering gear shaft Plate 10. Diagram and Nomenclature of Complete Steering Mechanism. (Society of Automotive Engineers Nomenclature). 260 MILITARY MEDICAL MANUAL Electrical bra\es are suitable for trailers or where remote control installations are needed. Electric brakes depend on the electrical (or a special) system of the vehicle for their operation. They are controlled through a rheostat cither operated by hand or synchronized with the foot brake pedal. Booster systems are often used to assist the operator in applying additional pressure when operating the brake. The commonest of these are the vacuum mechanical, and servo-systems. The servo-system utilizes forces built up in the brake shoe itself to apply additional pressure. Steering Mechanism. (Plate 10). A motor vehicle is steered by turning both front wheels. The wheels, which are mounted on movable steering knuckles (Plate 2), turn in vertical yokes at the ends of the front axle. The steering knuckles are held in the yokes by steering knuckle pivots (kingpins). The front wheels rotate on bearings which are mounted on the spindles of the steering knuckles. The steering knuckle pivots (kingpins) are generally set at an angle with the plane of the wheel; this angle is referred to as the pivot (or kingpin) inclination angle. The front axle is rotated backward at the top so that the pivots (or kingpins) have a slight backward tilt; this is the caster angle. The steering knuckle spindles are so adjusted that the front wheels are farther apart at the top than at the bottom; this dis- tance or angle that the wheel leans outward at the top is the camber angle. The tie rod between the steering knuckles is adjusted so that the front wheels are closer together at the front of the wheel than at the rear; this is the toe-in. This series of angles and their adjustments are called the steering geometry of the vehicle. They must be properly coordinated as ‘designated by the vehicle manufacturer in order to obtain satisfactory steering and control of the vehicle. The steering knuckles, upon which the wheels are mounted, are connected by means of a tie rod located either in front or behind the axle. The steering arm on the left knuckle (left hand drive) is connected by a steering gear connecting rod (or drag link) to the steering wheel gear arm (or pitman arm) of the steering gear. The steering wheel, which controls movement of the steering gear, is mounted at the top of the steering post. The steering gear mechanism is carried at the bottom of the steering column. In independent front suspension, modifications of this linkage are generally used. THE ENGINE General Principles. The motive power for the modern motor vehicle is usually furnished by an internal combustion engine in which a mixture of fuel and air is burned. The burning fuel-air mixture and the resulting expansion of heated gas and pressures, de- velops mechanical power by the use of reciprocating and rotating parts, such as pistons, connecting rods, and crankshafts. A reciprocating engine is one which converts linear motion into a motion of rotation. This is the most common type both in steam engines and internal combustion engines. The linear motion of a piston in a cylinder, through a connecting rod, causes the rotation of a shaft. The mechanical principle is illustrated in Plate 11. A strode of the piston is a movement from one end of the cylinder to the other. It will be noted that it corresponds to half a turn of the crank- shaft. Two strokes of the piston, one in each direction, correspond to one full turn of the shaft. Four strode Otto cycle. Any gasoline engine that requires four strokes of the piston, two down and two up (consequently, two complete revolutions of the crankshaft), to complete a cycle of events is called a four stroke cycle engine. Since the four stroke cycle employed in the modern gasoline engine follows closely a thermodynamic principle discovered by Dr. N. A. Otto in 1876, it is referred to as the four stroke Otto cycle. The fundamental working parts of a four stroke Ottocycle engine and their relation to each other are shown in Plate 12. It is essential that the cylinder be closed at one end and open at the other. The closed end has a threaded opening into which the spark plug is screwed and two openings in which two valves operate to control the intake and exhaust passages of the cylinder. The valves are held closed by valve springs except CARE AND OPERATION OF MOTOR VEHICLES 261 when they are forced open mechanically by the valve operating mechanism. A piston is fitted into the cylinder so that it is free to move up and down. Piston rings are fitted into grooves around the piston to form a gastight seal between the piston and the cylinder wall. The open end of the cylinder is mounted directly above the crankshaft. The crankshaft is supported by, and rotates freely in, suitable bearings. In order to convert the reciprocating (up and down) motion of the piston into rotating motion, the piston is connected to the crankshaft by a connecting rod fastened to the piston by the piston pin and to the crankshaft by a split bearing over the crank pin. One end of the crankshaft is ordinarily fitted with a fly wheel to smooth out the power impulses and to continue the rotation of the crankshaft between power impulses. Energy imparted to the flywheel by the power stroke is sufficient to keep it rotating through the exhaust, intake, and compression strokes. GAS PRESSURE? IN CYLINDER PISTON CONNECTING ROD FORCE CRANK ARM CRANK SHAFT TORQUE OR TURNING EFFORT Plate 11. Reciprocating Motion. The first event in the cycle is the intake stroke, Plate 13. The piston starts from its topmost position or top dead center. With the exhaust valve closed and the intake valve open, the piston moves downward creating a partial vacuum or suction in the cylinder that draws a charge of fuel and air through the intake valve port into the cylinder. As the piston reaches the bottom of its stroke or bottom dead center, the intake valve closes so that the cylinder full of fuel mixture is sealed. Valves are assumed to open and close at top or bottom dead center of the piston for purposes of explanation. The actual points of opening and closing vary widely. With both valves closed and the cylinder full of fuel mixture, the piston moves upward in the cylinder until it again reaches the topmost position. This event is called the compression stroke, Plate 13. During this stroke the fuel mixture is being con- stantly compressed into a smaller space in the combustion chamber. Upon completion of this stroke the crankshaft has revolved one complete turn or 360° and the piston has made two strokes, down and up. At this point in the cycle the highly compressed fuel charge is ignited by the spark plug and combustion takes place. Due to the heat of combustion, the gaseous charge builds up an extremely high pressure and the piston is forced downward to the bottom dead center position. This event is called the power stroke of the engine. As the piston reaches the bottom dead center position, the exhaust valve opens and the pressure on the piston is immediately relieved. The exhaust valve remains open while the piston again moves upward to the top xiead center position forcing the burned 262 MILITARY MEDICAL MANUAL Plate 12. Operating parts of four-stroke Otto cycle engine. CARE AND OPERATION OF MOTOR VEHICLES 263 gases out of the cylinder through the exhaust valve port. When the piston reaches the top the exhaust valve closes. This event is called the exhaust stroke of the engine Plate 13. The crankshaft has now made two complete revolutions or 720° of circular move- ment, and the cylinder begins a new cycle of operation. The camshaft has made only one revolution; the intake and the exhaust valve have each opened and closed only once. Plate 13. Events of one complete cycle of a four-stroke Otto cycle engine. This order of events, intake, compression, power, and exhaust, is repeated over and over again as long as the engine operates. Regardless of the number of cylinders any one engine may have, each separate cylinder of the engine follows this cycle of operation in the four stroke Otto cycle. An engine having only one cylinder would develop power only one fourth of the time. To keep such an engine running during its non-productive strokes the energy 264 MILITARY MEDICAL MANUAL must be stored in a fly wheel or in the momentum of a moving vehicle. A multiple cylinder engine of course provides a more uniform flow of power. From the above it is evident that to make use of the expansive power of burning gases in an internal-combustion engine: A combustible mixture of air and gasoline must be introduced into the cylinder, and the cylinder then sealed. The charge of air and gas must be ignited. The burned gases (the exhaust) must be expelled. There must be a means of repeating these events to produce continuous rotary motion from the power strokes of the piston. Diesel cycle. The Diesel engine operates on a four-stroke cycle which differs from the gasoline engine cycle. In this engine the first (down) stroke draws in a charge of pure air. The second (up) stroke compresses this air to over 500 pounds per square inch, thus producing a high temperature. Fuel (a low grade of fuel oil or distillate) is injected at the beginning of the third (down) stroke. The high temperature existing within the cylinder causes an immediate ignition of the fuel which forces the piston down. The fourth (up) stroke expels the burned gas. The semi-Diesel or oil engine is an adaptation of gasoline and Diesel engines. It operates at lower compression pressures than Diesel engines, and consequently the fuel has to be ignited by an electric spark as in the gasoline engine. Both Diesel and semi-Diesel engines require four events for the completion of each cycle and are manufactured in two- or four-stroke types. Fuel System. This system supplies the engine with fuel. It necessitates a place for fuel storage, a method of transferring the fuel from the place of storage to the engine, and a means for mixing the fuel with air and feeding it to the cylinder. Fuel pump method. In most modern vehicles the fuel is transferred from the fuel tank to the engine by a fuel pump. Starting from the storage tank the fuel passes through fuel lines or tubes, through a filter and fuel pump to the carburetor, where it is mixed with air and passed through the inlet port into the cylinder. Other methods. Gravity, air pressure, and the vacuum are other means utilized to move the liquid fuel from the tank to the carburetor. Fuel injector method. In the Diesel engine the fuel is sprayed into the cylinder by a fuel injector. Exhaust System. This system conducts the hot exhaust gases from the engine to the rear of the vehicle and discharges them into the atmosphere after the noise produced by their rapid expansion has been controlled and quieted. Exhaust noises are minimized by piping the gases through a chamber known as the muffler, which to a great extent allows the gases to expand and cool before being discharged. In the older type of mufflers a labyrinth is provided for the gas to pass through. The newer types allow the gases to pass “straight through” as they are cooled and toned by surrounding chambers. Cooling System. This system includes those units of the vehicle which are used for the specific purpose of carrying away and dissipating the heat from the combustion chamber that is not transferred into power. The metal parts of the engine, which absorb the heat of the burning fuel, not only contract and expand over a wide temperature range, but also have different coefficients of expansion at the same temperature. In order to prevent damage to parts by preignition of the fuel and incorrect working clearances, it is necessary that excessive heat be dissipated. Water (or other liquid) is the usual agent for cooling engines. It is circulated through a water jacket around the cylinders and combustion chambers and absorbs the heat carried by the metal cylinder head and walls. The cooling system includes a fan for creating air currents and a water pump for positive and forced circulation of the cooling agent. In most instances a thermostat control device prevents circulation of the liquid until correct operating temperatures have been reached. Plate 14 shows a typical liquid cooling system. The air stream CARE AND OPERATION OF MOTOR VEHICLES 265 drawn through the radiator actually cools the liquid during its passage down through the radiator core. Air, without the use of a liquid as an intermediate agent, cools some engines by being forced in large quantities over the cylinders, which have been provided with metal cooling fins having high heat conductivity. RADIATOR UPPER TANK WATER JACKET AROUND COMBUSTION CHAMBERS, VALVES AND CYLINDERS. RADIATOR UPPER HOSE RADIATOR CORE THERMOSTAT. WATER PUMP RADIATOR LOWER HOSE RADIATOR LOWER TANK Plate 14. Typical Liquid Cooling System. Engine Lubrication. Friction in the modern close-fitted, high-speed engine is great and can be controlled only by proper lubrication. An oil-distributing system for engine lubrication is necessary in order to maintain a film of oil on cylinder walls, bearings, and other points where moving parts come in contact. This may be a force feed (pump pressure) type, splash type, or a combination of both. In the force feed type, oil is pumped under pressure from the crankcase through oil tubes to all crankshaft bearings. In a full force feed system, the oil is pumped to the piston pin through the connecting rods. In the splash type, oil in the crankcase is splashed and converted into a fine mist by small devices called “dippers” located on the extreme lower end of each connecting rod bearing. Usually the oil is pumped into troughs directly under each connecting rod. The splashed oil settles on all moving parts and lubricates them. An oil filter is often added to pressure systems to filter all or part of the circulated oil each time it passes through the pump. 266 MILITARY MEDICAL MANUAL Oil coolers are also used on some engines to assist in cooling the lubricant for more efficient lubrication. A lubricating system of the full force feed type is shown in Plate 15. Correct engine lubrication is probably the most vital single factor in ensuring longer engine life. Piston OIL PRESSURE GAGE Oil Pressure Requlator or Relief Valve Rina Lands Piston Piru ?Rinq Grooves Main Dearinq Rib 5apportN> Oil 5praq :Oil Film Conneetinq Rod Oil header Pipe- Main > Dearinq Arroais Indicate I Direction ot Oil Floai OiL Film" -pil Film Circulating Pump Crank Shall Drilled from Main Dearinq to Conneetinq Rod Dearinq Screens Journals Oil Samp -Drain Pluq Plate 15. Full Force Feed Lubricating System. POWER TRANSMISSION Power Transmission System. (Plate 16.) The power generated by the engine of a motor vehicle is delivered to the driving wheels or tracks through the power trans- mission system. The clutch, transmission, transfer case, universal joints, propeller shaft, final drives, differential, and axle shafts comprise this system. Clutch. In order that the operator may control his vehicle properly, it is necessary that he be able at will to connect or disconnect the engine from the propulsion units. This is accomplished by an assembly known as the clutch, Plate 17. When the clutch is engaged, it functions by means of the friction created between its driving and driven members. The faces of the clutch disk are covered with a friction material similar to woven brake lining. The disk is held between the face of the flywheel and the clutch-pressure plate, which is spring loaded and rotates integrally with the flywheel. Other types of clutches are cone, hydraulic, multiple disk, and single and multiple disk clutches running in oil. Transmission mechanism. The power requirements of a motor vehicle vary with the speeds of the vehicle, road conditions, and loads. Since an engine develops only a small fraction of its cotal power at low speed (revolutions per minute), it is necessary for starting and for the lower speeds of vehicle movement to provide a variable gear ratio by sets of different transmission gear combinations. It is common practice to provide at least three forward gear (speed) changes on passenger cars, plus neutral and reverse positions, and as many as five or more forward changes on trucks. A typical transmission case having three speeds forward and one reverse is shown in Plate 18. The lubricating system of a transmission gear assembly is usually self-contained. The assembly is in a closed case known as the transmission case and runs in a con- stant bath of oil. CARE AND OPERATION OF MOTOR VEHICLES 267 Plate 16. Type of Power Transmission System. 268 MILITARY MEDICAL MANUAL Auxiliary transmission and transfer mechanism (or case). Heavy duty vehicles re- quire a greater selection of gear changes than the transmission normally affords in order to meet power requirements ranging from a no-load condition on level highways to a full-load condition on steep hills or rough terrain. In order to meet these excep- tional requirements an extra gear case, usually known as an auxiliary transmission, is used between the regular transmission and the driven axle to provide additional gear changes. The transfer mechanism (or case), usually located off center with relation to the engine and transmission, provides the means of driving both front and rear axles. A declutching device to disconnect the front driven axle is usually included. FLYWHEEL CLUTCH FINGERS CLUTCH PILOT BEARING CLUTCH PRESSURE PLATE CLUTCH VIBRATION DAMPENER SPRINGS CLUTCH COVER CLUTCH PESSURE SPRINGS CLUTCH DRIVEN DISK CLUTCH DRIVEN DISK HUB FLYWHEEL RING GEAR Plate 17. Clutch. GEAR SHIFT LEVER SHIFTER INTERLOCK TRANSMISSION CASE GEAR SHIFT LEVER HOUSING REAR BEARING SPEEDOMETER DRIVEN GEAR BEARING UNIVERSAL JOINT BEARING RETAINER CLUTCH SHAFT CLUTCH TEETH' SECOND 8,THIRD SPEED CLUTCH MAIN SHAFT MAIN SHAFT COUNTER DRIVEN GEAR SECOND SPEED GEAR COUNTER LOW SPEED DRIVE GEAR FIRST & REVERSE GEAR COUNTER GEAR ASSEMBLY COUNTER SECOND SPEED GEAR Plate 18. Transmission. CARE AND OPERATION OF MOTOR VEHICLES 269 “Power take off” for driving winches, hoists, and similar special equipment may also be included as part of these units. In all-wheel driven vehicles, the auxiliary transmission (subtransmission) and the transfer mechanism may be combined in one unit. A sectional view of such a unit is shown in Plate 19. HIGH SPEED DRIVE GEAR HIGH AND LOW SHIFT RAIL LOW SPEED DRIVE GEAR TO TRANSMISSION ONE OF 10 BEARINGS USED SPEEDOMETER DRIVE FRONT AXLE DISENGAGEMENT LEVER TO FRONT AXLE TO REAR AXLE -SPUNED COLLAR Plate 19. Transmission of All-Wheel Drive Vehicle. Propeller shaft and universal joint. Power transmission between transmission cases and transfer cases or driven axle units is accomplished through universal joints and propellor shafts. A propeller shaft may be either a shaft running in the open between universal joints or an enclosed shaft (torque tube) type. It must be provided with a sliding or slip joint (spline) and universal joint to overcome the variations in angles and distances between units rigidly mounted in the vehicle frame (transmissions and transfer mechanisms) and units mounted on the driven axle (pinion gears, spur gears, differential, or other final drive mechanism). These variations are caused by the flexing springs under road and weight (load) shocks. Unless provision is made to offset these changes in the location of the driving axle and related units, mechanical or structural failure will result. Plate 20 shows a portion of a propeller shaft, its slip spline, and universal joint. The ideal power transmission would be in a straight line. The driving axle, how- ever, is generally set somewhat lower than the transmission necessitating that the propeller shaft run down to the axle at an angle. This requires the use of one or more universal joints. A universal joint is substantially a double hinged joint with the pins of the hinges set at right angles. Several different methods are used to achieve this, but in each case, the basic principle is the same. 270 MILITARY MEDICAL MANUAL Final Drives and Differentials. Final drives and differentials are separate and distinct mechanisms, each serving a different purpose. A final drive transmits power from the propeller shaft to the differential case and changes the direction of the power transmitted by the propeller shaft through 90 to the driving axles. At the same time it provides a fixed reduction between the speed of the propeller shaft and the axle driving the wheels. A differential is a device which allows torque to be delivered to two shafts or wheels which may be turning at different speeds. UNIVERSAL JOINT SPIDER PROPELLER SHAFT SPUN ED JOINT SEAL NEEDLE BEARINGS COMPANION FLANGE Plate 20. Propeller Shaft, Slip Spline and Universal Joint. Plate 21. Gears Used in Final Drivers. Final Drives. General. Torque from the transmission is transmitted longitudinally along the chassis by means of the propeller shafts. At the axle the direction of this force must be changed through a right angle to rotate the wheels. This is done by the final drive, which also provides an additional gear reduction. There are three general types of final drive: The bevel gear, the worm gear, and the hypoid gear. Bevel gear final drives (Plate 21) invariably use spiral-bevel gears to secure quiet CARE AND OPERATION OF MOTOR VEHICLES 271 operation and long wear. The drive pinion is built integral with either a short pinion shaft or with the propeller shaft. Worm gear final drives (Plate 21) are used on many trucks, since they permit the use of high reduction ratios. In a hypoid gear (Plate 21) the axis of the pinion gear is either above or below the center line of the bevel gear. Its principal advantages are greater tooth area in contact, quieter operation, and increased chassis clearance above the propeller shaft. This increased clearance permits construction of vehicles with chassis closer to the ground. Plate 22. Differential with Part of Case Cut Away. Differentials. When a column of marching men turns a corner, the man in the inside file must take short steps, almost marking time, while the man in the outside file must take long steps and walk a much greater distance to make the turn. When a motor vehicle turns a corner, the wheels on the outside of the turn must rotate faster and travel a greater distance than the wheels on the inside. This causes no difficulty with the front wheels of the usual passenger car which are not driven because each 272 MILITARY MEDICAL MANUAL rotates independently of the other on opposite ends of a dead axle or on independent spindles (knee action). In order for the rear wheels to turn at different speeds, how- ever, their individual axle shafts must be connected to the bevel drive gear in such a way that each shaft can turn at a different rate of speed and still be driven as a single unit. This is the function of the differential. The type of differential in general use (Plate 22) consists of a differential case bolted or riveted to the bevel drive gear, and two or more differential pinions pivoted radially in the case and meshed with two differential side gears. These are splined to the two axle shafts which drive the wheels. The axle shafts pass through each side of the differential case but rotate independently of it. Spur bevel gears are almost always used for the differential pinions and side gears. Usually, either two or four differential pinions are employed. An actual differential, with the parts in their proper relative positions but without their housing, is shown in Plate 22. The differential pinions are pivoted on the trun- nions of a spider. These trunnions extend outward beyond the pinions and their outer ends are held in recesses between the two parts of the case which holds the side gears in mesh with the pinions. The action of the differential is as follows: The drive pinion rotates the bevel drive gear and the differential case and spider which are attached to it. The power is transmitted to the axle shafts through the differential pinions and side gears. When there is equal resistance on each rear wheel, the differen- tial pinions rotate the differential side gears and axle shafts at the same speed which is the speed of the bevel drive gear. In this case, there is no relative motion between the pinions and the side gears; that is, the pinions are not turning on the spider trunnions and their teeth are not moving over the teeth of the side gears. When the vehicle turns a corner, one wheel must turn faster than the other. Consequently there is a movement of the differential pinions around the spider trunnions and over the teeth of the side gears. This makes one side gear, axle shaft, and wheel revolve faster than the other. Any movement of the differential pinions over the side gears accelerates one axle shaft and retards the other. The average speed of the two side gears, axle shafts, and wheels is always the speed of the bevel drive gear. BODIES AND ELECTRICAL SYSTEM Bodies. Vehicle bodies (Plate 1) must afford comfort and safety to the operator and passengers. In passenger cars the body must also help support or stiffen the frame. Bodies are composite or all metal. However, composite bodies of steel, wood, and fabric are being rapidly replaced by all-steel bodies. The complete body assembly of a truck is considered as two distinct parts: the cab or operator’s compartment and the cargo body. In panel delivery bodies the cab and cargo body are usually seprated by a panel or wall. In many of the larger type trucks used for long distance highway hauling, space is provided for a bed in the operator’s cab for a relief driver. This is usually found in the wheeled tractor type unit used for trailer work. The instrument panel, across the front, of the cab within easy reach and vision of the operator, contains operating gages and instruments as well as engine controls. Many special types of cargo bodies have been produced, but the commonest are the platform, stake, panel, cargo, and tank types. Electrical System. Any electrical unit of automotive equipment on the motor vehicle should be considered as part of the complete electrical system. This equipment is generally grouped by circuits according to functional use: storage battery; generating and lighting; ignition; starting motor; horn; protective devices; and miscellaneous, such as lamps, switches, and special devices. A typical wiring diagram of these circuits is shown in Plate 23. Storage battery. This unit may be considered the heart of the electrical system of a motor vehicle. It furnishes electrical energy for cranking the engine and also for the electrical units of the vehicle when the generator output is insufficient. It is charged by any excess current from the generator. A wet cell battery of the lead acid type has an inherent potential of approximately 2 volts per cell. Thus a 6-volt system will CARE AND OPERATION OF MOTOR VEHICLES 273 use a 3-cell battery composed of 3 individual cells in series mounted together in a container and connected as a single unit. A sectional view of a lead acid storage battery cell is shown in Plate 24. Generator. A direct current generator with related control mechanism is usually attached to the engine of practically all motor vehicles in order to generate and supply electric current necessary to maintain the battery in a charged or nearly charged con- dition; otherwise, the battery would soon become discharged. The generator may be of 2- or 4-pole construction and may be driven by belt, chain, or direct gear drive. High current generators of the voltage regulated type are becoming more common because the modern motor vehicle requires a greater amount of current. DISTRIBUTOR IGNITION COIL SWITCH TO GAGES OR OTHER ACCESSORIES CONTROLLED BY IGNITION SWITCH HORN INST. PANEL LIGHTS TO SPARK PLUGS HEADLAMPS GENERATOR STARTER A[MMETER INST. => PANEL LIGHT SWITCH TAIL a STOP LAMP STARTER -n SWITCH FU SE BATTERY HORN BUTTON RELAY a GEN. CONTROL LIGHT SWITCh FOOT DIMMER SWITCH STOP LIGHT SWITCH Plate 23. Wiring Diagram of Car Showing Principal Units and Circuits. Lighting circuits. These circuits include head lamps, tail lamps, stop lamps, and any instrument lamps necessary for the night operation of the motor vehicle. Light switches are usually considered with the circuit of the lamp or lamps which they control. Ignition system. In the gasoline engine the charge of compressed fuel is ignited by an electric spark. This ignition spark is created and controlled by an ignition system composed of the battery ignition switch, coil, condenser, breaker (interrupter), distributor, spark plugs, and the necessary wire to connect them. A typical battery ignition circuit is shown in Plate 25. The magneto is another type of ignition system frequently used. It is self-contained, as the current that is ordinarily supplied by the battery (in a battery ignition system) is generated within the magneto. Plate 26 shows a typical magneto circuit. Starting motor. Electric motors with high torque characteristics are used almost universally for cranking the engines of motor vehicles. The starting motor may drive the engine by a silent chain and overrunning clutch, or by a pinion gear attached to the motor armature shaft, which is brought into mesh with teeth cut on the rim of the engine flywheel. However, the pinion method is used almost exclusively. The pinion gear is engaged with the flywheel either by being shifted along the armature shaft by a combined shifting yoke and switch operating mechanism or by being run into mesh along a screw shaft through a driving spring as the armature picks up speed. VENT PLUG POST FILLING TUBE SEAL NUT POST "GASKET POSITIVE STRAP POSITIVE PLATE v NEGATIVE STRAP RUBBER SEPARATOR LEVEL OF ELECTROLYTE WOOD SEPARATOR' NEGATIVE PLATE CASE Plate 24. One Cell of Lead Acid Storage Battery Showing Relationship or Plates, Insulators, and Terminals. 'RIB COIL TO DISTRIBUTOR HIGH TENSION CABLE CAM CONDENSER BREAKER “ POINTS COIL IGNITION SWITCH WIRE TO SPARK PLUG AMMETER SPARK PLUG' CORE v* STARTER SWITCH DISTRIBUTOR ENGINE BLOCK ROTOR ARM SPARK PLUG GAP BATTERY Plate 25. A Typical Battery Ignition Circuit. The latter type is known as a Bendix drive. This type of drive assembled on a start- ing motor shaft is shown in Plate 27. Horns. Horns or warning devices on motor vehicles are normally operated by elec- tricity. Usually they consist of an electromagnet equipped with an interrupter device and arranged in such a way that the electromagnet vibrates a thin metal diaphragm. A projector or bell placed over the diaphragm amplifies the sound and directs it forward. CARE AND OPERATION OF MOTOR VEHICLES 275 DISTRIBUTOR SPARK GAP BRUSH HOLDER INTERRUPTER- COLLECTOR. RING-' GONDENSER ARMAjTURE GROUND Plate 26. Typical Magneto Circuit. STARTER TERMINAL DRIVING STOP CONNECTION TO SCREW SHAFT BOLT CONNECTION TO ARMATURE SHAFT AUTOMATIC WEIGHT ARMATURE SHAFT PINION GEAR STARTING MOTOR FRAME DRIFT PIN AND SPRING SCREW SHAFT SLEEVE END PLATE DRIVING HEAD DRIVING SPRING Plate 27. Bendix Drive. 276 MILITARY MEDICAL MANUAL Protective devices. Devices such as fuses or magnetic circuit breakers are placed in the electrical circuits of the motor vehicle to protect the wiring and battery from overloads or short circuits. Too heavy a current will melt the fuse and open the circuit or will separate (open) the points of the circuit breaker. Miscellaneous. This group includes lamps, fuel gages, turn indicators, and other electrical accessories, or special devices operating from the motor vehicle electrical system. AUTOMOTIVE MAINTENANCE Basic Principles. The Army system of automotive maintenance is based on: Scheduled preventive maintenance operations, unit replacements, repairs, and in- spections with the primary objective of economical uninterrupted vehicle service. Systematic detection and correction of incipient causes of vehicle failures before they occur and the operations necessary to maintain satisfactory day-to-day operation. The principle of unit replacement rather than major repair of a unit while installed in the vehicle is practiced in all cases where such assembly is available. Within the motor maintenance system of operating organizations will be included only the tools, equipment, and personnel which are necessary to insure combat efficiency. It will be predicated upon: Close and adequate support by the supply service motor maintenance units. ORGANIZATION WITHIN THE COMPANY OR BATTERY FOR SECOND ECHELON MAINTENANCE UNIT COMMANDEF MOTOR OFFICER Instruction Operation Maintenance Inspection Records Reports Supply SUPPLY SERGEANT CHIEF OF SECTION MOTOR SERGEANT Supervision Inspection Operation Reports Shop Foreman Maintenance Inspection Records Surveys Property records Nonexpendable supplies DRIVERS Operation Caretaking Inspection Lubrication Trip ticket Accident report MECHANICS Caretaking Repairs Maintenance operations Lubrication CLERK Dispatcher Forms Records Supply Memo receipts CARE AND OPERATION OF MOTOR VEHICLES 277 Meeting the normal needs of operation (not the unusual needs). Minimum decentralization within the regiment. The expectation of a certain proportion of motor-vehicle casualties. The available elements essential to maintenance will determine in each case whether these casualties will be repaired by the organization or by the supporting service. Replacement of vehicles which cannot be repaired within the time element in the particular situation. The Echelon System of Maintenance. There are, in general, four divisions of Army maintenance called the first, second, third, and fourth echelons (AR 850-15). Responsibility. The first and second echelons of maintenance are the responsibility of the using arms and services, while the third and fourth echelons are the responsibility of the supply services. Essential elements. There are four elements essential to maintenance functions: personnel, equipment, supplies, and time. The work to be performed in the various echelons is limited by restrictions of one or more of these elements. Functioning. The succeeding paragraphs of this chapter are devoted to the detailed functioning of the first and second echelons and to a broad presentation of the third and fourth echelons. First Echelon—Driver and Assistant Driver. The first echelon maintenance is drivers’ maintenance. It covers the simple operations that can be trusted to the skill of the average driver using tools and supplies available on the vehicle. These operations may in- clude: drivers’ inspections; servicing (replenishment of gasoline, oil, water, antifreeze, and air); cleaning, lubrication, except items requiring special lubricants, equipment, or technical knowledge; tightening or replacement of nuts, bolts, screws, and studs; preparation of the vehicle for maintenance operations and for command and technical inspections; and care of tools and equipment of the vehicle to include the storage battery. Second Echelon. The second echelon maintenance is that maintenance other than first echelon maintenance performed by the using arms and services. It embraces preventive maintenance, minor repairs, unit replacements and inspections within the limits of time available. When vehicles are pooled or are in one special organization, the first and all the second echelon functions are combined. On the other hand when a com- pany or battery of a regiment has vehicles assigned to it, the second echelon functions are usually divided between the company or battery and the regiment. The organiza- tion to which the vehicles are assigned is responsible for first echelon maintenance and certain portions of the second echelon, limited as hereafter provided, by the tools, light portable equipment, parts, and mechanics authorized. The regiment, on the other hand, with its separate maintenance section, performs the operations requiring either more skill or special tools. Company or battery. Unit commander. The unit commander is directly responsible for the first and part of or all the second echelon maintenance. He normally has the assistance of a motor officer, a motor sergeant, and motor mechanics. In order to insure a high state of operating efficiency the unit commander must— Separate, so far as possible, the operating and maintenance functions of his personnel and establish definite responsibility for each function. Establish and maintain uniformly high standards for all work. Make vehicles and time available for maintenance operations. Enforce a simple but thorough method of record keeping. Conduct schools to insure uniform training of drivers (see Chapters XIII and XIV) and mechanics, and to supply replacements for personnel losses. Provide necessary lubrication, maintenance, and inspection guides. Establish and enforce routine scheduled maintenance operations. Make such inspections as are necessary to insure the proper coordination and func- tioning of all personnel. Maintenance is a function of command. Continued successful operation by a motorized unit requires that the personnel in command positions give to the activities of mainte- nance the time and effort necessary to meet the needs of operation. 278 MILITARY MEDICAL MANUAL Motor officer. The motor officer should be selected from those officers having either special motor training or aptitude. He should be familiar with all the peculiarities of his vehicles and should be able to inform his seniors at any time of the exact condition of each vehicle. He is responsible to his immediate commander for the technical opera- tion and maintenance of the vehicles. His duties include— Organizing and supervising the maintenance, repair, and servicing of vehicles. Instructing the drivers and assistants until they are fully qualified. Being in charge of all caretaking. Inspecting before leaving park, on the road, at the halt, at the end of the march; inspecting vehicles in storage; and making maintenance inspections. Assisting in making command inspections. Seeing that all parts and supplies are procured. Routing vehicles to a higher echelon. Supervising the keeping of forms and records. Instucting all maintenance personnel in their duties. Spot checking all maintenance operations. Carefully watching the lubrication services and checking the lubricants for type and condition. Having all fire hazards removed. Observing the drivers whenever practical. Directing the transfer of loads in case of break-down. Giving proper instruction in case any personnel is left behind on a march. Giving proper instructions to expedite any road repair or rescue. Riding usually at the tail of the column. Motor sergeant. The motor sergeant should be selected for his knowledge, mechanical skill, and his aptitude for organization and supervision. He allots the work to mechanics and inspects their work both during the actual performance and when the job is completed. He should be well versed in quickly and accurately diagnosing mechanical failures and should be able to give the mechanics proper instructions for corrective action. He should be trained in field expedients and should be able to get the vehicles through when stalled or in bad going. He should be present with the vehicles from the time of the arrival of the first driver until the last vehicle is in, and he should remain with them until they are all ready to operate again. His duties include: Principal assistant to motor officer. Direct charge of the park. Directing the work of mechanics and, if so assigned, the drivers. Closely supervising and checking the work of mechanics in scheduled maintenance. Assisting, as directed, in inspections. Observing operation of vehicles on the march, and supervising road adjustments, repairs, and rescues of stalled vehicles. Personally checking or designating a mechanic to check all vehicles immediately upon any halt and upon completion of the day’s march. Particular attention is paid to excessively heated parts, such as gears and brakes. Reporting evidences of neglect, abuse, or carelessness to the motor officer. Keeping or supervising the keeping of the record of repairs, adjustments fuel, and supplies. Supervising starting of engines to see that they start promptly and are warmed up properly. Riding usually at the tail of the column. Chiefs of sections. Chiefs of section direct the march of their sections and require drivers to comply with instructions as to gear, speed, distances, safety, and similar matters. Their duties include: Responsibility for and directing caretaking by drivers. Reporting vehicle troubles and faults to the motor sergeant. Responsibility for the replenishment of gasoline, oil, water, and other operating supplies. Riding usually in the first vehicle of the section. CARE AND OPERATION OF MOTOR VEHICLES 279 Mechanics. The number of mechanics allotted to the various units is given in the Tables of Organization. It is based on the number of vehicles to be maintained. Mechanics make repairs and adjustments under the direction of the motor sergeant. They perform the operations of scheduled maintenance, assist chiefs of section in care- taking when so detailed, and observe vehicles on the march. One mechanic usually rides with the motor officer and the others ride in the unit repair truck. Tools and equipment. The Tables of Basic Allowances prescribe the tools and equipment. For each general automobile mechanic the allowance is one set of hand tools consisting of about fifty items. In addition to the tool sets of the mechanics, the motorized battery, company, or similar unit is allowed a “unit equipment set.” A “mechanic’s truck” or repair truck is usually allotted to each unit for carrying me- chanics, tools and equipment and parts and operating supplies. Spare parts and supplies. In order to prevent the dissipation of spare units and parts, the stock is generally limited to that required for the discharge of necessary mainte- nance functions. Regiment. In most arms and services there is provided by the Tables of Organiza- tion a regimental second echelon maintenance organization. The personnel are a part of the headquarters company battery, or like unit of the regiment and are administered by the commanding officer of that unit. The regimental commander is directly re- sponsible for the operation of the regimental second echelon. Regimental motor officer. The regimental motor officer must be a highly trained full-time motor officer to command the motor-maintenance personnel and supervise its functions. His duties include: Being in charge of the regimental motor maintenance section or platoon. Coordinating and consolidating all requests for third echelon repairs. Cooperating with third echelon shops on requirements for repairs. Supervising replacements and maintenance operations. Making maintenance inspections as required. Supervising the keeping of motor-vehicle operation and maintenance records. Coordinating and consolidating all requisitions for motor transport parts and supplies, other than those handled by the unit supply officer. Supervising the supply and issue of motor transport supplies within the regiment, other than those handled by the unit supply officer. Keeping a record of expenditure of funds allotted. Checking upon the units to prevent the hoarding of parts and supplies to the detriment of other units. Prorating the budget allowance in money value for cleaning and preserving material and parts, as directed by regimental commander. Keeping in touch with all maintenance establishments that operate with the or- ganization. Preparing all records and reports in regard to motor transportation required to be forwarded to higher headquarters. Supervising the unit motor schools. Keeping in touch with the utilization and circulation of vehicles of the units. Assisting the commanding officer in making command inspections. Notifying all organizations of the location of his repair facilities in the field. Riding at the tail of the column, ordinarily allowing none to fall behind him, except those vehicles beyond repair. In time of peace he makes suitable arrangements for repair or salvage of vehicles so damaged that towing is not practicable. Examining driver candidates, and keeping record of and issuing W. D., Q. M. C. Form No. 228 (U. S. Army Motor Vehicle Operator’s Permit), in accordance with AR 850-15. Preparing scheduled maintenance guides for the various units under his technical supervision, as well as for the regimental maintenance section’s operation. Keeping unit commanders informed as to the efficiency of maintenance of their motor vehicles. 280 MILITARY MEDICAL MANUAL insuring that information issued in technical service bulletins or regulations reaches all maintenance personnel in the regiment. Making frequent visits to the unit motor maintenance personnel to render such assistance and advice as may be needed. Regimental motor sergeant. The regimental motor sergeant is the principal assistant of the regimental motor officer. He is in direct charge of the mechanics and assigns and supervises their work. He coordinates the duties of the supply personnel with those of the maintenance personnel. He prepares the maintenance records and reports required. In the absence of the regimental motor officer, he takes over his duties, establishes the maintenance set-up in the field, and notifies all organizations of his location. Regimental motor mechanics. The regimental motor mechanics should be among the best qualified mechanics in the regiment, thus making the services of the best mechanics available to all units. Regimental supply officer. The regimental supply officer is directly charged with the procurement and issue of fuel, lubricants, antifreeze solutions, cleaning and preserving materials, and similar items directly to the operating units. He should utilize the services of the regimental motor officer in preparing recommendations as to the quantity and quality of operating supplies and the quantity of maintenance supplies. The duties of the regimental motor officer in no way change the duties and responsibilities of the regimental supply officer. Spare parts and supplies. The bulk of the spare units, parts, and supplies for the entire regiment is carried in the regimental section or platoon. This prevents dissipation of the stock available and yet allows any portion of it to be readily available to the organ- izations. Ordinarily an unserviceable unit is replaced by a spare unit, if one is available, and the damaged unit is then returned by the regiment to the third echelon for exchange. Third Echelon. Third echelon maintenance is that normally performed in the field by quartermaster and ordnance personnel. It embraces principally the replacement of unserviceable unit assemblies by similar unit assemblies held in third echelon stock. In addition to unit replacement, the third echelon supports and extends maintenance facilities to the using arms and services by making repairs involving the use of medium mobile shop equipment and by the services of general mechanics and a limited number of trade specialists; by the supply of unit assemblies and parts to the second echelon; and by the evacuation to the third and fourth echelon shops of vehicles which require repairs beyond the scope of second and third echelon facilities. Fourth Echelon. The fourth echelon maintenance is that normally performed in the rear areas by the quartermaster or ordnance personnel. It embraces the tear-down and repair of any or all unit assemblies which are used in the motor vehicles of the com- mand to which the fourth echelon shop is assigned. Essentially this consists of major unit repair. It also includes salvage and reclamation service. Definitions. Repairs. Repair consists of adjusting, tightening, replacing, or recon- ditioning any part, subassembly, or assembly of a motor vehicle. Adjustments. Adjustment consists of placing parts, subassemblies, or assemblies in correct working relation to each other and securing them in that position. Tightening. Tightening consists of drawing up nuts and screws where adjustment is not involved. This is usually the duty of the driver; therefore, a clear distinction should be made between tightening and adjusting. The latter requires knowledge, experience, and often special tools and is usually performed by fully qualified repair personnel. Replacing. Replacing consists of exchanging any part, subassembly, or assembly, and placing them in proper adjustment. Reconditioning. Reconditioning consist of restoring any part, subassembly, or as- sembly to a state of serviceability. Scheduled Operations. In order to maintain the vehicles in as near perfect operating condition as possible, scheduled maintenance operations followed by maintenance in- MAINTENANCE OPERATIONS CARE AND OPERATION OF MOTOR VEHICLES 281 spections are necessary. These should be positive operations performed in accordance with a definite schedule based on time, mileage, or a combination of both. This schedule must be planned well in advance and coordinated with anticipated demands for vehicles. Scheduled maintenance operations for all vehicles, except those special purpose and combat vehicles for which maintenance operations are prescribed in service manuals and handbooks, are divided into five general classifications as follows: Daily. Daily maintenance consists of cleaning, servicing, tightening, and emergency repairs. Cleaning, servicing, and tightening are duties of the driver under the direct supervision of the chief of section and under the technical supervision of the motor maintenance personnel. Weekly. Weekly maintenance is a continuation and a check of the drivers’ daily maintenance. It will be performed at least once each week by the driver under the direct supervision of the chief of section and under the technical supervision of the motor maintenance personnel. Lubrication. Lubrication operations should be performed by designated personnel in accordance with a lubrication guide furnished with each type of vehicle. This guide represents the minimum requirements and must be increased to meet severe operating conditions. Monthly (1000-mile). This maintenance operation is normally performed by the company, battery, or similar unit mechanics under the supervision of the motor ser- geant. A record is made to show the defects that could not be corrected, the time of accomplishment, the mechanic who performed the operation, and the officer who made the maintenance inspection. This record should be retained until the semiannual (6000-mile) maintenance operations and technical inspection, at which time it may be disposed of as the unit commander sees fit. Pertinent data from the record are entered in the vehicle service record. A guide for this maintenance, which should be modified as necessary for a particular type of vehicle, follows. Tolerances and clearances might well be added. Items marked with an asterisk (*) may require tools and parts not available or authorized, in which case the defect should be corrected by the next higher echelon: Road test. Bring engine to operating temperature and examine for smoke or fumes. Examine condition of oil on measuring stick. Observe any evidences of blow-by or leaks. Test horns, lights, windshield wiper, and other safety devices. Drive vehicles. Test for proper steering. Observe engine for power delivery, acceleration, and unusual noises. Test clutch action. Stop and investigate unusual noises. Test gear sets and final drives for ease of shifting and unusual noises. Test brakes for equalization, stopping distance, pedal travel, and pedal “feel.” Observe action of instruments on dash. Observe the final drive and power transmission units while another person drives or while the vehicle is blocked up with the wheels off the floor. Note any overheating of units. Check lubrication levels after return to motor park. Maintenance operations, general. Clean and tighten storage battery, terminals, and carrier bolts. Test battery and refill to proper level. Tighten body bolts, fenders, running boards, splash pan joints, bumpers, brush guards, head lamp brackets, mirrors, tow hooks, pintles, body parts, radiator shell, and hardware. * Repair body injuries. Replace unserviceable instruments or safety devices. Adjust lights. Wheels, brakes, and springs. * Replace worn brake lining. Correct overlubrication or leakage of lubricant. 282 MILITARY MEDICAL MANUAL Remove looseness or bind from wheel bearings. Tighten wheel stud nuts. Correct any leaks in hydraulic or air brake system. Fill master cylinder to proper level. Centralize and adjust brakes. Replace unserviceable shock absorbers and linkage; replenish fluid. Repair broken or loose spring hold-down bolts, rebound clips, and center bolts. Tighten loose shackle bolts. Correct any malfunctioning of the brake system. Steering mechanism. Remove by adjustment or repair any excessive play in: Steering knuckle bearings. Tie rod ends. *Bushings. King pin wedge bolts. Drag link or connecting link. Pittman arm or sector shaft. Steering gear. Tighten attachment of steering mechanism to frame, and of steering column to body. Replace any excessively worn or bent parts. Tighten, replace, or properly secure all lock washers, cotter keys, nuts, and similar items. Adjust wheel stops when turning radius is incorrect. (Note any wear on drag link.) Lubricate entire mechanism while front wheels are off the floor. Turn wheels from side to side to insure distribution of lubricant and to ascertain whether or not the entire mechanism works freely. Driving axles. Tighten loose driving flange nuts and cap screws. Tighten and properly secure all assembly, pinion carrier, cover plate, spring seat, and other bolts and nuts. * Correct any leakage of lubricant. any excessive play or backlash. Clutch, transmission, transfer case, propeller shafts, and universal joints. Adjust incorrect clutch free travel and floor clearance. * Repair defective reverse shifter stop, and malfunctioning shifter mechanisms. Tighten all loose bolts and nuts, assembly support, carrier, and cover plate. * Correct any leakage of lubricant. Correct misalinement of universal joints. *Repair all fractures. * Replace excessively worn spline and universal joints. all evidences of slackness, looseness, or leakage. Open clutch housing drain vent. Repair or replace muffler or tail pipe. Cooling system. Tighten radiator supports, braces, and attachment of shell to core. Adjust fit of hood on shell and fit of hood locks. Replace unserviceable hose and hose clamps. * Correct all evidences of water leakage. Adjust incorrect fan-belt tension; replace unserviceable fan belt. Fuel system. Clean dirty sediment bowls. * Correct any leakage in or around the fuel pump. Tighten connections; repair or replace leaking lines. *Correct any malfunctioning of fuel pump. Engine. Service all air filters; replace oil filter if required. CARE AND OPERATION OF MOTOR VEHICLES 283 Tighten engine mountings, flywheel housing, oil pan, flywheel cover, timing-case cover, manifolds, accessory attachments, and other bolts and nuts. * Correct all breakage, cracks, or leaks. Set manifold heat valve to seasonal adjustment. * Repair unserviceable breaker points. Replace all damaged wiring. * Correct malfunctioning generator or starter. * Correct generator output. Adjust noisy valves. * If on the road test any missing occurs, the entire ignition system should be carefully checked and spark plugs removed, examined, cleaned, reset, and serviceable ones re- installed. * Remove causes of other knocks, noises, and unsatisfactory engine performance. (Vacuum gauge is valuable for diagnosis of troubles). Repair looseness in any controls. Road test. Check repairs. Record. Prepare a record as follows: Defects not corrected. Unit Deject Mechanic’s and motor sergeant’s certificate. I have performed the maintenance operations as outlined in the guide for monthly (1000-mile) maintenance operations, and so far as can be determined this vehicle can be expected to give 30 days, or 1000 miles, of satisfactory service, except as indicated under defects. Date Signature Signature (Mechanic) (Motor sergeant) Maintenance inspection certificate. I certify that I have performed the maintenance inspection on this vehicle as re- quired by AR 850-15 and that it can be expected to give 30 days or 1000 miles of saitsfactory service. Date Signature (Motor officer) Semiannual (6000-mile) maintenance operations. These maintenance operations are normally performed by the regimental second echelon of maintenance. Under ex- tremely severe operating conditions certain items may have to be checked every two or three months. An instructional guide similar to that used for the monthly (1000- mile) maintenance operations should be drawn up. These maintenance operations differ from the monthly operations in that all accessory units and some other parts are disassembled, cleaned, inspected, and lubricated. They are then repaired or exchanged if necessary. Semiannual (6000-mile) maintenance operations are thus more complete than are those performed monthly or every 1000 miles, and should assure reasonable vehicle service if the monthly (1000-mile) maintenance operations are carefully per- formed. If a shop card is not made out to show the repairs, the mechanic, the items not corrected, and the completion of the inspection, a record similar to that used in conjunction with the monthly (1000-mile) maintenance operations should be prepared and retained until after the technical inspection. Maintenance operations that should normally be included in the 6-month (6000-mile) service are: Records to include inspection of vehicle repair and operating records for the past six months (6000 miles), followed by a road test similar to the monthly (1000-mile) maintenance. Engine tune-up to include check of oil and air filters, a vacuum and compression test, cleaning of oil pan and interior of engine, adjustment of valves, adjustment of spark plugs, reconditioning of ipotion wiring, generator servicing, starter servicing, 284 MILITARY MEDICAL MANUAL ignition servicing, carburetor servicing, and check of tightness and serviceability of all parts and accessories. Fuel system to include examination and servicing of fuel pump, gas lines, carburetor, and tank. Cooling system to include radiator service and check of thermostat, fan belt, and water pump. Instruments and electrical systems to include check, service, or replacement of horn, lights, wiring, windshield wiper, and dash instruments. Clutch, transmission, and transfer case to include clutch travel and floor clearance, reverse shifter stop, transmission and transfer case supports, grease seals, tightness, and lubrication. Propeller shafts and universal joints to include slackness, free movement of spline joints, grease seals, and lubrication. Driving axles to include back lash, inspection, lubrication, and adjustment of wheel bearings, spring clips, spring hold-down bolts, spring shackles, driving flanges, leaks, grease seals, and lubrication. Steering mechanism to include attachment of steering mechanism and column, pitman arm, play in steering mechanism, steering linkage, steering stops, turning angle of front-drive axle, and lubrication. Front end to include spring hold-down bolts, rebound clips, shackles, shock absorbers, lubrication and adjustment of wheel bearings, tie rods, and tires for wear and alinement. Wheels and brakes to include hub bolts, grease seals, brake lining, brake linkage and and lines, and brake cylinders. General to include storage battery, body and attachments, curtains, muffler, and tail Pipe- . Engine chec\ by bringing engine up to operating temperature and checking results of engine tune-up for quietness; idling speed; acceleration; and leaks in carburetor, fuel pump, gas lines, cooling system, oil pressure lines, and oil seals. Road test. Record of operation. New Vehicles. During the break-in ’period, new vehicles usually require special main- tenance operations. War Department instructions, if issued for the particular vehicle, and the manufacturer’s recommendations should be followed. Prior to operating the vehicle and again at the end of the break-in-period, a complete mechanical inspection is made. All shortages, defective parts, and malfunctions are entered on the inspection report and action taken to replace or correct them. Company or Battery and Regimental Second Eechelon Repairs. The following ex- amples do not indicate all the operations performed but show some of the common ones. Circular 1-10, OQMG, covers the operations in detail for the entire second echelon. Company or battery. Adjustments. Wheel bearings, pedal clearances, steering gear and linkage, fan belt, water pump, spring shackles, and lights. Replacements. Carburetor, generator, distributor cap and rotor, fuel pumps, batteries and cables, manifolds, instruments and switches, oil lines and filters, and brake shoes. Regiment. Adjustments. Steering geometry, voltage regulator, carburetors, genera- tors, valve tappets, and timing. Replacements. Tie rods, distributor points, valve springs, carburetors, thermostats, fuel pump diaphragm, and governors. MARCH MAINTENANCE General. Maintenance while on a march presents special problems, although, in gen- eral, the principles already described apply. The speed maintained, especially on long marches, causes disabled vehicles to become separated from their units by considerable distances in a very short time. This must be considered in making decisions concerning the vehicles and any personnel left with them, especially on sections of road which will soon pass to the control of other units. Personnel and maintenance facilities may CARE AND OPERATION OF MOTOR VEHICLES 285 become so far separated from their respective units as to endanger their return. Because of the unpredictable nature of marches near the enemy, every opportunity for motor maintenance should be used, even if it is impossible to complete the work at one time. Maintenance Personnel. Where marches of tactical units are involved, each organiza- tion will have the maintenance personnel allowed by Tables of Organization, and pos- sibly some attached third echelon personnel. Maintenance personnel of batteries, com- panies, or similar units normally ride at the tail of their respective units, while the regimental motor maintenance personnel ride at the tail of the regiment. Repair Procedure. During marches, roadside repairs to disabled vehicles are fre- quently temporary in character. The necessity of keeping the vehicles under control often requires hasty repairs sufficient only to complete the trip. Upon reaching its desti- nation, the vehicle should be repaired properly. When a vehicle drops out of its battery, company, or similar unit, the maintenance personnel at the tail of the unit attempt to diagnose the trouble quickly. If the diagnosis shows that the vehicle needs a minor repair only, a mechanic with a kit of tools and spare parts is dropped off with the vehicle. In all cases where the vehicle is towing a gun or transporting troops its tactical cargo or tow is removed and loaded or attached to another vehicle. The driver always remains with the vehicle unless ordered by competent authority to abandon it. When a vehicle drops out, it is driven, pushed, or towed off and well to the right of the road, so that other vehicles may pass around without halting. If the vehicle is repaired by the mechanic who was dropped off, it resumes the march at the maximum authorized speed to rejoin the rear of the last unit that has passed. It does not take its customary place in column but remains at the rear of the first unit ahead until the next halt. If march orders so permit, it then doubles the column and proceeds to its organization. If the mechanic is unable to make the repair, the vehicle is either repaired or towed by the regimental motor-main- tenance platoon bringing up the rear of the column. If the mechanical crew of the battery, company, or similar unit decides that imme- diate repair is not possible, the vehicle may be towed and repairs made later, or it may be abandoned to regimental motor maintenance or to a higher echelon. The decision in all cases is made by the motor officer, or, in his absence, by the motor sergeant. When repair personnel are working by the side of the road, warning guards, signs, or flags must be put out unless the vehicle is completely off the road. At night, red lanterns should be utilized. Whenever a battery, company, or similar unit maintenance crew stops to diagnose the trouble of a vehicle that has fallen out, care must be exercised that the whole crew does not become separated from its organization. If such were the case, the unit would have no maintenance personnel with it to care for the remaining ve- hicles of the organization. Maintenance personnel should always be with the organiza- tion when it arrives in bivouac, to assist in the inspection, repair, and servicing of the organization vehicles. Towing Disabled Vehicles. Arrangements in any column for towing disabled vehicles will depend upon the type of vehicle, road conditions, type of march, and other con- siderations. Certain vehicles may march at the tail of the column for this particular purpose. Some vehicle or vehicles near the rear of each organization should be desig- nated as towing vehicles, if vehicles for that particular purpose are not available, so that when a vehicle falls out a towing vehicle near the rear will halt to tow it if towing is required. Such an arrangement prevents confusion and possible loss of a vehicle for the lack of a towing vehicle. These towing vehicles should be provided with tow bars, tow ropes, or tow chains. Abandoning Vehicles. When vehicles on the march become disabled and for some reason are not towed or are not capable of being towed with vehicles within the organi- zation, they may be abandoned either temporarily or permanently. When the abandonment is temporary, the driver and possibly a mechanic are left with the vehicle. In the combat zone consideration must be given to the possibility of not recovering the personnel and facilities thus detached. If a gun prime mover fails, the gun should b'e coupled to any available vehicle and accompany its organization. 286 MILITARY MEDICAL MANUAL Every effort should be made to remove to other vehicles all essential combat equipment prior to abandonment of the vehicle. A driver left with a vehicle awaiting maintenance or salvage personnel should be given explicit orders concerning the removal of the load. If the abandonment is permanent, the proper steps should be taken to comply with orders covering such action. Vehicles should be tagged to show the reason of their unserviceability. In time of active operations, supply services will provide measures making it convenient to turn over to them any disabled vehicles. When vehicles are left for the disposition of the supply services, the commander should make arrangements for replacements as soon as possible. When operating units abandon vehicles, the supply service concerned must be furnished accurate reports as soon as practicable of the loca- tion and general condition of such vehicles. In all cases when a disabled vehicle constitutes a road obstruction it will be removed from the road. General. Lubrication is one of the most important duties charged to personnel of organizations operating motor vehicles. It is an essential part of preventive maintenance; to a great extent it determines serviceability of parts and assemblies; it materially in- fluences repair and operation costs; and it is one of the most important factors affecting dependable mobility and useful vehicle life. Training, supervision, supplies, and equip- ment are required for the performance of correct lubrication. Correct lubrication provides and maintains under all conditions of operation a suitable oil film between friction surfaces where necessary. Methods. Lubrication operations may be decentralized or centralized. In either case the unit commander assigns definite responsibility for these functions. The motor officer, assisted by the motor sergeant, prepares lubrication schedules, supervises lubrication, and makes frequent inspections to assure himself that all vehicles are properly lubricated. Good teamwork must be developed if the desired results are to be accomplished. Decentralized lubrication. This method is particularly applicable to field service operations, and will give excellent results when personnel are properly trained and super- vised and lubrication schedules are carefully followed. Responsibility is divided as follows: The driver performs the prescribed driver’s lubrication functions. The mechanics perform special lubrication to include gear cases, steering gear housing, wheel bearings, universal joints, starting motor, generator, distributor, clutch release bearing, water pump, fan, air cleaner, and changes of crankcase oil. Chiefs of sections or truck masters are charged with direct supervision of driver lubrication. They should make frequent inspections to insure correct lubrication in accordance with the lubrication schedule. Centralized lubrication. When this method is employed, all lubricating functions are carried on at a central point and drivers are relieved of all responsibility for lubrica- tion except the replenishment of crankcase oil. When centralized lubrication is applied to a small fleet, responsibility for correct lubrication should be charged to one qualified individual; when the fleet is too large to be lubricated correctly by one individual, assist- ants should be provided and definite responsibilities should be assigned to each. Ve- hicles should be sent to the central station when lubrication is required, and should be accompanied by the driver. The driver’s services should be utilized to expedite the work. Centralized lubrication is not recommended for field service operations. When motor vehicles are detached from their organizations for such periods of time that they will miss their scheduled lubrication service, provision should be made for the performance of the lubrication functions. This should be accomplished in one of the following ways: Send qualified personnel and the necessary supplies and equipment with the vehicles. Arrange for the vehicles to be lubricated by other units. Provide the necessary supplies and equipment, and direct the driver to perform the lubrication. LUBRICATION CARE AND OPERATION OF MOTOR VEHICLES 287 Schedules. Lubrication schedules should be prepared for each make of vehicle as- signed to an operating unit. Lubrication periods recommended by the manufacturer are generally too infrequent to provide correct lubrication for military motor vehicles and should be modified to meet operating conditions. In general, the chassis and slow-motion parts should be lubricated after every 7 days or 50 hours of vehicle operation; the crankcase oil should be checked frequently and changed after 500 to 1000 miles of operation, especially if operated for considerable periods across country or in low gear. The gear lubricants should be checked weekly and changed seasonally, unless operating mileage requires more frequent changes. Records. A complete record of lubrication should be kept. Responsible personnel should report when lubrication duties have been completed in order that proper entries may be made. Lubricants. General. Lubricants used on military motor vehicles should conform to the recommendations of vehicle manufacturers or of the supply services concerned. Dur- ing field service it may be impossible to supply a complete assortment of lubricants which meet the above recommendations and it will be necessary to make the best use of those available. Types and uses. Correct lubrication of motor vehicles requires the use of several types of lubricants and the application of each type in accordance with a lubrication schedule. Types of lubricants and their general uses are as follows: Lubricating oils. Lubricating oils used on military motor vehicles are exclusively mineral oils obtained by distilling crude petroleum oils. In general, oils are employed to lubricate engine bearings; starting motors; generators; slow-moving surfaces such as brake pedal pivots and brake linkage, door hinges, and locks; some fan bearings; some water pumps; and some transmissions. Different makes of oils should not be mixed. Gear lubricants. Gear lubricants are heavy bodied oils, pure mineral oil or pure mineral oil to which materials have been added, used for the lubrication of parts where a strong oil film is required. In general, they are employed for the lubrication of final drives and differentials, transmissions, auxiliary transmissions, transfers, steering gear housings, some wheel bearings, and some universal joints. Greases. Greases are usually made by compounding mineral oil with a soap. The load-carrying properties of greases, except graphite grease, are determined by the oil used in compounding the grease. Greases are used to lubricate surfaces where pure mineral oil or gear lubricants cannot be retained. Miscellaneous lubricants and fluids. Spring lubricant. Graphite grease, a mixture of grease and graphite, is generally used for the lubrication of spring leaves. It is not to be used for general lubrication purposes. Penetrating oil. This oil is used principally to get into places that have become very dry or rusty, such as brake linkage and nuts or bolts that cannot be loosened or tightened with a reasonable amount of force. Petrolatum or vaseline. Petrolatum or vaseline is used to coat battery terminals and connections to reduce corrosion. It is also used to lubricate the fiber block on the mov- able breaker point arm in the distributor housing. Kerosene. Kerosene may be used to thin engine lubricating oil in very cold weather. Approved recommendations should be followed closely when it is necessary to resort to this practice. Cleaning solvent. Cleaning solvent is a compound fluid used for washing engines, parts, and assemblies. It is not highly inflammable; however, it should be employed with caution when used for cleaning hot engines. When cleaning solvent is not avail- able kerosene may be used. Gasoline must never be used. Alcohol. Hydraulic-brake parts should be cleaned with denatured alcohol. Gasoline, kerosene, cleaning solvents, and oils are harmful to these parts and must not be used for this cleaning. Means of Application. Lubricants are applied to the motor vehicle by employing the equipment provided by Tables of Basic Allowances. 288 MILITARY MEDICAL MANUAL Lubricating oils. Oil should be placed in the engine crankcase through the crankcase filler pipe. Extreme care should be taken to prevent dirt and other foreign materials from entering the crankcase. Oil measures and funnels should be scrupulously clean. Oil is applied to other required surfaces by using an oil or squirt can. Gear lubricants. Gear lubricants should be introduced into gear cases through their filler pipes. If a gear lubricant bucket with pump is available it should be used to expedite the work. Care should be taken to prevent overfilling, and the level should be checked after the mechanism has been warmed in operation. Chassis lubricants. Chassis lubricants should be applied by using a high-pressure hand gun or a power-operated grease gun. Lubrication fittings should be cleaned before the grease is applied. Grease should be forced through the bearing until clean grease is visible on both ends of the bearing. Cup grease. Cup grease is applied by removing, filling, replacing, and screwing down the grease cups. Water-pump grease. Water-pump grease, when required, should be applied by using a pressure hand gun or by using the grease cup, depending on the lubrication fitting. When the hand gun is used, care must be taken that the pump housing and the gland packings are not damaged. Fiber greases. Fiber greases should be applied to universal joints and clutch release bearings by using a low-pressure hand grease gun or by using the grease cups provided. Care should be taken that grease seals are not damaged. Miscellaneous lubricants and fluids. Spring lubricant. If the spring is provided with a spring cover, the lubricant should be applied with a grease gun. If no cover is provided, the spring should, when necessary, be removed, disassembled, cleaned, and thoroughly lubricated. Partial lubrication may be achieved by jacking up the vehicle, separating the spring leaves, and applying lubricant between the leaves with a putty knife. Penetrating oil. If supplied in small quantities, the penetrating oil will usually be furnished in a can, similar to a squirt can, ready for use. If furnished in quart or larger containers, the oil should be removed from its container, as required, and applied with a squirt can. Petrolatum or vaseline. Petrolatum or vaseline should be applied with a brush or by using small quantities applied by hand. Cleaning solvent. Cleaning solvent should be used with a stiff bristle brush or applied by an air-operated cleaning gun. Metal brushes should never be used when cleaning an engine. General. A thorough and comprehensive system of inspections is a primary requisite for the satisfactory operation of motor vehicles. Inspection has as its purpose the detection of deficiencies of mechanical condition, quality of maintenance operation, appearance, servicing, and operation of motor vehicles, and the recommendation of corrective measures to prevent recurrence of such deficiencies. While the appearance of the vehicle as a whole is of some concern, the important inspection is that which covers the normal adjustments and mechanical condition of operating units, and that which investigates the lubrication requirements of a vehicle with a view to main- taining the standards of reliability and performance originally built into the vehicle. Such inspections are classified as command, maintenance, and technical inspections. See Chapter XIII for the Preventive Maintenance inspections performed by the driver. Command Inspections. It is the duty of all commanders to make regular and frequent inspections of their motor vehicles and of the operating and maintenance activities of their commands. Maintenance Inspections. Maintenance inspections are a part of scheduled mainte- nance operations and normally should be performed by personnel of the operating organization during and upon completion of these operations. Daily inspections. Daily maintenance inspections normally are made by the chief of section under the supervision of company, battery, or similar unit officers. They INSPECTIONS CARE AND OPERATION OF MOTOR VEHICLES 289 consist in checking and* supervising the work of the vehicle operator in his perform- ance of daily maintenance operations. Wee\ly inspections. Weekly maintenance inspections normally are made by the chief of section under supervision of company, battery, or similar unit officers. They consist of checking and supervising the work of the vehicle operator in his perform- ance of weekly maintenance operations. In addition, the chief of section should examine the less accessible places, looking for rust spots, leaks, breaks, and excessive or deficient lubrication. The serviceability and completeness of tools and other equip- ment should be thoroughly checked. A guide for his weekly inspection should be drawn up and issued to him to fit the particular vehicle or vehicles he is assigned. A suggested guide is as follows: Accident report Appearance Battery Body bolts and screws . Bows Brakes Broken metal Bumper and tow hooks Canvas Chains Condition of motor .... Curtain fasteners Doors Driver’s permit Extinguisher Fender bolts Fenders Floor boards Glass Handle and latches .... Hood fasteners Horn Insulating material Keys Leaks on ground Lights Lubrication Mats Rear-view mirror .... Running boards Running gear Seat brackets Servicing Special mountings . . Springs Steering Straps Tail gate Tires: Cuts Inflation Unusual wear . . Tool brackets Tools Traction devices Upholstering Wheel lugs Windshield wiper . . . Defects to be corrected: Lubrication inspections. All lubrication operations performed by the driver nor- mally are inspected by the chief of section. The motor sergeant inspects all lubrication, including that performed by the driver, if any, and that performed by unit main- tenance personnel. Monthly (1000-mile) inspections. The monthly (1000-mile) maintenance inspection is a check on company, battery, or similar unit maintenance. It normally is made by the motor officer of that unit but may be made by the regimental, battalion, or similar unit motor officer. Before reporting a vehicle to the motor officer for maintenance in- spection, the motor sergeant assures himself that the work of his mechanics has been properly performed and that no items have been overlooked. The motor officer spot checks such items as he believes necessary, including those that are inaccessible or frequently neglected. He should make a short road test of the vehicle. Six-months (6000-mile) inspections. The six-months (6000-mile) maintenance in- spection is a check on the maintenance work performed by the regiment, battalion, or similar unit. It will be made by the unit motor officer, assisted by qualified enlisted personnel, upon completion of the six months (6000-mile) maintenance operation in a manner similar to that described for the monthly (1000-mile) maintenance inspection. Technical Inspections. Technical inspections are made by fully qualified technical personnel of the supply services to determine the vehicle condition. These inspections are covered in AR 850-15 and in Circular 1-10, OQMG. W. D., Q. M. C. Form No. 260 is used. 290 MILITARY MEDICAL MANUAL General. In maintaining a fleet of motor vehicles, certain reports and records are in- dispensable. They must be simple and complete, and must be prepared by qualified personnel. The regimental motor officer should periodically assemble all personnel of the regiment who prepare these records and reports, and explain and demonstrate the proper yet simplest manner of keeping them. Posting of all reports daily or at proper intervals should be enforced by supervisory personnel, and a careful check should be maintained by the commanding officers of all units operating and maintaining motor transportation. Records often clearly indicate items that require attention. Usually low gasoline or oil mileage might indicate poor motor-vehicle performance or unauthorized disposition of gas or oil by the driver. Excessive repairs might indicate careless driving. The records as a whole keep the organization commander informed of the general condition of the vehicles and assist him in making timely request for overhaul and replacement. Reports and Records Required by Regulations. Driver’s Report—Accident, Motor Transportation (Standard Form No. 26). Plate 28. This form will be carried on every military motor vehicle. Investigating Officers Report—Accident, Motor Transportation (Standard Form No. 27). Plate 29. The officer designated to investigate an accident will submit his report on this form (AR 850-15). (1) Action to be taken in case of traffic accident, (a) By the driver. In case of injury to person or property the driver of a motor vehicle will stop the vehicle and render such assistance as may be needed, complying with state and local regulations relative to reporting accidents. He will fill out immediately at the scene of the accident Standard Form No. 26 (Driver’s Report—Accident, Motor Transportation) and deliver it to his commanding officer immediately on returning to his station. This must be done in every case regardless of how trivial the accident may appear to be or whether Government property or personnel only is injured. (2) By the commanding officer. Upon receipt of Standard Form No. 26, the immediate command- ing officer will at once notify his commanding officer. The latter will make an investigation of the accident or detail an officer to do so when the reports show personal injury, damage to private property, or damage to Government property in excess of $10 for material and commercial labor. A complete and detailed report will be made to the investigating officer on Standard Form No. 27 (Investigating Officer’s Report—Accident, Motor Transportation). Par. 17, AR 850-15. Permit for Motor Vehicle Operators (W. D., Q. M. C. Form No. 228). This permit must be in the possession of the vehicle operator at all times when he is operating the motor vehicle. Motor vehicle operator’s permits are issued only to individuals who have satisfactorily passed an examination conducted by a qualified commissioned officer covering the following subjects: Mechanical. Nomenclature and functions of major units of the motor vehicle. Operation. Actual driving of the vehicle, involving use of controls, reversing, and parking under usual conditions of traffic and terrain. Traffic regulations, road procedure, safety precautions, speed limits, and vehicle abuse. Maintenance. First echelon (vehicle operator’s maintenance). Possession of a motor vehicle operator’s permit should be a guarantee that the in- dividual is a qualified driver. Accordingly, the permit will be suspended or revoked when an accident or other cause so warrants. Motor Vehicle Technical Inspection Report (W. D., Q. M. C. Form No. 260). (Plate 30.) This form will be used in recording the technical inspections required by AR 850-15. Driver’s Trip Ticket and Performance Record (W. D., Q. M. C. Form No. 237). No vehicle will be dispatched unless a trip ticket accompanies the vehicle. Drivers should be required to complete the form in full detail. These forms provide informa- tion required in the vehicle service record books. It is sometimes more convenient to make up a form for local use. Motor Vehicle Service Record Boo\ (W. D., Q. M. C. Form No. 248). This record will be kept for every quartermaster motor vehicle in operation. It constitutes the RECORDS AND REPORTS Plate 28. Standard Form No. 26. 292 MILITARY MEDICAL MANUAL Plate 29. Standard Form No. 27. CARE AND OPERATION OF MOTOR VEHICLES 293 Plate 30. Motor Vehicle Technical Insnection Rennrf.. 294 MILITARY MEDICAL MANUAL service record of the vehicle and will be transferred with it. Instructions relative to the posting of this record are contained in the book itself. This is a most important record, and must be accurately and promptly posted. Ordnance Motor Boo\ (W. D., 0. 0. Form No. 5956). This record will be kept for every ordnance vehicle in operation. It constitutes the service record of the vehicle and will be transferred with it. Instructions relative to the posting of this record are contained in the book itself. This is a most important record, and must be accurately and promptly posted. Other Forms. Other prescribed forms are: Data for U. S. Registration Number (W. D., Q. M. C. Form No. 220). Motor Vehicle Transfer Form (W. D., Q. M. C. Form No. 221). Report of Motor Vehicles on Hand (W. D., Q. M. C. Form No. 252). Report of Changes of Motor Vehicles (W. D., Q. M. C. Form No. 253). Gasoline and Lubricant Issue Slip (W. D., Q. M. C. Form No. 231). Motor Vehicle Operation and Maintenance Cost Record (W. D., Q. M. C. Form No. 222). Dispatching Record (Motor Pools) (W. D., Q. M. C. Form No. 254). Special Forms. Special forms necessary or beneficial in keeping the above records or making the above reports should be obtained from the supply services charged with third and fourth echelon maintenance functions when available. Otherwise such forms or charts must be prepared by the second echelon, normally under the direction of the regimental motor officers. Included are such forms as: Automotive operations sheet. A major part of the data for the motor vehicle record book is abstracted from the driver’s trip tickets. Where the entries on this record book are made monthly, a bulky stack of trip tickets accumulates before the entries can be made in the record book. To obviate this condition and to require all operating, inspection, and maintenance data to be consolidated up to date, the operations sheet may be utilized. One of these is required for each vehicle, and is an invaluable aid to the maintenance personnel. Preventive maintenance operations guides. Lubrication guides. A lubrication guide should be prepared for each class and type of vehicle. Unserviceable vehicle tags. This tag, conspicuously attached to a vehicle, indicates a disabled vehicle and provides a ready means of locating the trouble. THE MOTOR DRIVER Training. The manner in which the individual drivers perform their duties de- termines the mobility and dependability of the motor vehicle fleet as well as that of the single vehicle. Assignment of Drivers. A driver and, if authorized, an assistant driver should be as- signed to each motor vehicle. Except for instruction, inspection, or other like pur- poses, the vehicle should not be operated by other drivers if it can be avoided. Motor Vehicle Abuse. Territorial commanders and commanding officers of organi- zations, posts, camps, and stations are responsible for the careful operation of motor vehicles under their jurisdiction. This responsibility is primarily one of preventing improper use and vehicle abuse. Mechanical failures occurring during the ordinary life of a unit assembly of a motor vehicle which are found not to be due to defective material or workmanship, or to service requirements, are to be considered prima facie indication of the existence of vehicle abuse. The most important forms of abuse are: Excessive speeds, particularly over rough roads, and across country. Improper use of controls, particularly gear shift, clutch, brakes, and choke. Racing engine, particularly when cold. Overloading and improper loading. Lack of lubrication or use of improper lubricants. Lack of inspection, particularly systematic inspection. Deferred maintenance, including lack of proper servicing and adjustments. Accidents, CARE AND OPERATION OF MOTOR VEHICLES 295 Motor vehicle abuse when found due to carelessness or indifference of responsible personnel will be considered cause for disciplinary action. Safety Precautions. Rules for road procedure will be published in appropriate manuals. Failure to observe any one of the following rules will be considered cause for disciplinary action: Military or civil police on duty will be strictly obeyed and state and local highway regulations will be carefully observed. A vehicle will never double (pass traffic moving in the same direction)— When going around a corner or blind curve. In ascending or descending hills unless safe passage is assured. At street intersections or crossroads. Unless the road is wide enough to allow at least two feet between vehicles. Vehicles will be halted at railroad crossings not guarded by military personnel or civilian watchman. Vehicles will be slowed down to a safe stopping speed at all road intersections not covered by traffic control personnel or traffic control devices. Drivers will not permit their vehicles to coast down hills with clutch disengaged or gear shift lever in neutral. Fire Precautions and Fire Fighting. Motor vehicles, shops, and parks are constantly exposed to fires. Drivers must, therefore, be instructed in and required to comply with pertinent fire-prevention regulations. In addition they must be instructed and drilled in the use of fire-fighting equipment and in removing vehicles and other property from the danger area. Gasoline tanks will not be filled nor will work be performed on the carburetor or fuel system of a motor vehicle in the presence of a flame. If illumination is required to perform the work, an electric light will be used. Every motor-propelled vehicle will be equipped with an approved type of fire extinguisher. Water will not be used on a gasoline or oil fire as it will spread the fire. Fire extinguishers of the types prescribed in the existing Table of Allowances will be used. A box or bucket of sand with suitable scoop for spreading is also effective in extin- guishing gasoline fires. A waste can will be kept in the shop or garage, and all greasy and oily rags will be placed therein. Before closing time this can together with pans containing oil, gasoline, or other inflammable materials will be removed from the shop or garage and placed in some open space where there is no fire hazard. All trash will be disposed of daily. The two and one-half gallon foam extinguisher will be protected from freezing. All rags partially stained with grease or linseed oil, but of further use, will be put in a place where they are not likely to cause a fire. Trucks loaded with inflammable rubbish, such as excelsior, paper, or packing material, will be unloaded before parking for the night. Gasoline will not be used for cleaning purposes in shops or garages. Asphyxiation by exhaust gases of motor vehicle engines. Garages, shops, and vehicles carrying personnel will in all cases be well ventilated. No motor vehicle engine will be run in a garage or shop longer than necessary to move the vehicle in or out, unless it is standing near wide-open doors, or the exhaust is conducted through an aperture. Antifreeze Precautions. Officers responsible for the operation and maintenance of motor vehicles will see that all necessary precautions are taken to prevent damage in- cident to the freezing of water in cooling systems of motor vehicles. Accident Prevention. The formulation and observance of definite rules will eliminate the majority of accidents incident to the operation and maintenance of motor vehicles. These rules should include the following: Place the transmission gear-shift lever in neutral and set the hand brake before hand cranking an engine or starting it with the starting motor. 296 Make sure the way is clear before a vehicle is moved. If the driver cannot see the road, he should be directed by a dismounted individual. This is particularly important when a vehicle is backed or is moved through bivouac areas and across country at night without lights. Stop the engine before anyone gets under a vehicle. If it is necessary for a mechanic to work under the vehicle the engine is running, precaution must be taken that the vehicle cannot move accidentally. Block up a vehicle safely before the wheels are removed. Do not place reliance on jacks. Remove the battery when a vehicle is taken into the shop for major repairs. Provide ample ventilation for garages, shops, vehicle cabs, and vehicles carrying personnel. Do not operate motor vehicle engines in a garage or shop longer than necessary to move the vehicle in or out, unless the vehicle is standing near wide open doors or the exhaust gases are removed through a safe outlet fixture. In case of carbon monoxide poisoning, remove the patient to open air, keep him quiet, apply artificial respiration and warmth, and obtain medical assistance as soon as possible. Speed Limits. The caution plate mounted on a motor vehicle indicates the maximum safe speed for which the vehicle is designed. This speed presumes good operating con- dition of vehicles, good road, load, normal traffic conditions, and skilled driving. It will not be exceeded. Fast driving over rough, slippery, or congested roads is prohibited and the fact that the vehicle was being operated within the authorized speed limit will not be ac- cepted as an excuse for such driving. Speeds will not exceed the limits set by law or regulations of the States or towns in which the vehicle is being operated. Regulated governors, when installed, will be set and sealed at the maximum speed considered safe and not to exceed that indicated on the name and caution plate. Tam- pering with sealed governors will be considered cause for disciplinary action. Subject to the above limitations, corps area and exempted station commanders may establish such further limits, as, in their opinion, conditions in their respective com- mands may warrant. Nomenclature and General Purpose of Major Units of the Motor Vehicle. Preliminary instruction should cover the nomenclature and purpose of major assemblies only, in order that the driver may become familiar with his vehicle without being confused by details. Detailed instruction in nomenclature, function, operation, use, lubrication, maintenance, and limitations of motor vehicles, and the nomenclature, care, and use of vehicular tools and equipment should be given in subsequent periods. Motor Vehicle Controls. The day-to-day condition and the ultimate service of a motor vehicle, as well as safety to life and property, depend upon the condition and proper use of the controls. Consequently, careful instruction and supervision are necessary to insure the correct use of these important devices. The following controls should be explained and demonstrated: Carburetor choke control (if not automatic). Carburetor throttle control, to include accelerator. Ignition switch. Spark control (if not automatic). Transmission gearshift lever. Transfer case gearshift lever. Clutch pedal. Steering wheel. Brakes, hand and foot. Winch controls. Dump controls. MILITARY MEDICAL MANUAL CARE AND OPERATION OF MOTOR VEHICLES 297 Aids to Motor Vehicle Control. Although the devices given below cannot be classed as controls, they aid in motor vehicle control and should be explained and demonstrated. Light switches, including blackout. Horn button. Rear-view mirror. Windshield wiper. Speedometer. Instrument-Board Gages. Gages are placed on the instrument panel in plain view of the driver to give information concerning certain assemblies and systems of the motor vehicle. The instructor should explain the purpose of each gage, give its normal reading, and tell the driver what to do when an abnormal reading is observed. Clutch, Transmission, and Brakes. Drivers should familiarize themselves with the location and manipulation of the clutch pedal, the transmission gear shift lever, and the brake lever and brake pedal before actual driving instruction starts. For this pur- pose the motor vehicles should be blocked up securely with all wheels off the ground. When the candidate first gets into the driver’s seat, he should be required to assume the correct position; that is, sit erect, without stiffness, squarely behind the steering wheel; head erect, eyes looking to the front; hand on opposite sides of the steering wheel, on a horizontal line generally through the center of the wheel, grasping the steering wheel rim firmly but without tenseness; both feet flat on the floor boards except when actually manipulating the accelerator, the clutch and brake pedals, or the starter switch. After the candidate has familiarized himself with the location and manipulation of the controls, the instructor should start and warm up the engine. He should then demonstrate the operation of the accelerator; coordinated movements of the accelerator, clutch pedal, and transmission gear shift lever; gear shifting, to include reverse; opera- tion of the brake controls; manipulation of the steering wheel; and the use of the engine as a brake. Upon completion of the demonstration, the candidate should take the driver’s seat and practice manipulating the controls until he becomes reasonably pro- ficient. Careful supervision should be exercised to insure correct performance. Careful supervision should be exercised over the following: Engine speeds. The engine must not be raced. During the preliminary instruction period, the accelerator may be blocked to limit the engine speed. The accelerator should be released when shifting gears (except when double clutching), and depressed gradu- ally when the load is applied to the engine. Clutch pedal. To disengage the clutch, the clutch pedal should be depressed to the limit of its travel. To engage the clutch, the clutch pedal should be released gradually. The results to be anticipated if the clutch pedal is released too rapidly, and the injurious effects of allowing the foot to rest on the clutch pedal should be explained. Transmission gear shift lever. The lever should be moved smoothly but firmly fron one position to another and must never be forced. Position of the feet. While actually driving, the right foot should rest on the accelera tor and the left foot on the floor boards. The feet should he placed on the contro pedals only when the pedals are to he operated. Brakes. Brakes should be applied gradually with just enough pressure to accomplisl the desired results. The braking effort of the engine should be used when retarding the vehicle speed, the clutch being disengaged in time to prevent stalling the engine. Inspection Before Operation. A motor vehicle is not ready for service until certain items have been checked and certain Preventive Maintenance inspections have been made Before moving his vehicle from its overnight parking position, the driver, under propel supervision, makes this “Before Operation” Preventive Maintenance inspection and re- ports the results to his chief of section or other designated individual. The driver is held strictly responsible that all requirements are met. Items are checked as follows: Before starting engine— The surface (ground or floor) under the vehicle for evidence of leaks. The radiator for proper amount of water and to see that air passages are open. 298 MILITARY MEDICAL MANUAL The gasoline tank for proper amount of gasoline. The crankcase for lubricating oil. Spare oil if required. The engine for loose parts or electrical connections. Pneumatic tires, including spares, for proper inflation. The horn and all lights for proper functioning. Front axle and steering linkage. Tools and necessary equipment. Carried load for condition and distribution. Towed load for condition, attachment to prime mover, and brake connections. All transmissions and power take-offs in neutral. Drain valve in air brake storage tanks closed. After starting engine— Fan operation. Engine for loose parts and unusual noises. Proper functioning of all dashboard instruments as engine comes to operating tem- perature. Action of windshield wiper. The vehicle is moved, and the clutch, transmission, steering, and brakes are tested. Starting and Warming Up the Engine. Special attention should be devoted to the proper starting and warm-up period in order that unnecessary engine wear may be pre- vented. The procedure outlined below is satisfactory under average operating conditions: Set the hand brake. Place the transmission gear shift lever in the neutral position. Set the choke control and the hand throttle control. Consider the peculiarities of the engine, engine temperature, fuel, and manufacturer’s instructions. Care should be taken to avoid excessive use of the choke. Disengage the clutch. Turn on the ignition. Engage the starter switch contacts. Release the starter switch contacts as soon as the engine starts. If the starter device fails to engage the engine flywheel, release the starter switch contacts and allow the starter armature to come to rest. Try again. If the device still fails to engage, report to the chief of section or other designated person. If the starter device engages the engine flywheel and locks, release the starter switch contacts, turn off the ignition, place the transmission in high gear, release the brake, and rock the vehicle backward. If the starter device fails to disengage, place the trans- mission in neutral and report as above. If the starter device engages the engine flywheel and the engine fails to start after several attempts, report as above. The starter switch contacts should not be engaged for periods longer than 10 to 15 seconds. If the engine is magneto equipped and hand cranking is necessary, follow the facturer’s instructions. Adjust the setting of the dash throttle control to give the desired engine speed. Re- lease the clutch pedal. Allow the engine to warm up to the proper operating temperature, opening the choke as rapidly as the engine temperature permits. The cho\e should be closed, or partially closed, only as long as necessary and should never be used excessively. The engine has reached a safe operating temperature when upon acceleration with the choke wide open there is no backfiring, and when the oil pressure needle remains below the maximum reading on the oil pressure gage scale with the engine running at its normal operating speed. Inspection During Operation. During operation the driver should be alert to detect malfunctioning of the engine. He should be trained to detect unusual engine sounds or noises and to follow the proper procedure when they occur. He should frequendy glance at the instrument panel gages and know what to do when abnormal readings are ob- served. Before vehicles start on a march or are dispatched on individual missions, care- CARE AND OPERATION OF MOTOR VEHICLES 299 ful instructions should be given to drivers concerning the action to be taken when operat- ing troubles occur. Only under exceptional circumstances should a motor vehicle be operated after trouble has developed which will prove serious if operation is continued. When in doubt, the engine should be stopped and assistance obtained. Inspection during operation applies to the entire vehicle and should be emphasized throughout the driving instruction period. Inspection at the Halt. At each scheduled halt during the march or at intervals during a day’s work on dispatch, the driver should make a careful inspection of his vehicle to determine its general mechanical condition. Detection and correction of defects should give reasonable assurance that the vehicle is ready for continued operation. If the defects cannot be corrected during the halt, proper disposition of the vehicle should be made so that unnecessary delay may be avoided and a major failure prevented. Drivers and main- tenance personnel should make full use of halt periods to place all vehicles in condition for continued uninterrupted service. A suitable general routine, the sequence of which may be altered to suit a particular type of vehicle, is as follows: Allow the engine to run a short time. Listen for unusual noises. Walk around the vehicle, looking carefully for fuel, oil, and water leaks. Inspect all tires for inflation, cuts, nails, stones, and indications of misalinement. On track-laying vehicles, examine tracks for adjustment and for worn, loose, broken, or missing parts. Note condition of traction devices, if used. Feel brake bands, wheel hubs, and gear cases for evidence of overheating. Inspect the lights, if traveling at night with lights. Check the amount of fuel in the tank. Check the quantity of water in the radiator. Check the quantity and condition of the oil in the crankcase or oil reservoir. Add oil if necessary. Inspect the condition of the cargo and towed load, if any. Report promptly the result of the inspection to the chief of section or other designated individual. Inspection After Operation. At the conclusion of the day’s work, the driver should make an inspection similar to that made at halts but more thorough and detailed. Re- pair operations performed by the driver are determined by his ability and the equip- ment available for his use. If defects cannot be corrected, they should be reported prompdy to the chief of section or other designated individual. The inspection should be followed by preventive maintenance. A suitable routine is as follows: Check all items included in the inspection at the halt, testing lights in all cases. Raise the hood and look for loose, missing or broken parts, and indications of im- proper operation. Examine grease seals for evidence of failure or over-lubrication. Check front axle, steering gear, and linkage, and front springs for condition, aline- ment, and attachment. Check rear axle and rear springs for condition, alinement, and attachment. Examine propeller shaft for condition, tightness of connections, and foreign materials wrapped around the shaft. Examine brake linkage for loose, worn, lost, or broken parts. Check body bolts; tighten or replace as required. Check tools and equipment. Report results. DRIVING INSTRUCTION General Rule. Careful instruction and painstaking supervision must be the rule dur- ing the driving instruction period to insure that the driver learns the correct performance of his duties and forms the proper habits. This chapter on driving instruction of neces- sity contains valuable information on the conduct of motor marches. Gear Shifting and Use of Clutch. Preliminary driving should be conducted on a large open field where steering is of secondary importance. A qualified instructor should accompany each candidate to explain procedure, demonstrate application, and insure cor- 300 MILITARY MEDICAL MANUAL rect driver performance. Candidates should be permitted to drive at will with the trans- mission in the lower gear ratios until they are reasonably familiar with the operation and control of their vehicles, after which the driving should become progressively more difficult. After the driver has become reasonably proficient in shifting from lower to higher gears, he should receive instruction in double clutching, the procedure for which is as follows: Disengage the clutch and shift to neutral; at the same time decelerate the engine. Engage the clutch and accelerate to an engine speed slightly in excess of that required in the lower gear to maintain the vehicle speed. Disengage the clutch and shift to the next lower gear; at the same time slightly de- celerate the engine. Engage the clutch; at the same time accelerate the engine to effect clutch engagement without shock to the power transmission system. Practice double clutching until proficient in shifting from a higher to a lower gear. On medium and heavy vehicles it is sometimes difficult to shift from a low gear to a higher gear without clashing the gear teeth. The clashing may be avoided by using the double-clutching procedure without accelerating the engine during the shift. Use of Transmission and Auxiliary Transmission. A transmission is provided so that the engine may be permitted to run at a speed at which sufficient horsepower is de- veloped, and at the same time permit the vehicle to travel at a speed commensurate with the road and load conditions. The addition of an auxiliary transmission, sometimes in- cluded as a part of the power transmission system, increases the number of gear ratios available and permits greater flexibility in the transmission of power. Drivers should understand what happens when the gear shift lever is moved and must be practiced in the manipulation of the controls and the proper use of the transmission and auxiliary transmission. An engine should never be permitted to labor unduly when a change in transmission-gear ratios would lighten the load. The auxiliary transmission normally provided on military motor vehicles has two gear ratios: high, which does not change the gear ratios provided by the main trans- mission; and low, which gives a greater gear reduction (higher reduction ratio) than that provided by the main transmission. The auxiliary transmission is controlled by a gearshift lever in the driver’s compartment. The high range is used for normal opera- tion and the low range for heavy duty. The ratios in the auxiliary transmission of most types of vehicles should not be changed when the vehicle is in motion. Use of Brakes. The brakes should be in such condition that a hard application will cause all wheels to be locked, but the driver must realize that the maximum retard- ing effect occurs just before the wheels lock. Intermittent applications will reduce the wear of brake linings and drums. Application of the brakes should be gradual and with just enough force to accomplish the desired result. Judicious use of the braking effect of the engine will increase the serviceable life of the brake linings and drums. When the driver anticipates a stop, he should make full use of the engine braking effect, disengaging the clutch in time to avoid stalling the en- gine. When descending hills, a driver should use the engine as a brake by selecting and engaging the proper gear ratio, and use the intermittent application of the brakes to pre- vent overspeeding the engine. The ignition should not be turned off. The engine speed when descending a hill should be no greater than the speed necessary to ascend the hill when using the same transmission gear ratio. On steep hills the gear train necessary to give the desired results should be engaged before the vehicle is committed to the hill. Attempting to shift gears after the vehicle has started down a steep slope may result in a runaway vehicle. At all times a driver should know the performance and the general condition of his vehicle brakes. When operating conditions require vehicles to move through water, the brakes become very inefficient because of moisture on the brake linings and in the brake drums. If the distance to be traversed is short, considerable water may be kept out of the brake assemblies by a slight application of the brakes while the vehicle is in the CARE AND OPERATION OF MOTOR VEHICLES 301 water. After passing through water, the brakes should be set slightly and the vehicle operated until sufficient heat has been generated to dry the brakes. Vehicle stopping distances are dependent upon the nature and condition of the road surface, the condition of the brakes, the weight of the load, and the kind and condition of tire treads. When operating at a speed of 20 miles per hour on a dry, smooth, level road free from loose material, every motor vehicle or combination of motor vehicles should be capable, at all times and under all conditions of loading, of stopping within the following distances when the foot brake is applied: Vehicles or combination of vehicles having brakes on all wheels .... 30 feet Vehicles or combination of vehicles not having brakes on all wheels . . 45 feet Drivers should be cautioned against the use of brakes when a vehicle is skidding and when it is being operated on ice-covered roads. Turning, Backing, and Parking. After the driver has acquired facility in starting, simple driving, and stopping his vehicle, he should be practiced in maneuvering in difficult places. The ability to turn his vehicle in a confined space, to back it ac- curately, and to park it properly under various conditions are essential requirements for the motor vehicle driver. (The figure should be symmetrical, with the stakes placed to allow an over-all side clearance of approximately 18 inches.) Plate 31. Reverse Turning Course. Turns should be made at speeds commensurate with the road load, and traffic con- ditions. A vehicle driver should always give the appropriate arm, electrical, or me- chanical signal in sufficient time to afford ample warning that a change in direction is to be made. Turns should start and end in appropriate traffic lanes and should be made with as little corifusion to other traffic as possible. At least one hand should be kept on the steering wheel when the vehicle is in motion. A driver should never back a vehicle until he is certain that the way is clear. When the driver’s view is obstructed, he should act as directed by an assistant on the ground. When backing unassisted, the driver should always give warning of the movement by sounding his horn. Considerable practice is necessary to back a vehicle safely and accurately. This is particularly true when the driver is required to back a towed load. Parking includes turning and forward or backward movement of the vehicle in more or less restricted spaces. Factors which should be given consideration when park- ing are space for maneuver of vehicle, solid standing, interference with other traffic, and cover if applicable. The use of stake driving courses will permit instruction and practice without other traffic interference and will make closer supervision possible. The instruction courses shown in Plates 31, 32, and 33 are recommended. Starting Engine Under Unusual Operating Conditions. Gasoline boiling in carburetor. Some engines when stopped after having reached an operating temperature radiate 302 enough heat to boil the gasoline in the carburetor float chamber. This condition, which is not uncommon during hot weather operation, causes a rich mixture in the intake manifold. To start the engine, the hand throttle is fully opened, the carburetor choke is left in the normal operating position, and the engine started. The throttle MILITARY MEDICAL MANUAL (The figure should be symmetrical, with the stakes placed to allow an over-all side clearance of approximately 18 inches.) Plate 33. Backing Course. (Stakes should be placed so that when parked the vehicle will have an over-all longitudinal clearance of approximately 10 feet and a lateral clearance of approximately 3 feet.) Plate 33. Parking Course. should be adjusted to the desired engine speed only after the engine begins to run smoothly. Intermittent depression of the accelerator when the engine is not running will also produce a rich mixture in the intake manifold; the procedure outlined above should be followed in starting the engine. Vapor loc\. Vapor lock is caused by vaporization of the fuel before it leaves the carburetor jets. This condition results in a mixture that is too lean to sustain engine operation. The best solution is to wait until the fuel cools and returns to liquid form. CARE AND OPERATION OF MOTOR VEHICLES 303 After liquification takes place, the engine may be started in the normal manner. Signals. Drivers’ arm signals. Before a driver changes the direction or slows the speed of his vehicle, he should give the appropriate arm signal to warn other drivers of the contemplated change. Arm signals should be clearly made and should be given in time to afford ample warning. There is as yet no standard set of drivers’ arm signals. Drivers of military vehicles operated in civilian traffic should use the arm signals prescribed for the locality in which the vehicle is being operated. Drivers’ arm signals which are satisfactory for military use are: Turn right. Extend the left arm outward at an angle of 45° above the horizontal. Turn left. Extend the left arm outward horizontally. Slow or stop. Extend the left arm outward to an angle of 45° below the horizontal. Pass and keep going. Extend the left arm horizontally and describe small circles toward the front with the hand. Command and signals commonly used in a motorized unit are: Start engine. Simulate cranking. Report when ready to move (given by unit commander). Extend the arm vertically, fingers extended and joined. Ready to start. Senior in truck stands on running board, faces leader, and extends the arm vertically, fingers extended and joined, palm toward the leader. Stop engines. Cross arms in front of body at the waist and then move them sharply to the side. Repeat several times. Increase speed. Carry closed fist to the shoulder and rapidly thrust it vertically upward several times to the full extent of the arm. Decrease speed. Extend arm horizontally from shoulder, palm to front and move up and down vertically about 24". Continue motion as long as decrease of speed is desired. Prepare to mount. Extend the arm horizontally to the side, palm up, and wave the arm upward several times. Mount. Same signal with both arms. Prepare to dismount. Extend the arm diagonally upward to the side, palm down, and wave the arm downward several times. Dismount. Same signal with both arms. Close up. Extend the arm horizontally to the side, palm to front, then describe a 2-foot vertical circle. Each driver repeats. Open up. Extend the arm horizontally to the side, palm to front, then move the arm down to a vertical position and up to the horizontal, describing a 90° arc. Each driver repeats. Immediate danger. Use three long blasts of whisde or automobile horn repeated several times, or three equally spaced shots with rifle or pistol. The person giving the signal points in the direction of impending danger. This signal is reversed for warning of air, mechanized attack, or other immediate and grave danger. Drivers to turn around simultaneously. Extend both arms horizontally toward the drivers and describe small vertical circles, then signal forward in the desired new direction. When the distance between vehicles permits and the convoy is long, this signal may be given by a motorcycle messenger passing back along the column. Other authorized signals may be found in the manuals for the arms and services. Electrical and mechanical signals should be used, but not depended upon, when vehicles are so equipped. Road Rules and Traffic Regulations. Observance of prescribed road rules and traffic regulations permits the movement of traffic with a maximum of safety and a minimum of confusion and traffic direction. The following general rules should be observed by all drivers: Vehicles will keep to the right of the road. The appropriate warning signal will be given before changing direction, slowing down, or stopping. The driver will be alert and pay attention to road signs, convoy signals, and traffic directions. The right-of-way will be given promptly to faster moving vehicles. 304 Speed will be reduced on dry, dusty roads. Speeds for night driving, without lights, will be determined by road conditions, degree of visibility, and skill of the drivers. Lights will be dimmed when meeting another vehicle, if driving with lights. Unnecessary use of horns is prohibited. A disabled vehicle will not delay unnecessarily the march of a column. A vehicle will never pass traffic moving in the same direction— When going around a corner or blind curve. When ascending or descending hills unless safe passage is assured. At street intersections or crossroads. When the road is not wide enough to allow at least 2 feet between vehicles. A driver who has been assigned a place in a column will not pass another vehicle in the same column unless that vehicle is disabled or he receives a signal to pass. A driver when meeting and passing an oncoming vehicle will— Pass on the right giving at least half the road. Slow down if operating conditions are hazardous. Permit the vehicle having a clear road ahead to have the right-of-way. Vehicles will be halted at railroad crossings not guarded by military personnel or civilian watchmen. Vehicles will be slowed down to a safe stopping speed at all road intersections not covered by traffic control personnel or traffic devices. Vehicles will not be permitted to coast down hills with the clutch disengaged or the transmission in neutral. Vehicles will clear the roadway before being halted. Vehicles will not be halted on bridges, in defiles, at points where the vision of other drivers is restricted, or in such manner as to block cross traffic or entering side traffic. During the halt— The engine will be stopped if the vehicle is to stand longer than a few minutes. All personnel will keep to the right of the vehicles. The prescribed inspection and maintenance functions will be performed. Passengers will not mount or dismount from moving vehicles. State and local traffic regulations will be observed unless otherwise ordered. Under blackout conditions, conform strictly to all restrictions on use of ordinary and blackout lights. Marching. Successful marching requires well-trained drivers and teamwork on the part of all elements of the command. Drivers must therefore be trained in march or- ganization, march formations, march regulations, camouflage and concealment of ve- hicles, and procedure in case of air or mechanized attack. Through instruction and the enforcement of regulations, a degree of march discipline is attained which enables an organization to pass over roads with a maximum of speed and safety and a minimum of interference with other traffic, and to arrive at its destination in the best possible condition. During training in close column marching, special attention should be paid to safe driving distances between vehicles. These distances, which vary with vehicle speeds, should be prescribed initially to aid the driver in visualizing his proper place. The fol- lowing rule, properly modified to meet special conditions, gives the minimum distances for safe marching: The distance in yards between vehicles should be twice the speedom- eter reading. When marching over rolling terrain, a higher rate of march and smoother marching may be attained if drivers are permitted, within maximum prescribed speed, to increase the speed of their vehicles before commencing to climb. Vehicles should be slowed down while going down grades to compensate for the distance gained when running a hill. This practice will prevent excessive jamming and will allow drivers to take advantage of power and momentum to negotiate hills without excessive shifting of gears. Run- ning hills is particularly advantageous when tnarch columns are made up of mixed vehicles. MILITARY MEDICAL MANUAL CARE AND OPERATION OF MOTOR VEHICLES 305 Chains and Traction Devices. Chains and traction devices should always accompany the vehicle to which they pertain. They should be kept in serviceable condition and in proper adjustment to permit installation with a minimum of delay. Chains and traction devices should be removed when the necessity for their use no longer exists in order to prevent unnecessary damage to roads. Plate 34. Giant Lugs. Plate 35. Traction Devices. Chains. Chains are generally necessary in mud, sand, snow, or slush ice. Chains should not be used on ice-covered roads when they cannot bite into the ice. The follow- ing general rules apply to the application and use of chains: The chains are applied before the vehicle becomes mired. The chains are so applied that rotation of the wheel tends to close the chain fastenings. 306 MILITARY MEDICAL MANUAL If improperly installed, rotation of the wheel opens the fastening and the chain will be lost. Fairly loose adjustment gives better traction and less tire wear than tight adjustment. On all wheel-drive vehicles without center differential or other compensating device, chains must be installed on all wheels to prevent unnecessary strain. When only single chains are provided for dual-tired wheels, they should be installed on the outside tires. Traction devices. Giant tire lugs. Plate 34. Giant tire lugs provided for some military motor vehicles give better traction without increasing flotation. They are made for use on dual-tired wheels. The general rules for the application and use of chains apply, with few exceptions, to the application and use of giant tire lugs. Traction bands. Plate 35. Traction devices such as circular and oval bands are provided for some military motor vehicles to give increased traction and flotation. Cir- cular bands should be chained to the wheel to prevent slippage of the tires inside the band. Oval bands are used on bogie axles and should be applied and adjusted in accord- ance with manufacturers’ instructions. Tractor grousers. Grousers increase traction but do not improve the flotation qualities of the vehicle. Two general types of grousers, removable and integral, are used on tractors provided for the military service. The removable type should be applied when necessity for their use arises. The integral type grouser is a part of the track shoe and cannot be removed, but the grouser action may be eliminated by the use of street plates bolted to the track shoes. Plate 36. Lug Plate. Grouser Ropes or Chains, and Lug Plates. (Plate 36.) Improvised single grouser ropes or heavy single chains may be carried when a driver is operating a passenger vehicle alone. If the vehicle stalls on a muddy road, the traction of one or more wheels may be increased by the use of these devices. Makeshifts such as a short piece of rope or web CARE AND OPERATION OF MOTOR VEHICLES 307 belts may be used for the same purpose in case of an emergency. These should be applied only after chains have failed to give sufficient traction. Grouser Bars. (Plate 37.) For track-laying vehicles, grouser bars may be improvised. A grouser bar is installed across both tracks by means of the grousers after the vehicle is stalled in a mired position. The vehicle is rolled over it and the bar removed before it strikes the back of the vehicle. A pole or piece of timber may be secured across the tracks to serve the same purpose. Plate 37. Grouser Bar. Wheel Mats. Flat mats improvised by boarding together strands of rope, or pieces of heavy canvas, with ropes attached to the four corners are useful to place under the wheels where the going is soft. When a vehicle is stalled with wheels slipping, wheel mats may be used by attaching them to the wheels at one end, or they may be laid down in front of the wheels with the end away staked down. To increase traction over a soft or slippery spot, one or several of these mats may be tied end to end. They may then be staked down or maneuvered ahead of the wheels. Sacks or, in an emergency, blankets and like articles may be used to serve the same purpose. Cross Country Driving. After the driver has acquired facility in driving and maneu- vering, he should be taken through a series of increasingly difficult cross country opera- tions, such as ditches, ruts, chuckholes, woods, slippery roads, mud, difficult curves, and up and down steep slopes until he becomes reasonably proficient in handling his vehicle under all conditions. This training should include field expedients and the application and use of chains and tractor devices. The training should start with individual performances and empty vehicles and should progress to group performances with loaded vehicles and with towed loads if used in the organization. Trouble Truck. Although equipment in different types of motorized units will vary, each organization will generally have one trouble truck, usually equipped with a winch. All drivers should be taught winch operation, and be governed by the following principles: The winch truck should be taken across the obstacle first. When necessary, the winch truck is backed across an obstacle under the assisting power of the winch with cable attached to a deadman or tree. The power of the drive wheels should assist the winch, but the gears must be so chosen that the wheels will cover ground faster than the winch cable is pulled in. The same principle should be applied when pulling in a vehicle with the winch; that is, the towed vehicle should assist with its maximum traction. The best power combina- tion generally results if the winch is operated in the highest gear that will give sufficient power and the towed truck is pulling in lowest gear. After the winch truck has crossed an obstacle, the cable may be run out, the winch locked, and the truck used as a towing vehicle, or the truck may be baited and the winch utilized. 308 MILITARY MEDICAL MANUAL When the winch is used on a difficult pull, the winch truck may be held in place by use of the brakes, wheel blocks, or by anchoring to a tree or deadman. Traction devices will assist in holding the vehicle in place. Certain precautions are necessary in the proper use of the winch cable. Whenever the towing cable is slipped over the ground it should be protected by placing pieces of wood under it. Power must be applied to the cable gradually. As a precaution against the lashing ends of a broken cable, all men should stand clear before the winch cable is tightened. Hoist Attachment and Wrecking Crane. A hoist attachment may be issued to units. This equipment is intended primarily for use with the maintenance section. It may be mounted in either the trouble truck or the tender carrying the equipment of the main- tenance section. A wrecking crane may be improvised to serve the same purpose as the hoist attach- ment. The crane is installed so that it extends over the tail gate approximately 4 inches. The winch cable is placed over the crane only when necessary to get an upward towing lift. Figure 1. Clove Hitch (End Not Pulled Through) Plate 38. Knots. Either the hoist attachment or the wrecking crane will assist in towing a disabled vehicle in an elevated position when the steering mechanism or the axle is damaged. They may often be of use to give a towing lift on a mired vehicle. Care must be taken not to attempt to lift too heavy loads, which will nose-up the hoisting vehicle. Track-Laying Tractors. Where available, tractors will serve as powerful towing ex- pedients. They have good flotation and powerful traction. Once the tracks begin to slip, the clutch should be quickly disengaged and the tractor moved out in the opposite direction. A new trial is then made on new footing, inserting a tow chain or cable be- tween the tractor and towed load if necessary. The tractor has little if any more hill- climbing ability than a truck. When needed as a tow in such cases it should be moved to a position where it can pull without climbing a steep slope. Tow Chains or Cables. Tow chains or cables should be about 25 feet long and should have a hook on one end and a ring or loop on the other. Cables and chains % to Vi inch give sufficient strength. Spreader Bars. To prevent the frame from being bent inward in front, improvised spreader bars should always be used to attach a cable or tow chain to both tow hooks. Prolonges. A prolonge is made from a piece of rope about 30 feet long by making a loop at one end. With this, man power or a tow from another vehicle may be most CARE AND OPERATION OF MOTOR VEHICLES 309 efficiently and quickly applied. A detail of men may drop a prolonge over a tow hook before a vehicle is completely stalled and help it past a difficult point. Tow ropes can most safely be attached to tow hooks, pintles, or around the spring shackle. Knots easily untied, such as the clove hitch with end left through to form a bow, should be used. The double Blackwall knot for attachment to tow hooks and the single Blackwall knot for attachment to the pintle are the easiest to untie, but may occasionally slip. (Plate 38.) A 1-inch rope will safely stand a tension of about one ton. Larger or smaller ropes in- Figure 2. Single Blackwall Knot. Figure 3. Double Blackwall Knot. Flate 38. Knots—Continued. crease or decrease in safe tension limits by 500 pounds for each •/s-inch difference in size from a 1-inch rope. The vehicle being towed should always assist with its own power. Block and Tackle. Where a winch truck is not available, a block and tackle is carried in the trouble truck. Attached to a tree, anchored stake, or deadman it is useful to multiply the towing power of either manpower or a towing vehicle. Towing Bars. Towing bars are used when a vehicle is to be towed. A-Frame. (Plate 39.) An A-frame is an expedient which combines both a lift and a tow. It is easily constructed with two poles approximately 12 feet long and two tow 310 MILITARY MEDICAL MANUAL chains or cables. Holes are dug as supports for the foot of the frame, or a cross chain or plank is used to prevent the poles from spreading. Care must be taken to place the A-frame far enough away from the towed vehicle so that, when it is lifted over, the foot of the legs will not damage the front of the vehicle. This simple device is a useful expedient when a wrecking crane or hoist attachment is not available to lift a vehicle out of and over a ditch or hole. It is also of use when a heavy vehicle is completely mired. Plate 39. A-Frame. Deadman Installations. (Plates 40 and 41.) A deadman gives a firm anchor for various towing operations. To get the best results the following points are essential: Position. A position for the deadman is best if chosen at least a yard behind a natural crest or mound. It should be far enough back so that it will not enterfere with the vehicles clearing the obstacles and the attached cable or chain will not exert an upward pull. Plate 40. Deadman. Digging. A hole is dug about 1 foot deep and long and wide enough for the dead- man. The bank in the direction of pull is cut straight and is slanted away about 15° to the vertical. The bottom of the hole is cleared at a right angle to this bank. To assist in strengthening the top edge of the hole on the side in the direction of pull, two stakes are usually driven on either side of the cable at a slightly greater angle to the vertical than the bank. They are driven flush with the slanted bank near the top. A CARE AND OPERATION OF MOTOR VEHICLES 311 trench for the cable is cut from the hole through the crest of the hill or mound. This should be slightly deeper than the bottom of the hole at the beginning and should continue out in a descending slope. Cable attachment. A rectangular tie or larger timber of the type used for a wheel block is most suitable for the deadman, since it presents the maximum surface to op- pose the direction of pull. The cable or chain is attached to the deadman so that the largest dimension is vertical and the pull on the cable is exerted along the bottom surface. Plate 41. “Deadman” Type of Anchorage. Anchored Stake. (Plate 42.) Two stakes and a rope lashing may be used to quickly install an anchored stake which will withstand considerable tension. The first stake is driven into the ground at a little greater than a right angle from the direction of pull. The second stake is driven at an angle slightly closer to the ground at 3 to 6 feet away Plate 42. Anchored Stake. from the direction of pull. A rope is used to anchor the top of the first stake to the bottom of the second. In order that this rope will not slip down on the first stake, it is first tied to the bottom of the second, then wrapped over itself with a one-half clove hitch at the top of the first stake. The rope then is passed around the second and an- other half clove hitch is completed over the first, wrapping the rope around below the first hitch. This lashing is completed a number of times before the rope is secured 312 MILITARY MEDICAL MANUAL to the second stake. A third stake may then be used to twist the lashing tight, after which it is driven into the ground. Luminous paints which emit a faint glow in darkness may be used to replace night-lighting devices and may also be used on panels temporarily placed on the ground to guide a unit at night. Mechanical Expedients. The usual limitations for repair of the vehicle by the driver are stated early in this chapter. However, the following repairs can be made in the held in case of an emergency: Broken spring leaves are splinted by means of strong pieces of wood or metal held in place with wire. One or several tent pins may be used. If necessary, a block of wood is secured between the frame and axle to prevent spring action. When necessary, displacement of the axle is prevented by running a wire around the front spring hanger and the axle. When the light fuze is burned out, it may be temporarily replaced with tinfoil. This should be done only after the short in the system has been corrected. A fan belt may be replaced with rope or the old one fastened together with wire. Friction tape may be wrapped around the belt to hold it in place. When water has shorted the ignition system, it should be wiped away from the spark plugs. The wires should then be removed from the distributor head and wiped dry. Points to be Observed. In training drivers for difficult operations the following points should be observed by officers and noncommissioned officers: The column leader should have a good driver and a vehicle in good mechanical condition. On the approaching doubtful crossings or steep hills, a quick reconnaissance to deter- mine the best route is made on foot ahead of the first vehicle. Guards are dropped where drivers in rear should be cautioned. While moving, a driver is given freedom in the operation of his vehicle within the limits prescribed by the commander to insure safe and efficient operation of the column. When a vehicle is stalled, the driver must be given advice and help. A decision is required at once as to whether or not it can be moved by the next vehicle or by men at hand. If it cannot be moved without holding up the column, it is left for the crew with the trouble truck. The column must be kept moving. When the road is blocked, a new route around is immediately found for other vehicles. When the column comes to a halt, officers and section leaders should move forward to assist in carrying out the above principles. Power, Momentum, Traction, and Flotation. The ability of a motor vehicle to negoti- ate difficult terrain depends upon its power, momentum, traction, and flotation. A proper appreciation of these related factors will assist military personnel in the choice of a practical expedient to meet most road dufficulties. Power in any gasoline-propelled vehicle depends primarily upon maintaining sufficient engine speed. A shift to a lower gear allows the application of more power, but with loss of forward momentum. Momentum is the energy stored up by the weight in motion of the vehicle. It in- creases with the speed of the vehicle. Traction is the maximum wheel or track thrust that may be applied to the ground surface without slipping. Flotation is the ability of a wheel or track to ride the ground surface. Ascending Steep Slopes. Approaching normal hill. On approaching the usual hill, the leading driver should select a sufficiently low gear and proceed to the top without attempting to race his engine to keep up the normal rate of march. The driver of each succeeding vehicle closes up as the ascent begins and loses distance as the vehicle ahead picks up speed at the crest. Approaching difficult hill. Where the grade is slippery or the slope particularly CARE AND OPERATION OF MOTOR VEHICLES 313 steep, the leading driver on approaching the hill should select a sufficiently low gear and continue on to gain the maximum momentum which his load and the condition of the road permit. The driver of the next vehicle should slow up and halt before he arrives at the approach. He should wait long enough to see that the vehicle ahead has cleared the crest. The driver of each succeeding vehicle should close up, halt, and follow only after being certain that the vehicle ahead will negotiate the hill. Overcoming failure. On a steep ascent, stalling usually occurs because of either power or traction failure. Four solutions are presented: another run in a lower gear may be made, the load may be decreased or increased, traction devices may be added, or towing power may be applied. Taking another run. If a driver has failed to give his vehicle the maximum mo- mentum practical on the approach or if a shift has been made at the last moment in an effort to increase the power, the driver is usually at fault. Another trial, with the maximum momentum practicable or with a lower gear ratio, may succeed. Increasing or decreasing load. If power fails with maximum momentum and the lowest gear ratio, the load may be decreased. However, if failure is due to loss of traction and flotation is good, sufficient traction may be gained by increasing the load. This is usually done by loading men over the driving axle or axles. This solution will often be successful on vehicles with two-wheel drives, and on other vehicles not loaded but with heavy towed loads. On nontowing vehicles having front-wheel drives, the addition of more than the normal load is seldom advisable, because these vehicles will have sufficient traction to pull to the limit of their power. Applying traction devices. If the road is soft or slippery, chains or other traction devices should be installed. Applying towing power. Usually the most expeditious method of getting over a difficult ascent is to apply towing power utilizing manpower, the winch or another vehicle. If the hill or critical ascent is short, the use of manpower applied through prolonges is usually the quickest and most practical method. If the hill is long and a winch truck is available, it should go up first and then pull the other vehicles over. If one truck can be pulled over, a long cable or chain may be used to connect each vehicle in turn so that each helps the next over the ascent. Towed loads may be disconnected and pulled up separately. If necessary, several vehicles may be connected in tandem to pull up a towed load. Failure precaution. As a precaution, when a vehicle stalls on a hill, the driver should not shift gears until he has tested the brakes by disengaging the clutch gradually. After the brakes have been tested and found to hold, the driver should shift to reverse and back the vehicle down the hill or to the side of the road in gear. Descending Steep Slopes. Descents should be approached similarly to ascents. The following principles should be observed: Choosing descent. Very steep slopes should be descended straight down, so that in case sliding occurs the vehicle will not get out of control. All personnel except the driver should be dismounted. Bra\ing. Hills should always be descended in gear. The correct gear for the descent of a steep slope should be chosen during the approach and should not be changed until the bottom of the hill is reached. As a rule, the same gear is required in going down a hill as would be used in coming up the same hill. A sufficiently low gear should be selected so that the brakes need not be used. However, when necessary, brakes should be applied intermittently, being careful not to lock the wheels. In the descent of a hill, no attempt should be made to maintain the normal rate of march by racing the engine. The ignition should not be turned off. Assistance. Outside assistance should be given to vehicles descending steep slopes. It may be applied as follows: By manpower through the use of prolonges or block and tackle. A rope may often be snubbed around a tree or post. 314 MILITARY MEDICAL MANUAL By use of another vehicle on top of the hill, moving forward in lowest gear, con- nected by chain, cable, or rope to the vehicle descending. By use of the winch, the cable being run out in gear, the descending truck operating in the lowest gear. By setting brakes on towed loads and attaching a safety rope or tackle. When neces- sary, towed loads should be disconnected and let down separately. Muddy Roads. The usual muddy road that will be encountered is soft and slippery on the surface, while underneath it is generally hard or will pack sufficiently to sup- port a vehicle. Soft spots will allow spinning wheels to quickly dig in. The following principles are applicable to negotiating this type of muddy going: Traction aids. Chains usually give the best aid to traction and prevent skidding. Gear. In general, the highest gear that will give sufficient power is selected. As the loss of momentum and the sudden application of increased power at a critical point start the wheels to spin, the need for a gear reduction must be anticipated. Momentum. Momentum should be maintained across slippery places and up grades. Usually when slipping occurs, the speed of engine should immediately be decreased so that the wheels can take hold. Choice of trac\. Old ruts are the hardest packed and should generally be chosen. This principle usually holds for all vehicles following. The exception to this rule is covered in the paragraph below. Where road centers are high, ruts should be straddled or a new track should be made. Procedure on stalling. Once a vehicle has come to a complete stall in mud, the clutch is disengaged at once. No new trial is attempted until an outside check-up is made. Proper procedure for quickly extricating a stalled vehicle is dependent upon judgment and experience. The following possibilities are suggested: Dismounting personnel. If personnel are carried, they should dismount and try to push the vehicle out. Often the lightened load and this applied power will be sufficient. In making a try with outside aid, the driver should apply power to the wheels gradually by easing in the clutch. This trial should not be continued to such an extent that the wheels dig in. Selecting best way out. Usually a vehicle can be moved backward for a new trial easier than it can be moved forward. Use of manpower. If prolonges and sufficient men are available, an immediate at- tempt should be made to move the vehicle by manpower. Applying nearest suitable tow. If a light tow will probably succeed, the next suitable vehicle ahead or behind may be used. Often the next vehicle can be detoured and used for a tow. Where the vehicle has slid off a highly crowned road, men with prolonges attached to the sides may assist in helping the vehicle back onto the road. Stalled vehicle. Where the vehicle is found to be hopelessly stalled, a winch, tractor, vehicles in tandem, or a block and tackle must be used. Where a vehicle operating alone becomes stalled in mud, the driver and any per- sonnel that may be with him are dependent on one of the following methods of ex- tricating it: Improving traction. Any additional traction devices such as wheel mats, lug plates, or grouser ropes may be applied. Often one or more drive wheels must be jacked up and traction and flotation increased by placing brush, boards, rocks, or similar material under the wheels. When possible, a pole used as a lever inserted under the hub or in place of the wheel cap is the easiest method of raising the wheels. Digging out. Ditches dug in the direction that the wheels are expected to move assist in moving the vehicle out. When wheels are in deep ruts, usually cross ditches dug at an angle to the ruts with dirt thrown into the ruts are necessary to carry the wheels back on to a straddle position over the rut. Windlass method. The windlass method of having a dual-wheel truck pull itself out of a bad mud hole is simple and rather certain of success. A single long cable with loops on each end, or two tow cables, and four stakes are required. The vehicle may be pulled out either backward or forward. Two anchored stakes are installed on the CARE AND OPERATION OF MOTOR VEHICLES 315 bank at the same distance apart as the wheels and directly in front of or behind the vehicle. The loop ends of the cables are taken in between the tires of each dual wheel and secured by passing the loop between the spokes and over the hub. The cables are then attached to the anchor stakes. The vehicle is then pulled out on its own power by allowing the cable to wind up between the dual wheels whenever slipping occurs. Pole method. A similar principle may sometimes be applied by inserting a pole as a track between the dial wheels that are slipping. This method may be made more efficient with track-laying vehicles by attaching the pole to the track. The vehicle is rolled over it and the attachment is removed before strain is placed on the track. CAUTION: Because of the danger of slipping under the vehicle, personnel should be cautioned against pushing on the side of a moving vehicle that has slipped into the ditch from a high crown road or on a vehicle that has slipped into old wheel ruts. Swampy or Boggy Ground. Where water has been standing for a considerable time and swamp grass has grown, a surface crust has formed on top of a bottomless soil. Certain variations in principles and procedure apply in this exceptional type of muddy going. Avoiding swamps. Boggy or swampy soil may usually be avoided. Every effort should be made to move over the highest ground available. Traction devices. The addition of dual wheels in front, traction bands, and any other aids which increase the wheel surface in contact with the ground are a distinct advantage. Personnel dismount. Personnel should dismount and assist with prolonges at critical points. Maintaining momentum. The main requirement in moving over a boggy piece of ground is to move over it rapidly without stopping. Wheel spinning should be kept at a minimum. New tracks selected. The grassy crust may carry one vehicle but may not support another in the same track. Therefore each vehicle should follow a separate track. A guide should precede each vehicle on foot, locating the hard ground and guiding the driver carefully over the best route. Stalling. When a vehicle comes to a traction stall, the clutch should be disengaged at once. No attempt should ever be made to move it without outside power. Towed loads. To pull towed loads, several trucks may sometimes be hooked in tandem; or they may be pulled abreast, with the towed load attached by a pulley sliding on a cable between the two trucks. Gumbo and Other Sticky Soils. Gumbo and other sticky soils present a problem simi- lar to that of boggy ground. In addition these soils give little traction and stick to the tires and wheels in great masses. Boards, shovels, knives, and the like may be fastened to cut the mud from the wheels. Whenever possible, old, hard-packed roads should be selected through these areas. Passing Through Sand. Flotation in sand increases more or less below the surface. Usually sand will support a vehicle moving rapidly. However, traction is very limited because wheels are continually slipping. As soon as a drive wheel begins to spin it digs in fast. Although the difficulties in passing through sand vary, several additional prin- ciples are possible in overcoming traction failures in sand: Increasing tire surface. In exceptional circumstances air pressure may be decreased in the tires to give sufficient flotation. Digging vehicle out. When the sand is somewhat encrusted below the surface, the vehicle will continue to creep while the wheels spin. As long as the vehicle continues to move, the wheels may be kept slowly spinning, allowing the vehicle to dig itself out. Using same track• fn order to reduce road friction, vehicles should follow exactly the tracks of the vehicle ahead. Making roads. Hog or chicken wire fencing staked on the surface of sand will usually make a satisfactory surface for movement of motor vehicles. Driving on Snow and Ice. On soft snow flotation is at a minimum, while on ice traction is at a minimum. In addition to many of the principles already listed, the following are applicable to winter driving: 316 MILITARY MEDICAL MANUAL Traction aids. Chains on all wheels are usually the best safeguard in normal winter driving. However, on ice they add little or no traction and are apt to give a false feeling of security, because they increase skidding. Moving over fresh snow. When breaking freshly fallen snow, manpower should be readily available to push the first vehicle or to tow it with prolonges where the snow is deep. Other vehicles, following exacdy in track, usually move under their own power if they are able to gain momentum in approaching difficult slopes and crossings. Bracing. The engine should be used as a brake. The driver shifts to a lower gear when more braking power is needed. When used, brakes should be applied lightly and released quickly if skidding begins. Accelerating. Rapid acceleration should not be attempted, as it may cause one drive wheel to spin, thus losing traction or causing skidding. Overcoming skidding. If skidding occurs, the brake or clutch should not be touched. The accelerator should gradually be released. The front wheels are turned in the same direction the hind wheels are skidding, so that the vehicle will be carried forward with the momentum in a straight line parallel to its original path. Holding vehicles on road. Where necessary, men with prolonges may hold vehicles on dangerous icy roads. Crossing Ditches and Deep Ravines. Narrow or shallow ditches. Ditches in width up to nearly the diameter of the tire and wider shallow ditches should always be tra- versed at an angle, so that the drive wheel on one side will take hold of the far edge of the ditch at the same time that the opposite wheel is going into it. As this angle of crossing is a severe strain on the frame, springs, and driving mechanism, personnel should be dismounted to assist by pushing at the critical point. Ditches must be crossed slowly. Wide ditches or ravines. When a ditch is wider than the diameter of the tire and deeper than the running board or undercarriage clearance, no attempt should be made to pass it until the banks are thrown in and the bottom filled up. Such ditches should be crossed at right angles. If they are wet, they should be approached slowly and the vehicle speeded up without wheel slipping just as the front wheels cross the lowest point. Fording Shallow Streams. Fordings should be attempted only after careful recon- naissance. The following points are to be observed: Cross slowly. As a rule nothing is to be gained by attempting to use momentum in crossing streams. They should be crossed slowly in a low gear. Disconnect fan. If there is any danger of the water surging or splashing to the fan, it should be disconnected for the crossing, usually by loosening a bolt and raising the generator. Dry hra\es. After crossing a stream brakes should be applied intermittently until dry enough to hold. Chec\ lubrication. At the first opportunity wheels, crankcase, universal joint, differential, transmission, and subtransmission should be checked for proper lubrication. Deep-Stream Crossings. When the situation demands that streams too deep for ford- ing be crossed, the first consideration should be to obtain ponton bridges, bridging materials, ferries, or rafts. However, even if none of these are available, motor vehicles can be taken across streams of almost any depth without serious damage if suitable precautions are taken. The tackle and tow indicated in Plate 43 are used. The vehicle must be properly prepared for submersion by closing all openings and removing such parts as will be seriously harmed or rendered inoperative by moisture. After crossing, the vehicle should be thoroughly serviced and water removed from units. Bridges. Speed caution signs should be carefully observed, as well as the signs showing maximum capacity. When the capacity of a bridge is not sufficient, the towed load should be pulled across separately. Track-laying vehicles should be started across a bridge so that they will not have to be turned, because steering them places a severe strain on the bridge. CARE AND OPERATION OF MOTOR VEHICLES 317 Driving on Curves. Skidding on slippery curves is avoided by a reduction of speed before the vehicle goes into the turn. The importance of this consideration depends upon two factors: Centrifugal force, which tends to throw a vehicle to the outside of a curve, varies as the square of the speed. When the brakes are applied the weight of the load is shifted from the rear wheels to the front wheels, reducing the traction on the rear wheels and increasing the tendency to skid. When the brakes on a towed load are not applied, the tendency to skid is increased. Plate 43. Tackle for Deep Stream Crossing. Negotiating Turns With a Towed Load. If a curve is too sharp for truck and towed load, it is usually possible to uncouple the truck and drive it around the turn, and then by use of a tow cable or block and tackle to pull the towed load around the turn. Righting an Overturned Vehicle. (Plate 44.) In order to get a maximum leverage on an overturned vehicle, a cradle of two ropes should be passed over the body of the vehicle, one in front of the windshield and the other in rear of the center of the vehicle. Both should preferably be tied to the body frame or spring shackle. Brakes should be applied before the vehicle is righted. Any of the towing means may be used on the ropes. Holding lines should be used to prevent damage to the vehicle from setting too rapidly. Before the vehicle is moved under its own power necessary oil and gas, battery and radiator water should be replaced, and a careful inspection should be made to determine the damage done. Night Driving. Movements under cover of darkness are frequently necessary in order to escape observation and gain security. In forward areas, movements must be made without lights if casualties are to be minimized and secrecy preserved. Night move- ments are particularly difficult because of the limited control that can be exercised and the obstacles that must be overcome. Before such movements are undertaken, drivers should be given thorough training in marching, with and without lights. Training in night driving should start with empty vehicles operated over good roads with lights. Careful instructions should be issued and the road should be well marked. After the drivers have become reasonably skilled in driving with lights, they should be required to traverse the same route without lights. Provision should be made to prevent flashing of the stop light. The routes traversed should become progressively more difficult until drivers are proficient in handling their vehicles under all probable operating conditions. During this training, special attention should be paid to march discipline, to the prevention of smoking, and the use of lights. When a movement with 318 MILITARY MEDICAL MANUAL lights is to be continued without lights, time should be allowed to accustom drivers’ eyes to the changed conditions. Loads and Loading. (Plate 45.) In order that vehicle capacity and cargo space may be efficiently used, it is necessary that drivers have a knowledge of loads and loading. The driver ordinarily should not be required to handle cargo during the loading and unloading operations, but he should be directly charged with the following responsi- bilities: Maximum authorized load not exceeded unless ordered by proper authority. The maximum pay load, road and cross-country, and the maximum tow load are shown on the vehicle name and caution plate. These loads should not be exceeded except in case of emergency, and then only when specially authorized. Lack of knowledge of cargo weight is not an acceptable excuse for overloading. When scales are not available and cargo weight is unknown, adherence to the following general rule will prevent overloading: The position of the rear springs should be determined with the maximum authorized load. The position of the spring ends below this line indicates that the vehicle is overloaded. Plate 44. Righting an Overturned Vehicle. Proper location and reasonable distribution within the body. Efficient loading insures maximum use of cargo-carrying capacity and safety in transit. One loose piece of cargo may release an entire load; and, if the load is unbalanced, the vehicle is in danger of overturning, is difficult to handle, and is a menace to traffic. The following principles should be observed for correct loading: Heavy supplies should be placed at the bottom of the load and properly distributed. In building up the load, place cargo carefully to avoid shifting and distribute the weight equally on both sides of the body. Loads should not be built up too high. High loads cause swaying and danger of overturning and make the vehicle hard to handle. If the truck is not a covered vehicle, a tarpaulin should be placed over the cargo as a protection against sun, dust, or rain. Proper security of the load to the body or to the pintle. Loads built up above the Bags and bundles—pyramid loading; tail gate lowered and tarpaulin partially cut to reveal manner of loading. Keeping weight or cargo oil tail gate and preventing shifting of load; cutaway view showing load support inside vehicle. Plate 45. Loading of Vehicles. Headed barrels—pyramid load- ing; tail gate lowered and tar- paulin partially cut to reveal manner of loading. Improper loading—load not balanced; tail gate not shown to reveal deUails of loading. 320 MILITARY MEDICAL MANUAL top of the vehicle body should be securely lashed. The equipment for lashing loads on trucks consists of two 60-foot ropes which are sufficient for any ordinary cargo. Lash hooks or rings are usually provided on the bodies of cargo-carrying vehicles. The fol- lowing procedure should be followed when lashing the load: Fasten the end of one rope to one of the front lash hooks or rings. Pass the rope diagonally across the top of the load, through or under the second rope support, and pull the rope tight. Pass the rope diagonally back across the top of the load, through or under the third rope support, and pull the rope tight. Continue the process until the rear of the truck has been reached and secure the end of the rope. , Using the second rope, start at the other front corner of the truck and repeat the procedure, using alternate lash hooks or rings. Towed loads are attached to their prime movers or towing vehicles by means of the lunette on the towed load placed in a pintle on the towing vehicle. The pintle latch must be closed and secured before the load is moved. Safety of the load in transit. After the load has been placed in or attached to his vehicle, the driver is responsible for its safety until the destination is reached. Map Reading. Military motor vehicle drivers should receive sufficient instruction and training in map reading to enable them to follow routes on marked maps, to choose routes, and to recognize terrain features represented on topographic maps. Training should include the use of commercial highway maps, military topographic maps, airplane photographs, and mosaics. Servicing. Servicing is defined as a check and necessary replenishment of gasoline, oil in crankcase, water or antifreeze in cooling system, and air in tires. Precautions concerning the handling of gasoline must be rigidly enforced. When driver’s trip tickets are used, the amount of gasoline should be entered on the ticket. In the replenishment of oil in the crankcase, the following rules should be observed: Take every precaution to prevent dust and other foreign matter from entering the crankcase with the oil. Wipe out the oil measure, the spigot on the oil drum, the funnel, and the oil filler pipe with a clean cloth before refill oil touches any of the surfaces. Pour only the proper amount of oil into the crankcase. Do not overfill. Use the proper grade of oil for the season. Do not mix different makes of oil. Wipe off any oil spilled during refilling. When the driver’s trip ticket is used, the driver enters on the ticket the amount of replacement oil used. The water in the radiator should be maintained at the proper height below the overflow pipe. A hot engine should be allowed to cool before any considerable quantity of water is added to the radiator or the engine should be allowed to run and the water added very slowly. In freezing temperatures, if no antifreeze is used, care must be exercised to prevent freezing. When the cooling system must be drained, it is necessary in most engines that the cylinder block as well as the radiator be drained. Clean water, preferably soft, should be used to fill the cooling system. If conditions make it necessary to use dirty water, the cooling system should be drained, flushed, and refilled with clean water at the earliest opportunity. Lubrication. (See also Chapter X). In decentralized lubrication, the driver should be held responsible for the lubrication of all parts that cannot be damaged by overlubrica- tion except those requiring special lubricants. Parts that should be lubricated by the driver include spring and spring shackle bolts, spring pivot seats, steering knuckle pivots, steering knuckle tie rod pins, steering gear connecting rod (draglink) ends, clutch and brake pedal and brake lever pivots and linkage, accelerator linkage, door hinges and locks, tail gate hinges, and other slow motion friction surfaces. Equipment furnished the driver includes a high pressure lubricator and an oilcan. The driver is responsible for the care and condition of this equipment. CARE AND OPERATION OF MOTOR VEHICLES 321 Lubrication should be performed in accordance with a lubrication schedule and reports should be rendered by drivers when the lubrication is complete in order that proper records may be kept. Grease fittings and oil holes should be cleaned before lubricant is applied. Careful instruction and diligent supervision are necessary to as- sure good lubrication. Lubrication by the numbers is suggested as an effective method for teaching lubrication to untrained personnel. Lubrication by drivers involves the use of only two types of lubricant: oil and chassis lubricant. The oil used for lubrication of linkages, hinges, etc., should be of the same grade as that used in the engine crankcase. The chassis lubricant used on spring and spring shackle bolts, steering knuckle pivots, etc., is of semifluid grease usually having a brilliant color and stringy consistency. Drivers must be taught to distinguish between chassis lubricant and other types of lubricants. Tightening. The distinction between tightening and adjusting must be definitely understood, otherwise drivers will undertake operations which they do not have the knowledge, experience, or equipment to perform. In general, adjustment involves placing moving parts or assemblies in proper relative position and securing them in that position. Adjustments, except specified emergency adjustments, are prohibited to the driver. When a driver discovers a loose or lost nut, bolt, screw, stud, or cotter key, he should tighten or replace it unless the adjustment of a part or assembly is affected. If adjustment is involved, report should be made to the chief of section or other desig- nated individual. A driver should be taught the correct use of the tools furnished for his use and the proper degree of tightness of the various nuts, bolts, and screws on his vehicle. If the drivers are not sufficiently skilled or if the proper tools are not furnished for their use, all tightening operations should be performed by the motor sergeant and mechanics. Cleaning. A motor vehicle should be cleaned after operation to prevent hardening of dirt accumulations and to keep dust and other foreign particles from working into bearing surfaces. The body and exterior parts of the chassis should be washed, using a hose if available. Water should not be played on the engine as ignition troubles may result. Dirt should be wiped from the engine and its subunit assemblies. Gasoline should not be used to clean engines; cleaning solvent is recommended because of its greater safety. Gas and oil lines should not be polished. The use of paint on radiator cores is prohibited. Vehicles should be inspected before being washed, because of the greater ease in detecting loose parts and assemblies, broken dust films being the best evidence of loose- ness. Scheduled lubrication should be performed after washing so that any water or dirt which has entered bearing surfaces may be forced out by the pressure of the new lubricant. Care of Tools and Equipment. The driver is responsible that tools, spare parts, pioneer equipment, chains, traction devices, towing cables, paulins, and equipment furnished with his vehicle are in their proper places, are clean, and are in condition at all times for immediate use. Any equipment which becomes unserviceable should be repaired or replaced immediately. Shortages or unserviceable equipment should be reported to the chief of section or other designated individual. Care of Tires. The chief responsibility of the driver in caring for tires is that of proper inflation. Tires should be inflated to recommended pressures and the pressure checked daily with a reliable gage. Air pressure cannot be determined satisfactorily by looking at the tire. In general, tires should be removed from their wheels at least yearly to permit con- ditioning of wheel rim surfaces. Rim surfaces should be cleaned and covered with a protective coating to prevent rust. Wheels, including spares, should be changed periodically to secure uniform tire wear and to maintain resiliency in the spare tires. When mounting tires on a motor vehicle, particular attention should be paid to 322 MILITARY MEDICAL MANUAL sizes. In general, tires should be mounted in pairs. That is, tires of equal outside diameter should be mounted on the front wheels and those of equal outside diameter on the rear wheels of a 4 x 2 vehicle. However, on an all-wheel-drive vehicle without a center differential or other compensating device, all tires should have the same outside diameter. In order to maintain this condition after tires become worn, it may be necessary to transfer tires from one vehicle to another. When mounting dual tires, the worn tire should be placed on the inside. Tires differing more than one-half inch in outside diameter should not be mounted on the same wheel or on the same axle. Drivers should be constantly alert to detect evidence of excessive or unusual tire wear. The most common causes of excessive tire wear are: Improper inflation, including under and over inflation and bleeding. Poor driving, including fast starting and stopping and improper use of brakes. Rocks or other foreign material wedged between dual tires. Misalinement. Overloading and improper loading. Improper sizing of tires (different sized tires on the same axle, etc.). Care of Storage Battery. The motor vehicle driver should have a general knowledge of the functioning of a storage battery. He should know the correct ammeter reading for proper functioning of the generator and the general procedure to be followed when any abnormal reading is observed. He should know how to use the storage battery so as to prolong its period of usefulness. The following care by the driver should be routine: Keep battery terminal connections clean and tight. Remove and clean corroded connections, using a weak alkaline solution if available. Dry the connections, apply a thin coating of vaseline or soft grease, replace and tighten the connections. Corroded terminal connections reduce storage battery efficiency and overload the generator. Keep the battery clean and securely clamped in the battery carrier. Inspect the height of the battery electrolyte each week during summer and each two weeks during winter seasons. If the electrolyte is below the prescribed level, report the fact to the chief of section or other designated individual. Report any unusual performance or battery condition immediately. Duties During Scheduled Maintenance and Technical Inspections. Before his vehicle is submitted for scheduled maintenance or technical inspection, the driver should correct such mechanical defects as are within the limits of his ability and the tools and equipment provided for his use. The vehicle should not be cleaned unless it is excessively dirty, since the dust film aids the mechanics in detecting defects. The driver should report known mechanical defects which he is not authorized to correct and accompany his vehicle while it is undergoing scheduled maintenance or technical inspection in order to further his knowledge of the mechanical condition of the vehicle and to permit the motor officer, or his representative, to point out results of improper operation or vehicle abuse and take proper corrective action. Characteristics of Motor Movements. The outstanding characteristics of modern motor movements are the tremendous distances over which immense tonnages may be transported and the great potential flexibility in the rates of march employed. The principal difficulties which such moves entail are those of control, communication, con- cealment, length of columns, vulnerability to attack, defense, and dependence on technically correct supply and maintenance systems. Influence of Air and Mechanized Forces. The vulnerability of large-scale motor move- ments to aviation and the secrecy usually desired in such moves are frequently deciding factors in the selection of a suitable method of march. The threat of attack by hostile mechanized forces is to a lesser extent responsible for the march methods adopted. March Discipline and Training. The very nature of modern motor movements, particularly the difficulties of control and communication, the sudden changes in orders, MARCHES CARE AND OPERATION OF MOTOR VEHICLES 323 and the high rate of movement, as well as the amount of discretion and responsibility which must be left to subordinate commanders and even drivers, makes necessary a high degree of march discipline and training. Principal Elements of Motor Movements. Some or all of the following elements may be essential in the successful execution of motor movements: In the selection of routes, avoiding stream lines, mountain passes, and similar terrain features which may be classified as natural bottle necks. Provision of suitable detachments of engineer ponton trains and pioneer troops. Provision of a suitable escort to protect against attack by aircraft or mechanized forces. Adoption of a type of marching giving sufficient dispersion to avoid offering a profitable target whenever both air and ground escorts are insufficient to give air and ground superiority. Use of multiple columns in marching. Use of the necessary control personnel and plans to permit rapid rerouting of columns in case of emergency. Use of concealed bivouac or assembly areas in which to commence and terminate each movement, utilizing the minimum number of halts. Use of dispersed small bivouac or assembly areas. Prevention of massing of vehicles, particularly at the initial point, during halts, and at the entrance to bivouac or assembly areas. Measurement of distance in time rather than space in all staff planning. Thorough ground and air reconnaissance, to the extent time permits, of contemplated routes to include search for possible mining of roads and bridges. Provision of suitable radio equipment. Provision of sufficient motor maintenance facilities. Definitions. Accordion action (whip). The variation of distances and speeds of ve- hicles within a column during movement. Arrival time. The time at which the head of a column, or specified element thereof, arrives at a designated point. Clean-up party. Personnel under command of an officer who remain in camp after the departure of the main body to make the final police of camp. Clearance time. The time at which the tail of a column, or specified element thereof, completes passage by a designated point. Column. One or more march units, or serials, under one march commander, using the same route. Column commander. The senior officer with the column or the person designated by him to exercise command. Commander of troops. The officer in command of the unit being transported. He may be also the march or convoy commander. Control car. The car which precedes a column, or element thereof, and sets the rate of march. Control officer. An officer usually the executive or second in command, who rides at the head of a column, or element thereof, and regulates the rate of march. Control point. A definite, easily identified and described reference location along a route of march, at which information and instructions are given in order to facilitate and regulate supply or traffic. Convoy. A group of motor vehicles organized to operate as a column for the purpose of transporting non-organc troops or supplies, in contra-distinction to organically motor- ized tactical units or supply trains. Convoy commander. The officer in charge of motor transportation and operating personnel of a convoy. Distance. The space from the rear of one vehicle (including towed load, if any) to the front of the next vehicle in the column; or the space from the rear element of a march unit or serial to the leading element of the following march unit or serial. Double banking. The act overtaking and passing, or parking or moving abreast of, other traffic headed in the same direction on a roadway. 324 MILITARY MEDICAL MANUAL Double staggered column. A two-lane column so arranged that the vehicles in one lane are opposite the spaces between vehicles in the other lane. Entrucking point or detrucking point. An easily recognizable location where the head of a motor column, or element thereof, halts for the loading, or unloading, of troops or supplies. Entrucking groups. Troops, materiel, or supplies properly disposed for loading at an entrucking point. Escort. Troops detailed to prevent interference with a motor movement by hostile air forces, by mechanized or other ground forces, or by other traffic. Guard. An individual placed at a danger point, such as a railroad crossing or a turn into or off a main road, to prevent traffic accidents. Guide. An individual who leads or directs a unit or vehicle over a predetermined route or into a selected locality. Headway. The interval of time between individual vehicles, march units, serials, or columns, measured from head to head as they pass a given point. Initial point. An easily recognizable point at which a moving column, or element thereof, is formed by the successive arrival thereat of its various subdivisions. Lead. Linear spacing between the heads of successive vehicles, serials, march units, or columns. March discipline. That quality acquired through training and experience in marching which insures adequate march control; care of equipment; obedience to march restric- tions; proper conduct and performance of duty by individuals; correct formations, dis- tances, and speeds; and effective use of cover. March graph. A time-space diagram used in planning and controlling marches and in preparing or checking march tables. March order. An order issued by a commander, covering the details of a march. March report. An official report submitted at the end of a march. March table. A composite list showing the general organization and time and space schedule for a march movement. March unit. One or more motor vehicles under a single commander for purposes of march control. A company, troop, battery, or similar organization normally forms the march unit. Marker. An individual, distinctive sign, or notice placed at a critical location to in- dicate a position, direction, procedure, or obstacle. Mobility. Facility of, or capacity for, movement. Ear\. An area used for the purpose of servicing, maintaining, or parking vehicles. Pioneer wor\. Rough, hasty construction or demolition tasks executed to facilitate the movement of friendly troops or to impede the movement of hostile troops. Quartering party. Personnel, under the command of an officer, who precede the main body on the march and lay out the camp or make arrangements for shelter of the troops. Rate of march. The average speed of a column over a period of time including short periodic halts. Regulating point. An easily recognizable location where an incoming motor column, or element thereof, is separated into groups for movement to assembly or bivouac areas, or to entrucking or detrucking points. Release point. A location at which specified elements of a column revert to control of their respective commanders. Road bloc\. Any obstacle which delays or prevents traffic movement on the road. Road space. The total length of roadway occupied by a column or element thereof. Road time. The total time a column or element thereof, requires to clear a given section of road. (Road time = time length -f- time-distance between ends of the given section of road). Route marking party. Personnel used to mark the route and to control traffic at congested points along the selected route of march. The party precedes the march column and is usually commanded by an officer. CARE AND OPERATION OF MOTOR VEHICLES 325 Serial. One or more march units, preferably with the same march characteristics, placed under one commander for march purposes. Shuttling. A system for moving troops or supplies when more than one trip is re- quired to complete the move. Speed. A rate of travel, usually measured in miles per hour. Speedometer multiplier. Any number by which the speedometer reading is multiplied to determine the lead (usually in yards) between vehicles in open column. Strip map. A sketch or map, either schematic or drawn to scale, delineating a route to be followed. Time-distance. The time required to move from one point to another. Time-gap. The interval of time, measured from tail to head, between successive vehicles, march units, serials, or columns as they move past a fixed point. Time length. The time required for a column, or element thereof, to pass a given point. Traffic bloc\;. Any use of a section or roadway by vehicles or traffic which prevents the passage of other vehicles or traffic in a specified direction. Traffic bottleneck A section of traveled roadway having a greater traffic density or a smaller traffic capacity (capacity bottleneck) than that of the roadway or roadways leading thereto. Traffic capacity. The maximum traffic flow attainable with close column marching on a given roadway, using all available lanes. Traffic density. The number of vehicles per unit length of roadway {e.g. 75 vehicles per mile). Traffic flow. The number of vehicles that pass a given point within a given period of time {e.g., 500 vehicles per lane per hour). Trail car. The car carrying the trail officer. Trail officer. An officer, usually the motor maintenance officer, who rides at the rear of a column, or element thereof. Turn-around. A locality where the direction of march may be reversed. Vehicle commander. Usually the senior officer or man riding in the vehicle. TYPES OF MOVEMENTS Infiltration (Type I). Description. Vehicles are dispatched individually or in small groups over a carefully marked route. Observation from the air should disclose what appears to be only normal or routine traffic. Advantages. This type of march provides the best possible passive protection from hostile observation and attack. Under light traffic conditions, movement of individual vehicles is not affected materially by other vehicles in the column and is limited only by road conditions, vehicle mobility, and the training, experience, and physical condition of drivers. Thus, the rate of march is the highest practicable. Driver fatigue and the probability of accidents is reduced to a minimum. Since traffic density is normally very light, cross traffic can move without impeding the march. A traffic escort is not nor- mally required, although intersection control may be desirable. Operating conditions re- sulting from the employment of the infiltration type of march approximate those to which individual drivers are accustomed in civilian traffic. Disadvantages. Time length of column is greater than with any other type of march. Thus, in spite of a higher rate of march, the total road time for a column may be longer. Because of extended distances between vehicles, internal control of the column is extremely difficult. Since drivers are not always able to regulate their movements on the vehicle ahead, careful marking of the route is necessary to prevent individual ve- hicles from getting lost. Uses. When sufficient time and road space are available, this type of march is used to provide the maximum of secrecy, deception, and dispersion as a means of passive protection against enemy observation and attack. It is therefore well suited to daylight marches in the combat zone. Because an infiltration column provides a minimum of interference with other traffic and a higher average rate of march, it is likewise suitable for non-tactical motor movements in peacetime. 326 MILITARY MEDICAL MANUAL Close Column (Type II). Description. In this type of march, the column is formed as compactly as practicable in order to reduce its time length to a minimum. Advantages. For any given speed, time length and road space of column are re- duced to the minimum practicable, and the full traffic capacity of the road can be utilized. Because of the small headways between vehicles, column control and intra-column com- munication are the best obtainable. An aerial escort or active antiaircraft protection can be utilized to maximum advantage. Since time length of column is reduced to the minimum, short moves may be completed before enemy air units have time to strike. Disadvantages. This type of march does not provide dispersion for passive protection against enemy observation and attack. The strength and type of organization are readily apparent to hostile observation. In most cases, vehicles will arrive at terminal areas faster than they can be handled without producing congestion. Careful scheduling and rigid control of traffic are required if dangerous jams at intersections are to be avoided. Intercolumn interference is particularly troublesome and slows down the rate of march of the column. Uses. Close column is used when a large volume of traffic must be moved over short distances in a minimum period of time. It is also applicable to short, high-speed movements from cover to cover when a minimum time of exposure may reduce the chances of discovery and attack. Normally, however, close column is not justified except when the column is protected by an aerial escort or is otherwise secure from hostile air attack. Close column may be useful for night moves under blackout conditions, par- ticularly over poorly marked routes, when it is essential that distances between vehicles be short enough to enable drivers to maintain contact with and follow the vehicle ahead. This type of march may sometimes be used for peacetime movements through cities or other congested areas, providing a traffic escort is available, the move has been coordi- nated with civilian traffic authorities, and the movement is important enough to warrant delaying civilian traffic. Because of the excessive intracolumn interference produced by close column marching, close column should never be used when open column will pro- vide the desired traffic flow. Open Column (Type III). Description. This method is characterized by approxi- mately constant headways at all speeds, and by intervehicular leads that vary directly with speed of movement. The spacing of vehicles is a compromise between the maxi- mum and minimum leads employed in march types I and II, respectively. Advantages. Open column provides the best possible compromise between the conflicting requirements of a large traffic flow (or short time length of column) and a wide dispersion of vehicles within the column. Intracolumn interference is minimized, and the rate of march is practically as high as in infiltration marching. Column control is not as good as with close column, but is much superior to that obtainable by infiltra- tion. Driver fatigue and probability of accident is much less pronounced than in close column marching. Because time interval between vehicles is greater than in close column, it is easier to direct units to alternate routes in an emergency. On dusty roads, open column gives drivers better vision and better control of their vehicles than if close column were used. Disadvantages. Because of the relative regularity of vehicle spacing, little secrecy is possible in moves of this type during daylight, and more losses will be suffered during aerial and mechanized attacks than will be the case with an infiltration column. Inter- vehicular headways in an open column are generally longer than in close column, and consequently the full traffic capacity of the road is not utilized. Other traffic may be delayed, since headways are smaller than in infiltration marching and may not be suffi- cient to permit such traffic to pass through the column. Driver fatigue is greater than when infiltration marching is used, and drivers must be trained to estimate and main- tain the variable leads required. Uses. Open column is particularly applicable to tactical moves which must be made during daylight without aerial escort and when time is so important that lack of secrecy and reasonable losses from attacks are acceptable. Sufficient dispersion may usually be prescribed to prevent simultaneous shelling or bombing of two or more vehicles. Open column may be used to advantage when moving with driving lights at night, or with CARE AND OPERATION OF MOTOR VEHICLES 327 blackout lights on moonlight nights. It is likewise applicable to non-tactical peacetime marches if drivers must depend on vehicle ahead for route guidance, or when volume of traffic to be moved precludes the use of infiltration march. Shuttling. When repeated trips of the same vehicles are required in order to transport troops or supplies, a system of movement known as shuttling is employed. Any of the foregoing types of march, depending on traffic and tactical conditions, may be used for shuttling. This system is not well suited for the movement of troops to an area in which combat is imminent unless the force moved in the first trip is capable of sustained combat pending arrival of remainder of unit. The dumping of organic cargoes in order to move foot troops by shuttling, must be limited to those supplies not immediately needed in combat area. Terminals are selected so as to provide adequate turn-around facilities. The preparation of entrucking and detrucking tables will help eliminate delay and confusion at terminals; and the march graph will assist in scheduling the movement. MARCH TECHNIQUE Mechanics of Column Movement. General. Whenever the tactical situation permits, a march column should be made up of vehicles with similar march characteristics, even if this requires the temporary separation of a tactical unit into two or more independent columns. When the tactical situation demands that a column be composed of vehicles with differ- ent march characteristics; the rate of march of the column is governed by the performance of the slowest vehicle. For march contol purposes, it is usually desirable to place the slowest vehicle at the head of the column. Speed variance within the column. It is theoretically possible for an entire motor column to move at a constant speed. Practically, however, a column of any length will cover simultaneously many diverse stretches of road and incidents of terrain, including hills, sharp curves, dust clouds, and varying road surfaces. The result is that different parts of the column, regardless of traffic conditions and vehicle performance charac- teristics, move simultaneously at different speeds. This produces accordion-like action, and on a long hill or bad stretch of road, serious conditions may result. On the near side of the obstruction, a long and constantly increasing mass of vehicles will accumulate and on the far side, the column will be elongated (Plate 46, Fig. 1). Solution to problem of column movement at varying speeds. A long column can be held together under such conditions only by continuously adjusting the speed of the control car, and every succeeding vehicle in the column, to that of the vehicle moving at the slowest speed. Column compactness, if that is desired, can be attained only by sacrificing high rates of march. If compactness is not essential, the ideal type of column movement should be such as to permit each vehicle to pass over any given stretch of road at the same speed as the control car. This ideal can be approached by varying inter- vehicular distances to produce constant headways throughout the column at all speeds. (See Plate 46, Fig. 2) When this is done the rate of traffic flow up to a section of road, which must be traversed at a reduced speed, is made equivalent to the rate of traffic flow over and away from this section of road. Intracolumn interference is thereby elim- inated, and every vehicle in the column is enabled to move as rapidly as if there were no other vehicles on the road. In picking up speed after leaving the traffic bottleneck, the control car should increase its speed gradually, in order to mitigate the accordion action. If fixed intervehicular distances had been maintained by the column shown in Plate 48, figure 2, the entire column would have been forced to slow down as soon as the first vehicle began to ascend the hill. The slow movement would then have been continued until the last vehicle had completed its ascension of the hill. For a column 20 miles long, the result would have been to reduce the speed of every vehicle from 30 to 10 miles per hour over a road dis- tance of 20 miles. With the type of column movement actually shown in Plate 48, figure 2, on the other hand, the rate of march of each vehicle is reduced from 30 miles per hour to 10 miles per hour only while ascending the hill. The nearer the approach to constant headways throughout the column, the nearer will be the approach to the ideal type of column movement. 328 MILITARY MEDICAL MANUAL Infiltration. The route of march must be carefully marked, and every driver and front seat passenger should be given detailed instructions regarding it. A strip map should be provided for each vehicle. Complete operating instructions to include run- ning speed, maximum speed, and restrictions on passing should be issued. Vehicles should be dispatched individually or in small groups of not more than 3 to 5 vehicles, and there should be no massing of vehicles which might disclose the movement to enemy observers. Vehicles accumulate on near side of hill at the rate of 385 vehicles per hour and are forced to slow down before they begin to ascend the hill. On far side of hill vehicles roce to close up SPEED 30 MILES PER HOUR 10 MILES PER HOUR INTERVEHICULAR LEAD 53 YARDS 22 YARDS INTERVEHICULAR HEADWAY 3.6 SECONDS 4.6 SECONDS TRAFFIC FLOW 1000 VEHICLES PER HOUR 790 VEHICLES PER HOUR Figure 1. Traffic flow is the some toward, through,and away from the hill. Therefore vehicles do not accumulate on the near side SPEED INTERVEHICULAR LEAD 30 MILES PER HOUR 10 MILES PER HOUR 30 MILES PER HOUR INTERVEHICULAR HEADWAY 150 YARDS 10 2 SECONDS 50 YARDS 10 2 SECONDS 150 YARDS 10 2 SECONDS TRAFFIC FLOW 352 VEHICLES PER HOUR 352 VEHICLES PER HOUR 352 VEHICLES PER HOUR Figure 2. Plate 46. Column Movements. Deception may be further provided by intermingling various types of vehicles and by permitting passing within the column. In order to provide passive protection from enemy observation and attack, vehicles should normally be dispatched so as to produce an average traffic density (so far as the vehicles in the column are concerned) of not to exceed 5 vehicles per mile. When more than one movement is taking place simultan- eously over the same route, it may be necessary to coordinate the rates of dispatch in order to obtain desired dispersion. Dispatching is normally effected by company, troop, battery, or similar unit in accordance with the plan of the column commander. Staff control can be exercised at the initial point, but movements up to the initial point must be planned so as to avoid an excessive concentration of vehicles near this point. CARE AND OPERATION OF MOTOR VEHICLES 329 Average headways between vehicles are determined initially by the rate at which vehicles are dispatched; thereafter, speeds and headways are regulated by individual drivers in conformity with operating instructions. These may include the use of a pre- scribed speedometer multiplier (open column marching) when slower speeds occur en route or minimum leads to avoid presenting remunerative targets from the air, orders of the vehicle commander, and instructions of traffic personnel. If it should become necessary for any part of the column to halt on the road, vehicles should stop and pull off the road as soon as need for the halt is detected, and if possible, maintain distances of not less than 100 yards. Supervision of movement is affected by stationing necessary control personnel along the route of march. In order to prevent massing of vehicles at or near the march destination, it is important that adequate guides and markers be posted to insure that vehicles disperse to their assigned areas with minimum delay. Close Column. When time and road space permit, sufficient headways (1 to 3 minutes added to the time length of the preceding serial or march unit is normally ample) are prescribed between serials and march units to localize intracolumn interfer- ence, allow reasonably smooth marching, and provide a faster rate of march. If time or available road space makes it impracticable to divide the column into serials and march units, the entire column moves in one compact group as a single march unit (the so- called “follow me” method of marching). Within each march unit, drivers arc in- structed to follow the vehicle ahead as closely as they think is reasonable and con- sistent with safe driving practices. For purposes of safety, a maximum speed (greater than the average running speed) is prescribed for vehicles regaining lost distances. Changes in speed should always be accomplished smoothly and gradually in order to insure safety and uniformity of column movement. At the halt, unless the tactical situation prohibits congestion, vehicles within each march unit should close up to a distance of approximately one yard between bumpers. March units and serials, however, do not close on the units ahead. If a multiple lane road is available for a movement in a single direction, any number of lanes may be employed. However, since vehicles in a close column operate at minimum headways possible, there can be no weaving or interchange of traffic between lanes. A traffic escort is necessary when close column marching is used. Open Column. In order to give drivers a practical means of maintaining approxi- mately constant time intervals or headways, at all speeds, the leads in yards be- tween vehicles in the column are indicated as the product of the speedometer reading by a specified number called the speedometer multiplier (sm). For example, the column commander might announce that the lead between vehicles will be twice the speed- ometer reading. At slower speeds and with smaller speedometer multipliers, it is im- possible to maintain the small leads necessary to provide constant headways; at higher speeds and with larger speedometer multipliers, intervehicular leads become so large that it is difficult for drivers to estimate them accurately. Whenever the former situation occurs during a march, drivers operate their vehicles as they would in a close column (unless dispersion is sought, in which event vehicles will not approach closer to other vehicles than a minimum prescribed distance); when the latter occurs, drivers should operate their vehicles as they would in an infiltration column until the preceding ve- hicle slows down sufficiently to permit resumption of reasonably accurate estimates of intervehicular distances. The selection of a specific speedometer multiplier for any particular stretch of road- way will ordinarily require a compromise between two mutually conflicting requirements. In the first place, it is desirable to increase intervehicular leads so as to avoid presenting a concentrated target to enemy attack. It is particularly desirable that vehicles never approach closer to each other on the road than the maximum diameter of the effective burst area of a shell or light bomb. (This diameter will generally not exceed 30 to 50 yards). In the second place, it is often necessary to reduce intervehicular leads in order to facilitate column control, decrease road time, minimize delay to cross traffic, or in- crease traffic flow through bottlenecks. Since intervehicular lead in open column marching varies directly as speed, the 330 MILITARY MEDICAL MANUAL stretch of road at which the slowest speed occurs is the one which is critical in so far as dispersion of vehicles in the column is concerned. (Momentary halts or reductions in speed may be disregarded.) Hence, it is necessary to base the selection of a speedometer multiplier on the slowest speed expected between halts. Thus, . , -i. desired minimum intervehicular lead speedometer multiplier = t-; ;—i— slowest speed expected between halts For example, as a result of careful consideration of the requirements affecting the selec- tion of speedometer multipliers as indicated in subparagraph b. above, it is decided that vehicles should not approach closer than 35 yards. The slowest speed expected during the next stage of an open column march is 10 miles per hour. Vehicles average 7 yards in length. The highest speed expected is 30 miles per hour. It is obvious that if an inter- vehicular lead of at least 42 yards is maintained at 10 miles per hour, sufficient lead will be provided at all speeds greater than 10 miles per hour. Hence, the speedometer mul- tiplier in this case should be 42/10 or 4. A speedometer multiplier of 5 would be pre- scribed. At 30 miles per hour intervehicular lead will be 150 yards. If prescribed maxi- mum time length of column will be exceeded by use of speedometer multiplier, a smaller sm, which will produce desired time length, is designated. It is often advisable to pre- scribe a minimum distance beyond which vehicles will not close either at the halt or while the column is in motion. In order to localize intracolumn interference resulting from inaccurate maintenance of intervehicular headways, it is desirable to have serials and march units move a specified number of minutes behind the head of the column. Vehicles do not close up at the halt, but stop with approximately the same spacing between vehicles as was being maintained just before the halt was executed. If it becomes necessary or desirable to reduce the time length of a march unit while it is in motion, the march unit commander can indicate a smaller speedometer multiplier. When this is done, the head of the march unit should slow down or stop until the tail of the unit has been able to close up sufficiently to observe the smaller speedometer mul- tiplier. This time should be approximately equal to the desired reduction in time length. When it becomes necessary or desirable to increase the time length, this may be accom- plished by indicating a larger speedometer multiplier. Before the time-length is in- creased, the march unit commander should make certain that there is sufficient time- interval between the rear of his unit and the head of the following unit to absorb the increase. The march unit control car should then continue the march at the fastest safe speed, each following vehicle slowing down until it is following the car ahead by the desired distance. When protective dispersion is not necessary (e.g., during peacetime marches or under conditions of friendly air superiority) a doubled staggered formation may be used. A traffic escort is required for an open column, except where other traffic on the route of march is light. Shuttling. There are two general methods by which shuttling may be performed. In the first method, troops or supplies may be transported over the entire distance between the origin and the final destination. This is the normal method of shuttling and the only method applicable to the movement of supplies. It is easy on the troops to be moved, and it eliminates uncertainty in making contact with troops once they start out on the road on foot. Total time required for shuttling by this method is somewhat greater than by other methods, but in most tactical movements time saved by having troops march part of the vfcay on foot is negligible and usually does not justify the complicated planning required. Sometimes it may be desirable to have troops march part of the way on foot. In this case, the truck column on its first trip will stop short of the destination at a pre- viously reconnoitered turn-around. The troops detruck and march the remaining dis- tance on foot. Meanwhile the troops to be transported on the second trip start off on foot as soon as the truck column clears the original entrucking point with its first load. The trucks which transported the first load of troops, after turning around, then move back along the line of march or on parallel routes, pick up the second load of troops, CARE AND OPERATION OF MOTOR VEHICLES 331 and transport them to a second detrucking point nearer to the destination than was the first. The process is continued until the last load is picked up and transported to the final destination. This latter method of shuttling has the advantage of reducing the total time required for the movement and truck mileage with consequent savings in gas and oil. Its disadvantages are lack of simplicity and greater troop fatigue. This shuttling procedure may be varied by having the truck column return all the way to the origin to pick up loads after discharging preceding loads at previously reconnoitered turn-arounds short of the destination; or by having the truck column transport the first load direct from the origin to the destination and on the subsequent trips proceed all the way to the destina- tion after picking up troops who have meanwhile proceeded on foot along the route of march. ORGANIZATION FOR A MARCH Command. Organic motorized tactical units. Movements of organic motorized tac- tical units are made under the direction and supervision of unit commanders. Organic motorized trains. Organic motorized trains carrying equipment and sup- plies likewise move under the direction and supervision of the train commander who is the senior officer or noncommissioned officer present in the units comprising the train. Nonorganic vehicles. Movements of troops in vehicles that are not a part of their unit equipment are usually commanded by the senior troop commander present. His staff acts as a convoy staff. The motor-transport officer acts as a member of the com- mander’s technical staff. However, if the troop movement is being handled by the staff of a higher headquarters as a part of a large move, the arrangement is usually as follows: The transportation units are organized, staffed, and commanded on orders issued by the higher headquarters. The convoy commander moves his vehicles to previously planned entrucking points. He is responsible for the technical operation of the transportation and the movement of the column. Orders to the convoy-operating personnel will be given only by the convoy commander and his assistants. The commander of troops will exercise no control over the operations of the column except in a tactical emergency. He is responsible for the administration and discipline of the troops transported. Command and Staff of a Convoy. The commander of a motorized regiment or other large convoy should be assisted by competent staff officers in handling the details of the movement. He may designate a staff officer, usually the executive officer, as convoy commander. Ordinarily, the following staff should be employed: Adjutant. The adjutant handles the routine administrative paper work and the mail service. Operations officer. The operations officer handles details connected with the actual operations of the convoy, such as preparing plans, march tables, march graphs, and drafts of move orders. Supply officer. The supply officer handles details of supply except those for which the mess officer is responsible. He may be charged also with responsibility for cargo loads. In general, he handles fuels, lubricants, spare parts, clothing, and equipment. Mess officer. A mess officer is usually detailed when all messing facilities for the convoy are to be consolidated. Advance agent. An advance agent (or reconnaissance officer) handles all advance arrangements. He makes reconnaissance, locates detours, selects alternate routes when necessary, and posts markers. He also provides for billeting or bivouac of troops at destination. Maintenance officer. The maintenance officer is the technical inspector responsible for the mechanical and operating condition of the rolling equipment. Classification of Convoys. Convoys may be classified as follows: According to their loads, they are known as troop or supply convoys. According to their type of vehicles they are classified as light, medium, or heavy convoys. 332 According to the service of their vehicles, they may be classified as— Train convoys made up from trains. Provisional convoys made up from either military vehicles not ordinarily formed as such, or vehicles from nonmilitary sources. Organization of Motor Movements. In motor movements of both tactical units and convoys in the combat zone, the organization into columns, serials, and march units is determined by the mission, the tactical situation, the road net, and the equipment of the units concerned. Logistical considerations, for instance, may dictate the separation of tactical units into speed columns and heavy columns. Considerations. The type of march to suit the tactical situation may affect the organiza- tion of the movement. For instance, secrecy may dictate a movement by infiltration where identity of units is sacrificed. Action imminent. Whenever a move terminates in areas where action is imminent tactical organization takes precedence over all other considerations. Here the cohesion and unity of action possible only to an organization knit together by association and arduous training become all important. Variations. With the many variations of march organization open to the staff planning the move, the final choice should be made only after a careful study of the particular situation. Details. The details given below must be considered in planning a motor movement. Depending on the conditions under which any particular movement is made, it may be practicable to combine one or more of the groups outlined. Reconnaissance Party. Where practicable, reconnaissance prior to any motor movement is advisable. Pioneer Work. The necessary pioneer work in preparing the route is usually accom- plished by engineer troops. Lacking these, this important work must be performed by the units making the march. The requirements for this work vary gready. They are negligible when moving over primary highways but become extremely heavy when moving over routes recently in possession of the enemy. In any case an estimate must be made of the necessary personnel, tools, material, and time for elimination and re- duction of obstacles. Equipment. Personnel and equipment for pioneer parties are based on an estimate of the road work that will be required. Each vehicle in the military service should carry some pioneer tools and equipment to assist in crossing difficult terrain. These will vary according to Tables of Basic Allowances. In general, the allowances will permit the following equipment per vehicle: 1 pick 1 shovel 1 tow chain or cable 1 prolonge 1 axe 1 bucket 1 set skid chains 1 set wheel lugs, improvised grouser ropes, or other traction device One or more vehicles in a march unit should carry additional equipment for the pioneer party. This equipment is usually carried on the trouble trucks of organizations not equipped with transportation for this purpose. The following will serve as a guide for loading a pioneer truck: 1 winch with 300 feet of cable (or equivalent block and tackle if winch is not available) 2 towing bars 2 shovels 1 pick 2 axes 1 sledge MILITARY MEDICAL MANUAL CARE AND OPERATION OF MOTOR VEHICLES 333 2 heavy iron stakes or crowbars (about 4 feet) 1 rectangular log block (suitable for dcadman, or wheel block) having two chains attached, long enough to fasten to tow hooks or body frame so that it cannot be rolled over when used to block wheels 300 feet 12-gage wire 1 saw, crosscut, 2-man 2 tow chains (about 15 feet) 1 block and tackle (with 300 feet 1-inch rope) 4 wheel mats, rope or canvas 2 prolonges 2 I-beams large enough to be used as stringers across an 8-foot span, or enough planks or other bridging materials for the same purpose 1 %-inch or larger cable 300 feet long 500 pounds decontaminating material 1 apparatus, demustardizing Duties. The principal operations performed by a pioneer party are as follows: Large obstacles such as rocks, logs, stumps, trees, and holes which cannot be detoured are eliminated. Soft surfaces such as sand, marshes, or loose soil are strengthened by covering with logs, planks, brush, rocks, wheel mats, cornstalks, hay, or like materials. Sand may be covered with chicken netting or tar paper. Ice-covered winter roads are covered with sand or dirt. Ravines and ditches are made passable by breaking down steep banks sufficiently so that running boards, lower parts of the chassis, overhanging front or rear portion of the body, or the spade of a towed gun trail will not hang on the banks. When wet, the bottoms of ditches are strengthened to withstand the wheel impact and spin of heavy vehicles. Logs, rocks, brush, sacks of dirt, etc., are used to fill in; planks or logs are used to bridge across. These materials are secured so that they cannot be displaced. Shallow stream crossings with good approaches and solid bottoms are chosen. Steep approaches are cleared straight down so that there will be no danger of side slipping. Traction is increased where banks are soft or slippery. If this cannot be done sufficiently with brush, hay, etc., ramps may be built with poles. Loose dirt is never added on slippery approaches, in holes, or on steep ascents, because it reduces traction. Rocky creek bottoms are checked carefully against dangerous obstructions. If there are holes or if the bottom is soft, rocks, brush in fascines, or logs are used to fill in and increase flotation. On steep ascents or descents or where a deep crossing is required tackle is placed in position. Bridges which are found to be weak are usually strengthened by the addition of a bent, a single support, or stringers. Where there is danger of loads breaking through the flooring, additional planks are laid along the wheel tracks to distribute the load. Joints are staggered and planks are nailed down. Wheel guides of heavy timbers, ties, or poles are secured near the safe edge of the bridge to prevent vehicles from running off. (Plate 47.) Rafts are usually built for crossing navigable waters where bridges, engineer equip- ment, or commercial ferries are not available. Simple rafts large enough to ferry trucks and their towed loads can be built from boats, oil drums, logs, and timbers. Twenty-five 50-gallon drums floated between the cross timbers of a platform will give a capacity of about 10,000 pounds. The outside or end drums may best be lashed to the platform. Care must be taken that the drums are sealed. In crossing a flowing stream a raft may best be utilized as either a trail or flying ferry. In the first method the raft is attached so it will slide long a cable which is run across the river and fastened to either bank. In streams where the current is faster the raft is attached to a long cable which is anchored upstream. In either method ropes are attached from both shores to pull the ferry back and forth. 334 MILITARY MEDICAL MANUAL Barbed-wire entanglements are cut out and towed away by means of a smooth wire or chain passed around them. In an emergency a truck can go through entangle- ments under 4 feet high with a fairly good chance of success but with some damage. Sections of road and bridges which have been sprayed with persistent chemical agents are decontaminated. Where decontamination is not immediately practicable, detours are selected. Figure 1. Bent. Figure 2. Single Support. Plate 47. Reinforcing Bridges. Route Marking. Proper route marking, especially if the infiltration type of march is employed, is important. Even though the primary highway signs, flags, and luminous markers have their proper uses, a certain amount of personnel is usually necessary for marking the route. The detail should be carefully organized and instructed. Traffic Control. To provide for such contingencies as bombing of bridges, artillery CARE AND OPERATION OF MOTOR VEHICLES 335 fire, and changes in orders, all of which necessitate rapid rerouting, a series of control points interconnected by communication may be necessary. Under other circumstances, traffic personnel such as military police and motorcycle messengers may be required to supplement the route marking detail. Reinforcing stringer added rn Rotted stringer Figure 3. Added Stringer. Wheel guard Reinforcing planks joints staggered Figure 4. Additional Planking and Wheel Guards. Plate 47. Reinforcing Bridges—Continued. Quartering Party. The early dispatch of a quartering party is important. Its mission is to lay out the bivouac or assembly areas at the march destination and to guide units as they arrive at a selected release point to these exact areas. It also prepares a plan for suitable disposal of available antitank weapons for the antitank defense of the area, as well as similar provisions for the antitaircraft defense. Suitable personnel for this party usually include an assistant S-3 and one other officer from the battalion staff, an agent or guide from each company or battery, and the necessary enlisted men, drivers, and mechanics. In moves of a division, regimental representatives only will be required. Command and Communication. The exercise of command over a long, fast-moving motor column is difficult compared to that of columns composed of foot elements and animals. The sudden attacks to which it is subject and the destruction of bridges and 336 MILITARY MEDICAL MANUAL roads all combine to make reliable communication agencies a necessity. When the tactical situation prohibits the use of radio, airplanes and motor messengers must be depended upon for transmission of orders. When the use of radio is permissible, pro- vision should be made to make full advantage of it. A chain of control points connected by radio or commercial telephone or telegraph is often a necessity, particularly when infiltration moves are in progress. Traffic per- sonnel may also be employed to assist in communication. Two command echelons should be organized. The forward echelon should consist of the column commander, part of his headquarters personnel, and representatives from each battalion or similar unit. In moves of a division, regimental representatives only would be required. The commander with his echelon is free to move where he chooses. Because of the length of the column, it is usually impossible for him to make passages of the column, and his echelon will usually be found near the head of the column. In certain situations he may move directly to the new assembly area. It is important that he be far enough to the front to render decisions as the situation requires. The second echelon will consist of the executive officer, the remainder of the headquarters staff not elsewhere employed, and representatives from each subordinate unit. The second echelon, in case of marches of the infiltration type, will at first supervise the dispatch of vehicles and later patrol a sufficient part of the route or routes to insure proper movement of vehicles. In movement of a column or columns the executive or his representatives will ride in control cars at the heads of columns, directing the speed and routes to be followed. This group is also responsible that the time the control car passes markers or prominent landmarks is made known to march unit commanders every 15 to 20 minutes, either by use of radio, time blackboards, or an- nouncement by the marker by voice. Their other duties are to take charge of the arrangements for any unforeseen detouring, to take necessary action in case of mech- anized or aircraft attack, to superintend the halting and refueling of the columns, and to enforce march discipline. Evacuation of Bivouac Areas and Supervision of the Tail of Columns. The proper supervision of evacuation of bivouac areas and of the rear of moving columns must be delegated to specified officers and men, since the length and speed of columns prevent these functions from being executed by members of the column proper. Clean-up party. Sufficient personnel to inspect bivouac areas and halt sites after they are vacated by the column and to correct and report any deficiencies must be provided. In peacetime where camp sites are leased, it would be the function of the officer with this party to complete the necessary paper work with the property owners. Salvage of disabled vehicles. Another function of this group is the salvage of disabled vehicles. After completing his duties at the bivouac areas, the officer in charge and his detail join the tail of the column or columns just ahead of the motor maintenance section. His duties then are the investigation of accidents en route, and the inspection of damage to roads and bridges in peacetime. Trail officers. The column (serial or march unit) trail officer marches at the rear of the column (or element thereof). His job requires considerable skill and good judg- ment, as well as a thorough knowledge of motor transport technique. For this reason, an experienced motor officer or transport officer is usually selected. Trail officers usually perform the following duties: Dispatch individual vehicles, march units, or serials from the column (serial or march unit) initial point. Report location of tail of column (or element thereof) to their respective control officers when called on to do so. Inspect disabled vehicles and decide whether to abandon them or take them in tow. Note infractions of march discipline, and when necessary take immediate corrective action. Prevent vehicles or other columns from passing from the rear whenever this operation presents a traffic hazard. CARE AND OPERATION OF MOTOR VEHICLES 337 When column halts, post necessary guards, warning flags, caution lights, or flares to warn traffic approaching from the rear. The column trail officer picks up and, as soon as practicable, returns to the head of the column all guides and markers distributed by preceding elements of the column. Escorts. Air and ground escorts to guard against air and mehanized attacks are pro- vided for in the original plan. In the plans for antimechanized defense it may become necessary to reorganize all units present which are capable of antitank defense by splitting them up and inserting sections in column intervals. Daily Time Schedule. In day to day operation of a motor convoy, the following may be considered as a reasonable guide and schedule: Preparation for starting (includes reveille, breakfast, breaking camp, police of area) and vehicle inspection 1 hour. Operating or running time (includes all halts, except noon meals) 8 hours. Refueling and servicing vehicles and noon meal 1 hour. At destination; inspecting and servicing vehicles, making camp, and supper . .2 hours. MARCH GRAPH No doylight movement ond no lights on vehicles*?^ "Time interval ollowed to reduce chance of conflict between serials Head of column. Toil of column - TIME LENGTH 1st FA 193 motor vehicles ot 600 pet hour (Par. 74 b) = 19.3 or 20 minutes 3d FA 237 motor vehicles = 23.7 or 25 minutes Distance in miles Dork 6:50 PM - Rood spoce Indicates remark in March Order l—Time length i Plate 48. March Graph. It is. noted that motor personnel operating convoys on a day to day basis must have about 4 hours for starting, for meals and refueling, for inspection and servicing, and for settling at the new camp sit or bivouac. Loading and unloading time for cargo is not included. March Graph. To avoid physical fatigue of operating personnel with all the harmful effects that may arise, such as traffic congestion, accidents, lack of alertness, vehicle damages, troops not being in condition, etc., it is advisable to plan the daily operating schedule so as to avoid unduly long hours of operations. A march graph (Plate 48) should be prepared for any day’s run, showing daily estimated mileage and probable 338 MILITARY MEDICAL MANUAL operating time. This graph, when used also to plot actual mileage and operating time, furnishes an instantaneous comparison of actual mileage and running time with original estimates. Halts. Halts en route are usually made to provide for physical relief of personnel, for a check of gasoline, oil, and water of vehicles, and for making such mechanical ad- justments or corrections as may be advisable. Usually these road halts are made for about 15 minutes after the first hour from initial point (or point of origin) and for about 10 minutes every two hours thereafter. Selection of the places for halting must consider availability of wooded or sheltered areas, avoiding stops or grades, turns, and curves, possibility of enemy action, and con- dition of troops. CHAPTER XII MILITARY COURTESY AND DISCIPLINE DISCIPLINE General, a. Military discipline is intelligent, willing, and cheerful obedience to the will of the leader. Its basis rests on the voluntary subordination of the individual to the welfare of the group. Discipline is the cohesive force that binds the members of a unit, and its strict enforce- ment is a benefit for all. Its constraint must be felt not so much in the fear of punish- ment which it evokes as in the moral obligation it imposes on the individual to heed the common interest of the group. (Par. 106, FM 100-5). b. Discipline establishes a state of mind which produces proper action and prompt cooperation under all circumstances, regardless of obstacles. It creates in the individual a desire and determination to undertake and accomplish any mission assigned by the leader. c. Acceptance of the authority of a leader does not mean that the individual soldier surrenders all freedom of action or that he has no individual responsibility. The Ameri- can system of discipline calls for active cooperation from the subordinate. d. True military discipline extends far deeper than and beyond mere outward sign. For example, proper dress and smartness of appearance, while desirable and conducive to good discipline, are not alone conclusive proof of true discipline. A more likely indication is the behavior of individuals or units away from the presence or guidance of their superiors. Importance, a. Man is and always will be the vital element in war. As an individual, he is most valuable when he has developed a strong moral fiber, self-respect, self-reliance, self-confidence, and confidence in his comrades. A feeling of unity must be achieved if the group of individuals is to function as a unit instead of a mob. Modern warfare requires self-reliance in every grade; individuals capable of independent thought and action, who are inspired by a distinct feeling that as an individual or as members of a unit they are competent to cope with any condition, situation, or adversary. In spite of the advances in technique, the worth of the individual man is still decisive. His importance has risen due to the open order of combat. Every individual must be trained to exploit a situation with energy and boldness, imbued with the idea that success will depend upon his action. (Par. 102, FM 100-5). b. The ultimate purpose of all military training is effectiveness in battle. Only well- disciplined troops exercising cooperative and coordinated effort can win. Without proper discipline, a group of men is incapable of organized and sustained effort. The dispersion of troops in battle, caused by the influence of modern weapons, makes control more and more difficult. Modern combat, therefore, requires more than ever a strong cohesion within a unit in order to give it a sense of unity. This cohesion is promoted by good leadership, pride in the accomplishments and reputation of the unit, and by mutual confidence and comradeship among its members. (Par. 102, FM 100-5). Attainment, a. Military discipline is attained only by careful and systematic education and training. All types of military training which tend to develop a sense of duty, pride, and responsibility, loyalty, morale, respect, confidence, initiative, and teamwork are beneficial. Such training may be conducted in numerous ways and by many different methods; there is no perfect formula or single rule. No two groups or even two indi- viduals necessarily respond to the same type of training. It is essential to keep in mind that in our country the environment of the soldier may differ materially from that of his previous surroundings. To disregard the civil environment is a serious error. The necessary transition may be a slow, laborious process requiring infinite patience and consideration on the part of the leader. Impossible or unnecessary demands will quickly undermine or even destroy the confidence so necessary in well-disciplined individuals and units. Drills that require accuracy, mental and physical coordination, precision, 340 and smartness assist in attaining discipline. Short, varied exercises in group physical training are valuable. The fundamentals listed below will be helpful as guides in the attainment of the desired aim. b. Good leadership, based on personality and character, is essential to the attainment of military discipline. The key to effective leadership is the development of respect and mutual confidence. It is gained when the leader shows in every possible way that he is a member of the unit, and as the ranking member thereof he will leave nothing undone to promote the unit’s comfort, welfare, and prestige. Similarly, loyalty and respect are developed through mutual understanding and consideration, through fairness and justice, and by sharing dangers and hardships as well as joys and sorrows. A commander must live with his troops, and share their dangers and privations as well as their joys and sorrows. By personal observation and experience he will then be able to judge their needs and combat value. A commander who unnecessarily taxes the endurance of his troops will only penalize himself. * * * * Comradeship among officers and men is to be fostered by every available means. The strong and the capable must encourage and lead the weak and less experienced. On such a foundation, a feeling of true comradeship will become firmly established, and the full combat value of the troops will be made available to the higher commander. (Par. 107, FM 100-5). MILITARY MEDICAL MANUAL GENERAL (SILVER) LT. GENERAL (SILVER) MAJ, GENERAL (SILVER) BRIG. GENERAL (SILVER) COLONEL (SILVER) LT COLONEL (SILYER) MAJOR (GOLD) CAPTAIN (SILVER) lST LIEUTENANT (SILVER) 2D lieutenant (GOLD) Plate 1. Officer’s Insignia of Grade, Army and Marine Corps. A willingness to accept responsibility is the foremost trait of leadership. This willing- ness should not, however, manifest itself in a disregard of orders on the grounds of probably having a better knowledge of the situation than the higher commander. Inde- pendence must not be confused with personal caprice. Officers and men of all grades are expected to exercise a certain independence in the execution of tasks assigned to them and to show initiative in meeting situations as they arise. Every individual from the highest commander to the lowest private must always remember that inaction and neglect of opportunities will warrant more severe censure than an error of judgment in the choice of the means. (Par. 108, FM 100-5). c. A sense of individual pride and responsibility is essential to good discipline. A soldier must be made to realize that all his acts are reflected on the unit to which he belongs. He must aspire to the trust that goes with responsibility. Pride in his organi- MILITARY COURTESY AND DISCIPLINE 341 zation is aroused by making him feel that he has some responsibility in developing it. Leaders must use their ingenuity to create opportunities which place responsibility on individuals appropriate to their training and grade. d. Good morale is conducive to good discipline. It implies contentment and warrants the leader’s closest attention. Suitable living conditions, physical welfare, appetizing food, healthful recreation, and relaxation all contribute to morale. e. Mutual trust is essential for group unity. It stimulates and fosters that unity of purpose and spirit, which under such names as morale, elan, or esprit de corps, is the very heart of a unit’s power. ADMIRAL VICE ADMIRAL REAR ADMIRAL CAPTAIN COMMANDER LIEUT. COMMANDER LIEUTENANT LIEUTENANT JUNIOR GRADE ENSIGN Plate 2. Sleeve Ornamentation, Naval Officers. Star Denotes Line Officer. Troops are strongly influenced by the example and conduct of their commissioned and noncommissioned leaders. Will power, self-confidence, initiative and disregard of self will enable a leader to master the most difficult situation. A bold and determined leader will carry his troops with him no matter how difficult the enterprise. Mutual confidence between the leader and his men is the surest basis of discipline in an emergency. To gain this confidence, the leader must find the way to the hearts of his men. This he will do by acquiring an understanding of their thoughts and feelings, and by showing a constant concern for their comfort and welfare. (Par. 104, FM 100-3). Maintenance, a. Discipline is maintained in much the same manner as it is attained. There is not and should not be a sharply defined line of demai cation between the two. For example, common sense, good judgment, fairness and justice, high morale, pride, and responsibility contribute as much to maintaining discipline as to attaining it. 342 MILITARY MEDICAL MANUAL b. Self-respect must be maintained at all costs. Corrections are made privately when- ever practicable and are never personal or degrading in nature. c. Commendation for duty well performed is equally as important as admonition, reprimand, or other corrective measures for delinquencies. d. Young and inexperienced leaders must realize that while firmness is a military requisite, it does not necessitate harshness of manner or of tone. Relationship Between Superiors and Subordinates, a. A leader sets the example for his men to emulate. To accomplish this, he exhibits cheerfulness, loyalty to subordinates as well as to superiors, strict observance of military regulations, customs, and courtesies, neatness and smartness of appearance, and punctuality. Through loyalty to his sub- ordinates, he will gain their confidence and trust and will make them feel that he demands no more of them than he is willing to do himself. The superior will do much toward creating and maintaining the proper relationship with his subordinates by conducting REAR ADMIRAL CAPTAIN COMMANDER LIEUT. COMMANDER LIEUTENANT LIEUTENANT (J. G.) ENSIGN Plate 3. Sleeve Ornamentation, Coast Guard Officers. himself with such dignity and demeanor that his position in the unit is unquestioned. Excessive familiarity between them is avoided. On the other hand, aloofness must be avoided since it will discourage mutual confidence and close relationship between leader and subordinate. The combat value of a unit is determined by the soldierly qualities of its leader and members and its “will to fight.” An outward mark of this combat value will be found in the set-up and appearance of the men, in the condition, care, and maintenance of their weapons and equipment, and in the readiness of the unit for action. Superior combat value will offset numerical inferiority. The greater the combat value of the troops, the more powerful will be the blow struck by the commander. Superior leadership MILITARY COURTESY AND DISCIPLINE 343 combined with superior combat value of troops, constitutes a reliable basis for success in battle. (Par. 105, FM 100-5). b. Superiors are forbidden to injure those under their authority by tyrannical or capricious conduct or by abusive language. They habitually employ an ordinary con- versational manner and tone of voice in addressing subordinates. Firmness and dignity are essential, but an officious, discourteous manner is harmful to the end sought. Arrogance will breed contempt, sap morale, and destroy discipline. COURTESY General, a. Courtesy implies polite and considerate behavior toward others, whether senior or junior, and whether or not members of the military service. b. In general, juniors habitually give the same precedence to and show the same deference toward their seniors that any courteous person does to his elders. These courtesies should be shown promptly and smartly. Slovenly and half-hearted execution of these acts is in itself discourteous. Plate 4. Hand Salute. The Army Regulations say: “Courtesy among military men is indispensable to discip- line,” Courtesy is hardly less important in civil life. We cannot enjoy friendships nor have loyal subordinates in any walk of life unless we treat other people with courtesy. Courtesy must be second nature to the soldier, and it should be second nature, that is an almost unconscious habit, to everyone. Courtesy pay? the largest returns for the least effort, of anything one can do. Courtesy in civil life is nothing more than the habit of being gentlemanly, thoughtful, kindly and considerate towards others. It has certain forms: such as saying “Good morning,” shaking hands, raising the hat to ladies, etc. In the military service the expressions of courtesy are more formal and precise than in civil life The most important of them is the military salute. Definitions, a. Structures such as drill halls, riding halls, gymnasiums, and other roofed inclosures used for drill or exercise of troops are considered as “out of doors.” b. When the word “indoors” is used, it is construed to mean offices, hallways, mess halls, kitchens, orderly rooms, amusement rooms, bathrooms, libraries, dwellings, or other place of abode. c. The expression “under arms” will be understood to mean— (1) With arms in hand, or (2) Having attached to the person a hand arm or the equipment pertaining directly to the arm, such as cartridge belt, pistol holster, or automatic rifle belt. Exception: Officers wearing the officers belt, Ml921, without arms attached. Saluting, a. The salute fulfils two functions; to render respect, and to serve as the act of recognition between military personnel. An individual is required to salute when 344 MILITARY MEDICAL MANUAL he meets a person entitled to the salute. Those entitled to the salute are commissioned officers of the Army, Navy, Marine Corps, and Coast Guard. It is also customary to salute officers of friendly foreign countries when they are in uniform. The formal salute has been the symbol and sign of the military profession since the dawn of history, and, in some form, was probably practiced before that time. The salute is not a mark of subordination, but its omission is a mark of insubordination and lack of courtesy or a bad state of discipline. It is the equivalent of the “Good morning” of civil life. Regulations require that the salute be rendered by both parties. Naturally the junior should salute first. Figure 1. In uniform, with hat or cap, armed with pistol. Figure 2. In uniform, with hat or cap, without arms. Figure 3. In uniform, with hat or cap, armed with rifle. Figure 4. In uniform with hat or cap removed. Figure 5. In civilian clothes with headdress. Figure 6. In civilian clothes without headdress. Plate 5. Salutes. b. Saluting distance is that distance at which recognition is easy. Usually it does not exceed 30 paces. The salute is rendered before the person to be saluted approaches closer than 6 paces. This permits him time to recognize and return the salute. c. In executing the salute, the head is turned so as to observe the person saluted. Salute with the hand. (1) The commands are: 1. Hand, 2. SALUTE. At the com- mand Salute, raise the right hand smartly until the tip of the forefinger touches the lower part of the headdress or forehead above, and slightly to the right of the right eye, thumb and fingers extended and joined, palm to the left, upper arm horizontal, forearm inclined MILITARY COURTESY AND DISCIPLINE 345 at 45°, hand and wrist straight; at the same time turn the head and eyes toward the person saluted. (TWO) Drop the arm to its normal position by the side in one motion, at the same time turning the head and eyes to the front. (2) Execute the first position of the hand salute when six paces from the person saluted, or at the nearest point of approach, if more than six paces. Hold the first position until the person saluted has passed or the salute is returned. Then execute the second movement of the hand salute. (Par. 20, FM 22-5). Plate 6. Officer in Civilian Clothes, Soldier in Uniform With Hat or Cap and Without Arms (Or Armed With the Pistol). Plate 7. Soldier in Civilian Clothes, Officer in Uniform. A salute is returned by all officers present entitled to it unless they are in a formation, when the senior only returns the salute except as noted in p below. Subparagraph p refers to a case where an officer is talking to a sentinel—if the officer salutes a senior officer, the sentinel will also salute. The salute must never be returned in a casual or perfunctory manner. d. The custom and requirement of an exchange of salutes between officers and en- listed men when outside the confines of a military post, camp, or station, has been reinstated. (Circular No. 50, War Department, February 20, 1942.) 346 MILITARY MEDICAL MANUAL e. Covered or uncovered, salutes are exchanged in the same manner. /. The salute is rendered but once if the senior remains in the immediate vicinity and no conversation takes place. If a conversation takes places, the junior again salutes the senior on departing or when the senior leaves. g. Usually the junior salutes first. However, in making reports, the person render- ing the report salutes first, regardless of rank. An example of this is the case of a bat- talion commander rendering a report to the adjutant at a ceremony. h. A group of enlisted men within the confines of military posts, camps, or stations and not in formation, on the approach of an officer, is called to attention by the first person noticing him; if in formation, by the one in charge. If out of doors, and not in formation, they all salute; in formation, the salute is rendered by the enlisted man in charge. (Plates 9 and 10). If indoors, not under arms, they uncover. If outside the limits of military posts, camps, or stations, the salute is authorized but not required unless the group or an individual thereof is addressed by an officer. (See o below.) i. The salute is rendered only at a halt or a walk. If a person is running, he comes down to the walk before saluting. Likewise a mounted person at the trot or gallop comes down to the walk before saluting. (Plate 11) When reporting to an officer in his office, a junior (unless under arms) removes his headdress, knocks, and enters when told to do so. Upon entering, he marches up to within about 2 paces of the officer’s desk, halts, salutes, and says, “Sir, reports to ,” (using names and grades). Plate 8. Both Officer and Soldier in Civilian Dress. For example, “Sir, Private Jones reports to Captain Smith” or “Sir, Private Jones reports to the battery commander.” Conversation after the report is made is carried on in the first person and second person. When the business is completed, the junior salutes, executes about face, and withdraws. One uncovers (unless under arms) on entering a room where a senior is present. If the junior reports under arms he does not take off his hat or cap; and he executes the prescribed salute. (Figures 1 and 3, Plate 5.) Drivers of vehicles salute only when the vehicle is halted. The driver of a horse- drawn vehicle will salute only when halted and both hands are not required to control his team. (Plate 14.) Any other individual in the vehicle renders the hand salute whether the vehicle is halted or in motion. An officer or a noncommissioned officer in charge of a detail riding in a vehicle renders the hand salute for the entire detail. (Plates 13 and 15.) The intent of the two sentences above is that, if a vehicle (horse or motor) is oc- cupied by persons not riding in the vehicle as a detail, or as part of the formation, all of the individuals will salute. MILITARY COURTESY AND DISCIPLINE 347 If the vehicle is occupied by a detail or part of an organization the individual in charge will, if he is in the body of the vehicle, rise and salute; if he is sitting in the front seat with the driver and it is impracticable because of the construction of the vehicle to rise, he will salute seated. The other members of the detail will not salute. Plate 9. Detachment (Not at Ceremony) Armed With Rifle, Plate 10. Detachment (Not at Ceremony) Armed With Pistol. /. Except as noted in paragraph g (below), whenever or wherever the National Anthem* is played or To the color (standard) is sounded, at the first note thereof all dismounted officers and enlisted men present but not in formation will face the music, stand at Attention, and render the prescribed salute, except that at Escort of the color (standard) • Note.—The “Star Spangled Banner" written September 14, 1814, during the “War of 1812“ by Francis Scott Key, poet, lawyer and author. 1a designated by Act of Congress dated March S, 1931. as the National Anthem. It should be played as written without flourishes or repetitions. It should not be played as part of a medley. 348 MILITARY MEDICAL MANUAL or at Retreat they will face toward the color (standard) or flag. The position of salute will be retained until the last note of the music is sounded. Those mounted on animals will halt and render the salute mounted. (Plate 11.) Vehicles in motion will be brought to a halt. Persons riding in a passenger car or on a motorcycle will dismount and salute as directed above. Plate 11. Mounted (At a Halt or Walk). Occupants of other types of military vehicles remain seated in the vehicle at attention, the person in charge of the vehicle dismounting and rendering the hand salute. For example: the person in charge of each vehicle in a convoy (private, noncom- missioned officer or officer) will dismount and salute. It is not sufficient for the officer in charge of the entire convoy to salute. The one exception to this general provision is that tank commanders salute from the turret of the tank or combat car. Plate 12. Officer Reporting to a Senior Officer, or Soldier to an Officer in an Office. MILITARY COURTESY AND DISCIPLINE 349 Individuals leading animals or standing to horse will stand at attention but will not salute. The same remarks of respect are shown the national anthem of any other country when played upon official occasions. Plate 13. Moving Vehicle, Driver Does Not Salute. m. When passing or being passed by an uncased national color (standard), honors are rendered in the same manner as when the National Anthem is played. n. When personal honors are rendered, officers and men present in uniform (not in formation) salute and remain in that position until the completion of the ruffles, flourishes, and march. In formation the detail, detachment or organization is brought to attention by the com- mander who then executes the prescribed salute (Plates 9 and 10). o. Organization or detachment commanders salute officers of higher grades by bringing the organization or detachment to attention before saluting. (Plates 9 and 10.) Plate 14. Horse-Drawn Vehicle, Halted, and Driver’s Hands Necessary to Control Team. Individuals in Vehicle (Not Part of a Detail) All Salute. p. In garrison, sentinels posted with the rifle salute by presenting arms. (Plate 16.) Being at order arms. 1. Present, 2. ARMS. At the command Arms, with the right hand carry the rifle in front of the center of the body, barrel to the rear and vertical, grasp it with the left hand at the balance, forearm horizontal and resting against the body. (TWO) Grasp the small of the stock with the right hand. (Par. 41, FM 22-5.) During the hours when challenging is prescribed, the first salute is given as soon as the officer has been duly recognized and advanced. A sentinel in conversation with an officer will not interrupt the conversation to salute another officer, but in case the officer salutes a senior, the sentinel will also salute. 350 MILITARY MEDICAL MANUAL q. At a military funeral, all persons in the military service in uniform or in civilian clothes, attending in their individual capacity, will stand at attention uncovered and hold the headdress over the left breast at any time when the casket is being moved by the casket bearers and during services at the grave, including the firing of volleys and the sounding of Taps. (Plate 17.) During the prayers, they will also bow their heads. In cold or inclement weather, they will remain covered and execute the hand salute Plate 15. Officer or Noncommissioned Officer in Charge of Detail, Rises and Renders Hand Salute. at any time when the casket is being moved by the casket bearers and during the firing of volleys and sounding of Taps. To raise pistol. The commands are: 1. Raise, 2. PISTOL. At the command Pistol, unbutton the flap of the holster with the right hand and grasp the stock, back of the hand Plate 16. Sentinel, Armed With Rifle, Saluting When Anthem is Played or “To the Color (Standard)” is Sounded. (If Armed With Pistol, See Figure 1, Plate S.) outward. Draw the pistol from the holster; reverse it, muzzle up, the thumb and last three fingers holding the stock, the forefinger extended outside the trigger guard, the barrel of the pistol to the rear and inclined to the front at an angle of 30°, the hand as high as, and 6 inches in front of, the point of the right shoulder. This is the position of Raise pistol. Summary The prescribed salute is as follows: In uniform other than as sentinel or as member of detachment or detail (Plate 4; Figures 1, 2 and 3, Plate 5; and Plate 23). Posted as sentinel (Figure 1, Plate 5 and Plate 16). As member of detachment or detail (Plates 9 and 10). MILITARY COURTESY AND DISCIPLINE 351 In civilian dress with headdress (Figures 5 and 6, Plate 5, and Plate 17) In civilian dress with no headdress (Plate 18). Persons on motorcycles (or in passenger cars) (Plate 19). Persons in charge of vehicle (Plate 20). Plate 17. In Civilian Clothes, With Headdress. Plate 18. In Civilian Clothes, With No Headdress. Tank or combat car commanders (Plate 21). Leading or holding horse (Plate 22). When Not to Salute. Salutes are not rendered by individuals in the following cases: Plate 19. Persons on Motorcycles (Or in Passenger Cars) Dismount and Salute. a. An enlisted man in ranks and not at attention comes to attention when addressed by an officer. The officer or noncommissioned officer in command renders or receives the salute for the entire organization on the approach of the one entitled thereto. b. When an officer enters the messroom or mess tent, enlisted men seated at meals remain seated at ease and continue eating unless the officer directs otherwise. Exception: An individual addressed ceases eating and sits at attention until completion of the con- versation. c. Details at work do not salute. The officer or noncommissioned o.fficer in charge, if not actively engaged at the time, salutes or acknowledges salutes for the entire detail. d. When actually engaged at games such as baseball, tennis, or golf, one does not salute. (Plate 27.) 352 MILITARY MEDICAL MANUAL e. In a squad room or tent, individuals rise, uncover (if unarmed), and stand at at- tention when an officer enters. If more than one person is present, the first to perceive Plate 20. Person in Charge of Vehicle Saluting When National Anthem is Played or “To the Color (Standard)” is Sounded. the officer calls, “Attention.” /. When standing to horse or leading a horse, one does not salute. g. In churches, theaters, or other places of public assemblage, or in a public conveyance, salutes are not exchanged. h. When carrying articles with both hands, or when otherwise so occupied as to make saluting impracticable. Plate 21. Tank Commander Saluting From the Vehicle. i. When on the march, in campaign, or under simulated campaign conditions. /. No salute is rendered to persons by a member of the guard who is engaged in the performance of a specific duty, the proper execution of which would prevent saluting. A mounted or dismounted sentinel armed with a pistol does not salute after chal- lenging. He stands at Raise pistol until the challenged party has passed. l. The driver of a vehicle in motion is not required to salute. m. Indoors, salutes are not exchanged except when reporting to a senior. Uncovering. Officers and enlisted men under arms as a general rule do not uncover except when— a. Seated as a member of or in attendance on a court or board. (Sentinels over pris- oners do not uncover.) b. Entering places of divine worship. MILITARY COURTESY AND DISCIPLINE 353 c. Indoors when not on duty and it is desired to remain informally. d. In attendance at an official reception. Plate 22. Stand to Horse. Plate 23. A Soldier (Armed) Saluting the Colors (Standards). Plate 24. A Civilian Saluting the Color (Standard). Personal Courtesies, a. Except in the field under campaign or simulated campaign conditions, a mounted junior always dismounts before speaking to or replying to a dismounted senior. When accompanying a senior, a junior walks or rides on his left. b. Military persons enter automobiles and small boats in inverse order of rank and leave in order of rank; that is, the senior enters an automobile or small boat last and 354 MILITARY MEDICAL MANUAL leaves first. Juniors, although entering the automobile first, take their appropriate seat in the car. The senior is always on the right. Titles, a. The following titles are used in intercourse with officers of the Army: (1) Lieutenants are addressed officially as “Lieutenant.” The adjectives “first” and “second” are not used except in official written communications. Plate 25. Raise Pistol. (2) Other officers are referred to by their titles. In conversation and in non official correspondence, brigadier generals, major generals, lieutenant generals, and generals are referred to and addressed as “General.” Lieutenant colonels, under the same conditions, are referred to and addressed as “Colonel.” Plate 26. Colors (Standards) Cased—Never Saluted. (3) Senior officers frequendy address juniors as “Smith” or “Jones,” but this does not give the junior the privilege of addressing the senior in any other way than by his proper title. (4) Chaplains are addressed as “Chaplain” regardless of their grade. A Catholic chaplain may be addressed as “Father.” b. Cadets of the United States Military Academy are addressed as “Cadet” officially and in written communications. Air Corps cadets are addressed as “Cadet.” c. Warrant officers are addressed as “Mister.” d. Members of the Army Nurse Corps are addressed as “Nurse.” e. Noncommissioned officers are addressed by their titles. Officers address them as MILITARY COURTESY AND DISCIPLINE 355 “Sergeant,” “Corporal,” etc. Officers address privates as “Smith” or “Jones.” Master sergeants, technical sergeants, staff sergeants, etc., are all addressed simply as “Sergeant.” In official communications, the full title of an enlisted man is used. /. In the Navy, officers in both line and staff are addressed officially by their titles. Any officer in command of a ship, whatever its size or class, while exercising such command is addressed as “Captain.” Visits to War Vessels, a. A vessel of war will be approached and boarded by com- missioned officers and visitors in their company by the starboard side and gangway; all other persons will use the port gangway. The commanding officer of the ship may change this rule, if expedient. b. In entering a boat, the junior goes first and other officers follow in order of rank; in leaving a boat, the senior goes first. Plate 27. In Athletic Costume—Stand at “Attention.” c. An officer paying a boarding visit to a vessel of war or transport is met at the gangway by the officer of the deck. d. The salutes to be exchanged upon boarding and leaving a vessel of war arc pre- scribed below and conform to regulations of the United States Navy. All members of the Army visiting a vessel of war will conform. (1) All officers and men, whenever reaching the quarterdeck either from a boat, from a gangway, from the shore, or from another part of the ship, will salute the national ensign. In making this salute, which will be entirely distinct from the salute to the officer of the deck, the person making it will stop at the top of the gangway or upon arriving upon the quarter-deck, face the ensign, and render the salute, after which the officer of the deck will be saluted. In leaving the quarter-deck, the same salute will be rendered in inverse order. The officer of the deck will return both salutes in each case, and shall require that they be properly made. (2) The commanding officer will clearly define the limits of the quarter-deck; it will embrace so much of the main or other appropriate deck as may be necessary for the proper conduct of official and ceremonial functions. When the quarter-deck so designated is forward and at a considerable distance from the ensign, the salute to the ensign prescribed in (1) above will not be rendered by officers and men except when leaving or coming aboard the ship. (3) The salute to the national ensign to be made by officers and enlisted men with no arms in hand will be the hand salute, the headdress not to be removed. e. All officers in the party salute the ensign, but only the senior renders or returns the salutes, other than that to the ensign, given at the gangway of a naval vessel. (See AR 605-125). CHAPTER XIII CUSTOMS OF THE SERVICE Titles, a. Army of the United States. A certain amount of familiarity is necessary between senior and juniors in social intercourse, but young officers should be exceedingly careful to show proper respect to their seniors at all times. Officers of the same grade, except when there is considerable difference in age and dates of commission, generally address one another by their last names. (Par. 2, Appendix, FM 21-50). b. Navy captains. In speaking to or introducing captains of the navy, it is customary to add after the name, “of the Navy,” in order to indicate that the officer belongs to the Navy and not to the Army or the Marine Corps. The reason for this practice is that the grade of captain in the Navy corresponds to the grade of colonel in the Army. (Par. 2, Appendix, FM 21-50). c. Relative ran\ between officers, of the Army and the Navy. General with admiral. Lieutenant general with vice admiral. Major general with rear admiral. Brigadier general (no corresponding grade). Colonel with captain. Lieutenant colonel with commander. Major with lieutenant commander Captain with lieutenant. First lieutenant with lieutenant (junior grade). Second lieutenant with ensign. (Par. 2, Appendix, FM 21-50). Calls of Courtesy, a. General. The interchange of visits of courtesy between officers is of great importance, and the well-established customs of the Army in this respect will be scrupulously observed. Failure to pay the civilities customary in official and polite society is to the prejudice of the best interests of the Service. ' Calls are made at a time convenient to the officer upon whom the call is to be made. As calling customs vary somewhat at different posts, camps, and stations, it is wise to ascertain local practices from the adjutant. It is customary for officers to call on a new arrival as soon as he is situated so that callers can be received comfortably and without em- barrassment. If the newcomer is married and his family is present, ladies call with their husbands. b. Formal. Formal calls are those made in the discharge of an obligation. A formal call ordinarily should not exceed 15 minutes’ duration. An officer should be exceedingly punctilious about formal calls. Calls should ordinarily be returned within 10 days. An officer arriving at a post whether for duty or for a visit longer than 24 hours, will call on the post commander at his office and at his quarters unless directed otherwise by the adjutant. He ascertains from the adjutant what other calls are customary, when they should be made, and complies therewith. If unable to wear uniform, an explanation is made for appearing in civilian clothes. The official visits to the post and intermediate commanders should be repeated at their residences during proper calling hours within 24 hours after arrival. If the commander is married and his wife is present on the post, it is customary for the officer making the visit at the residence to be accompanied by his wife. These calls are formal and ordinarily should last no longer than 15 minutes. It is normally not necessary for the new arrival to make other calls until the officers of the battalion, regiment, or garrison have called on him. An officer who is assigned or attached to a place and who is about to depart perma- nendy therefrom makes a parting visit to his immediate commanding officer and lo 358 MILITARY MEDICAL MANUAL the commander of the post, camp, or station. (Sec AR 605-125.) c. Calling hours. Inquiry should be made of the adjutant as to the normal calling hours in effect at the post, camp, or station concerned. Evening calls are usually made between 7:30 and 9:00 p.m. d. Dress when calling. Proper uniform or civilian dress is worn. (See AR 600-35 and 600-40.) e. Calling cards. Leave cards when making formal calls. A man should leave one card for each adult member of the household, including guests. Ladies leave one card for each adult lady of the household. More than three of any one card should never be left, however, regardless of the number of people being called upon. (Par. 3, Appendix, FM 21-50). Messes. In garrison, the officers’ mess is important as a meeting place of bachelor officers, and customs of the service have laid down strict rules regarding it. These rules vary at different posts and in different messes. However, in general, an officer never attends a meal unless he is properly dressed. The senior officer at the table is the president of the mess and receives due consideration as such. Similarly, this may apply to the senior officer at any table in the mess. Usually the evening weekday meal and the Sunday midday meal are formal. At these meals, it is customary in some messes to await the arrival of the senior officer before being seated. Normally, no one leaves the table until the senior officer present has finished his meal or otherwise excuses them. Exceptionally, when departure is necessary, the officer requests to be excused. If a member of the mess arrives late, he expresses his regrets to the president of the mess before taking seat. Social Functions. It is customary for all officers to attend garrison social functions and to make them pleasant affairs. Procedure is similar to that at like civilian functions. Officers of all grades make a point of presenting themselves to seniors, especially to their commanding officers and their families. Visitors must not be neglected. They must be considered as guests of the assembled group. All officers must be solicitous for their entertainment and well-being. Official subjects are avoided at these functions. General Rules. Distinguished visitors, either military or civilian, are generally hon- ored by appropriate receptions, either by the commander or by the officers of the garrison. Although such gatherings are primarily social, nevertheless they have an official aspect. Attendance is regarded as obligatory and absence therefrom should occur only for those reasons which necessitate absence from a military formation. When the commanding officer says, “I desire,” or “I wish,” rather than, “I direct you to do so-and-so,” this wish or desire has all the authority of an order. Custom demands that officers be meticulous about their personal appearance and especially so when in uniform. Their behavior at all times must reflect only credit on the military service. (Par. 6, Appendix, FM 21-50). Avoid the impolite practice of approaching a senior officer, whom you know or remember well, expecting him to remember your name and where he has known you before. When you speak to an officer, introduce yourself by name and refresh his memory regarding where he has known you. The same rule applies when approaching members of a receiving line. An officer should wear proper civilian clothing on those occasions which permit or require it to be worn. Explanations are made only when called for. Courtesy should be habitual. Courtesy to subordinates is equally as important as courtesy to superiors. Conversation between military personnel is conducted in the first and second person except when making an official report. Punctuality should be a habit. (Par. 6, Appendix, FM. 21-50). Miscellaneous. Because of the unfavorable comment which may arise as a result thereof, officers of the Army are prohibited from using, or permitting to be used, their military title in connection with commercial enterprises of any kind. Personnel of the Army are prohibited from soliciting contributions for gifts or pres- ents to those in a superior official position. Likewise no persons will accept “any gift or present offered or presented to them as a contribution from persons in Govern- Vertically Against a Wall., Prom a Horizontal Staff. At Half Stuff. With Another Flag on a Halyard. Plate L Proper Use and Display of Flag. Acroas a Street. On a Casket. Apt*I net a Wull with Another Flag. Horlaontally Against a Wall. How to Fold the Fla*. 360 MILITARY MEDICAL MANUAL ment employ receiving a less salary than themselves.” (See AR 600-10.) (Par. 7, Appendix, FM 21-50). Display of Flag. (See “Standards and Guidons.”) While there is no law or regulation on the subject, the following procedure should be observed in displaying the national flag: a. When not flown from a staff, the flag should always be suspended flat, whether indoors or out. b. When used on a rostrum, the flag should be displayed above and behind the speaker’s stand. c. The flag should never be used as a drape for a platform, desk, chair, or bench. For such purpose, and for general decoration, bunting of the national colors should be used. For correct use of the flag under various circumstances, see Plate 1. The Flag of the United States, a. Our flag is the visible symbol of our nation, and as such is held sacred by all loyal citizens. b. In the service the flag is designated also as “color,” “standard” or “ensign” according to its use. A color is a flag carried by dismounted troops; a standard is carried by mounted or motorized troops; an ensign is a flag flown on a ship or boat. The flag has 7 red and 6 white stripes, representing the original 13 states, and a union of white stars on a blue field, one star for each state now in the Union. Colors and standards are trimmed with a knotted fringe, with a cord and tassels on the staff or pike. The following customs for display of the flag are in further explanation. (Plate 1) When on a staff or pole the inner upper corner of the union is at the peak of the staff, with the stripes perpendicular to the staff. The edge attached to the staff is called the heraldic dexter or right edge. (2) When carried with another flag or flags the national emblem is always on the right. (Plate 23, Chapter XIII.) (3) When a number of flags are grouped and displayed from staffs the national emblem should be in the center or at the highest point of the group. (4) When hung either horizontally or vertically on a wall the union should be up and to the flag’s right (the observer’s left.) (5) When displayed across a street the flag is hung vertically, with its right edge secured to a cable stretched at right angles across the street. The union should be up and to the north in an east or west street or to the east in a north or south street, and the flag should be at such a height that it is well clear of all traffic in the street. (6) When displayed on the same staff or pole with another flag or flags the national emblem is always placed at the peak (top) of the staff. In time of peace the flag of one nation may not be displayed above that of another. If two national emblems are displayed together they should be on separate staffs and at the same level. (7) On occasions of mourning the flag may be flown at half-mast or half-staff. It is first raised to the peak and then lowered to half-staff position. Upon being taken down it is first raised to the peak and then lowered to the ground. (8) The national emblem may be used to cover the casket at a military funeral. It is placed with the union at the head and over the left shoulder of the deceased. It is not lowered into the grave. (9) Colors and standards, when not on display or during inclement weather, remain on their staffs and are covered with a waterproof case. When stowed away for the night, or at any time when not on display, a flag is folded as described in AR 260-10. (10) The national emblem is never dipped in salute. Regimental colors and standards are dipped in salute by lowering the staff to an inclination of about 45 degrees. (11) The flag is always displayed flat. It should not be looped or festooned. It should not be used to drape or cover anything (except a casket), nor should anything be placed on or above it. For such decoration red, white and blue bunting may be used with the blue uppermost. (12) The flag is never allowed to touch the ground. (13) No lettering is ever placed upon the flag. It should not be used for advertising nor decorative purposes, such as part of a costume, at the head of a letter, embroidered upon a cushion, etc. CHAPTER XIV BALLISTICS AND PROJECTILES Introduction. The purpose of this chapter is to present a digest of many of the essentials of ballistics, projectiles, and the effects of fires in producing casualties. The medical officer needs an understanding of the nature of the machines which cause injuries in order that he may provide for their proper treatment. He requires an understanding of the characteristics of the fires delivered by the many weapons in use in order that he may protect his own personnel and the wounded from unnecessary exposure which might result in additional casualties. Ballistics. Ballistics is the science which treats of the flight of projectiles discharged from firearms. Interior ballistics deals with the flight of the projectile within the barrel of the weapon from the starting point until it leaves the muzzle. A projectile reaches its maximum initial velocity (muzzle velocity) just beyond the muzzle. Exterior ballistics deals with the flight of the projectile from the muzzle of the gun to its striking point. As soon as the powder charge of the propellant is ignited, gas is given of! and the Plate 1. Trajectory for 1000 Yards, Model 1906 Ammunition. Ficure 1. —Trajectory diagram for the cartridge, ball, caliber .30, M190G (vertical scale is 20 times the horizontal scale). Figi'Re 2.-Trajectory diagram for the cartridge, ball, caliber .30, Ml (vertical scale is 20 times horizontal scale). Plate 2. Trajectory Diagrams. 362 MILITARY MEDICAL MANUAL Area defiladed from flat trajectory fire ■ Trench mortar Plate 3. Trajectories of Guns, Howitzers, and Mortars. 3” fielder) Mortar Howitzer Field howitzer li§hpower gun High power gun lAnti air- poft^un chamber pressure increases enormously. The force of this gas drives the projectile through the barrel. The interior of the barrel contains “rifling” (spiral lands and grooves), the interior diameter being somewhat less than the maximum diameter of the projectile. When the pressure in the chamber is high enough to overcome the shearing resistance of the copper rotating band, in the case of artillery ammunition, or of the relatively soft metal of a rifle bullet, the projectile moves forward, scaling the bore to retain the force of the expanding gases and engraving the rifling upon the rotating band or the projectile itself. Thus the expanding gases impart the forward motion, and the rifling imparts a spin to the projectile; these factors prevent tumbling and hold the projectile true in flight. At the time the projectile leaves the muzzle, that is to say, when the projectile enters the field of exterior ballistics, it is acted upon at once by the torce of gravity and the effects of air resistance. The effect of gravity is to curve the projectile downward, to retard its flight during the upward movement, and to accelerate it during the descent. The effect of air resistance is material and complicated. For the immediate purpose of this discussion, a wind from the side will deflect the bullet in its trajectory; further, the reaction of the air sets up a drag incident to the creation of a vacuum at the base of the projectile while in flight. Improvements in the design of projectiles, as in the Ml or “boattail” rifle ammuni- tion, reduce the extent of this drag which causes material changes in the characteristics of the fire with respect to the range, which is increased, and the maximum ordinate while in flight, which is reduced. Trajectory. The trajectory is the curved path followed by the bullet in its flight through the air. Because of its great speed the trajectory of rifle or machine-gun fire at short ranges is nearly flat, the bullet flying in almost a straight line from the muzzle of the gun to the target. The height of the trajectory increases and rises above the line of aim as the range increases. Plate 1 shows the trajectory of a rifle bullet for a range of 1000 yards; it will be noted that the projectile rises to a height of only 14 feet above the line of aim. Trajectory diagrams for the rifle and other weapons are further illustrated in Plates 2 and 3. The vertical height of the trajectory above the horizontal plane, at any point, is known as the ordinate, and the greatest height at the summit of the trajectory is called the maximum ordinate. Danger Space. Since the trajectory of a rifle bullet for a range of 750 yards does not rise above the height of a man standing (68 inches), it follows that on level or uniformly sloping ground all the space between gun and target is endangered. Thus, the danger space for ranges up to 750 yards is continuous. (See Figure 1, Plate 4.) For ranges of 800 yards or more the bullet does rise above the height of a man. For such ranges the danger space consists of two parts; first, the space from the rifle to the point at which the bullet rises above the height of a man; and second, the space from the point where it again falls within the height of a man to the target. (See Figure 2, Plate 4) This characteristic of the tra- jectory enables machine guns to deliver supporting fires (overhead fire) in support of troops in the line of fire in advance of the gun positions, within the limits established by safety angles which are prescribed in fire control tables. Dispersion. Experience has shown that bullets fired from a firearm do not follow exactly the same path. (See Plate 5) Due to minute differences in ammunition, aiming, holding, and atmospheric conditions the bullets scatter slightly. This effect is called dispersion, and the trajectories of those bullets form an imaginary cone-shaped figure, with its apex at the muzzle, called the cone of dispersion. This characteristic is applied in firing against hostile aviation since the dispersion compensates for minor errors in aim. Shot Groups. When the cone of dispersion strikes a vertical target it makes a pattern upon it called a vertical shot group. (See Plate 6) The pattern made on a horizontal target or surface is called a horizontal shot group. Hits are not distributed evenly over the entire pattern but are much closer together near the center. Vertical shot groups are oval shaped while horizontal shot groups take the form of a long, narrow ellipse. Beaten Zone. The ground struck by the bullets forming a cone of dispersion is called the beaten zone. Where the ground is level, the beaten zone is also a horizontal shot group. The slope of the ground has great effect on the size and shape of the beaten zone. (See Plates 4 and 7.) BALLISTICS AND PROJECTILES 363 Fig.1 Continuous danger, space At short range the height of the trajectory never exceeds that of a man FlG.2 SHORT DANGER. SPACE AND LONG SAFETY SPACE IN LONG RANGE FIRE Between A and B the bullet is always higher than a man’s head Fig.5 Danger, spaces of trajectory and ricochet At A occurs thcTirst catch" by lowest part ofcone of fire . At B occurs the "first graze'. At short and medium ranges , where trajectory is flat, there is an indefinite danger space beyond C.due to ricochet depending on the direction and remainingvelocity of the ricochet bullets 5 HEAFS OF FiRE.BEATEN ZONES AND DANGER SPACES AT SHORT AND AT LONG RANGES Fig.4 Short range Fig. 5 Long range Plate 4. Danger Space, Beaten Zone, and Danger Zone of Rifle Fire. Plate 5. Cone of Fire or Dispersion and Beaten Zone. BALLISTICS AND PROJECTILES 365 Danger Zone. An enemy is in danger when he is in the beaten zone or in the correspond- ing danger space. Where bullets strike the ground at an acute angle they ricochet (glance up in the air); this results in additional danger space. The danger zone is comprised of all the danger spaces mentioned above. (See Plate 4) 500 yds. 600ycLs. 700yds. 600Y&5. 900yds. IOOO yds. Plate 6. Vertical Shot Groups at Various Ranges. Defilade. In the presence of an enemy, troops seek areas for stationary installations and as avenues of advance or retirement which are protected from enemy fire. These areas are provided by ground forms such as intervening hill masses, valleys, minor irregularities in the surface of the ground, and trenches. If they cannot be reached by the flat-trajectory on level ground Fon rising ground zone is shortened falling ground is ,ort reverse slope weapons of the enemy, such as rifles, machine guns and light artillery, they are said to be in defilade. It is impossible to secure defilade from high-trajectory weapons such as the 81-mm mortar because its projectile may fall at right angles to the surface of the ground. Overhead protection must be obtained to escape the effect of such fires. Mere concealment on a reverse slope may not provide defilade since the curve of the trajectory may permit the fire to sweep and search such slops. (See Plates 3 and 7.) Projectiles. Casualty producing projectiles include bullets fied from small arms (rifles and caliber .30 machine guns), infantry mortars, antitank guns, chemical mortars, and artillery projectiles such as shrapnel, high explosive shell, and chemical shell. Armor- piercing projectiles are designed to penetrate protective armor, such as tank armor, in order to cause casualties within the vehicle. (See Plates 8, 9, and 10.) Plate 7. Effect of Ground Slopes on Beaten Zone. 366 MILITARY MEDICAL MANUAL High Explosive Shell. High explosive shell is a cylinder of iron and steel with a conical head. The projectile has thick walls, and the hollow core is filled with an explosive charge which is detonated by means of a time fuse or percussion cap that explodes on contact. Plate 8. The Rifle and Machine Gun Cartridge, Caliber .30. The casing is ruptured and fragmented, and each individual fragment becomes in itself a projectile capable of inflicting serious lacerated wounds, owing to the jagged shape of the individual pieces. These fragments vary in weight from a few grains to as much as 150 pounds. Light artillery shells weigh approximately 15 pounds; heavy artillery shells weigh as much as a ton. Legend: 1. Bullet; 2. Propelling charge; 3. Cartridge case. Plate 9. An Assembled Round of 75-mm High Explosive Ammunition. Legend: 1. Fuze, point detonating Mk. Ill; 2. Adapter and Booster, Mk. m-B; 3. High Explosive Shell, Mk. IV; 4. Bursting charge TNT; 5. Cartridge case; 6. Propelling charge; 7. 49-graln primer, Mk. I. Plate 10. Projectile Only, 75-mm Shrapnel. Legend: 1. Waterproof cover; 2. 21-second combination fuze; 3. Head; 4. Inner tube; 5. Bourrelet; 6. Central tube; 7 Balls; 8. Case; 9. Matrix (resin); 10. Fiber paper cup; 11. Cloth disk; 12. Diaphragm; 13. Rotating band; 14. Base charge (loose black powder). Shrapnel. Shrapnel consists of a cylinder of steel which contains a varying number of round lead bullets approximately .5 inch in diameter. The bursting charge in the base is exploded by means of a time fuse in the head. The usual employment of this fire is to obtain an air burst above the ground and on the near side of the target. At the time of bursting, the lead balls are driven out in the form of a cone. In effect, shrapnel is a flying BALLISTICS AND PROJECTILES 367 shotgun. The case itself does not undergo much fragmentation, but each individual bullet, as well as the time fuse and the casing, becomes a separate projectile. Shrapnel is especially useful for employment against exposed personnel. Chemical Shell. Chemical shells obtain their name from the nature of the filler. The filler may be a lethal gas or a smoke compound. When the shell bursts, the chemical filler produces a gas or smoke cloud, in contradistinction to the effect of high explosive shell which depends upon the blast of explosion and the fragmentation of the shell body. Smoke shells are used to deny observation to an enemy; the smoke itself is not a casualty producing agent. Bombs. Bombs dropped from airplanes in flight include fragmentation, demolition, and chemical bombs. High explosive is the most common load as it is effective in demolitions as well as in producing casualties. Airplanes are able to carry bombs which weigh as much as two tons. Bursting Radius. The radius measured from the point of impact or detonation of a bursting projectile and including the zone within which casualties arc almost certain to be produced is called the bursting radius. It varies in size in accordance with the nature of the shell, the kind and quantity of the charge, and the slope of the ground. Fire Superiority. Fire superiority is the condition obtained by delivering such an effective fire against an enemy that his own fires are greatly reduced in accuracy and volume. In its utmost application it causes the enemy to forget all else save self-preservation. It must be obtained before troops can advance upon an enemy position except at the cost of heavy casualties. It is a moral phenomenon and purely relative. It is obtained as a result of ac- curacy, proper distribution over the entire area occupied by an enemy capable of holding up an advance, and great volume. Against inferior troops the condition may be obtained with relative ease. Once established it must be maintained for without it an attack will be stopped or the defense will be overwhelmed. Effect of Rifle Fire. The bulk of rifle fire is delivered at ranges within 600 yards, al- though selected men may open fire at longer ranges. In the defense where good observation and long fields of fire are available, fire may be opened at ranges as great as 1000 yards. Machine guns fire at much greater ranges because of their volume of fire and the fixed mount (tripod), as well as their capacity for delivery of fire by indirect laying at invisible targets. At a range of 2500 yards a rifle bullet has enough force to disable a man. Rifle fire has both physical and moral effects. Properly placed, fire produces casualties and may cause the enemy to remain under cover. At ordinary ranges the sound of a bullet passing within a few yards is a sharp, frightening crack. Bullets which fall a little short kick up a shower of dirt and stones and ricochet with a loud, disconcerting whine. Thus, while hits are desirable, shots that come close to the target have considerable effect. The enemy is afraid to stick his head up long enough to take careful aim. He may become excited, unable to think clearly, or to act with coolness. These factors are worthy of consideration during the training process of all troops whose missions take them within the combat zone since this knowledge will serve to increase confidence and overcome many human fears. Effect of Artillery Fire. Artillery projectiles cause the bulk of battle casualties. It is accurate, it may be delivered with surprise effect at long range, and may be massed in great volume to strike within a limited area. It may be used to destroy material objectives. Because of the high trajectory of mortars and howitzers they can place their projectiles in areas which are in defilade from flat-trajectory weapons. Against troops in dense formation the casualty effect of even a single shell is material because of the extent of its effective bursting radius. The force of detonation of high explosive shell may cause casualties without hits by shell fragment. The moral effect of artillery fire is especially serious. A.E.F. Battle Casualties by Arm and Service. The statistics recorded below indicate by arm and service the rate per thousand and the absolute numbers of killed and wounded in the American Expeditionary Force.1 * Medical Department of the United State* In the World War, Vol. XV, Statistics, Part 3. Medical and Casualty Statistics. 368 MILITARY MEDICAL MANUAL Rate Per Absolute Branch Thousand N umbers Infantry 583.96 229,223 Signal Corps 101.74 2,128 Tank Corps 100.44 454 Field Artillery 73.11 11,146 Corps of Engineers 59.24 8,456 Medical Department 51.62 3,954 Quartermaster Corps 18.81 2,136 Cavalry 17.81 96 Air Corps 13.64 685 Ordnance 1036 113 Others 30.29 2,392 Total 260,783 Classification of Death-producing Agents. Of the 50,385 deaths in the AEF classified as killed in action or died of wounds, the following table indicates the agent causing the casualty by percentages. Gun-shot missiles, shrapnel, or shell, kind not stated 81.53% Rifle and machine gun 7.02% Mustard gas 438% Other gases 4.47% Others 2.60% Part 11 Medical Subjects CHAPTER I MEDICO-MILITARY HISTORY EVOLUTION OF THE MEDICAL DEPARTMENT, U. S. ARMY The Medical Department of the United States Army had its origin at the very beginning of our national history. In 1775, upon the recommendation of General George Wash- ington, the Congress created the first military-medical service known in America. At this early period each of the widely separated forces was provided with its own medical service. There was no central medical organization. However, there was created the position of Director General and Chief Physician, the first appointee being Dr. Benjamin Church of Boston. The evolution of the Medical Department into its present form has been based upon necessity and upon the constantly increasing need for its growth and development. The periods of greatest development correspond to the major military and political vicissitudes of the United States government. There are, however, two distinct basic eras: the period prior to central organization which occurred in 1818 when General Joseph Lovell be- came the first Surgeon General; the period of development since that time. THE SURGEONS GENERAL OF THE U. S. ARMY Chiefs of the Medical Department (1775-1942) 1775-1775—Benjamin Church, Director General and Chief Physician of the Hospital of the Army. 1775-1777—John Morgan, Director General and Physician in Chief of the American Hos- pital. 1777-1781—William Shippen, Jr., Director General of the Military Hospitals of the Con- tinental Army. 1781-1783—John Cochran, Director General of the Military Hospitals of the Continental Army. 1792-1796—Richard Allison, Surgeon of the Legion. 1798-1800—James Craik, Physician General. 1813-1814—James Tilton, Physician and Surgeon General. 1818-1836—Joseph Lovell, Surgeon General. 1836-1861—Thomas Lawson, Surgeon General. 1861- —Clement Alexander Finley, Surgeon General. 1862- —William Alexander Hammond, Brigadier General, Surgeon General. 1864-1882—Joseph K. Barnes, Brigadier General, Surgeon General. 1882- —Charles Henry Crane, Brigadier General, Surgeon General. 1883- —Robert Murray, Brigadier General, Surgeon General. 1886-1890—John Moore, Brigadier General, Surgeon General. 1890-1890—Jedediah Hyde Baxter, Brigadier General, Surgeon General. 1890-1893—Charles Sutherland, Brigadier General, Surgeon General. 1893-1902—George Miller Sternberg, Brigadier General, Surgeon General. 1902-1902—William Henry Forwood, Brigadier General, Surgeon General. 1902-1909—Robert Maitland O’Reilly, Brigadier General, Surgeon General. 1909-1913—George H. Torney, Brigadier General, Surgeon General. 1914-1918—William Crawford Gorgas, Brigadier General and Major General, Surgeon General. 1918-1931—Merritte Weber Ireland, Major General, The Surgeon General. 1931-1935—Robert Uric Patterson, Major General, The Surgeon General. 1935-1939—Charles Ransom Reynolds, Major General, The Surgeon General. 1939- —James Carre Magee, Major General, The Surgeon General. 372 The Medical Department remained loosely organized until the appointment of Gen- eral Lovell as Surgeon General. For a time during the Revolution there was a semblance of centralization which was briefly revived during the war scare of 1798 and during the War of 1812. But as a regular procedure each regiment or post attended to its own medical affairs. Medical progress remained slow and uncertain with this lack of common interest and a considerable ignorance of preventive measures against contagious diseases. Nevertheless, during this period of disorganization, the amplified mistakes gave loud warnings which guided the medical service toward central organization. The results have been of benefit not only to the Army but to the health and economic progress of the nation as well. Perhaps it was in realization of the suffering and hardships of the American soldier in peace as well as war that Congress, in 1818, passed the bill which provided a Medical Department for the Army, appointed a Surgeon General, and set up a central organization. This basic framework has been continued and exists today. This chapter records a chronological summary of many of the important and interesting developments, changes, activities, and achievements of the Medical Department and its members. They are listed according to period and exact date so far as possible. In addi- tion, a very few of the major achievements of the department are discussed in some detail. MILITARY MEDICAL MANUAL ERA PRIOR TO CENTRAL ORGANIZATION 1775-1812. The Period from the Revolutionary War to the War of 1812 1775 July 1. The Provincial Congress of Massachusetts, after the Battle of Bunker Hill and the use of several large homes as hospitals, fixed the medical personnel in two classes: for a hospital, two surgeons and two surgeon’s mates; for a regiment, one surgeon and two surgeon’s mates. July 27. The Congress provided for the establishment of “an Hospital” for an army of 20,000 men. The need for this medical service was foreseen by General Washington soon after his initial inspections, and he recommended it in writing on July 21. 1776 The Army made the first request for women to care for the wounded. Wives, mothers, and sisters of the soldiers were used on the basis of one per each ten soldiers sick. The equivalent of the present Hospital Fund was established by John Morgan, M.D., Director General and Physician-in-Chief of the Continental Army. With the counsel of General George Washington, and the assistance of regimental surgeons, he drafted the first hospital regulations for the American Army. Dr. John Jones included in his book, which was the first American book on surgery, a chapter on camp and military hospitals. The Continental Army retreated from Quebec, during which there was a smallpox epidemic. While orders forbade the use of inoculations, the soldiers themselves commonly put it into practice by self-administration. 1777 Benjamin Rush, a famed medical man of the Revolutionary period, published a pamphlet on the hygiene of troops entitled Directions for Preserving the Health of Soldiers. Dr. William Shippen, Jr., Director General of the Military Hospitals of the Continental Army, drew up a plan for “flying” ambulances. These chariot-like ambulances were used to bring the doctors to the patients in the field rather than to bring the patient to the doctor. Authority was granted to Director General William Shippen, Jr., and his deputies to utilize the services of surgeons, either in the hospital or with the regiments, as circum- stances indicated. 1778 A resolution was passed by Congress to fine each officer who entered a hospital for the cure of venereal disease ten dollars; similarly, soldiers were fined four dollars. The money thus obtained was used for the purchase of blankets and shirts for soldiers who were sick in the hospitals. The results are unknown. MEDICO-MILITARY HISTORY 373 The medical administration was divided among three large territorial departments: Northern, Middle, and Eastern. Each department was authorized a “Physician and Sur- geon of the Army,” a “Physician General,” a “Surgeon General,” and a “Deputy Director General.” Appointments were made for all positions except the “Deputy Director General” of the Middle Department. The earliest pharmacopoeia for use of the Continental Army was prepared by Dr. Wil- liam Brown, who was Physician General of the Middle Department. It was the first American pharmacopoeia. 1780 The first Army regulations were written. They contained a chapter on “Treatment of the Sick.” This chapter was helpful and gave information which would still be con- sidered as good common sense. James Tilton, later Physician and Surgeon General, introduced log huts as hospitals. Most of the suffering of the sick was due to exposure. 1781 February. Congress appointed a Secretary of War, and medical reports heretofore sent to the Medical Committee of Congress were sent to him. Prior to this time, medical affairs had been regulated through the Medical Committee, which had been permitted to visit and inspect the hospitals and to make necessary investigations of the medical administration. 1784 June. All troops were discharged except 700. One surgeon and four surgeon’s mates were retained to provide medical care for the Army. 1788 The number of troops in service was 595, most of whom were stationed on the western frontier. The medical officers were appointed by the States from which the troops were received. 1789 August 7. The War Department was organized as an executive department, four months after the inauguration of General Washington as President. 1790 The Regular Army was organized with a strength of 1216 enlisted men and a small number of officers. Three years was the length of service for both rank and file. The President was authorized to engage extra surgeon’s mates as he deemed necessary. 1792 An Act of Congress reorganized the Army as a “Legion” under command of a major general and further divided it into four sub-legions, each commanded by a brigadier gen- eral. The chief medical officer on the staff of the major general commanding the “Legion” was titled “Surgeon of the Legion.” Richard Allison was the first appointee to this posi- tion. Each sub-legion was authorized a surgeon and three surgeon’s mates. While this law remained in effect for over a century, and was the only “militia law” during this period, it was never fully carried into effect. 1790-1798 The Army was increased by numerous additions to the strength of the regiments. Medical officers were appointed as regimental surgeons, but central organization of the Medical Department for these medical services was not provided. 1798 Because of fear of a war with France, an attempt was made to reorganize the Army and Medical Department. The Physician General, Dr. James Craik, was authorized the rank, pay, and emoluments of a lieutenant colonel. Medical officers were appointed for the regiments, but hospital appointments had not been considered. Secretary of War Dr. James McHenry, a surgeon during the Revolution, noted this omission and recom- mended to Congress that it be corrected. 374 MILITARY MEDICAL MANUAL 1800 Since war with France was no longer feared, Congress passed a bill discharging all the troops raised for the increase of the Army, including the Physician General and all medical officers, except six surgeons and twelve surgeon’s mates. 1800-1812 During this interval very little information is available concerning the medical service of the Army. It is known that there was no central organization of the medical staff, and there was no hospital department. Sanitation in the modern sense did not exist. The average soldier was without medicines or medical attendance and recovered from illness by the strength of his own physical resistance or died in misery. 1812-1818. The War of 1812 to the Administration of General Lovell 1812 Congress provided for the appointment of such number of hospital surgeons and surgeon’s mates as the service might require. However, the organization of the medical service was haphazard, leaving the medical officers without authority and subjected to many interferences from line officers. 1813 Members of the Medical Department were given uniforms for the first time in the history of the Army. The uniform was black, with a very high collar in front. 1814 The first Medical Department regulations which dealt with the duties of medical officers were issued as part of the Army regulations. Dr. James Tilton, Physician and Surgeon General, abolished the distinction between a physician and a surgeon. Since that time army medical officers have been known as surgeons, although their duties have never been limited to the surgical specialty. 1815 The army was reduced to one-sixth its former size, and the Physician and Surgeon General was discharged on June 15. The Medical Department’s only activities until 1818 seem to have been receipt of reports made by medical officers who took part in the War of 1812. Francis Le Baron continued as Apothecary General until April 18, 1818. Other Events during the Period 1812-1818 Early observations were recorded relative to the cleanliness and ventilation of hospitals. Although preventive measures as we know them now were not used, there was a faint realization that the hospitals which were kept clean and well ventilated had the least dissemination of disease. It was again demonstrated during the War of 1812 that the care of sick and diseased soldiers was a larger burden than the care of soldiers injured in battle. Contagious diseases and infections from wounds caused more deaths than enemy fire. It was early evidence that the mission of the medical service must be “to conserve the fighting strength of the military force.” ERA OF CENTRAL ORGANIZATION 1818-1836. Surgeon General Lovell’s Administration 1818 An Act of Congress reorganized the staff departments of the Regular Army, including the Medical Department. A Surgeon General was appointed as head of the Medical Staff. All orders and instructions, reports, and communications in connection with medical af- fairs were ordered to be issued through the Surgeon General’s Office. This was the first basic central organization and the beginning of definite progress for the Medical Depart- ment. Because of his excellent service in the Northern Division during the War of 1812, and his Remarks on the Sic\ Report of the Northern Division for the year ending June 30, 1817, Dr. Joseph Lovell was appointed the first Surgeon General of the United States Army. MEDICO-MILITARY HISTORY 375 November 1. Surgeon General Lovell submitted the first quarterly report of the Medical Department to the Secretary of War. 1826 The first meteorological report issued by the Army was dated 1826 and entitled, Meteorological Register for the Years 1822-25 inclusive, from Observations made by the Surgeons of the Army at the Military Posts of the United States. It was prepared under the direction of Joseph Lovell, M.D., Surgeon General of the U. S. Army. 1833 A medical officer and pioneer physiologist, Dr. William Beaumont, encouraged by General Lovell, made his abstract report on Experiments and Observations on the Gastric Juice and the Physiology of Digestion. This report was based on his experiments on Sergeant Alexis St. Martin, who developed a gastric fistula following a gunshot wound through his stomach. 1836 The “Library of the Surgeon General’s Office” was founded. (This is the origin of the present Army Medical Library in Washington, D. C.) Other Events during the Period 1818-1836 The Medical Department regulations were further revised. An Act of Congress required professional examination for appointment in the Medical Corps of the Regular Army; the pay and simulated rank of medical officers were estab- lished. Surgeon General Lovell introduced weather reports and included them in his quarterly reports to the Secretary of War. Many studies were made by members of the Medical Department relative to febrile diseases which were then prevalent; these diseases at that time included scurvy, bilious remitting fever, dysentery, and dengue. In his reports General Lovell attributed much illness to the excessive consumption of spirituous liquor, and it is probably the result of his recommendations that the rum ration was discontinued. 1836-1861. The Period from General Lovell’s Administration to the Civil War 1836 November 30. General Thomas Lawson succeeded Surgeon General Lovell but did not assume the duties of his office until 1838. He was occupied in organizing a battalion of volunteers for the Florida Seminole War. 1840 Members of the Medical Department were given a new uniform with an aiguillette in- stead of epaulettes, which met with serious objection from the medical officers. Surgeon General Lawson wrote a letter to the Adjutant General expressing his opinions substantiat- ing those of the medical officers. The following year the epaulettes were restored. The letters “M.S.” were placed on the epaulettes as a mark of distinction. However, it opened a long dispute about the rank of medical officers which continued until the Mexican War. 1841 The Surgeon General’s Report for the year 1841 recorded the mean strength of the army as 9,748 officers and men, and admissions to sick report as 38,559. Of the latter, 320 were discharged from the service, 30 deserted, and 387 died. The above would in- dicate each soldier had been on sick report at least four times during the year. 1842 There was a marked reduction of the Army and the Medical Department following the Florida Seminole War. 1845 A general hospital and several regimental hospitals were established in anticipation of war with Mexico. 376 MILITARY MEDICAL MANUAL 1846 May 13. President James K. Polk proclaimed a state of war to exist with Mexico and called for 50,000 volunteers; each new regiment was authorized to have one surgeon and one assistant surgeon. William Lloyd Garrison, historian, stated the condition of the American troops in Mexico to be as follows: “There were no ambulances in the Army before 1859; only one hundred and eighty mule-drawn wagons were available on April 5, 1847; there were no shelter or hospital tents, hospital equipment, etc. Ignorance of the character of water supplies brought hundreds down with diarrhoea and dysentery; hospitals were hastily improvised in any convenient buildings, and the misery of the sick was increased by the squalor of Latin surroundings.” 1847 An Act of Congress provided definite rank for medical officers. Surgeon General Thomas Lawson recommended: an increase in the number of Medical Department officers; enlistment of competent and trained personnel as hospital stewards; extra-duty pay for hospital nurses and attendants detailed from the line. 1851 The first delegate from the Medical Department was sent to a meeting of the American Medical Association. 1855 The Army Meteorological Register, a separate weather data report, was prepared by a medical officer, Surgeon Coolidge. Previously the weather reports had been a part of the Surgeon General’s quarterly report to the Secretary of War. The Medical Department submitted weather reports and other essential weather data for all stations from 1820 until the Weather Bureau assumed this task in 1855. 1856 Congress authorized the appointment of hospital stewards as had been previously recommended by Surgeon General Thomas Lawson in 1847. 1857 The caduceus of yellow silk worn on the sleeve was designated in Army regulations as the insignia for hospital stewards. The medical officer’s uniform was similar to the line officer’s except that the full-dress sash was an emerald green. 1857-1859 Medical Statistics, United States Army was published, the first part being completed in 1857 and the second part in 1859. A study was made of medical transportation, and two types of ambulances were adopted. 1851-1861 Medical officers accompanied troops and furnished medical care during the Apache warfare in the southwest United States. They also provided medical assistance during the survey of the transcontinental railroads. 1861-1865. The Civil War Period 1861 Congress created the position of brigade surgeon and appointed 107 to this position. At this time Congress also authorized an addition of 10 surgeons and 20 assistant surgeons for the Medical Department, and allowed when necessary the use of female nurses with pay at the rate of fifty cents per day. 1862 William A. Hammond was appointed Surgeon General, the first medical officer to hold the rank of brigadier general with pay and emoluments of the position. Under his administration several important developments and recommendations were made. He issued orders requiring full and detailed reports about diseases and injuries which led MEDICO-MILITARY HISTORY 377 to closer professional supervision and improved the accuracy of statistics; the general hospitals were placed under the command of the Surgeon General; he started the Army Medical Museum; he added many books to the Library of the Surgeon General’s Office; he made compilations for The Medical and Surgical History of the War of the Rebellion. He recommended the establishment of a permanent hospital in Washington, D. C., in- dependent transportation for the Medical Department (ambulance corps), an Army Medical School, construction of hospitals by the Medical Department, and the establish- ment of a central laboratory; these recommendations were far-sighted and were executed many years later. The “Letterman Plan” for the evacuation of sick and wounded was used successfully at the Battle of Antietam. It involved the use of field aid stations, ambulances, field hos- pitals, hospital trains, and general hospitals, upon which the present method of evacua- tion of sick and wounded in battle has been based. The plan called for an ambulance corps for each army corps, with two-horse vehicles, provided with two litters each, in the proportion of three ambulances for each regiment of five hundred. The ambulance corps was commanded by a captain; a lieutenant was provided for each division, one sergeant for each regiment, two privates and one driver to each ambulance, and one driver to each medicine wagon. The personnel was under the control of the Medical Director. 1864 General Hammond proposed that a plan similar to the “Letterman Plan” be adopted for the entire Army, and during the year this recommendation became law. Other Events during the Period 1861-1865 During the Civil War, 1,057,423 sick and wounded were treated. There were 13,000 medical officers in the Union forces and 9,000 in the Confederate Army. Many advancements in the Medical Department and in medical field service occurred during Surgeon General Hammond’s administration. He was dismissed August 30, 1864, and Surgeon Joseph K. Barnes was appointed to succeed him. Later the findings and sentence of the court dismissing General Hammond were annulled, and he was retired as a brigadier general. He refused to accept retired pay and continued to lead an active and useful life until his death in 1900. 1865-1898. The Period Following the Civil War Period to the Spanish-American War 1865-1898 The Civil War armies were demobilized and the Regular Army reorganized. How- ever, by 1869 the Army was still further reduced by the action of the “Benzine Board”; the remainder was scattered to small stations in the South and on the western frontier. This increased number of stations was beyond the care of the small number of medical officers remaining in the Army, and authorization was granted to hire 264 assistant (contract) surgeons. Eighty thousand dollars of the hospital fund on hand after the Civil War were used for the improvement of the Library of the Surgeon General’s Office, and the first catalogue of this library was printed. It consisted of a pamphlet of 24 pages. (This library has reached international fame and is known as the Army Medical Library.) Lieutenant John S. Billings, Medical Corps, prepared the first printed catalogue of the Surgeon Gen- eral’s Library, a pamphlet of 24 pages. It was through the far-sighted efforts of Lieutenant Billings that the present Army Medical Library became a reality. He is recognized as one of the greatest medical officers of the United States Army. An Act of Congress established the Hospital Corps. The teaching of first aid to line officers and company bearers was instituted. 1866 Assistant Surgeon Albert J. Myer was made Colonel and Chief Signal Officer, the first officer to hold that position in the United States Army. Fort Myer, Virginia, was named in honor of this officer. 378 MILITARY MEDICAL MANUAL 1867 A descriptive catalogue of the Army Medical Museum, Washington, D. C., was pub- lished. 1875 Colonel Jedediah H. Baxter, later appointed Surgeon General, prepared a report of Medical Statistics of the Provost Marshal General’s Bureau which was published and is still used as a source of early statistical information. 1879 The Index Medicus, a monthly record classifying current medical literature, was origi- nated by John Shaw Billings, a colonel in the Medical Corps. 1881 George Miller Sternberg, a medical officer and noted bacteriologist, discovered the pneumococcus. He also photographed the tubercle bacillus for the first time. December. The caduceus, as a collar and a cap ornament, was adopted for the hospital stewards. 1885 Orders were issued by the Surgeon General directing that medical officers submit monthly sanitary reports. 1887 The Army and Navy General Hospital at Hot Springs, Arkansas, was completed and opened for patients. There were 16 beds provided for officers and 64 for enlisted men. The law authorizing the organization of the Hospital Corps was signed by President Grover Cleveland. The uniform was trimmed in green with a red cross on a white arm band. 1888 The organization of the Hospital Corps neared completion and began to render valuable assistance to the Medical Department. The men transferred from the line to the medical service were given training in nursing and medical field work. They were soon utilized in the laboratories and in the operating rooms; they performed the duties of our modern nurse corps. 1890 A shield was adopted as a collar device for army officers, including the medical officers. 1891 The reports of Surgeon General Charles Sutherland indicated that the Medical De- partment was beginning to realize definitely the importance of sanitation in the housing of troops. Faults of construction, heating, ventilation, and drainage were recorded, but recommendations to improve these conditions went unheeded. September 17. The radical defects of the medical departments of the organized militia units came to the attention of their medical officers, with the result that as a remedy they organized the “Association of Military Surgeons.” This Association now includes medical department officers from all government services and is very active in the coordination of their activities. Its members receive The Military Surgeon, a monthly publication con- taining many timely and useful medical and military articles. The objects and aims of the Association are to increase the efficiency of the Medical Services of the Federal Government both in peace and war by the further development of means to care for the sick and wounded and for the prevention of epidemics. This is accomplished by the following procedures: by mutual inspiration and improve- ment; by maintaining military practice as a specialty, well defined and clearly recognized; by constantly striving to improve military and naval medicine, surgery, and hygiene; by the creation of a living and growing body of medico-military literature available as a standard for permanent reference; by encouraging acquaintance between medical officers of the several services; by providing an interchange of views and ideas between these MEDICO-MILITARY HISTORY 379 medical officers; by establishing uniformity of procedure between the Medical Depart- ments of the National Services and those of other countries; by preserving a medico- military esprit de corps; by maintaining the military position of the medical officer upon an equality in rank, authority, autonomy, and initiative with that of other officers; by en- couraging legislation beneficial to the Medical Departments of all Services; by promoting a constant condition of readiness for duty in the Medical Departments of all of these Services. The Association is the only organization in the United States which attempts to bring together and coordinate the efforts of the various medico-military services of the Federal Government. The Association of Military Surgeons is now an incorporated body of medico-military men recognized by the Federal Government as a medical society organized to promote the specialty of military medicine, surgery, and sanitation. It was organized by the late Nicholas Senn, former Surgeon General of the States of Wisconsin and Illinois. Active membership in the Association is open to: those who are, or have at any time been, commissioned officers in the Medical Department (or Service) of the Army, the Navy, the U. S. Public Health Service, the National Guard, the Organized Reserves, the U. S. Volunteers, and Acting Assistant or Contract Surgeons of these Services; regularly appointed members of the Medical Service of the Veterans’ Administration and those who have been such; those who have been duly elected members of the Air Service Medical Association and of the Medical Veterans of the World War; officers of the Military Medical Services of other countries, and Medical and Dental Officers of the U. S. Indian Service. The Association maintains an office in the City of Washington, where all business of the Association is transacted. 1893 Colonel George M. Sternberg, a pioneer bacteriologist in America, was appointed Surgeon General by President Grover Cleveland. Colonel Sternberg was the most pro- fessionally eminent officer in the Medical Corps and was in a position to achieve and conduct medical advancement. As Surgeon General he stimulated the professional zeal of all the medical officers of the Army. The Division Hospital at Manila, Philippine Islands, was later named the Sternberg General Hospital in his honor. It is the Army’s largest and best hospital in the Philippines. Authority was granted by General Orders No. 51, Adjutant General’s Office, dated June 24, 1893, for the establishment of an Army Medical School. Originally, it was located in a building with the Army Medical Library and Museum, but the school has since grown, now having a special building at the Army Medical Center, Washington, D. C., where large numbers of medical, dental, and veterinary officers are instructed. It is a medical theater of scientific study, research, and instruction. 1894 The modified Maltese cross was adopted in place of the shield as a collar device for medical officers. 1895 The Medical Department adopted the metric system of weights and measures for pharmaceutical procedures and prescriptions. A room especially well cleaned, in which the necessary anesthetics, medicines, and equipment were kept, was required in each station hospital for emergency operations. These emergency rooms were the origin of operating rooms in station hospitals. The new international system of statistical reports was adopted. The department also began to furnish medical officers with current medical facts by sending them recent publications. (This custom still continues, and there are now well equipped, local medical libraries at many station hospitals.) Other Events during the Period 1865-1898 Many advances in medicine occurred in which the Medical Department of the Army took an important part. Medical officers who accompanied troops came into contact with many kinds of febrile diseases, the most common of which was typhoid fever. 380 Diphthcria antitoxin was used with success by the Medical Department of the Army soon after its discovery. The Roentgen ray was also used soon after its discovery; its value as an aid to diagnosis and as a means of record and identification was soon appreciated by the Medical Department. The interest in bacteriology manifested by the civilian doctor, as well as the medical officer, soon brought to light the necessity for preventive measures to control the dissem- ination of contagious diseases. Field sanitation became of major interest, and military medicine started to have a prominent part in military affairs. Water and food supplies were becoming a matter for inspection and discussion. Scientific studies were being made by many officers. MILITARY MEDICAL MANUAL 1898 April 21. There were 192 medical officers and 791 enlisted men in the Medical Depart- men when war was declared. This was not sufficient for the peace-time Regular Army of 28,000. The necessity for expansion of the Medical Department was evident, and the task was made more difficult, because of the lack of experience and field training of the medical officers. With incomplete knowledge of field sanitation, without field equipment, without general hospitals, the Medical Department was given a perilous mission. April 22. An Act of Congress provided for an increase in the Medical Department of 8 corps surgeons, 110 division and brigade surgeons, and 650 contract surgeons. During the year the “Central Hospital Fund” was designated by the Surgeon General as a reserve fund. Into this reserve the custodian of each station hospital fund, upon request of the Surgeon General, was required to transfer the money in excess of its normal primary needs. May 12. Congress authorized the appointment of 15 assistant surgeons. In 1894 Con- gress had reduced the number of medical officers by the same number. May 18. The Surgeon General directed that regimental hospitals be discontinued and their supplies used for the establishment of division hospitals. Division hospitals were kept mobile, serious cases being sent to general hospitals. Near New York and Philadel- phia many patients were sent to civilian hospitals, and others were furloughed home for recovery. May 31' The Adjutant General authorized the transfer of men from volunteer organi- zations to the Hospital Corps. There were about 6000 enlisted and transferred men in the Medical Department during the war, and that was far from an adequate number to render even the minimum service. By the utilization of female nurses as overseers these men accomplished a great deal and received training which was useful later in the Philippine Islands. June 2. Congress increased the number of hospital stewards (sergeants) to 200. It was difficult to increase the size of the corps during the war and even more so after the occurrence of epidemics, because soldiers feared taking care of the sick. June 9. Secretary of War Russell A. Alger approved the use of the facilities and per- sonnel of the American National Red Cross Association during the Spanish-American War. General Sternberg commended on several occasions the record made by these Red Cross nurses during the period 1898-99, relating their skill, sincerity, and devotion to duty. July 2. The Hospital Ship “Relief,” a converted passenger steamer, sailed for Cuba to transport sick and wounded to Montauk Point, Long Island, New York. Montauk Point was the point selected as a camp for returning troops. The ship “Relief” was used later in service to the Philippine Islands. August 18. The general hospital at Montauk was completed. The boat “Red Cross Yacht” reported to assist in transporting sick and wounded to New Haven, New London, and Bridgeport hospitals. Several other hospital ships were also used, most of which were converted commercial ships. In the Spanish-American War, through the Women’s National Relief Association, a corps of selected expert cooks and assistants was furnished to the Chief Surgeon of the Camp at Montauk Point for use in the kitchens of the hos- 1898-1899. The Spanish-American War Period MEDICO-MILITARY HISTORY 381 pitals. The Army ration was increased until it included a menu equal to the best hotels of large cities. Other Events during the Period 1898-1899 Medical service for the various campaigns in Cuba, the Philippine Islands, and Puerto Rico was furnished by the Medical Department and the Red Cross. The care of the soldiers in the camps was entirely inadequate. Since typhoid fever was frequently diag- nosed as malaria, a short period of time elapsed before typhoid was recognized epidemic in nature. The death rate from both diseases increased month by month. “The Typhoid Fever Board” composed of Major Walter Reed, Major Victor C. Vaughn, and Major Edward O. Shakespeare, all of the Medical Corps, was directed to make a detailed study concerning the epidemiology of typhoid fever in the military camps in the United States. They concluded that typhoid fever was not a strictly water- borne disease, and that it could be, and was, spread by personal contact. The first vision of a future Dental Corps became evident when Hospital Steward J. W. Horner was assigned as corps dentist, assisted by Acting Hospital Steward Watts. They opened an office and attended dental patients of the Seventh Army Corps free of charge. General hospitals which had been established were continued. The missions assigned to the Army following the Spanish-American War prevented reduction of its strength to that prior to the war. Consequently, the necessity for medical care for this personnel existed. The Medical Department had come to realize the value of general hospitals for treatment of patients requiring special therapeutic measures under the care of specialists. Civilian hospitals were also increasing in number as it was the trend of the period. The general hospitals which were established during the Spanish-American War and con- tinued afterwards were: Sternberg, Letterman, Tripler, the general hospital for the treat- ment of tuberculosis at Fort Bayard, New Mexico, and the general hospital at Wash- ington Barracks, Maryland. Due to the sudden emergency of the war and the inability of the Medical Department to secure sufficient enlisted men, the need for an organized nurse corps was realized. The Nurse Corps (female) was organized in 1899 without any specific authorization. The early history of the Nurse Corps was included in the Surgeon General’s report for 1899. There were 1158 nurses in service on September 15, 1899; however, during the war con- tracts were made with 1,563 nurses. The casualties of the Spanish-American War were relatively few. In the Army 22 officers and 244 men were killed; in the Navy 1 officer and 17 men were killed—a total of 284 deaths out of 235,631 men engaged in war. About 3,500 died because of disease; most of these deaths were due to the typhoid epidemic which was prevalent in the Army camps during the War. The Medical Department won the favor of the American people and began to get the support and sympathy of the public. Since the public was interested the problems of the medical service were better known to them. The war service provided a valuable ex- perience, consolidating members of the department into a cooperative and aggressive band of workers. It was a difficult but important period in the progress of medicine and the future of the Medical Department. 1899-1914. The Period After the Spanish-American War to the World War 1899 As a result of the Spanish-American War and immediately after its termination, “The Dodge Commission” was appointed by President William McKinley to investigate and report on the conditions of the Army. The Medical Department was definitely included and its errors and needs investigated. Fulfilling the recommendations of the Dodge Com- mission occupied the attention of Army leaders for many years following the receipt of the findings. April 11. The peace treaty, originally signed December 10, 1898, was finally confirmed. The strength of the Regular Army was then established at 65,000. The men enlisted for the Spanish-American War in the Hospital Corps were retained in the Philippine* longer 382 MILITARY MEDICAL MANUAL than those who volunteered for service in the line; this was due to the necessity for im- proving sanitary conditions theic. 1900 Medical personnel accompanied the troops who were sent from the Philippines to sup- press the Boxer Rebellion in China. The sick and wounded were handled successfully, final evacuation being to San Francisco. (The Medical Department furnished personnel for medical care to Army troops in Tientsin, China, from the time the International Force of Occupation was established until the Army units were withdrawn in 1938.) The Medical Department established the first “Tropical Disease Board.” It was established in Manila, Philippine Islands, foi the study and control of tropical diseases. May. A board composed of Major Walter Reed, Major James Carroll, Dr. Jesse W. Lazear, and Dr. Aristides Agramonte was appointed by Surgeon General Sternberg to study the transmission of yellow fever. They began their investigations in Quemados, near Havana, Cuba a month later. This board demonstrated positively that yellow fever is transmitted by the bite of the mosquito Aedes acgypti. 1901 The Act of February 2 authorized a strength of 100,619 officers and men for the Regular Army; this included an increase of the Medical Corps officers from 192 to 321 and the hospital stewards from 200 to 300. This same Act authorized the employment of thirty dental surgeons under contract; it also recognized and confirmed the establishment of the Nurse Corps (female). All Medical Department personnel were directed to wear the caduceus as a collar orna- ment on the uniform. The Maltese cross previously used was discarded. Green was dis- continued as the department color, and maroon, which is the present color, was adopted. 1903 March 2. The title of “Hospital Steward” was eliminated and the title “Sergeant First Class” substituted by the Act of March 2, 1903. The same Act provided that the Hospital Corps would consist of sergeants first class, sergeants, corporals, privates first class, and privates. National Guard medical units were organized to provide field medical service to the rear boundary of the division. Major William C. Gorgas reported that he had successed in the campaign against yellow fever and that no new cases of this disease had originated in Cuba for two years. Major Gorgas had successfully put into practical application the principles established by Major Walter Reed and his board. He conceived of a triple threat against yellow fever: first, destruction of mosquitoes; second, prevention of mosquito breeding; and third, protection of yellow fever patients from bites of mosquitoes. To accomplish this task, he organized a “Stegomyia Brigade,” an “Anopheles Brigade,” and a “Yellow Fever Brigade.” The first two were used for the prevention of mosquito breeding and the latter for the destruction of mosquitoes within houses occupied by yellow fever patients. In spite of shortage of medical officers, the Surgeon General loaned officers to other government services to assist in important scientific work. Captain B. K. Ashford was placed at the disposal of the insular government of Puerto Rico to carry out a campaign against a “tropical anemia” due to hookworms. This policy continued for many years afterwards, and included the assigning of Colonel William C. Gorgas and five other medical officers to Panama and Major J. R. Kean to the governor’s staff in Cuba. The latter, assisted by four other medical officers, guided the sanitary department of the island. 1904 Brigadier General Fred C. Ainsworth, who had been in charge of the Division of Records and Pensions in the Surgeon General’s Office, was made the Military Secretary. Later, when the title was changed back to “The Adjutant General,” he continued to hold the position. 1906 March 21. The second “Tropical Disease Board” was established (W. D. Special Orders No. 16, January 19, 1906) in Manila, Philippine Islands. The more important MEDICO-MILITARY HISTORY 383 work of this board and the previous board established in 1900 included the following: the confirmation of the mosquito theory of dengue transmission; discovery of a new species of filaria, malaria; studies in amoebiasis, leprosy, cholera, and yaws; extensive observations regarding the influence or tropical climates; investigations as to the causa- tion of beriberi; eradication of beriberi among Philippine Scouts; discovery of a cure for infantile beriberi; determination of the amoebicidal properties of emetin, as a result of which that drug became the established specific for amoebic dysentery; investiga- tions regarding surra in horses; studies as to the prevalence of typhoid fever and diphtheria in the Philippine Islands; experiments on the effect of ultraviolet light upon amoebae; experiments regarding the relative value of different uniform materials and military head coverings for use in tropics; observations on pulse rates, blood pressure, and blood composition in the tropics. This second board continued until October 24, 1914, when the board was dissolved. The first motor ambulance was obtained for the Army and placed in use at Washington Barracks, Maryland. President Theodore Roosevelt instituted the annual physical examination for all field officers. He had developed a keen interest in medical affairs during the Spanish-American War. 1907 April. President Theodore Roosevelt appointed the Panama Canal Commission of which Colonel William C. Gorgas, Medical Corps, was a member. The combination of Army administration and competent field sanitation was a paramount necessity; the United States had selected the tools to conquer the jungle, which had defeated former attempts because of disease. 1908 Major F. F. Russell, Medical Corps, submitted a report on the epidemiology of typhoid fever. He had studied about its effects in foreign armies while he was in England. After receipt of his report, a board was appointed which reviewed the history of vaccination against typhoid with the view of its use in the protection of troops. The findings and recommendations of this board led to the adoption of antityphoid inoculation in the United States Army. The Army was the first institution to establish the use of typhoid vaccination on a large scale and to definitely determine its value in preventive medicine. Acts of Congress made the following changes and provisions for the Medical Depart- ment: The Medical Reserve Corps was created and assignments to active duty permitted; the Medical Corps was increased by 6 colonels, 12 lieutenant colonels, 45 majors, and 60 captains or first lieutenants; promotion to the grade of captain was provided after three years’ service; an increase in strength of the Medical Corps by four annual increments was provided; the pay of the Army was increased; examination for promotion to all grades of the Medical Corps below surgeon general was established. The commissioned medical personnel of the Medical Department was designated as the “Medical Corps of the United States Army”. During this year a large collection of medical field equipment and supplies was stored for national emergencies, a practice which has been very helpful in many peace time disasters. The preparation of typhoid vaccine for use in the Army and in other government services was started at the Army Medical School, Washington, D. C. The Walter Reed General Hospital was built at Washington, D. C. It was named in honor of Major Walter Reed who headed the board that made the discovery of the means of transmission of yellow fever. 1909 February. The typhoid vaccine prepared at the Army Medical School was ready for use, and the War Department approved volunteer antityphoid inoculation. During 1909 it was given to 830 individuals. Voluntary venereal prophylaxis was started. Since 1903 the Surgeon General had noted the prevalence of venereal diseases on the sick reports. This was a further step in the attempt to cut down the venereal rate of the Army. 384 MILITARY MEDICAL MANUAL 1910 Leonard Wood, Captain and Assistant Surgeon, was appointed major general and Chief of Staff of the Army, the first medical department officer to attain that rank and position. The first medico-military problem given in an Army school was solved by officers of the line in the Army Service School, Fort Leavenworth, Kansas. Major John S. Morrison, Assistant Commandant and senior instructor in Military Art of The Army Service Schools, realized the need of medical information in the line, and in collaboration with Major P. M. Ashburn of the Medical Corps published a book A Study in Troop Leading and Management oj the Sanitary Service in War. The disposi- tion of medical troops and installations for a division were presented under various tactical situations. Medical Service in Campaign by Major Paul F. Straub, Medical Corps, was also pub- lished. The need for careful consideration of the medical field service had developed a new field of tactical research. Major C. R. Darnall, Medical Corps, originated the liquid chlorine method of water purification. Although not as widely celebrated as other medical feats, this method of water purification has been adopted throughout the world and probably has saved and will save more lives than any other single medical achievement. 1911 March 3. An Act of Congress established the Dental Corps of the Regular Army, con- sisting of 60 dental surgeons, as a part of the Medical Department. November 13. A general order of the War Department was issued designating the large hospital at the Presidio of Saa Francisco, California, to be named Letterman General Hospital in honor of Surgeon Jonathan Letterman, who did so much for the organization of field medical service. There is also a field at Carlisle Barracks, Pennsylvania, used for demonstration of medical field service, appropriately named in his honor. During the latter part of 1911, the War Department granted the request to establish the “Field Service and Correspondence School of Medical Officers” at Fort Leavenworth, Kansas. A six weeks course limited to 12 officers was started the next year. Six Medical Corps officers of the Regular Army and six medical officers of the National Guard at- tended. The school continued until the World War, and thereafter it was transferred to its present location at Carlisle Barracks, Pennsylvania. Antityphoid immunization was made compulsory for all members of the Army, and inoculation was put into practice on the Mexican bordei. 1912 April 24. The National Red Cross was recognized by Congress. The President was authorized to employ its facilities with the Army and Navy according to such rules and regulations as he deemed best. August 24. An Act of Congress consolidating the Quartermaster’s Subsistence and Pay Departments included the “Manchu” provision, which required all officers of the Regular Army to serve two years out of each six with troops. This inclusion prevented medical officers from remaining on duty in Washington, D. C. on permanent assignment. September 10. The Surgeon General announced a policy and issued regulations gov- erning the operation of Red Cross units with the Army in time of war. Major Edward L. Munson, M. C., as president of the “Army Shoe Board” devised the “Munson Last” for Army shoes. It was adopted by this Board for the Army and has since been adopted by large numbers of the civil population. 1914-1918. The World War Period 1914 Colonel William C. Gorgas completed his medical service in Panama, where he had been the Chief Sanitary Officer during the construction of the Panama Canal. The first boat passed through the Canal on August 3, 1914. MEDICO-MILITARY HISTORY 385 Colonel Gorgas had achieved so much fame by the use of practical means in eliminating yellow fever from Cuba and Panama that it was evident he would succeed Surgeon General George H. Torney as head of the Medical Department. General Torney died suddenly of pneumonia on December 27, 1913, but Colonel Gorgas did not hear of his own appoint- ment until later because he was in South Africa advising on the control of pneumonia. Well known and esteemed by the medical profession, he had been elected President of the American Medical Association in 1908. The successful completion of the task in Panama opened the eyes of the world to the value of preventive medicine. The Medical Department of the Army received recognition as well as the confidence and gratitude of Congress, of the Army, of the civilian medical profession, and of the American people. The health, economics, and commerce of the nation and world had been affected by application of simple sanitary measures within a strategic geographical area. Colonel Gorgas was appointed Surgeon General with the rank of major general, the first surgeon general to attain that rank. Due to the prestige of General Gorgas, Congress respected his council and advice; conse- quently the Medical Department progressed rapidly. It was fortunate that such confidence should exist at a time when, unknowingly, the nation was approaching a war that mini- mized by its immensity all previous warfare. In 1914, the War Department issued New Tables of Organization and Field Service Regulations. Medical officers began to take active training in field work and medical tactics. They participated in field maneuvers. 1916 The strains of paratyphosus “A” and “B” were added to the typhoid vaccine used by the Army. Venereal prophylaxis was made compulsory, and a monthly physical inspection of en- listed men was instituted. June 3. Congress passed the National Defense Act. Some of the provisions of interest to the Medical Department were as follows: a Regular Army limited to 175,000 enlisted men; reorganization of the Dental Corps providing grades of first lieutenant to major; organization of the Veterinary Corps (formerly civilian employees of the Quartermaster General’s Department) as a part of the Medical Department, with rank from second lieutenant to major. Reserve hospital and ambulance units were organized by the Medical Department in cooperation with the American Red Cross. The American Red Cross base hospitals pre- viously organized were the initial and earliest American medical installations and service in the World War. George P. Foster, Captain, Medical Corps, demonstrated that certain colds (upper respiratory infections) were due to an invisible and filterable virus. 1917 April 6. War was declared on Germany by the United States, and the Medical Depart- ment like other departments of the Army began a tremendous expansion. It was necessary to establish two separate medical services: a medical service for the theater of operations in France and another for the zone of the interior in the United States. Fortunately, the Medical Department was not entirely unprepared for its task. The Medical Reserve Corps and the American Red Cross were in existence and were of in- valuable aid. Much had been learned about field sanitation. Immunization against typhoid and smallpox was universally used. Nevertheless, a new medical problem in respiratory diseases appeared in the form of the influenza epidemic. At this time the personnel strength of the Medical Department was recorded as follows: Medical Corps, 833; Dental Corps, 86; Veterinary Corps, 62; Nurse Corps, 403; and en- listed men, 6,619. There were in the Army 131 station hospitals, 4 general hospitals, and 5 temporary base hospitals, the total of which furnished a bed capacity of 9,530. So many expansions of the Army began to take place at the same time that the facilities .and personnel of the Medical Department had to be increased and made flexible to meet 386 MILITARY MEDICAL MANUAL new demands, as well as to carry on the increase of its normal work. It resulted in the creation of additional subdivisions and several independent divisions of administration, most of which were organized during 1917 and the early months of 1918. The five divi- sions which were already in operation were: Personnel; Sanitation; Supply (including Finance); the Army Medical Library and Museum; and the Division of Records, Corres- pondence, and Examining. Since the Division of Sanitation handled all professional subjects, it was evident that it would receive the majority of subdivisions, which were the following: Hospitals, Over- seas Hospitals, General Surgery, Military Orthopedic Surgery, Head Surgery, Internal Medicine, Neurology and Psychiatry, Laboratories and Infectious Diseases, and Roentgen- ology. The other four original divisions were divided into sections but, in general, remained intact. The new and independent divisions were: Psychology, Gas Warfare, Foods, Air Service, and Physical Reconstruction. The Dental, Veterinary, and Nursing Divisions were closely associated with the Personnel Division and coordinated their activities with the administra- tion division pertinent to their respective affairs. A Sanitary Corps was organized to furnish the necessary technical assistance to the Medical Department officers. The members of this Corps were selected from highly trained and educated civilians with technical knowledge that made them valuable in laboratories and other auxiliary medical tasks. After the close of the World War many of the Sanitary Corps officers were commissioned as Medical Administrative Corps officers in the Regular Army; others continued in the Sanitary Corps Reserve. A regular peace-time Sanitary Corps of the Regular Army does not exist, but it is a corps of the Medical Department Reserve. To facilitate the early use of the Medical Department of the United States Army a re- quest was made by the French Army for an Ambulance Service. In response to this re- quest a commissioned Ambulance Service Corps was established. It was discontinued after the World War. Three hundred medical officers were sent to Great Britain and placed in training camps. This number was later increased to 1300. Upon completion of training, medical units were furnished to Great Britain, France, and Italy. The bulk of the Medical Department officers was furnished by the Reserve Corps of the Medical Department. The Nurse Corps received its increase from the Red Cross Reserve. The additional enlisted men were drafted men or volunteers. The National Guard units in the war supplied their own medical personnel. With the cooperation and the confidence of the American public, the interest and activi- ties of the American Medical Association and other professional societies, the Medical Department went swiftly ahead with a medical program that was carried out not only efficiently but to a size never matched or visualized before. Medical activity and progress in the zone of the interior was not limited to the Medical Department of the Army. Civilian institutions made their facilities available for training of the Medical Department officers and enlisted men. Linked with the training camps and schools this speeded up their preparation for war duty and permitted many more to be taught at the same time. The Red Cross filled all the needs for trained nurses; how- ever, looking ahead into the future, the Army started the Army School of Nursing at Walter Reed General Hospital, Washington, D. C., with branch units in all military hospitals. The influenza epidemic during 1917 and 1918 was a large medical problem of generalized national intensity. The civilian doctors, decreased in numbers by their colleagues in the government services, were taxed by many hours of vigilant duty. By no means did the epidemic miss the men in uniform. The World War casualties did not present any duties comparable to the control of this epidemic of respiratory disease known as influenza, and which so readily became complicated by pneumonia. There were 24,575 deaths among the officers and enlisted men of the American troops from this disease alone during the World War. May. Since November, 1915, the Medical Department had been tentatively assigned the MEDICO-MILITARY HISTORY 387 task of furnishing gas-defcnsc equipment, but in May, 1917, it became a definite responsi- bility. A special division of the Medical Department was organized and placed under the charge of Colonel W. P. Chamberlain, Medical Corps. May 8-19. During this period six fully equipped base hospitals had been shipped from the United States and were on the way to Europe. These hospitals were ready for operation before General John J. Pershing, the Commander in Chief of the American Expeditionary Force, arrived the latter part of May. June. Colonel William J. Mayo, Medical Reserve Corps, was asked to report to Wash- ington, D. C. to act as an adviser in organizing the Division of Surgery. The Medical Department profited a great deal by the cooperation and interest of Colonel Mayo and other capable medical men who were interested in the welfare of their nation. It can also be said that they in turn gained new professional knowledge and thereby profited by their Army experiences. June 13- There were with the American Expeditionary Force in Europe seven medical officers and two enlisted men of the Medical Department. The organization of the Medical Department of the American Expeditionary Force was not yet established, but plans were being completed rapidly. July. The Hospital Division of the Medical Department was created and Colonel Robert E. Noble (later Major General) was placed in charge. This division made plans and provisions for constructing and establishing the necessary hospitals. In some instances entire army posts were converted into hospitals. By autumn 44,000 beds were available for use in the large camps of the United States. This division was afterwards headed by Colonel (later Brigadier General) James D. Glennan who, on completing the necessary hospital provisions in this country, sailed for France and took charge of the Division of Hospitals in the Chief Surgeon’s Office of the American Expeditionary Force. In July the Chief Surgeon’s Office was established in Chaumont, France. As the ad- ministrative departments of the American Expeditionary Force simulated those of the War Department, so the Chief Surgeon’s Office simulated the Surgeon General’s Office and was organized accordingly with almost identical divisions and subdivisions. The Medical Department of the American Expeditionary Force early received the whole hearted support of General Pershing, resulting in the rapid development of the American medical service in Europe. August. The Division of Physical Reconstruction was created for disabled soldiers, Colonel Frank Billings, Medical Corps, being placed in charge. The purpose of this division was to secure for disabled soldiers the proper facilities for treatment and care which would restore them to the best possible health. September. Major Theodore C. Lyster, Medical Corps, was assigned Chief Surgeon of the Air Service for the purpose of organizing a specialized service, giving particular atten- tion to aviation medicine. Necessary specialists and equipment were made available and a central testing laboratory was established at Mineola, Long Island, New York. September 4, 11:00 p.m. First Lieutenant William T. Fitzsimons, Medical Reserve Corps, United States Army, was killed by an enemy airplane bomb that was dropped in the area of General Hospital No. 11, British Expeditionary Force, near Camiers, France. Lieutenant Fitzsimons was the adjutant of the United States Army Base Hospital No. 5 which was operating General Hospital No. 11 of the British Expeditionary Force. He was the first American officer to be killed by the enemy during the World War, and in recog- nition of his death the War Department named the largest army hospital at that time “The Fitzsimons General Hospital.” This hospital is located at Denver, Colorado. The same night, a little later and in the same area, another enemy bomb killed Private First Class Oscar C. Tugo of the Medical Department. He was the first enlisted man of the United States Army to be killed during the World War. Tugo Hall, the gymnasium building at Carlisle Barracks, Pennsylvania, was named in his honor. October 18. A medical board was established by the Adjutant General’s Office for the consideration of all matters pertaining to the physical examination and physical standards of airplane pilots. 388 MILITARY MEDICAL MANUAL October. The Food Division was authorized and Lieutenant Colonel John L. Murlin, Sanitary Corps, was placed in charge. The purpose of this division was to improve cooking, to prevent waste, to secure better balanced diets, and to increase the nutritional value of foods served in the Army. General John J. Pershing made a request for the appointment of a Superintendent of Nurses for the American Expeditionary Force, and Miss Bessie S. Bell, a former chief nurse of Walter Reed General Hospital, was selected and assigned the position. November. In the American Expeditionary Force, the issue of gas-defense equipment was turned over to the Chemical Warfare Service. December. The Sanitary Corps had trained 186 officers and 1199 enlisted men who later were transferred to the Engineer Corps. There was now in the Medical Department of the American Expeditionary Force a hos- pital bed capacity of 63,000. Plans had been made in October for 200,000, and this was the progress for the two months’ construction. 1918 January. The Research Laboratory for Aviation Medicine was completed at Hazel- hurst Field, Long Island, New York. The Division of Psychology was established with the object of eliminating mental de- fectives and to classify personnel examined for special services. It was originally a section of the Division of Neurology and Psychiatry. Major Robert M. Yerkes was placed in charge. Before the Armistice was signed, 1,151,552 men had been examined, and a large research problem in psychology had been performed. February. The Service of Supply (S.O.S.) of the American Expeditionary Force was organized. This S.O.S. included the Medical Department and had headquarters at Tours, France. It was divided into sections, each section having its own section surgeon. Because of the close friendship and the cooperative spirit of the heads of the medical departments of the S.O.S. and the zone of the armies, .'his arrangement worked out harmoniously. March. There were 2,099 nurses from the United States in service in France, 700 of whom were serving with the British torces. April 28. Colonel Merritte W. Ireland, M.C., was made a brigadier general and The Chief Surgeon of the American Expeditionary Force, replacing General A. E. Bradley who became ill and was invalided home. General Ireland had a thorough knowledge of the department as he had been serving as assistant to General Bradley. General Ireland was the original choice of General Pershing for Chief Surgeon, but General Bradley was senior to him and General Ireland expressed his thorough willingness to serve as General Bradley’s assistant. May 25. The Secretary of War authorized the establishment of the Army School of Nursing at the Walter Reed General Hospital, Washington, D. C. This school trained many nurses who after the war returned to civilian life and fostered a fine reputation for their professional training school. June. The hospital-bed capacity of the Medical Department in the United States had expanded to 73,066, and construction was in progress for an additional 16,799. The combat forces had so many sick and wounded in France that the Chief Surgeon, General Merritte W. Ireland, cabled to the United States for all available assistance. The Medical Department of the American Expeditionary Force, as of June 1, consisted of 5,198 officers, 2,539 nurses, and 30,574 enlisted men. The responsibility of the Medical Department of the United States Army for furnishing gas-defense equipment was turned over to the Chemical Warfare Service. Prior to this date, however, the Medical Department had already furnished 1,718,000 gas masks, 502,000 extra cannisters, and 154,000 horse masks. July 9. An Act of Congress provided that the Nurse Corps (female) would be known as the “Army Nurse Corps of the United States Army”. August. The personnel of the Medical Department of the American Expeditionary Force had increased to 9,601 officers, 4,735 nurses, and 67,144 enlisted men. The United States Army sent an expedition to Eastern Siberia with a force of 8,831 officers MEDICO-MILITARY HISTORY 389 and men. The medical personnel of this expedition consisted of 698 officers and men. Activities of this expedition extended as far as 1,700 miles away from the base at Vladivostok. Medical statistic show that there were 8,100 admissions to sick report and 86 deaths. Another large American Expeditionary force of 4,477 officers and men was sent to Archangel, Siberia in August, accompanied by the necessary medical personnel. Total admissions to hospitals were 2,352. There were 104 deaths in hospitals, and 82 deaths occurred in battle. General Merritte W. Ireland, the Chief Surgeon of the American Expeditionary Force, in recognition of his able and outstanding service, was promoted to the rank of major general. His responsibility and activity were proportionate to the rapidity of expansion and the burden of the Medical Department at this period. August 22. The War Department regained control of the Carlisle Barracks Military Reservation, previously administered by the Department of the Interior. September. Medical activity of the World War was at its peak. Influenza was adding to the task of the Army, especially the Medical Department. Nevertheless, according to reports received from active combat units, the average elapsed time from the soldier’s re- ceipt of a battle wound until he reached a field hospital was about five hours. The average elapsed time from the front line to an evacuation hospital was ten hours. Many factors altered the time element, but in spite of all obstacles tew if any went without medical care. The wounded arrived at the base hospitals in train loads of 300 to 500 men, with several train loads per day. During this month, 52,762 short tons, approximately 6,331,440 cubic feet, of medical sup- plies were shipped across the Atlantic Ocean to the American Expeditionary Force. The equipment for sixty base hospitals of 1,000 beds each was also available and awaiting ship- ment. The Veterinary Service was organized temporarily as a part of the Remount Service. October 4. General Merritte W. Ireland was appointed Surgeon General, succeeding General William C. Gorgas. Brigadier General Walter D. McCaw became the Chief Surgeon of the American Expeditionary Force. General Ireland had built up a large, efficient Medical Department in foreign territory, and in less than six weeks the task of demobilizing this same organization to include the zone of the interior would become his responsibility. The Army consisted of over three and one half million men, who would have to be examined physically and returned to peace-time activities. November 11. Armistice Day terminated the World War combat activities, but it did not end the duties of the Medical Department and other Army services. At the close of the war the Medical Department itself had expanded to: Medical Corps, 30,591; Dental Corps, 4,620; Veterinary Corps, 2,002; Sanitary Corps, 2,919; Nurse Corps, 21,480; and enlisted men, 281,341. The Medical Department was larger by 100,000 than the entire Regular Army of 1939. There were 76,964 patients in base and general hospitals of the United States and 193,026 patients in hospitals of the American Expeditionary Force, a total of 269,990 patients who were undergoing active treatment on November 11. The normal bed capacity of the hos- pitals of the American Expeditionary Force was 192,844, with an emergency expansion capacity to 276,347. There were 153 base hospitals, 66 camp hospitals, and 12 convalescent camps in France. The maximum strength of medical personnel in the American Expeditionary Force during the World War was 18,146 medical officers, 10,081 nurses, and 145,815 enlisted men. The bed capacity of 91 large hospitals in the United States totaled 120,916. Construction was in progress for 25,000 more beds, and plans had been made for an additional 60,000 beds. The Medical Department during the World War treated 4,000,000 sick and wounded in hospitals, and over 7,000,000 men were given physical examinations. Besides this pro- fessional work there were many administrative duties. The Medical Department in both the zone of operations and the zone of the interior maintained and operated hospitals, laboratories, medical supply depots, hospital trains, training schools, and numerous other essential medical activities. 390 MILITARY MEDICAL MANUAL Approximately $314,544,000 were spent to accomplish the medical missions of the United States during the World War, which was only 2.2 per cent of the total war ex- penditure of $14,244,061,000. The medical service extended to Great Britain, France, Italy, Siberia, and, after the Armistice, to Germany. The files of the Surgeon-General’s office record the medical service of the World War as follows: “Each soldier of the A.E.F. was provided, as a part of his individual equipment, with either a Medical Department regulation first aid packet or a front packet, enclosed in a metal case . . comprised of two gauze bandages, three and one-half by three and one- half inches, two gauze bandages, four by eighty-four inches and two safety pins. The packages contained definite directions for application. Medical Department enlisted men assigned to the battlefield carried usually in a duffle bag or gunny sack a liberal quantity of these packets and also iodine swabs. This was important because of the frequency of multiple wounds and of the frequent lack of a packet on the person of the wounded by reason of its having either been lost, or, contrary to instructions, applied to a wounded comrade. “The idea was to apply first aid immediately at the place where the wound was incurred, either by Medical Department personnel on duty with organizations in the front line or serving as litter bearers, or by litter bearers detailed from the line who were instructed in elementary first aid. “Company Aid Station.—In some instances stations subsidiary to battalion aid sta- tions were established in the front line for each company, conducted by two dressers assigned from the battalion medical personnel. At these company aid stations emergency treatment was given the wounded brought thereto usually by line litter bearers. “Such stations were more commonly used in trench warfare when it was possible to keep a small supply of surplus dressings and even splints, and sometimes a battalion medical officer took station there; but in open warfare the only available dressings were those carried on the person, and often the only shelter was that afforded by a shell-hole, consequently the wounded habitually were borne to the battalion aid station. “The Battalion Aid Station.—In trench warfare, battalion aid stations usually were located in dugouts in the support line, two hundred and fifty to one thousand yards in rear of the front line, on or near an evacuation trench. Briefly, the equipment, in addition to that enumerated in supply tables for a battalion, consisted of medical and surgical supplies adequate for a modern emergency first aid room. It included at least two Thomas splints, and a shock table for warming patients. Light was supplied by simple petroleum lamps, and in some electricity was present. Cooking was done below, when possible, coke or any available fuel being used and ventilators having dampers for excluding gas, led to the surface. . . . The source of heat was small wood-burning stoves. . . . Supplies were usually brought up by battalion medical carts . . . and habitually included stimulants and ample facilities for the preparation of hot liquid foods, and other articles of food were also stocked, as often in periods of intense bom- bardment patients could not be evacuated until after dark. . . . With respect to surgical treatment, the procedures which obtained in the battalion aid stations may be sum- marized as follows: (1) Revision of first aid dressing. Pain, when present, was usually due to constriction of the wounded parts by gauze and bandage, which required chang- ing or loosening. (2) Revision of splinting to insure proper immobilization for subsequent transportation. Application of the Thomas leg or arm splint when traction was indicated. “To arrest severe hemorrhage whenever the element of time, available surgical facilities, and good surgical judgment permitted, the bleeding artery was sought in the wound and ligated above and below its laceration. . . . Only dire necessity justified the evacuation of a patient with tourniquet on arm or thigh. . . . The maintenance of the body heat of the wounded by means of blankets, coats, hot water botdes, canteens filled with hot water, and hot drinks (when not contraindicated by the nature of the wound) was vastly important. . . . Antitetanic serum was administered habitually, even in case of an apparently trivial wound, and the fact of administration recorded on the field tag, and indicated on the patient’s forehead by a cross painted with iodine. If the MEDICO-MILITARY HISTORY 391 wound or dressings involved the forehead, the cross was painted on the dorsum of one hand. The standard dose of morphine, one-fourth grain, was given immediately to all severely wounded, and to those slightly wounded in whom the element of pain was considered to be a factor in the development of shock. Often it was found advantageous to repeat the dose. . . . “In battalion aid stations, it was usually impossible for the surgeon to scrub his hands and change gloves for each wound treatment: Water and gloves were not always available, or the supply was limited. However, instruments could be sterilized suffi- ciendy by immersion in alcohol or ether, and by experience, the surgeon could easily learn to dress all wounds without having his hands make contact with septic tissues or objects. With two pairs of dressing forceps, or with one pair each of artery and dressing forceps, he could accomplish any kind of dressing and continue with a series of cases without scrubbing his hands or changing his gloves after completion of each. . . . “The Dressing Station.—The number and locations of divisional dressing stations were dependent upon the roads, available shelter and the width and activity of the divisional sector; generally from one to three to a division, located from three thousand to six thousand yards from the front line. “In trench warfare the dressing station, usually located in a dugout or in any avail- able building, contained a greater amount and variety of equipment than was possible in open warfare, and had separate rooms for such purposes as receiving, recording and dressing the wounded, for shock treatment, the serving of hot foods, and for adminis- tration. Since more time was available for the care of men brought to the dressing station than was true in open-warfare conditions, many who were merely exhausted were returned to duty after a few hours’ rest during which they were given hot food; also, casualties depleted by hemorrhage or suffering from shock could be retained longer and consequently evacuated in better conditions. The personnel usually worked in shifts. “Each dressing station was placed as near the front as conditions permitted, the loca- tion selected being generally with a view to its subsequent occupation by a field hospital as the action developed. . . “The function of the dressing station in general was to receive casualties, to administer indicated emergency treatment, and to evacuate to designated destinations when conditions permitted, but, habitually, to field hospitals. The emergency treatment comprised arresting hemorrhage, readjusting dressings, applying or readjusting splints, administration of morphia and of antitetanic serum, when time permitted, stimulation by hot drinks, and the retention and reviving of gassed and shocked cases as far as possible. Operations were limited practically to the closure of aspirating wounds of the chest, and to emergency ligations. “The Field Hospital.—The field hospital was the last and largest divisional unit of the Medical Department in the chain of evacuation, the function of which, in general, was to receive casualties from the dressing station, and to institute all measures possible under varying conditions to best fit them for continued evacuation, usually to evacuation hospitals. Field hospitals were located from three to eight miles from the front line, depending upon such factors as the enemy range of fire, roads, fuel, water, availability of buildings, and the location of evacuation hospitals. Whenever possible they were grouped, preferably in a village or at the confluence of roads from the sector served, for convenience both in the interchange of patients and for the ambulances. “In trench warfare and in some quiet sectors the field hospital was of semi-permanent character and was often elaborately installed with modern equipment and conveniences in well-adapted, commodious buildings or well-arranged dugouts. The equipment, in addition to all surgical essentials, included electric lights, portable radiographic and laboratory units, steam sterilizer, and other similar conveniences. In a few instances they, complete with equipment, were taken over by the French. Usually, under these condi- tions, one field hospital functioned as triage and cared for the wounded and gassed, one cared for the sick, one for skin and venereal cases, and a fourth was held in reserve, frequendy conducting a convalescent camp for transportable patients and supplementing the others as required. All cases likely to become fit for duty in from ten to fourteen 392 MILITARY MEDICAL MANUAL days were held. While no definitive measures were undertaken, greater latitude and freedom of action within the discretion of the stall was customary than usually proved possible in open warfare. “The normal personnel of the field hospitals usually was augmented by the division specialists of the various branches and at times also by special operating rooms and shock teams. In a few instances, their facilities for the care of non-transportable wounded were increased by the attaching of mobile surgical units. “It was not intended that definitive surgery should be performed in field hospitals except upon certain non-transportable patients, as evacuation hospitals were provided for this purpose. The scope of professional activities in field hospitals varied greatly according to the intensity of the action, but during an offensive it was customary to evacuate all patients as soon as they could endure transportation.” 1918-1931. General Ireland’s Administration After the World War Period 1918 November. Demobilization and reorganization of the Regular Army was the problem of the hour, returning and restoring men to their occupations in the homeland. The Army consisted of over 3,500,000 men; the Medical Department had over 350,000 officers and men. There were still approximately 265,000 sick and wounded remaining in hospitals in France and the United States. The Medical Department continued to restore the disabled and sick soldiers to the best possible health. Physical examinations were conducted on all soldiers prior to their discharge in order to make records of their physical condition and to list their disabilities if any were noted. 1919 May. The “Medical Research Laboratory and School for Flight Surgeons” was estab- lished at Hazelhurst Field, Long Island, New York, and the first course of eight weeks was started. June. A serious outbreak of typhus fever in Serbia led to the dispatch of a commission by the American Red Cross to fight the disease. Lieutenant Colonel Edgar Erskine Hume, M.C., United States Army, was appointed Chief Medical Officer and American Red Cross Commissioner. The work was completed successfully, and the Commission withdrew during the summer and early fall of 1920. July 1. The Medical Department had gradually been reduced by demobilization to 12,731 officers, including the Medical Reserve Corps still on active duty, and 83,577 en- listed men. Approximately 18,000 officers and 195,000 enlisted men of the Medical De- partment had been discharged since Armistice Day. July. The responsibility of caring for the war veterans was turned over to the United States Public Health Service. Several large Army hospitals used during the war were also transferred to the Public Health Service to increase their facilities for this added duty. August. The “Medical Research Laboratory and School for Flight Surgeons” was moved to Mitchell Field, Long Island, New York, and the course extended to 4 months. September 1. The Office of the Chief Surgeon of the American Expeditionary Force was concerned only with the personnel of the American Forces remaining in Germany. December. The Chief Surgeon’s Office of the American Expeditionary Force organized the Polish Typhus Relief Expedition consisting of Medical Department personnel of the Regular Army. This expedition was later placed under the control of the Army of Occu- pation in Germany. Miss Julia Stimson was appointed Superintendent of the Army Nurse Corps in recogni- tion of her excellent war service. She had been chosen by the Chief Surgeon of the American Expeditionary Force to be Chief Nurse of the Red Cross Nurses in France in March, 1918, which position she held until November of the same year. Then she was appointed Director of Nursing Service of the American Expeditionary Force. She returned to the United States in July, 1919, and served as Dean of the Army School of Nursing until her appointment as Superintendent of the Army Nurse Corps. She succeeded Miss Dora MEDICO-MILITARY HISTORY 393 E. Thompson, who voluntarily resigned as Superintendent. Miss Thompson, after return from an extended leave, was appointed Assistant Superintendent of the Army Nurse Corps. 1920 January and February. There was a mild epidemic form of influenza, which increased considerably the soldier death-rate for 1920. However, it was not as severe as the form of influenza during the World War which so frequently led to complications of pneumonia. May 15. The Secretary of War authorized the use of the Carlisle Barracks Military Reservation for the purpose of establishing a Medical Field Service School. The Barracks, previously occupied by the Indian Industrial School, had been used by the War Department during 1918 as General Hospital No. 31. April 28, 1920, General Merritte W. Ireland, then Surgeon General, wrote to the Adjutant General requesting that the reservation be permanently assigned to the Medical Department for a service school for field training of its officers and enlisted personnel. The letter of approval from The Adjutant General’s Office was dated May 15, 1920. June 4. The amendments to the National Defense Act provided the Medical Administra- tive Corps as a part of the Medical Department to furnish an auxiliary service to the pro- fessional corps. The organization was fixed at 140 officers and the Corps was established by giving permanent commissions to enlisted men who had been commissioned in the Sanitary Corps during the World War. Nurses of the Army Nurse Corps received relative rank and were authorized to wear insignia on their uniforms. They were given the rights and privileges of their respective rank as officers. The Superintendent of the Army Nurse Corps, Miss Julia Stimson, re- ceived the rank of major. June 30. Over 5,500 military patients of the United States Army whose disabilities were caused by battle wounds were still remaining in hospitals of the United States. July. The Medical Department officer personnel was further reduced to: Medical Corps, 1,948; Dental Corps, 322; Veterinary Corps, 283; and the Nurse Corps to about 1,500. October 1. The Medical Department Equipment Laboratory was established at Carlisle Barracks, Pennsylvania, to provide an experimental laboratory for producing, testing, and determining the serviceability of medical equipment, especially the equipment used in medical field service. During 1920. Graduates of Class A medical schools were accepted as internes in the larger station hospitals and the general hospitals of the Army. After completing an in- terneship of one year many were offered commissions as first lieutenants in the Medical Corps. 1921 The Medical Field Service School was established at Carlisle Barracks, Pennsylvania, for the purpose of training Medical Department officers in medico-military matters to include tactics, field sanitation, administration, organization of medical units for field service, equitation, motor mechanics, and allied subjects. On May 25 of the same year The Adju- tant General approved the present coat of arms for the Medical Field Service School with the motto “To conserve fighting strength”. (For further information relative to this school see Chapter II.) February. The Medical Research Laboratory and School for Flight Surgeons was listed by the War Department as a “service school”. August. The “Veterans’ Bureau” was created by Congress and became responsible for the care and treatment of the War Veterans. This duty had originally been handled by the Medical Department of the Army until July, 1920, when it was relinquished to the United States Public Health Service. 1922 Upon recommendation of Major General Merritte Weber Ireland, the Surgeon General, a third “Tropical Disease Board” was established in Manila, (W. D. Special Orders No. 38-0, February 19, 1922, and No. 85-0, April 12, 1922) where it functioned until Major General Robert Urie Patterson recommended its transfer to the Panama 394 Canal Department in 1934. The third Tropical Disease Board included in its member- ship medical, veterinary, and medical administrative corps officers. Hookworm, leprosy, tuberculosis, dengue, veterinary bacteriology, beriberi, cancer, surra, and rinder- pest were among the subjects investigated in the Philippine Islands. A general remodeling and modernizing of all field medical equipment was begun. The demobilization of the World War was nearing completion, and the lessons learned in that war were being given consideration and thought. The need for a professional training school for Army dental officers had become evident and the Army Dental School came into existence at the Army Medical Center, Washington, D. C. The personnel strength of the Medical Department was now as follows: Medical Corps, 983; Dental Corps, 128; Veterinary Corps, 126; Medical Administrative Corps, 72; Nurse Corps, 669; and enlisted men, 7,200. Army Regulation 350-105 changed the name of the School for Flight Surgeons to “The School of Aviation Medicine.” 1923 The regular monthly medical meetings which are held at the Army Medical Center were initiated. These meetings foster a closer relationship socially and professionally between Medical Department officers. In addition, they extend this relationship to corresponding medical officers and officials of other governmental agencies and civilian doctors practicing in the vicinity of Washington, D. C. Officers of the Medical Department Reserve Corps are also invited to attend. These meetings are held at eight o’clock at the Auditorium (center wing of the School Building), Army Medical Center, on the third Monday evening of each month, from October to May inclusive. The professional address and discussion is followed by a social hour during which refreshments arc served. The School Building of the Army Medical Center was built near Walter Reed General Hospital, Washington, D. C. The War Department issued orders directing that the Takoma Park section of the District of Columbia be known as “The Army Medical Center,” Washington, D. C. 1924 The Medical Department Reserves had grown steadily and attained the following strength: Medical Corps, 7,559; Dental Corps, 3,055; Veterinary Corps, 865; Sanitary Corps, 416; Medical Administrative Corps, 880; and the Red Cross (Nurse Reserve), 40,636. 1926 June 30. The School of Aviation Medicine was moved from Mitchel Field, Long Island, New York, to Brooks Field, Texas. 1927 The Index Medicus of the Army Medical Library and the Quarterly Cumulative Index of the American Medical Association were combined and published jointly. 1928 Domestic cattle in the Philippines were vaccinated against rinderpest, eliminating in large measure this disease of animals in the Islands. The rinderpest vaccine used was pre- pared by Major Raymond A. Reiser of the Veterinary Corps, Regular Army. This im- munization measure has been of tremendous value to economics of the Philippine Islands and adjacent countries. The Reserve Corps of the Medical Department had continued to grow, and the number in each corps at this time was: Medical Corps, 12,113; Dental Corps, 4,706; Veterinary Corps, 1,061; Sanitary Corps, 497; Medical Administrative Corps, 1,889; Nurse Corps, 47,252. Many non-divisional reserve units of the Medical Department had been organized to which Reserve officers were assigned. Eight Regular Army Medical Department officers were assigned to full time duty in connection with industrial preparedness through procurement planning. Also, Reserve officers who were engaged closely with production of Medical Department supplies had been given tours of active duty in the Surgeon General’s Office in order that procurement planning might, be carried out more wisely. MILITARY MEDICAL MANUAL 395 1929 A medical officer, Colonel Harry L. Gilchrist, Medical Corps, was appointed Chief of the Chemical Warfare Service with rank ot major general. At the request of Major General Ireland, Surgeon General of the Army, Colonel P. M. Ashburn, Medical Corps, wrote and published A History of the Medical Depart- ment of the United States Army which was dedicated to the Unknown Soldiers of the Medical Department. This book covers in detail the growth and history of the Medical Department, the biographies of important Medical Department officers, and the activities and achievements of the Medical Department and its members. It is a book which every Regular and Reserve officer of the Medical Department should own and read. In May of the same year, Lieutenant Colonel Edward B. Vedder, Medical Corps, puh- lished his book Medicine, Its Contribution to Civilization. Colonel Vedder had worked on the study of beri-beri while a member of the Tropical Board in the Philippines and had written an excellent book on the subject in 1913. He was also one of the first physicians to advocate the use of emetine in the treatment of amoebic dysentery. 1930 Lieutenant Colonel George C. Dunham, Medical Corps, published the first edition of Military Preventive Medicine (Army Medical Bulletin No. 23), a comprehensive text of basic information necessary to the practice of preventive medicine in the Army. The third edition was completed June 30, 1938. This excellent book is used as a text in the Depart- ment of Sanitation for the students who attend the Medical Field Service School at Carlisle Barracks, Pennsylvania. Its usefulness is not limited to the Army but is a ready reference in public health measures pertaining to civilian communities. 1931 An order of the Secretary of War directed the discontinuance of the Army School of Nursing, Washington, D. C. Its true professional value had been revealed by the excellent qualities of its graduates, but the school was closed for reasons of economy as graduates from civilian hospitals could readily be secured for commissions in the Army Nurse Corps. October 30. The School of Aviation Medicine was moved from Brooks Field to Ran- dolph Field, Texas, its present location. December. The publication of the Index Medicus, originated by the Army Medical Li- brary during Surgeon General William A. Hammond’s administration, became a function of the Journal of the American Medical Association. Other Events during the Period 1918-1931 Surgeon General Ireland made many progressive changes and additions to the Medical Department during his administration. He had a thorough knowledge of the needs of the Medical Department and its relationship to the rest of the Army. During the World War his leadershiD was in a large way responsible for the success and harmony between the combat forces and the medical service. One of the largest of Surgeon General Ireland’s advancements for the Army was the organization of the Army Medical Center, Takoma Park, Washington, D. C., where is lo- cated the Walter Reed General Hospital, The Army Medical School, The Dental School, The Veterinary School, and the technical training schools for enlisted men of the Medical Department. The Medical Department passed through a stabilizing period following the World War; the knowledge which had been acquired shaped the development of future policies and organization of the Medical Department. MEDICO-MILITARY HISTORY 1932-1942. The Period from General Ireland’s Administation to 1942 1932 The Army Medical School was enlarged to provide additional facilities. January 14. The Book Shop at the Medical Field Service School was opened for the benefit of officers of the Medical Department. This institution provided a place where 396 they could secure all materials necessary for instructional purposes in medico-military training. 1933 March. Complete medical service was instituted for the Civilian Conservation Corps. Reserve officers of the Medical Department were ordered to active duty and utilized as much as possible, relieving Regular Army Medical Department officers who had initiated this work. This medical service for the Civilian Conservation Corps is still conducted by the Medical Department of the Army. July 1. The School of Aviation Medicine, Randolph Field, Texas, was closed until December 31 because of Civilian Conservation Corps activities. The Medical Department was authorized to employ civilian nurses for the Civilian Conservation Corps at the rate of one nurse per each ten patients. The increased activity of the Army in caring for the Civilian Conservation Corps re- quired similar changes in the Medical Department, with expansion of the peace time hos- pital facilities. The medical supplies which were left over from the World War were utilized for the initial period of enrollment and establishment of camp dispensaries. The knowledge of field sanitation was put into practice immediately and proved its value many times. 1934 A post graduate course at the Army Medical School was initiated for Medical Department officers of higher grades as a professional refresher course. January 2. The School of Aviation Medicine, Randolph Field, Texas, was reopened. Two courses for medical officers have been conducted each year. April 19• In compliance with the recommendation of Major General Robert Urie Patterson, the Surgeon General, the Secretary of War ordered the transfer of the Third Tropical Disease Board from the Philippine Islands to the Board of Health laboratory, Gorgas Hospital, Ancon, Canal Zone. It was established there on July 26, 1934 and functioned until it was dissolved in 1939 upon the recommendation of Major General James Carre Magee. In Panama the Board’s studies included malaria, dysentery, de- generative arthritis in horses and mules, and equine encephalomyelitis. April 26. The Medical Department Reserve Officers’ Training Corps enrollment was discontinued. The Medical Reserve Corps appointments were given to graduates of ap- proved medical schools who were licensed and engaged in practice, upon recommendation of an examining board. 1935 January 30. The Veterinary Corps was reorganized with grades and promotion of officers from appointment to retirement made similar to appointment and retirement of the Dental and Medical Corps. All second lieutenants of the Veterinary Corp« were pro- moted to first lieutenant at once. 1936 The average strength of the Medical Department was reported as: Medical Corps, 1,033; Dental Corps, 183; Veterinary Corps, 126; Medical Administrative Corps, 72; Nurses Corps, 625; and enlisted men, 8,377. Appropriation Acts provided an increase of 50 medical officers and 25 dental officers for each of the next three years, 1936, 1937, and 1938. January 13- The Surgeon General’s Office was reorganized into 10 divisions and 30 subdivisions. (See Surgeon General’s Office). February. The Medical Instructors Bulletin was authorized by the War Department to be issued by the Surgeon General to corps area and department surgeons and medical in- structors of the National Guard and Organized Reserves. This bulletin contained infor- mation of special interest to medical instructors dealing with the problems of the National Guard and the Organized Reserves. May 13. The Medical Reserve Officers’ Training Corps was reestablished and, in the fall of the same year, instruction was started in several medical schools. MILITARY MEDICAL MANUAL MEDICO-MILITARY HISTORY 397 June 4. An Act of Congress provided changes in the requirements tor appointment of Medical Administrative Corps officers. It limited appointments to graduates of a four year course in recognized schools of Pharmacy, thereby excluding the commissioning of former Medical Department enlisted men unless they possessed the above requirements. November 16. The celebration of the 100th Anniversary of the founding of the Army Medical Library was commemorated in Washington, D. C. Approximately 600 guests were present, many of whom were world famous doctors, scientists, librarians, and rep- resentatives from medical institutions and societies from all parts of the United States and foreign countries. The chief oration was made by Sir Humphry Davy Rollcston, Baronet, G.C.V.O., K.C.B., M.D., Emeritus Regius Professor of Physic (Medicine), University of Cambridge, England. The library contained more than a million items and was then and still is the largest medical library in the world. 1937 January. A physiological research laboratory was completed at Wright Field, Dayton, Ohio. It was designed for research work in aviation medicine. July. The Medical Instructors Bulletin, previously issued quarterly, was discontinued as a separate publication, and the information contained therein was placed in the Army Medical Bulletin. The latter, containing administrative and professional information of interest to all members of the Medical Department, is issued quarterly to each Regular Army officer of the Medical Department. This bulletin is edited by the executive officer of the Surgeon General’s Office and printed at the Army Printing Plant, Carlisle Barracks, Pennsylvania. September 9. Interneships in Army hospitals were discontinued. Commissioned officers of the Medical Corps, Regular Army, were appointed by competitive examination. A physical examination was required before the candidate was permitted to take the pro- fessional examination. This method of appointment is still used. December. Type I and Type II pneumonia immunization, following experimentation for one year prior to this time, was extended to the Civilian Conservation Corps in all corps areas using the vaccine prepared at the Army Medical School. The results proved very favorable. During the year. Over 500,000 doses of typhoid prophylactic were made available to the Red Cross in the flood relief of the Ohio Valley. The 1st Medical Regiment, Carlisle Barracks, Pennsylvania, assisted in relief work dur- ing the flood of the Ohio River Valley. The regiment arrived near Louisville, Kentucky, about January 30, and set up and directed medical care in several centers. 1938 Appropriation for the fiscal year 1939 authorized an average strength of 165,000 en- listed men and 14,659 officers for the Regular Army. The Medical Department strength was: Medical Corps, 1,183; Dental Corps, 258; Veterinary Corps, 126; Medical Adminis- trative Corps, 63; Nurse Corps, 675; and enlisted men, 8,643. There were also 740 civilian employees in the Surgeon General’s Office. An addition of two assistants to the Surgeon General in the grade of brigadier general was authorized. The first brigadier general of the Dental Corps was appointed as Assistant to the Surgeon General, Chief of the Dental Division. Lt. Colonel Leigh C. Fairbank, Dental Corps, was appointed and assumed office March 17, 1938. March 16. Central dental laboratories were established to serve groups of station hos- pitals with the exception of those station hospitals having their own dental laboratory service or those served by a general hospital laboratory. April. A report was made which indicated that prior to this time there were 36 graduates of the Command and General Staff School, 30 graduates of the Army War College, 8 graduates of the Infantry School, and 31 graduates of the Army Industrial College in the Medical Department. June. The daily mean strength of the Civilian Conservation Corps was 244,342. There- fore, in reality, the Medical Department was caring for the Regular Army plus the 398 MILITARY MEDICAL MANUAL Civilian Conservation Corps, a total of approximately 500,000. Since the enrollment periods are six months, many physical examinations for entrance and discharge from the Civilian Conservation Corps are conducted at these periodic intervals. Although the Civilian Conservation Corps was introduced on a temporary basis, it is now being con- sidered for permanent establishment. June 13. The President approved a bill passed by the Congress authorizing $3,750,000 for the future construction of a building to replace the present Army Medical Library and Museum. However, funds were not appropriated for this construction in 1938. June 29-July 6. About 1,900 Civil War veterans of the North and the South joined in a reunion at Gettysburg, Pennsylvania to celebrate the 75th anniversary of the Battle of Gettysburg, which was fought July 1, 2, and 3, 1863. The Surgeon General was in com- plete charge of all medical activities and responsible only to the Federal Commission. The Surgeon General utilized the 1st Medical Regiment, Carlisle Barracks, Pennsylvania, to carry out his medical plan. Including visitors the strength of the command reached a maximum of 209,319. There were 2,693 outpatient treatments, 83 admissions to hos- pitals, and 7 deaths. Only 2 deaths occurred at Gettysburg, the other 5 deaths occurring en route to or from the reunion of the Blue and the Gray. Lieutenant Colonel Paul R. Hawley, 1st Medical Regiment, was the Surgeon, Blue and Gray Reunion, and the repre- sentative of the Surgeon General. The civilian hospitals in nearby cities were used when necessary. Little difficulty was experienced in handling the veterans, who averaged the age of 94. During the year. Research on the medical aspects of chemical warfare was carried on at Edgewood Arsenal, New Jersey. 1939 May. The George S. Huntington anatomic collection was presented to the Medical Department of the Army by the Columbia University Medical School. It is the most comprehensive and one of the most valuable collections of comparative and human anatomic specimens in the world, illustrating most structures of the body. The delivery of this collection to the Army Medical Museum was completed during May, 1939. May 7-May 13. The Tenth International Congress of Military Medicine and Pharmacy met in Washington, D. C. Major General Charles R. Reynolds, Surgeon General of the United States Army, was President of the Congress and Chairman of the organizing committee. It was the first meeting of this medico-military congress in the western hemisphere. July 13. President Roosevelt signed a bill authorizing the construction of a new build- ing for the Medical Field Service School at Carlisle Barracks, Pennsylvania. October. The Surgeon General announced that prospective dental officers might apply for training as internes in Army hospitals. This enables the Medical Department to com- plete the training of Dental Corps candidates under its own supervision. December. As a part of the program initiated by the declaration of the President of a state of “limited emergency,” the courses at the Army Medical School and Medical Field Service School were materially rearranged. The class at the Army Medical School was graduated December 1. Two Basic classes, for a period of three months each, were pro- vided at the Medical Field Service School instead of one, the first to start December 4, 1939, the second March 11, 1940. During the year. Authority was granted by the Congress to increase the medical officers of the Regular Army from 1133, as of July 31, 1939, to 1492 by June 30, 1949, this increase to be attained by equal, annual increments. During the fiscal year 1940, the Medical Corps was to be increased by 77 officers. Because of the prevalent epidemics of equine encephalomyelitis in the United States during 1939, the Army Veterinary School completed the manufacture and distribution of sufficient encephalomyelitis vaccine for the immunization of all horses and mules of the Regular Army, National Guard, and R. O. T. C. units, and the vaccination of ap- proximately 35,000 animals. MEDICO-MILITARY HISTORY 399 1940 January 13. A Medical Department Research Coordinating Board was appointed by Major General James Carre Magee, the Surgeon General, to investigate and report upon the various diseases or conditions directly affecting the military personnel and Army animals. The members included the chiefs of the Professional Service Division, Statistics Division, Finance and Supply Division, and Veterinary Division of the Surgeon General’s Office; Chief pf the Division of Aviation Medicine in the Office of the Chief of the Air Corps; the Assistant Commandant of the Medical Department Professional Service Schools, Army Medical Center; Director of Laboratories, Medical Department Professional Service School; Director of the Dental School; Chief of the Medical Research Division, Edgewood Arsenal, Maryland; and the Secretary of the Medical Department Professional Service School, Recorder. June 30. The personnel strength of the Medical Department Reserve Corps was ap- proximately as follows: Medical Corps, 16,000; Dental Corps, 5000; Veterinary Corps, 1500; Sanitary Corps, 500; and the Medical Administrative Corps, 1200. The total strength of the Medical Department Reserve Corps was about 24,000. July 13. Starting with the course of instruction beginning July 15, 1940, graduates of the School of Aviation Medicine were classified as “Aviation Medical Examiners.” When a graduate has served a minimum of one year of active duty with the Air Corps, after having received such a qualification, and has demonstrated that he possesses the required qualifications, he may, under such regulations as the Surgeon General pre- scribes, be rated as “Flight Surgeon.” September 9. Construction began on the new school building (Hoff Hall) for the Medical Field Service School at Carlisle Barracks, Pennsylvania. During the year. Changes in Army Regulations were made to classify noncommis- sioned officers of the Medical Department in all grades within two categories: the tactical group and the hospitalization and administration group. The tactical group includes personnel with medical regiments, medical battalions, medical squadrons, medical or veterinary troops, separate companies, medical or veterinary, and unit medical detachments. The hospitalization and administration group includes all other non- commissioned officers of the Medical Department. 1941 February 12. Regulations were issued to provide for vaccination against yellow fever for all United States military personnel stationed in the tropical regions of the Western Hemisphere, including Panama and Puerto Rico. April 16. War Department S. G. O. Circular No. 34 directed that tetanus toxoid be administered to all military personnel on active duty. Subsequent vaccination with tetanus toxoid (a single “stimulating” dose of 1 c.c.) will be administered at the end of the first year only, regardless of duration of service. In time of war a “stimulating” dose will be given during the month prior to departure for a theatre of operations. Record of the immunization will be placed on the individual’s identification tag and on an Immunization Register, M.D. Form No. 81. July. The initial Medical Administrative Officer Candidate School was started at Carlisle Barracks, Pa. August. Completely mobile, surgical, field hospital units with self-contained operating facilities permanently installed in motor vehicles were authorized for purchase by the War Department. A new department, “Department of Medicine and Surgery in Forward Areas,” was established at the Medical Field Service School, Carlisle Barracks, Pennsylvania, to collect, classify, evaluate, and disseminate information relative to new methods of treat- ment for wounded on battlefields. It will also study the progress of industrial medicine as adapted to military practice. October. The new building (Hoff Hall) for the Medical Field Service School at Carlisle Barracks, Pennsylvania, was completed. December 7. The Japanese Navy attacked Pearl Harbor, Hawaii, thereby declaring war on the United States. The strength of the Army of the United States was 1,700,000. 400 MILITARY MEDICAL MANUAL During the year. The routine annual physical examination of officers of the Regular Army was suspended during the “National Emergency” for officers below the grade of lieutenant colonel. Professional examination for promotion in the Regular Army of officers of the Medical, Dental, and Veterinary Corps was discontinued by law until May 15, 1945. Physical examination for promotion was not discontinued. Three medical replacement training centers were constructed and activated. They were located at Camp Grant, Illinois; Camp Lee, Virginia; and Camp Barkeley, Texas. Upon completion of the 13-week training period, as outlined by Mobilization Training Program 8-5, at these replacement training centers, the trainees are requisitioned and transferred to Medical Department units, where they continue their training as pertains to the unit to which they may be assigned (unit training). The War Department established eighteen branches of the School of Aviation Medi- cine at various Air Corps stations in the United States, the Panama Canal Zone, and Hawaii. Julia O. Flikke, Major in the Army Nurse Corps, was promoted to the grade of Colonel, the first Army Nurse to attain this rank. 1942 A new medical replacement training center was established at Camp Joseph T. Robin- son, Arkansas, bringing the total of medical replacement training centers to four. The Replacement Training Center at Camp Lee, Virginia, was moved to Camp Pickett, Virginia. March. There was a reorganization of the War Department into three main com- ponents: the Army Ground Forces, the Army Air Forces, and the Services of Supply. The Medical Department was placed within the Services of Supply. April 11. The second Medical Administrative Officer Candidates’ School composed of an initial group of 250 candidates was started at the Medical Replacement Training Center, Camp Barkeley, Texas. This capacity was increased progressively. During the year. In order to provide for the prevention of disease in the Army during the present emergency the following subdivisions of the Surgeon General’s Office were made: Epidemiology, disease control and individual hygiene; Sanitation, hygiene, and laboratories; Sanitary engineering; Venereal disease control; and Medical intelligence in tropical medicine. WITH DUE RESPECTS TO ARMY MEDICINE The Army medical officer is frequently confronted with the following or similar questions from his friends and civilian colleagues: “What medicine and surgery do you practice in the Army?”; or “What does the doctor in the Army accomplish as an individual?” The questions are often vague because so few people know what the Army medical officer does and the scope of his activities. Neither do they know his responsibilities nor the true mission of the Army Medical Department of which he is a member. Therefore in a brief resume of achievements of the Medical Department of the United States Army and its officers this chapter may help the reader to under- stand the true value of Army medicine. Army medicine in the United States began with the Revolutionary period when Dr. Joseph Warren, a major general of militia, and several other medical men fought in the line during the Battle of Bunker Hill. When the battle was over the wounded were placed in several large commodious homes which were used as hospitals. These doctors devoted their service in whatever capacity they thought most necessary for their cause of liberty. If the superiority of fire was deemed most urgent they placed themselves firing a weapon in the line, and when the firing ceased they returned to their medical work, caring for the sick and wounded. This same spirit prevails in the Medical Department of the United States Army today. Its officers arc still giving their time and efforts to preserve the fighting strength of our Army. As the result of improved medical care and sanitation the health of America is constantly MEDICO-MILITARY HISTORY 401 improving. The result of this progress is already manifest in the Army during rhe present emergency. All troops destined for foreign shores have been given special im- munization against diseases which they might encounter. The Army was one of the first organizations to put many of these modern health measures into practice with demonstrable success. A few examples of these methods are: regular physical ex- amination of the personnel of the Army; routine immunization against typhoid, small- pox, diphtheria, tetanus, and yellow fever; and the control of venereal disease. The early discoveries, the application of practical sanitary measures, and the medical practices of the Army have not only prolonged the life of its own personnel but that of all people of the civilized world. An Army Doctor Purifies Water It was a medical officer of the United States Army who originated and devised a method of purifying water by means of chlorine. He discovered that the amount of chlorine required to kill the pathogenic organisms in water did not render it unpalatable for drinking. Later, in 1910, he added to his discovery by developing a mechanical liquid chlorine water purifier which is now used throughout the world. Major C. R. Darnall, Medical Corps, is re- sponsible for these feats, which have not been generally known to the public. Water can be purified in large quantities by this method, and large cities now are almost en- tirely dependent upon it since their original sources of water supply are unfit for human consumption. Purifying water, a source of many diseases, has done more to save human lives than any other preventive health measure. The Army Conquers Yellow Fever It was an Army doctor, assisted by members of his medical board, who made the out- standing investigation about yellow fever, proving this particular disease to be transmitted by the mosquito. Then the Army immediately went to work utilizing this information for the benefit of all mankind. Major Walter Reed, Medical Corps, was provided with the support of the Army in making this discovery possible. At that time Major General Leonard Wood, who was formerly a Medical Corps officer, was the Chief of Staff of the United States Army. Because of his medical knowledge and loyalty to the medical pro- fession, he insured the cooperation of the Army in supporting the investigation, furnish- ing necessary personnel and materials to carry out the proposed sanitary measures. Yellow fever had ravaged Cuba for over 150 years and had puzzled many expert authorities; therefore, the United States Army can rightly take pride in this achievement. The method of transmission of yellow fever having been determined, the Army quickly put on an active campaign against the guilty mosquito. In less than two years, under the supervision of Major William Gorgas, Medical Corps, Cuba became a tropical paradise, without yellow fever except those cases which came from outside sources. Since 1941 all military personnel have been inoculated against yellow fever. This is a large biological experiment testing the usage of prophylaxis against yellow fever for an army of several millions. Many of the troops inoculated are expected to serve in regions where yellow fever is still prevalent. The Army Builds the Panama Canal Four years later, in 1907, when the United States was determined to build the canal across the Isthmus of Panama, the Army Medical Department was given the mission of controlling the yellow fever that had defeated the French in their attempt to build the Panama Canal. Colonel Gorgas was appointed Chief Sanitary Officer. He continued the same fight against mosquitoes in Panama that he had used successfully in Cuba. Yellow fever was eradicated in Panama, permitting the Engineer Corps of the United States Army to accomplish an engineering feat at which other countries had failed. The clearing of the jungles of Cuba and Panama brought not only a great economic result, but awakened the knowledge of the control of disease. Many cities in the tropics began to rise out of their diseased darkness and became prosperous, their populations healthy, and their locations attractive. Therefore, thanks to the Medical Department of the United States Army, yellow fever 402 MILITARY MEDICAL MANUAL no longer is a dreaded fear to the medical profession. Within the United States no case of yellow fever has originated for thirty years. In 1937 the reported prevalence of yellow fever was confined to Africa and South America. The benefits which have come to our civilization cannot be given a monetary value, but certainly the Army deserve: unrestricted credit for the elimination of this disease. The Army Investigates Typhoid During the Spanish-American War in 1898, the Medical Department was confronted with the dreaded typhoid fever. Out of every 100,000 soldiers, 14,000 were admitted to sick report with this disease. About 3,450 men died of diseases during this war, due mainly to the epidemics of typhoid among troops at camps. The “Reed-Vaughn-Shakespeare Typhoid Board” composed of medical officers was appointed to make a study of the disease in the camps. The report of these Army officers on typhoid shed much of our present light on the disease. The one important factor missed was the detection of human carriers and their relation to the dissemination of typhoid. In the opinion of the medical profession of that period typhoid was generally con- sidered a water-borne disease. The board’s study disclosed many of the weak spots in sanitary measures and the agents by which typhoid is transmitted. Following the Spanish-American War, during which typhoid was so prevalent, a steady improvement was brought about by the general observance of sanitary measures. It was learned that it could be transmitted by means of direct contact, flies, milk, and water. Although prophylactic immunization was not known, the improvement in sanitation cut the admission rate for typhoid in the Army from 85.46 cases per 1,000 strength per annum in 1898 to 3 per 1,000 strength per annum in 1908. In 1908 the Army sent Major F. F. Russell, Medical Corps, to Europe to study the epidemiology of typhoid fever in foreign armies. He submitted a valuable treatise from his study, whereupon the Army appointed a board to consider the use of vaccination for protecting the troops against typhoid fever. Voluntary prophylaxis was started in the Army in 1909 and made compulsory in 1911. The Army thereby introduced typhoid immunization into this country and initiated immunization on a large scale. Now compare the results with those of the World War, since the Army had the necessary materials and facilities to carry out their studies and plans. It will be re- called that in the Spanish-American War that out of every 100,000 soldiers, 14,000 were afflicted with typhoid fever. In the World War this ratio was reduced to 37 cases of typhoid per every 100,000, a striking result of controlled, preventive medicine. Ap- proximately 1,500 cases of typhoid occurred during the World War, whereas, in compari- son to the Spanish-American War rate, there would have been 500,000 cases. The lesson from this evidence not only convinced the Army of the value of typhoid prophylaxis, but the entire medical profession accepted it sincerely; today anti-typhoid inoculation is a generalized and accepted practice. Army statistics report but four cases of typhoid in the Army in 1938, all of which were in the Philippines. The Army has another conclusive record of the control of typhoid fever in the Civilian Conservation Corps, which has an average of 300,000 young men of typhoid age. The cumulative case rate per 1,000 strength per annum for the Civilian Conservation Corps since 1933 averages less than .25 cases per 1,000 strength per year. In 1936 the rate was .08 per 1,000 strength, a remarkably low figure, which illustrates the result of a con- trolled Army prophylaxis against typhoid when administered to a civilian body of men. The Army is a large contributor to the history and confirmation of typhoid inoculation. For 1936 and 1937 the typhoid and paratyphoid case rate in the United States was 12.4 cases per 100,000 population. The typhoid death rate per 100,000 population in the United States for 1935, 1936, and 1937 was 2.4. There were but 2 deaths from typhoid in the Army during 1940. During the present emergency there has been no serious outbreak of typhoid fever. The Army Makes and Distributes Vaccine In addition to the administration of typhoid prophylaxis in the form of inoculations and sanitary measures, the Army produces a vast amount of typhoid vaccine in its laboratories. MEDICO-MILITARY HISTORY 403 During national emergencies, such as the Ohio Flood Relief in 1937, over 500,000 doses of prophylactic vaccine were distributed to civilians. Besides furnishing this vaccine, the Army also placed its personnel, equipment, and transportation as needed to facilitate the service of relief. The former experience of the Army which occurred in the camps of the Spanish-American War was averted, and the fear of a typhoid epidemic checked before it started. The Army acts with sensible preparedness. The Army Medical Department distributes vaccine to many agencies besides the Army itself. Its yearly distribution of typhoid vaccine is over 2,000,000 cubic centimeters, 500,000 cubic centimeters of which are held in reserve above routine requirements in anticipation of national emergencies. Other governmental agencies such as the Navy, Marine Corps, Civilian Conservation Corps, National Guard, Reserve Officers’ Training Corps, and Citizens’ Military Training Camps secure their vaccine from the Army Medical School. In terms of immunizing courses (consisting of three doses) since 1929, over 8,000,000 courses (approximately 15,000,000 cubic centimeters) of typhoid vaccine have been dis- tributed by the Army Medical Department. The increased production of vaccine during the past few years has been due to the greater strength of the Army, Navy, and the Civilian Conservation Corps. The Army is still pushing forward in this great work of defense against the typhoid bacillus, with results already obtained deserving commendation. The capacity of production in the Army laboratories at present is so organized that over 1,500,000 doses can be made in one week. The argument is often made that the lowering of the typhoid rate in the Army was just coincidental with that of the general population and due to the improvement of community sanitation. It is undoubtedly true that these factors have lowered the civilian rate for typhoid fever, and to some extent the army rate, but a comparison of the Army rate after compulsory inoculation in 1911 with the civilian typhoid rate in regis- tration areas indicates a far greater reduction of typhoid in the Army. The Army ac- complished more in five years than the United States as a whole accomplished in almost thirty years. The Army mortality rate for typhoid fever had been reduced to 3.24 cases per 100,000 by 1915, and this ratio was not accomplished by the civilian population until after 1935. Could the civilian population be subjected to the preventive control of typhoid as practiced in the Army, their rate would soon be reduced to a more favorable proximity of zero. The Army Pioneers American Bacteriology The discovery of germs, and the fact that they cause disease, rationalized the practice of medicine and opened the field of preventive medicine and public health. Bacteriology became a science of paramount importance. The Army Medical Department in 1893, administered by Surgeon General George M. Sternberg, a pioneer bacteriologist, was in the front line. The department was quick to advance the knowledge and study of pre- ventive medicine. Laboratories were established in all station hospitals during General Sternberg’s administration, and he founded the Army Medical School. Since that time the Army has continued to do pioneer work in the field of preventive medicine. Its success in research work is due to the well trained personnel who are permitted to engage uninterruptedly in their investigations. Another fact is that the Army has large groups of men under military control, which facilitates investigation and permits follow-up of re- sults and corrections. When war comes, the clinical field is enlarged with much the same control under full government authority. Consequently the Army Medical Department has been able to make many advances in medicine that have been of outstanding service to humanity. Surgeon General Sternberg made many researches on pneumonia, malaria, yellow fever, and serum therapy. The Army is still persevering in those same researches step by step, adding daily to the value of bacteriology in medicine. Several agencies of the Medical Department are now engaged in study and research work. A Medical Depart- ment Research Coordinating Board was appointed January 15, 1940, to facilitate research problems in the Army. During the present emergency the services of eminent men of the medical profession are being utilized by the Army in order to control diseases caused by bacteria. 404 MILITARY MEDICAL MANUAL The Army Studies Pneumonia Prevention General Sternberg’s early study of pneumonia is today being enhanced on a large scale, especially the preventive and protective measures against it. Since 1933 the Army has been producing and distributing pneumococcus vaccine to governmental agencies, and in addition is conducting an experimental measure against pneumonia in the Civilian Con- servation Corps. Favorable reports have been made, and the experiment is being con- tinued. In the inoculated groups during 1933 to 1937 the case rate for lobar pneumonia was 79.5 per 100,000 enrollees, and the rate in the uninoculated (control) group was 225.9. During the year 1938 over 271,000 doses of pneumococcus vaccine were supplied to the Civilian Conservation Corps agencies, and a reserve stock of 450,000 was prepared in anticipation of its extended use in the Regular Army. The modern army is not different from that of the period of General Sternberg. It is digging deep into the wells of knowledge uncovered by the science of bacteriology. The Army realizes the high mor- tality and incidence of pneumonia and the need of specific preventive measures against it. The Army Lowers Its Venereal Rate Reccndy the public has been able to secure more information and become vitally conscious of the prevalence of venereal disease. The military departments of our government were early promoters of venereal disease control. During the Civil War, the venereal rate was 215 cases per 1,000 soldiers in service; during the Spanish-American War there was only a slight improvement. As late as 1909, prior to the institution of voluntary venereal prophylaxis, the rate was 179 cases per 1,000 soldiers. Preventive methods since 1909 have been made compulsory. The soldiers have become better informed as to the physical and mental disturbances from venereal diseases and instructed carefully in the prophylactic measures against them. In addition, drastic disciplinary actions, loss of pay and time, and required prophylactic treatment after sexual intercourse have lessened the incidence of the venereal diseases. The Army administration as a whole has taken part in this control measure, assisting the Medical Department. The cooperative efforts of all branches in this respect have now cut the venereal rate to 34 cases per 1,000 soldiers per annum. It is a hopeful result which is now being increasingly extended to the non-military popula- tion. The Army rate will also decrease thereby since the source of venereal diseases in the Army is in the civilian contacts. All venereal cases in the Army are isolated until cured, excepting syphilitics without open lesions who are undergoing controlled treat- ment. As for the Army, the progress already made does not conclude its efforts to devise a more efficient method in further reducing the venereal rate of soldiers. Though not complete it is a triumph in the field of preventive medicine. It is stated by public health authorities that of the small percentage of the clinic population who seek treatment for venereal diseases in early stages of syphilis only about one-half remain long enough to secure minimum treatment necessary to control syphilis. Could Army control measures be applied it would surely prove helpful. The Army Strikes the Hookworm The Army’s part in tropical medicine has been executed, in large degree, away from the mainland. Among the island-workers of Puerto Rico in 1900, there existed a “debil- itating anemia.” An Army doctor, Colonel Bailey K. Ashford, discovered that the disease was due to hookworms and thereby laid the foundation for the eradication of the parasitic infestation. The Army assisted in an active campaign to combat the source of this anemia. Thousands of people were treated, preventing reinfestation of the soil, whereupon Puerto Ricans began to work, live, and enjoy a new health. The discovery made possible the treatment and progress of the inhabitants of our own “sunny” South, and the simple treat- ment and prophylactic measures used have since been extended to many other countries. Though this fact is not widely known and not as dramatic as many others, nevertheless the Army again brought happiness to countless inhabitants of Puerto Rico, the southern United States, and elsewhere. MEDICO-MILITARY HISTORY 405 The Army Wins With Proper Food In the Philippine Islands, the Army encountered a disease prevalent among the natives and which frequently appeared among the American soldiers. The disease, altogether too familiar to the Orient, was called beriberi. It was usually accompanied by paralysis, tissue wasting, peripheral neuritis, and cardiac disturbances. Death resulted from heart failure. An Army medical officer made an intensive investigation of this disorder, discovering that it was due to eating highly milled or polished rice. He also proved that eating the husk of the rice grain would prevent the occurrence of beriberi, with the result that a rice-eating population was spared many deaths. The discovery of this food deficiency disease lead to further scientific work on vitamins which are now common food topics of discussion in every housewives’ magazine. Balanced diets and study of essential food elements in the diet were considered in preparing Army rations; the use of polished rice was reduced and meat and unpolished rice substituted. The application of these cura- tive and preventive measures was soon extended to the diets of all the troops in the tropics, with complete elimination of beriberi in the Army. Colonel E. B. Vedder,1 Medical Corps, furthered the accomplishments of the Army Medical Department by his fortunate and wise investigations of this deficiency disease. An interesting bit of data about beriberi has been recorded in reference to the Philippine Scouts. In 1909, 604 scouts were admitted to hospitals with beriberi, 50 in 1910, 2 in 1911, and since that year there has been none. Therefore, the Army presents early figures which have since been duplicated by civilians, except that they have not yet quite reached zero. It is highly improbable that the civilian rate will ever be as low, because not all civilians are sub- jected to as much supervision nor provided with the adequate balanced ration of the soldiers. The Army Encounters Dengue Fever Far away from the mosquito-infested island of Cuba, at the other side of the earth, the mosquito carried a dreaded sickness to man. The Army with one of its medical boards began a research on the illness known as “breakbone fever” which was enjoying an epi- demic at Fort McKinley, near Manila, Philippine Islands. The disease had previously been confused with yellow fever and malaria. One of the members of this Army board. Colonel Joseph F. Siler,2 Medical Corps, worked out in detail the mosquito’s act in the transmission of dengue fever. Because of the severe bone crushing pain it was and is still known as “breakbone fever.” Although rarely a fatal disease, it produced tremen- dous suffering, the relief from which was welcome. This medical officer’s efforts as a member of the Army board resulted in the decrease in the incidence of the disease. The character of dengue fever is now well understood due to the continued work of this board of medical affairs. The board was known as the “Tropical Disease Board.” Army Sanitation is Victorious Over Cholera The Tropical Disease Board and its members made many additional contributions to the advancement of medicine. Cholera was one of the first diseases to demand the atten- tion of the Army and the Medical Department in Manila. The disease was disseminated by the personal habits and the ignorance of the people it affected. China and the Eastern Orient were especially involved. From March 20, 1902 to March 23, 1904, there were 166,252 cases of cholera in the Philippine Islands, from which there were 109,461 deaths. There were probably many cases and many deaths that were not reported. Compare this with the controlled efforts within the Army during the same period: In 1902, there were 485 cases, 286 deaths from cholera; in 1903, 1,479 cases, 96 deaths; and in 1904, one case and no deaths. It was a problem of sanitation, and the Army could control it readily within its own command. The Commissioner of Health, Manila, called on the Army for assistance. Thirty-one officers were detailed to duty, and, in furtherance of the plan, medical officers were made members of the boards of health and sanitation throughout the Islands where they were stationed. The prompt control of the epidemic of such a high mortality rate was another Army accomplishment which adds credit to the advent of western civilization in the Orient. There was one case of cholera, with one death, re- 1 Retired as colonel on October 31, 1938. * Retired from active service in 1938. 406 MILITARY MEDICAL MANUAL ported in the Philippine Islands for 1937; no cholera appeared in the United States in 1937. Throughout the world 198,389 cases of cholera, with 101,201 cholera deaths, were reported; 86 per cent of these were in India. All troops sailing beyond the continental limits of the United States for regions where cholera is present are inoculated against cholera before departure. Army Veterinary Service Eradicates Rinderpest Many years later, about 1928, in the Philippine Islands, an Army Veterinary Officer, Major Raymond A. Kelser,1 developed a very successful vaccine against rinderpest. Rinderpest, a highly destructive disease of cattle, was fatal to many of the water bulfalo which are beasts of burden in the Orient. The vaccination of the domestic animals of the Philippines with this vaccine soon decreased the disease to negligible proportions. Rinder- pest is now rare in the Philippine Islands. The use of the vaccine was extended to other countries where rinderpest was prevalent. In the ten-year period prior to 1926, the annual loss of carabao and cattle from this disease averaged 18,000 animals. During the past few years animals used by the Army have been immunized against equine encephalitis and the results have been very satisfactory. Again the Army, through its veterinary services, has added a measure in animal immunization that has contributed to the economic development of the nation. The Army Believes in Smallpox Vaccination In one year, in the early eighteenth century, smallpox killed 25,000,000 individuals in Europe. Edward Jenner in 1801 established the value of his discovery of vaccination against smallpox by means of compulsory vaccination in Denmark. But, as time passed, the forgetfulness and the stupidity of the human race had resulted in the discard of preventive measures in Puerto Rico and the Philippines, as in many other places. Small- pox vaccination had been neglected prior to the arrival of the American troops. The disease was endemic and common in both places. The inhabitants were marked with smallpox scars, and the disease was readily disseminated in public areas and vehicles of transportation. Major John Van R. Hoff,2 Medical Corps, the Chief Surgeon of the Puerto Rican command, put on an active campaign to free the island from this disease by reinstituting controlled vaccination of thousands of its people. Colonel Louis M. Maus, Medical Corps, as Commissioner of Health in Manila, likewise conducted extensive campaigns of vaccination against smallpox. Success followed the efforts of both these officers, and the uncontrolled scourge was removed from both places, relieving their inhabitants from unnecessary suffering and deaths. It was not because means of pre- vention were not known, but it took the United States Army to put simple, effective methods into use with imperative precision. The use of smallpox vaccination in the Army is a routine procedure, and not a single member is omitted. In this connection, it is interesting to note this fact with the percentage of civilians who are vaccinated. Army statistics show that of the first 30,000 civilians enrolled in the Civilian Conservation Corps over 30 per cent were found unprotected from smallpox. This is a serious weakness in American preventive medicine. It has been stated that as the result of this lack of compulsory vaccination the United States continues to occupy second place in smallpox prevalence among the nations of the world. In 1937, 48 states reported a total of 11,673 cases of smallpox, the highest since 1931. But none of these cases occur in the Army. A large proportion of the civilian population has been benefitted by the receipt of smallpox vaccination while they were on active or tem- porary duty with the Army. The Army has proven that the presence of this unnecessary disease depends upon the extent of the application of vaccination. Anopheles Falls for the Army Malaria was a disease well known to the ancient Romans. It was called the “ague,” a disease of chills and fevers, by the colonists of North America. The first successful step 1 Now Brigadier General, Chief of the Veterinary Corps. * Hoff Hall, the school building of the Medical Field Service School, was named in his honor. MEDICO-MILITARY HISTORY 407 made toward combatting it was taken in the tropics by the natives, who drank a bitter fluid with the taste "'f bark. This fluid came from chinchona bark, from which our present active antimalaria element, quinine, is recovered. But that was curative and not preventive medicine. It did not relieve individuals from the suffering they had to endure while having the disease. In 1880, a French Army surgeon in Algeria, Alphonse Laveran, discovered the miscroscopic animal parasite in the blood of malaria victims. In 1897, Ronald Ross of the Indian Medical Service, British Army, discovered the same parasite in the stomach of the anopheles mosquitoes that had sucked the blood of patients with this disease. This made possible the control of malaria by eliminating the mosquito. Although malarial preventive measures were demonstrated on a small scale in other countries, it was not until the Spanish-American War that they were convincingly demonstrated on a large scale by the American troops. The United States Army soldiers were required to use mosquito nets and to carry on an active campaign against mosquito breeding and destruction. While combatting the breeding of the yellow fever mosquito in Cuba and Panama, the Army at the same time reduced the incidence of the breeding of the Anopheles mosquito. The malarial case rate decreased concomitantly with that of the yellow fever. Since the Anopheles mosquito is more domestic in its habits of breeding than the Aedes egypti mosquito, its control is more difficult. Therefore the incidence of malaria cases has not decreased proportionately to that of yellow fever. The Army has made progress in spite of the arduous preventive measures necessary to insure con- trol. Note the following malaria case rates in the Army: In 1901, the rate was 708.52 cases per 1,000 soldiers; in 1902, 272.3 per 1,000; in 1907, 63.19 per 1,000; and in 1927, 6.73 per 1,000. The rate is declining each year, even though more accurate methods of diagnosing the disease are used. Seventeen varieties of the Anopheles mosquito are now known, further confirming the practical difficulties in eradicating the malaria carrier. Malaria causes more disability throughout the world than any other disease. The grouped efforts of medical officers of the Army throughout its jurisdiction have controlled the disease to a great extent. One medical officer, Colonel Charles F. Craig, made many extensive in- vestigations and has written and advanced much information about malaria. To him and the Army as a whole, medicine owes a great deal for the practical knowledge and preventive measures against the disease. Recently an Army medical officer, Colonel Leon Fox, had a prominent part in the discovery of a new malaria vector, the Anopheles bellator, a mosquito whose breeding place of choice is among the leaves of an air-plant that grows in the upper branches of trees used as shelter for growing the cocoa plants. Army Hygiene Controls Dysentery During the Spanish-American War, one of the chief diseases which afflicted our troops in the tropics was dysentery. Bacillary and amoebic dysentery both played their part. Extensive studies and investigation were made by the Army with the result that much progress was made toward the control of dysenteries. Colonel Craig, in addition to mak- ing malaria studies and investigations, included amoebic dysentery, from which much of our present information regarding the disease originated. Colonel E. B. Vedder, Medical Corps, was one of the early advocates of the use of emetine in the treatment of amoebic dysentery. With concerted efforts the Army secured results as is indicated by the following rates: In 1900, the admission rate for dysenteries was 145.13 cases per 1,000 soldiers; in 1901, 82.65 per 1,000; in 1902, 62.03 per 1,000; in 1907, 18.09 per 1,000; and in 1926, .02 per 1,000; and since that time for the entire Army less than 1 per 1,000 per year. Thus is noted again the rigidness of preventive medicine in the Army, which is difficult to transpose to the civilian population. The Army Shuts Out the Bubonic Plague Bubonic plague came under the study and investigation of the Army medical boards. It is a fearful and highly dreaded disease. It confronted the United States Army in the Philippine Islands, prompting the first American studies of this disease. The Board 408 MILITARY MEDICAL MANUAL issued a circular about plague in February, 1901, during its extensive outbreak in Manila. Although the transmission of the disease by fleas was not known at the time, nevertheless, by means of supervised sanitary control measures, the disease was kept out of the Army. The epidemic in Manila was controlled by Army medical officers. Since the transmission of the plague by the flea has become known, the campaigns of all governmental agencies including the Army have practically eradicated the disease from America. The United States Public Health Service is now carrying on the necessary plague-suppressive measures. The Dental Corps Curbs Heart Disease In another field of endeavor the dental officers of the Army have over a period of time made a most welcome progress by reducing the suffering and non-effectiveness which results from valvular heart disease, arthritis, and rheumatism. Diseases of this class in the Army have decreased over 90 per cent during the past 25 years. This decrease has been of marked benefit. Every member of the Army has a dental survey at least once each year; then proper treatment is scheduled and conducted for the individuals having defects. Removal of apical abscesses, curing gum infection, and care of carious teeth and dental cavities have shown progressive health benefits. Note the progress in this field as in- dicated by admission rates for rheumatic fever: In 1900, the rate was 5.28 cases per 1,000; 1902, 5.22 per 1,000; 1926, 0.53 per 1,000; and since that time less than 1 per 1,000 per annum. The Dental officers, though not heralded with publicity, have quietly and con- scientiously assisted the medical officer in efforts to preserve the fighting strength of the Army. In conjunction with the dentists, the medical officers have removed other foci of infection, especially diseased tonsils. It is evident that much success has come from this cooperative work, which will become better understood as the younger generation reaches the arthritic ages. The Army Advanced the Physiology of Digestion The first American experimental physiologist was a surgeon in the United States Army. The Army assisted him in carrying out his experiments in the physiology of the stomach, which were the starting point for our modern ideas concerning digestion and dietetics. While stationed at Fort Mackinac in northern Michigan just after the War of 1812, Surgeon William Beaumont was called to treat a young voyager, Alexis St. Martin, who was ac- cidently shot in the abdomen. Beaumont, familiar with the treatment of gunshot wounds, took the patient into his own home and nursed him back to health. The wound, how- ever, developed into a fistula leading from the stomach to the surface, offering a means of investigation of digestion in the stomach. Beaumont immediately appreciated this opportunity and began a series of careful experiments. Surgeon General Joseph Lovell, then head of the Medical Department, assisted Surgeon Beaumont by having the patient enlisted in the service, so that he could be studied and kept under control without expense to the patient or to William Beaumont. From the careful and experimental investigations, the investigator published his report on “Experiments and Observations on the Gastric Juice and the Physiology of Digestion” in 1825. In this report were described: the ap- pearance of the normal mucous membrane of the stomach; the movements of the stomach during digestion; that gastric secretion occurred after taking food and was not continuous; the observations on the effects of the stomach secretion on various foods; that the diges- tive juices of the stomach depended on hydrochloric acid and some other substance (later discovered to be pepsin) for their effects. This contribution to American medicine is most noteworthy and was due in no small part to the encouragement that William Beau- mont received from his Army colleagues. His patient, Alexis St. Martin, lived an active life despite his fistula until his death at the age of 82 years. The Army doctor is still privileged to carry on individual research and investigation with the encouragement of the Medical Department, in the same manner as in Dr. Beaumont’s period of service. The Army Made America’s Greatest Gift to Medicine There is another contribution worthy of mention, unique in its kind and priceless in value, a heritage of the Army. That is the Army Medical Library, an unreplaccable treasure, MEDICO-MILITARY HISTORY 409 the loss of which would be felt by the entire world. For over one hundred years, since 1836, the Medical Department has painstakingly accumulated a precious possession and is holding it in trust for the world. It contains approximately a million books and pamphlets published in all parts of the civilized world from the earliest days to the present time, the rarest and most extensive collection of ancient medical books in existence. It is the largest and greatest medical library in the world. The wealth of material within its collection is available to any responsible individual for study. The usefulness of the library is the result of patient and concerted efforts of medical officers who sensed its value to the nation many years ago and to those others who have continued their efforts. The Army Medical Library has rightfully been termed “America’s greatest gift to medicine” and “the pride of the medical profession of the United States.” Army Improves Traumatic Surgery Many other achievements and interesting activities have been accomplished by the Army Medical Department and its members. Medical officers of the World War made numerous advances in surgery and orthopedics. The use of antiseptics in the treatment of wounds led to the use of Carrell-Dakins solution now so well known. In the Civil War 31,978, a ratio of 10.48 per 1000, died from wounds in hospital, and in the World War 13,691, a ratio of 4.5 per 1000. The Medico-Military Man Problems will always confront the medical officer as he ventures forth with the Army in conflict or exploration. To plan intelligently it is necessary for him to have a broad general knowledge of military science, so that he may know the principles which reg- ulate the conduct of a campaign. As a member of the unit staff in the field he must have a sufficient military knowledge to insure rendering professional information as may be of valuable assistance in the development of the military plan. Such are his duties in war, and these duties contain many variations and increases from the normal. Herein lies the necessity for continuous military training of the Medical Department Reserve Officer, so fie will be able to adapt himself readily, to the military plan. Probably the most commonly known and spectacular duties of the medical officer involve the care of the wounded in battle. They are not, however, the most important. The preservation of the strength of the command is best maintained by the prevention of contagious diseases and the control of epidemics. History contains many instances where diseases have destroyed armies, and victories have been lost by a scourge of disease rather than the enemy bullets or weapons. The Army doctor must be a good public health officer. He must have a thorough knowledge of camp sanitation, water supply, sewage disposal, food inspection, mosquito control, louse control, and other allied subjects. The professional attainment of the medical officers in the field comes by years of training and experiences in the Army. It is an interesting, useful life of unlimited importance. The career of the medical officer in the United States Army may not offer so great a financial reward as that of the successful civilian doctor. However, there arc compensa- tions for those who wish to advance the general medical science. There is no group of professional men which has accomplished more in this direction than have Army medical officers. Their contributions have been numerous, their efforts sincere and purposeful, of value unredeemable in money. Many diseases which once took a heavy toll of American lives and caused much suffering are becoming almost extinct, because of their experi- ments, the investigating researches, and practical application of their knowledge. The service of the Medical Department is by no means devoted to the Army itself. The discoveries in preventive medicine, the improvements in sanitation, and the production of vaccines have been extended to the public. Silent Success Medical progress is most manifest in the negative—the absence of disease. Today there are many memorials to the building and economical progress of our nation repre- sented in concrete and steel visible to all. But who considers the medical triumphs that 410 were necessary to the existence of these engineering monuments? Take away the lessons of preventive medicine now in use and within a decade the glorious structures with the industries that accompany them would soon be empty and idle in a land of fearful disease. The world is a healthier place in which to live and so kept through the relentless application of the lessons of preventive medicine. Few people realize the efforts which are made by the members of the medical profession, and altogether too few are acquainted with the role of the Army-doctor in this task. A search into the historical literature of medicine will convince the investigator that Army doctors of all nations, especially those of the United States Army, have been gallant warriors in the battle against disease. The Army doctors have practiced medicine which deserves due respect. The record of the Army and its Medical Department is an enviable and honorable one. Associa- tion with this great institution of progress develops loyalty and sincerity of purpose. Individualism, essential facilities, cooperation, assistance, and the spirit of progress embody Medical Department members in a united effort. In it they find a position in which they can serve humanity, practice advanced medicine, control and observe results, and carry on biological and clinical investigations on a large scale, thereby making a healthier and happier world for posterity. What else could cope so well with the Oath of Hippocrates? MILITARY MEDICAL MANUAL CHAPTER II ORGANIZATION AND ACTIVITIES OF THE MEDICAL DEPARTMENT The Medical Department is responsible for the health of all military personnel and animals of the Army. Commissioned or enlisted personnel must be physically and mentally qualified according to the standards established in the Army Regulations, and the examination must be conducted by authorized members of the Medical Department. The department then endeavors to keep all personnel physically fit during their service and in as nearly normal health as possible upon discharge from the Army. The depart- ment also has charge of the veterinary service for the Army animals. To attain its objective the Medical Department is constantly engaged in doing research work in order to develop the best that medical knowledge can provide. In short, the mission of the Medical Department is to conserve the fighting strength of the United States Army. THE PURPOSE OF THE MEDICAL DEPARTMENT COMPONENTS AND DISTRIBUTION OF THE MEDICAL DEPARTMENT According to the present organization, the Medical Department consists of a Surgeon General, four assistants to the Surgeon General, the Medical Corps, the Dental Corps, the Veterinary Corps, the Medical Administrative Corps, the Army Nurse Corps, the Medical Department enlisted personnel, and a small number of contract surgeons. In addition, the Organized Reserves have a Sanitary Corps. The officers of the several corps of the Medical Department and its enlisted men are distributed in all military stations throughout the United States, Alaska, and in overseas theatres. They are located at every type of military establishment, includ- ing institutions of military education, centers of technical production, and the posts of tactical organizations of troops. The sanitation and health supervision of each station is under the control of a station surgeon, a medical officer. Officers of the Medical Corps, Dental Corps, Veterinary Corps, Medical Administrative Corps, Army Nurse Corps, and enlisted men of the Medical Department are allotted to each station ac- cording to the needs of the garrison and to tactical organizations during field training. To provide medical attention for groups of military personnel not located at army stations, general dispensaries staffed with Medical Department officers and enlisted men are established at centers of military activity. Excluding the Surgeon General’s Office and the exempted stations and establishments directly under the War Department, the medical activities of the stations are under the control of the respective commanders of the service commands or departments in which they are located. The administrative control is under the supervision of a Medical De- partment advisor to the commanding general of the service command. This officer of the Medical Corps is known as the surgeon of the service command. These medical super- visors in the Departments of Panama, Hawaii, and Puerto Rico, arc known as department surgeons. The surgeon of each service command and department has an assistant from the Dental Corps and one from the Veterinary Corps. THE SURGEON GENERAL The Medical Department is classified as a “service,” in contrast to the “arms.” The chief of this service is the “Surgeon General of the Army.” He has the military grade of major general, and the assistants to the Surgeon General have the grade of brigadier general. These officers are selected by the President and hold their appointments for a period of four years. The Surgeon General is selected from among the list of colonels of the Medical Corps, and the assistants to the Surgeon General from Medical Department officers having at least 15 years of commissioned service. They are assigned to Important positions within the Medical Department. The Secretary of War promulgates as compulsory regulations the principles and policies 412 MILITARY MEDICAL MANUAL governing the operation of the medical service of the Army upon recommendation of the Surgeon General presented through the Commanding General, Services of Supply. Therefore, The Surgeon General is able to establish a unified policy of medical service for the Army Ground Forces, the Army Air Forces, the Army Service Forces, the Task Forces, the Defense Commands, and the Theatres of Operation. THE OFFICE OF THE SURGEON GENERAL The Surgeon General maintains an office termed “The Office of the Surgeon Gen- eral,” the abbreviation for which is SGO. In this office the policies and practices per- taining to the different functions of the Medical Department, its personnel, and its fiscal matters are elaborated and coordinated within the department and with the other agencies of the War Department. The relations of this office with the Commanding Gen- eral of each Service Command and each Department are conducted through The Adju- tant General’s Office of the War Department. Correlation with the other forces is ob- tained through representatives of the Medical Department assigned to the Army Air Forces and the Army Ground Forces. Inasmuch as the Surgeon General heads the Medical Department the divisions and subdivisions of his office include functionally all the activities of the Department (see Plate 1). Each major activity is organized as a separate unit. The functions of the medical service of the Army Air Forces are coordinated by the Surgeon General through the Air Surgeon. The Executive Officer. The Executive assists the Surgeon General and coordinates the work of all divisions and branches. During the temporary absence of the Surgeon General and/or the Deputy Surgeon General, or when authorized to do so the executive acts as his representative. He is usually a colonel of the Medical Corps. Administrative Services. The Administrative Division under the Chief of Administra- tive Services is divided into four divisions, Office Administration Division, Vital Records Division, Research and Development Division and Historical Division. The sub- divisions of the Office Administration Division are: Editorial and Review Branch, Mail and Records Branch and Office Communications and Reproduction Branch. The subdivisions of the Vital Records Division are: Individual Records Branch, Health Reports Branch, Statistical Analysis Branch, Machines Branch and Selective Service Branch. The Division of Vital Records is charged with the classifica- tion of records relating to sick and wounded which, from an economical and professional standpoint, are extremely valuable and form the basis for the administrative action in regard to claims, awarding of pensions, and disability compensation The subdivisions of the Research and Development Division are: Civilian Liaison, Development Branch and the Research Branch. Professional Services. The Professional Services Division under the Chief of Profes- sional Services has charge of the management of the professional services of the Medical Department. It evaluates advances in medicine and allied sciences important to the military establishment. It is composed of five divisions, Medical Practice Division, Preventive Medicine Division, Dental Division, Veterinary Division and Nursing Division. The Medical Practice Division has to do with the accepted methods of medical practice and the advances made in medicine and surgery. Policies concerning medical practice in the Army are coordinated in cooperation with civilian medical centers, Army general hospitals, station hospitals and Army Medical School. The sub- divisions of the Medical Practice Division are: Surgery Branch, Medicine Branch, Neuropsychiatry Branch, Nutrition Branch, Procurement and Advisory Branch, Ad- jutant General's Liaison Branch and Physical Standards Branch. The Preventive Medicine Division has supervision over military sanitation and the control of communicable diseases, except among animals, and includes the operation of the Medical Department Laboratories. The sub divisions of the Preventive Medicine Branch are: Sanitation Branch, Sanitary Engineering Branch, Laboratories Branch, Venereal Disease Control Branch, Occupational Hygiene Branch, Medical Intelligence Branch and Epidemology Branch. ORGANIZATION AND ACTIVITIES 413 INTERNATIONAL OIVISION Branch CHIEF OF SUPPLY SERVICE DISTRIBUTION DIVISION Steel S3? Egu prriini Ca.-qo NURSING DIVISION Branch PURCHASES DIVISION '’°rzr Branch Er:ir VETERINARY DIVISION S M**» * Odi'y “ [REQUIREMENTS I DIVISION I Program Chief of PROFESSIONAL SERVICES PRODUCTION Planning S’l^‘ Plate L Office of the Surgeon General, a Staff Division of the Services of Supply. s hsr FooMiej 6>arcK PREVENTIVE MEDICINE S Branch Venerea! Control Hyq.ene I B‘ anch p5r Ni a"ch Physical CONSTRUCTION DIVISION An Corps Fjcsl.tlei " is MEDICAL PR ACTlCE Surge-, PU8HC RLl ATIONS Division & EVACUATION DIVISION Boj C.ed.N THE SURGEON GENERAL DEPUTY SURGEON GENERAL | EXECUTIVE OFFICER Division Mobil Idt.on °z:r- FISCAL DIVISION 6-*"c*S MEDICAL BRANCH DEPOTS 08°-VrcKe FiSCil CHIEF QF administrative SERVICES MEDICAL PROCUREMENT DISTRICTS HISTORICAL OIVISION MEDICAL MUSEUM RESEARCH & DEVELOPMENT DIVISION CHIEF O' PERSONNEL SERVICE PERSONNEL DIVISION lT.:r 1 w,,. »d. B.d«cK ■k? PERSONNEL DIVISION °7E;r Ef.lisNd RECORDS Statistical S3 Office Comm.& GENERAL WASH D. C OFFICE ADMINISTRATION id.tc-.at ARMY CENTER CONTROl DIVISION Brunch 414 MILITARY MEDICAL MANUAL The Dental Division supervises matters relating to the Profession of dentistry in the army and its subdivisions are: Dental Service Branch and Miscellaneous Branch. The Veterinary Division has general supervision of the veterinary service in the army, particularly from the professional standpoint. It is charged with the inspection of food, particularly meat and dairy products, purchased by the Quartermaster Corps. Its sub- divisions are: Animal Service Branch, Meat and Dairy Hygiene Branch and Miscel- laneous Branch. The Nursing Division has general charge of the procurement and assignment of army nurses and the more intimate responsibilities connected with this service. It has extensive control of the personnel records of the Army Nurse Corps and liaison is maintained with the Nursing Service of the American Red Cross which is charged with the procurement of reserve nurses for the federal service. Its sub-divisions are: Nursing Service Branch and Selection and Standards Branch. Personnel Services. The Personnel Division under the Chief of Personnel Service ad- ministers all matters relating to the commissioned, enlisted and civilian personnel of the Medical Department. It is composed of the Military Personnel Division and the Civilian Personnel Division. The sub-divisions of the Military Personnel Division are: Commissioned Personnel Branch, Nursing Branch and Enlisted Branch while the Civilian Personnel Division is divided into four branches: Employment Branch, Classification and Wage Administration Branch, Training Branch and Employee Service Branch. Supply. Supply under the Chief of Supply Service is composed of five divisions, Production Planning Division, Requirements Division, Purchase Division, Distribu- tion Division and International Division. The Production Planning Division is sub- divided into Facilities and Standards branches. The Requirements Division is charged with the computation of requirements and its sub-divisions are: Supplies Branch, Factor Branch and Program Branch. The Purchase Division is charged with procurement and has three branches, Procurement Control, Purchase and Expiditing. The Distribution Division is sub-divided into Stocks Control Branch, Station Branch, Field Equipment Branch, Overseas Branch and Cargo Branch. The International Division’s sub-divisions arc: Procurement Branch, Purchase Branch and Distribution Branch. Operations. The Chief of Operations has charge of the Plans Division, Hospitalization and Evacuation Division and the Hospital Construction Division. The Plans Division is charged with the preparation of war plans, defense projects, tables of organization, and tables of basic allowances for the Medical Department and supervision of experi- mental development of types of field equipment for individuals and units of the Medical Department. Its sub-divisions are: Mobilization Branch, Organization Branch and Field Equipment Branch. The sub-divisions of The Hospitalization and Evacuation Division are: Bed Credits and Evacuation Branch and Miscellaneous Branch. The Hospital Construction Division, charged with the preparation of plans for hospital construction and maintenance is subdivided into: Air Corps Facilities Branch, Ground Troops Facili- ties Branch, Civilian Facilities Conversion Branch and Hospital Maintenance and Repair Branch. Training Division. The Training Division is charged with the preparation of policies and plans for the training of the Medical Department and the Reserve Officers’ Training Corps; the preparation of Medical Department training regulations; the supervision of Medical Department special service schools; the authorization of projects for the issuance and distribution of bulletins and other printed matter from the Medical Field Service School; the supervision of Medical Department Replacement Training Centers and Officer-Candidate Schools. Its sub-divisions are: Replacement Training Center Branch, Training Doctrine Branch, School Branch, Unit Training Branch and Fiscal and Supply Branch. Fiscal Division. The Fiscal Division has charge of all finance responsibilities. It is concerned with funds necessary for the functioning and operation of the Medical Depart- ment. It prepares estimates of requirements for funds; apportions funds to activities of the Surgeon General’s Office; prepares defense of estimates for presentation before the supervising budget agencies and Committees of Congress; maintains a control ledger ORGANIZATION AND ACTIVITIES 415 of all funds appropriated to the Medical Department, funds received from other services, and from the sale of medical supplies and equipment. It reviews and approves for payment vouchers for civilian medical, hospital, nursing and ambulance service for medical personnel and other claims that may arise in connection with Medical Department activities. Its subdivisions are: Budget Branch, Accounts and Reports Branch, Voucher Audit Branch, Expenditures and Analysis Branch, Field Account and Audit Super- vision Branch, Cost Analysis Branch. Medical Corps. The Medical Corps is a commissioned component of the Medical Department. An applicant for commission must be a graduate of an acceptable medical school legally authorized to confer the degree of doctor of medipine, and must have had at least one year’s hospital training in an approved hospital subsequent to the completion of a 4-year course of instruction in such medical school or its equivalent in practical professional experience as determined by The Surgeon General in each case. Further each applicant for commission must successfully pass a rigid physical examination, and must be found by an examining board to possess the necessary aptitude and adaptability for military service. For detailed information relative to appointment in the Medical Corps, Regular Army, see All 605-20. All members of the Medical Corps of the Regular Army are given a broad basic ex- perience through formal training and duty assignments early in their military careers which qualifies them generally for the usual assignments in the service either in peace or war. This training lies within the fields of preventive medicine, sanitation, medicine, surgery, and field duties. Later, the training tends toward either the professional or administrative duties. With the exception of about ten per cent of the Corps, specializa- tion is not exclusive but rather it is additional to practical experience in all duties to which a medical officer may be assigned. A few selected officers of the Medical Corps attend the Army War College, the Army Industrial College, the Command and General Staff School, the Infantry School, and the Chemical Warfare School. Medical officers are also assigned as instructors at these schools. Due to the urgent need for officers in the field, the Army War College closed in 1939 and the Army Industrial College was dis- continued in 1941. In peace time, for each promotion in the Medical Corps of the Regular Army an officer is given a professional examination and a physical examination. Failure to meet the physical requirements results in the officer’s retirement in the next higher grade. Fail- ure to meet the professional requirement, in the case of junior officers, results in discharge with a year’s pay. After the lapse of a year a reexamination is given field officers; should they again fail they are retired in the grade actually attained. The fixed intervals re- quired for promotion (AR 605-50) are as follows: First lieutenant upon appointment. Captain after three years’ service. Major after twelve years’ service. Lieutenant colonel after twenty years’ service. Colonel after twenty-six years’ service. Brigadier general or major general by Presidential appointment in accordance with law. Since the declaration of War, officers of the several components of the Medical Depart- ment have received temporary promotions in the same manner as provided for all officers of the Army. The Dental Corps. The Dental Corps is a commissioned component of the Medical Department consisting of dentists. For detailed information relative to appointment in the Dental Corps, Regular Army, see AR 605-20. The method of promotion of dental officers is the same as described for officers of the Medical Corps. Officers of the Dental Corps attend the basic courses of instruction at the Medical Field Service School and the Army Dental School early in their careers; later in their service they are eligible to attend the Advanced Graduate or Specialists’ Courses at the Army Dental School. Selected officers are sent to civil institutions for special instruction. 416 MILITARY MEDICAL MANUAL The Dental Corps conducts the dental service for the Army, preserving and promoting the dental health of all military personnel. The dental officer is governed by a definite policy of treatment applied to classified patients in order that he may accomplish the greatest good for the group. The secondary mission of the Dental Corps is to assist the Medical Corps during combat. In addition to their dental services they assist in emer- gency treatment, evacuation, and such other emergency activities as may be delegated. The senior dental officer of a command is known as the “dental surgeon.” Dental officers are assisted in their work by enlisted men (dental technicians) of the Medical Department who have been trained locally or through special courses conducted at the Army Dental School. The Veterinary Corps. The Veterinary Corps is a commissioned component of the Medical Department consisting of veterinarians. Since the declaration of War in 1941, the chief of the Veterinary Service, who has an office in The Surgeon General’s Office, has been promoted to the temporary grade of Brigadier General, Army of the United States. The system of promotion for the veterinary officers is the same as for the Medical and Dental Corps. The Veterinary Corps conducts the veterinary service for the Army. Their duties involve the preservation and promotion of the health of Army animals and the inspection of dairy and meat products purchased for the Army. This inspection of foods is to de- termine whether or not they comply with federal specification requirements and War Department contracts under which they are purchased by the Quartermaster Corps. The Sanitary Corps. The Sanitary Corps, which is a reserve component of the Medical Department, comprises individuals having skill in sciences and vocations technically allied to the functions of the Medical Department, such as chemists, food and nutrition experts, hospital architects, producers of medical supplies, psychologists, public health specialists, and sanitary engineers. The Medical Administrative Corps. Medical Administrative Corps officers assist in the administrative affairs of the Medical Department in such capacities as medical supply officers, registrars, detachment commanders, adjutants, personnel officers, instructors, mess officers and in tactical medical units may serve as administrative officers and ambulance and litter bearer platoon leaders. Qualified pharmacists may be assigned to manage hos- pital pharmacies or other duties which pertain to their profession. Formerly the Medical Administrative Corps was chiefly composed of officers who, prior to their appointment, were experienced noncommissioned officers of the Medical Department. After June 24, 1936 original appointments in the Regular Army were restricted to pharmacists between the ages of 21 and 32 who were graduates of acceptable schools or colleges of pharmacy requiring four years of instruction for graduation and legally authorized to confer the degree of bachelor of science in pharmacy or its equiv- alent. The increase in the Medical Administrative Corps for the present emergency is being accomplished by the appointment of warrant officers and enlisted men to the Officer- Candidate Schools for the Medical Administrative Corps at the Medical Replacement Training Center, Camp Barkeley, Texas. A few selected qualified enlisted men in the Regular Army are given original appointments by the War Department. For further details see section “Officer-Candidate Schools.” The Army Nurse Corps. The Army Nurse Corps consists of female nurses having the following grades, with relative rank, in order of importance from the lowest to the highest: Nurse (relative rank of second lieutenant), Chief nurse (relative rank of first lieutenant), Assistant director (relative rank of captain), Director (relative rank of cap- tain), Assistant superintendent (relative rank of captain), and Superintendent (relative rank of major). (AR 40-20). The Superintendent of the Army Nurse Corps during the present emergency holds the relative rank of Colonel. Two assistants hold the relative rank of Lieutenant Colonel and Major respectively. Appointments in all grades, except that of Superintendent, are made by the Surgeon General with the approval of The Secretary of War from among physically qualified. registered female nurses who are citizens of the United States, unmarried, and gradu- ates of accredited high schools and schools of nursing of approved standards, or has a record of desirable post-graduate training or experience. The Superintendent of the Army Nurse Corps is appointed by The Secretary of War. Nurses have the relative rank and the rights and privileges of commissioned officers. Upon original appointment, members of the Army Nurse Corps are given the relative rank of second lieutenant. Promotion to the higher grades to include major is deter- mined by length of service and selection. Army nurses are stationed in medical establishments according to the needs of the service. AR 40-20). Their duties are similar to those of a civilian nurse in hospitals of like character. Contract Surgeons. In emergencies civilian physicians may be employed as general (full-time) or special (part-time) contract surgeons under contracts entered into by the Surgeon General with the approval of the Secretary of War. The professional and ad- ministrative duties of a contract surgeon are the same as those of an officer of the Medical Corps, except in so far as they are limited by the fact that the contract surgeon does not perform his functions by virtue of military rank or commission. Employment as a con- tract surgeon is limited to graduates of reputable medical schools legally authorized to confer the degree of doctor of medicine. He must be a licensed practitioner of medicine in good standing at the time the contract is made. He must also, in the opinion of the contracting officer, possess satisfactory moral, professional, and physical qualifications. (AR 40-30). Pay and allowances are the same as commissioned officers serving in the second pay period. A part-time contract stipulates the compensation in the contract. Civilian physicians employed under part-time contract are not entitled to subsistence or rental allowances. (AR 35-1920, AR 35-4820 and AR 35-4830.) Officers’ Reserve Corps. The Medical Department Reserve consists of a body of civilians qualified and willing to serve as officers of the various components of the Medical Department in time of emergency and war. They have been given appropriate com- missions and assignments in preparation for such service. The sections of the Officers’ Reserve Corps pertaining to the Medical Department are as follows: Medical Corps Reserve, Dental Corps Reserve, Veterinary Corps Reserve, Sanitary Corps Reserve, and the Medical Administrative Corps Reserve. The missions of the several corps and the qualifications of their members are analogous to those of the corresponding Corps of the Regular Army. The Medical Administrative Corps Reserve is selected from candidates who have had experience in administrative duties comparable to those performed in medical units and establishments. Also see section “Officer-Candidate Sdhool.” The Reserve Officers’ Training Corps. The medical branch of the Reserve Officers’ Training Corps is composed of a group of medical students in certain selected medical schools pursuing courses of instruction prescribed by the War Department to prepare them for commission in the Medical Corps Reserve of the Army. The maintenance of these instruction units at civilian institutions is authorized by Section 40-47c of the National Defense Act as amended, and in their operation the War Department and the institution assume a joint responsibility. An officer of the Medical Corps, Regular Army,* is assigned at each school to conduct the instruction. The school insures a membership of at least fifty students, provides for ninety hours of instruction per year, and makes the basic course, when entered upon, an academic requisite for graduation, unless the student is released. Membership in these units is voluntary. The 23 institutions which in the fiscal year 1941 maintained medical units of the Reserve Officers’ Training Corps are: Boston University, University of Vermont, Cornell University Medical College, Syracuse University, University of Buffalo, Georgetown University, George Washington University, Jefferson Medical College, University of Pennsylvania, University of Pittsburgh, Medical College of Virginia, Vanderbilt Uni- ORGANIZATION AND ACTIVITIES 417 418 MILITARY MEDICAL MANUAL versity School of Medicine, Indiana University, Ohio State University, Western Reserve University, University of Michigan, the State University of Iowa, University of Minnesota, St. Louis University School of Medicine, Washington University, Baylor University, University of Oregon Medical School, and the University of California. The prescribed courses of instruction extend through the four years of the medical school curriculum, the first two years constituting the Basic Course and the last two years the Advanced Course. A summer training camp period of six weeks is also required. Enrollees in the advanced course, which carries a nominal rate of compensa- tion, are selected from students who have successfully completed the basic course. A medical student cannot be enrolled in the Reserve Officers’ Training Corps unless he is a citizen of the United States and is physically qualified for military service. Upon graduation from the Advanced Course and recommendation by the Professor of Military Science and Tactics and the school authorities, he is granted a commission in the Medical Corps Reserve of the Army. MEDICAL REPLACEMENT TRAINING CENTERS Three medical replacement training centers were established by the War Depart- ment during 1941 and one in 1942. These four centers provide facilities for the train- ing of a large number of selectees each training cycle. They are: Camp Barkeley, Texas; Camp Grant, Illinois; Camp Pickett, Virginia; and Camp Joseph T. Robinson, Arkansas. The center at Camp Barkeley also conducts an Officer-Candidate School for Medical Administrative Corps officers. At the medical replacement training centers selectees participate in a 11-week training period as outlined by the Mobilization Training Program 8-5, after which they are sent to medical units where they continue unit training within the organization to which they are assigned. Selected trainees are sent from the replacement centers to enlisted technicians’ schools for special technical training before they are assigned to medical units. Several additional schools for trainees are also conducted at the centers. They include: a Clerks’ School, a Chauffeurs’ School; a Mechanics’ School; a Bakers’ and Cooks’ School; a Sanitary Technicians’ School; and an Officer-Candidates’ Prepara- tory School. Trainees to attend these schools are selected by classification during their first few days at the center. After three weeks of basic training they report to the respective school for which they have been selected (except chauffeurs and sanitary technicians) where they continue training for the remaining eight weeks. If qualified they are requisitioned and shipped accordingly. Trainees not selected for such schools continue the basic and regular training for medical units. Each Center conducts an Officers’ Refresher Course for Medical Department Pool Officers. OFFICER-CANDIDATE SCHOOLS The Medical Department operates one officer-candidate school for the Medical Ad- ministrative Corps: at the Medical Replacement Training Center, Camp Barkeley, Texas. Each warrant officer and enlisted man who applies for this training is considered for attendance. The primary quality sought is proven leadership capacity. The length of the course is three months. Successful graduates are appointed second lieutenants of the Medical Administrative Corps, and assigned to duty with medical units or installa- tions where their services are needed at the time of their graduation. In addition to the officer-candidates selected from medical units a large number of officer-candidates are enlisted men who have completed their training in Medical Replace- ment Training Centers. The trainee must complete three months of service before he is eligible to the Officer-Candidate School, except that a trainee may be ordered to an Officer-Candidate School regardless of his length of service when in the opinion of the • Retired officers used during war. ORGANIZATION AND ACTIVITIES 419 enlisted man’s company or detachment commander, the applicant is by reason of educa- tion, experience or prior service and his current state of training qualified to complete satisfactorily the course of instruction. Trainees may be held in an Officer-Candidate Preparatory School at the Medical Replacement Training Center for a period of one month in order to complete the requirement of three months’ service. Upon completion of Officer-Candidate Preparatory School selected applicants of the class are sent to the Officer-Candidate School. Any enlisted man is privileged to make application at any time after three months’ service even though he has not been selected on the original application. For detailed information see AR 625-5. Selected applicants are chosen when the candidates appear before an Officer- Candidate Board which must consist of one field officer and two other officers prefer- ably from the same branch for which the Board is being held. Accepted applicants in excess of the quota allowed for the Center are held to fill vacancies which might occur in the Officer-Candidate Schools. THE ARMY MEDICAL CENTER In 1923, during the administration of Surgeon General Merritte W. Ireland, the War Department issued orders directing that Medical Department facilities in the Takoma Park section of the District of Columbia be known as “The Army Medical Centert Wash- ington, D. C.” Its purpose was to place in one location the clinical facilities for the professional care of sick and injured, the training schools for medical department per- sonnel, and the equipment for research and the manufacture of biological products. Plate 2. The Army Medical Center. The center was established in 1923 and continues to fulfill the purposes for which it was created. It consists of the Walter Reed General Hospital, The Army Dispensary, the Army Medical Department Professional Schools, and the biological laboratories. This need for a centralized military medical establishment was realized during the World War. The center is located in Washington, D. C., about 6 miles northwest of the Capitol in a beautiful landscaped area of 110 acres. This location provides dose coordination with the Surgeon General’s Office, the Army Medical Museum, and the Army Medical Library. Command and Organization. For many years past the Army Medical Center has been commanded by assistants to the Surgeon General, who have been brigadier generals of 420 MILITARY MEDICAL MANUAL the Medical Department. The Assistant Commandant, a colonel, has charge of the schools and training. The hospital has a commanding officer responsible for its internal administration. The Commanding General, in addition to medical personnel, has on his staff, officers of the Quartermaster Corps, Finance Department, and representatives of the Signal Corps and Ordnance Department. Walter Reed General Hospital. The Walter Reed General Hospital was built in 1908 and named in honor of Major Walter Reed, Medical Corps, United States Army, who proved the means of transmission of yellow fever. It is a general hospital equipped to treat all types of cases, including diagnosis and treatment of acute and chronic diseases as well as injuries. Normally it has a capacity of 1200 beds, which are about equally divided between medical and surgical. Women and children who are dependents of military personnel are admitted to the hospital when beds are available. Each year approximately 7500 patients are admitted to the hospital; of these 45 per cent are medical and 55 per cent surgical. Plate 4. Walter Reed General Hospital. During the year 1939, a part of the activities of the General Dispensary in the Muni- tions Building of the War Department was transferred to the Army Medical Center. That part of the activities of the Dispensary which remained in the Munitions Building treats the military personnel on active duty in the various departments of the War De- partment. The dispensary at the Center handles more serious cases among the military personnel and conducts a large outpatient clinic for the families and retired officers and their families living in and near Washington, D. C. Its location in the Army Medical Center permits utilization of the most modern methods of diagnosis and treatment, facili- tated by available laboratory means and adequate equipment. The Medical Department Professional Service Schools are located in buildings separated from the hospital. They include the Army Medical School, the Army Dental School, Recruiting Officer /oluntefr! RED CROSS] WORKERS I TRAINING MED DEPT ENLISTED MEN School for Medical Department Technicians Post Exchange Officer MEDICAL DEPARTMENT SCHOOLS TRAININC OF INTERNES Johns Hopkins Univ Physiotherapy J Gov't Hotp. for Insane U. S P.H $ Fire Marshal HOSPITAL TRAINING COURSES Dietetics Occupational Therapy Recreation Officer Assistant Commandant Secretary ARMY SCHOOL OF NURSING Director^ Supervisors I Surgical Nursing j Medical Nursing Obstetrical Nursing I Dietetics Affiliated Institutions Summary Court ARMY VET SCHOOL Director] lAss'i Secretary! Preventive Mcd.c.ne Meat and Dairy Hygiene Veterinary Medicine and Surgery Forage I Inspection] j IWnlg.nology j | ARMY ! DENTAL SCHOOL Director! |A»*’t Secretary! Oral Surgery Roentgenology! u «♦* § o 1 3 & s N o> JS -t-i o 0 1 O « I Chaplain J Preventive I Medicine Dental Proathesis ARMY MEDICAL SCHOOL j Ass t Secretary] Preventive [Medicine I Clinical I Surgery Clinical Medicine Oto-Rhmo Laryngology j Roentgenology1 I Director Commanding Officer Executive Officer Anaesthesia and Operating Surgical Service | Septic Surgery | Max.llo- I Facial | Surgery Urology i Dental j , Service 1 Surgery Chest Surgery Orthopedic ObiKiricj and Gynecology Eye. Ear. Nose and Throat Adjutant THE WALTER REED GENERAL HOSPITAL Cardio-Renal Metabolic | Respiratory] Diseases | cardiography Phyjchiatry (Phynotherapy Personnel Adjutant Adjutant Mcdtcal Service General Intestinal D.vea,ea |Tuberculoaia J 11 eolation J* X-Ray Occupational Therapy Surgeon Laboratory Service Basal Metabolism jBacteriofogyl Commanding Officer Executive Officer ■ Serology [Chemotry I Pathology Signal Officer Detachment j Medical I Departmentj Piofouonol Office I Information Office i Medical Supply Officer Hospital Inspector Registrar Veterans' Bureau Office I Detachment I ©I P.uitrm Receiving And Ditpoaition j Pharmacy Finance Officer Dietet* Department Hotpiul Fund [ Quartermaster INuo cld latrine Plate 6. Straddle Trench Latrine. excavated earth is placed at the ends of the long trenches or at the center between parallel short trenches. The whole should be enclosed in a canvas screen so as to insure privacy. A latrine guard is usually designated to enforce cleanliness. Men are required to cover their excrement and toilet paper with a shovelful of soil. If crude oil is available the trench should be sprayed daily with this oil. When the trench is filled to within one foot of the top it should be back-filled with earth, mounded up to one foot above the ground surface, and marked by a suitable sign. All latrines should be constructed to the leeward of camp (if there is any prevailing wind); 75 feet from the nearest tent or other quarters; 100 yards from kitchens and mess halls; and 100 feet from any source of water. They should be on high ground or so ditched that storm water cannot flood the area and the ditches and so spread the ex- crement over the surface. All latrines should be marked by suitable lanterns at night, whenever the military situation permits, so that men can find them easily. The Pit Latrine for Camps of More than One Week. For camps of over one week dura- tion straddle trenches are used until pit latrines can be constructed. Deep pits should be two feet wide, from four to ten feet deep, and eight feet (or some multiple of eight) long. The depth will depend on the length of time that the latrine is to be used, the depth of the ground water, the character of the soil, and the presence or absence of rock. If the level of the ground water is high it is useless to make a deep pit as water will seep in and interfere with the drainage and sanitary care of the pit and also, there is danger of contaminating a nearby source of water. In the same way a stratum of impervious clay prevents soakage of urine. Rock will prevent deepening the pit unless explosive is used, which is seldom worth while. If explosives are used, fissures may be opened in the rocks, allowing wastes to seep through and possibly contaminate nearby sources of water. FIELD SANITATION 445 In average soil a pit four feet in depth should be sufficient for two weeks. For a longer period a foot in depth should be added for each additional week. For four weeks a pit six feet deep is required and for six weeks a pit of eight feet in depth. Like the straddle trenches, these pit latrines must be protected from surface water by the construction of a drainage ditch around the outside, and they should be provided with canvas latrine screens for privacy. If in very soft ground the pit must be protected by sand bag revetments or shoring and made correspondingly larger. All of these pits must be fly proof in so far as is possible. Flies lay their eggs in the fecal material, where they hatch into larvae. When these larvae are ready to pupate they migrate to a dry place. They may migrate four feet through loose loamy earth, and the adult fly may penetrate a distance of one foot. In order to prevent these young adults emerging to the surface the area around the latrine must be made impervious to them. This is done by excavating an area four feet wide all around the pit to a depth of six inches. The floor of this excavation is then covered with burlap that is soaked in crude oil and the area again covered with the soil. The burlap should hang over the edge of the pit to a depth of eighteen inches. If no burlap is available then a three inch layer of soil should be tramped down with oil and this again overlaid with another three inches of packed earth that is well oiled. If oil is unavailable water may be used. (1)—Standard latrine box. (2)—Trough urinal. (3)—Pipe leading from urine trough into latrine pit. Plate 7. Pit Latrine for Temporary and Semi-Permanent Camps. The latrine box is provided by the quartermaster. (See Plate 7). It consists of a box eight feet long, provided with four seats, all having covers. The covers are so constructed that they automatically close when they are not held open. This is accom- plished by placing a block near the hinge of the seat cover which prevents the cover from being raised to or beyond a vertical position. They thus close automatically from their own weight when the user leaves the seat. The edge of the pit should be curbed so that it will fit close to the box, so that it will not cave in, and so that the passage of flies is prevented. The front (inside) of the box should be guarded with a strip of sheet metal to divert urine into the pit, and the back should be sloped to prevent fouling with excreta. The bottom of the pit, sides, and interior of the box should be sprayed daily with crude oil. This kills the larvae of flies, acts as a deterrent to the adults, and serves as a deodorant. When the pit is filled to within two feet of the surface it should be abandoned and 446 MILITARY MEDICAL MANUAL covered with earth to a height of two feet above the ground surface. If the locality is to be occupied by troops in the next few months the spot should be marked as the site of an old latrine. Pit latrines should be at least seventy-five feet from the nearest tentage, 100 yards from kitchens and mess halls, and 100 feet from any source of water, and should be marked with a lantern at night, if the military situation permits guarded by a latrine police. The scats should be washed with hot soapy water daily and 2 per cent cresol solution twice a week. In rainy weather some sort of shelter against the weather must be devised. Pail latrines may be employed but this requires much more equipment and more effi- cient policing. They are frequently used in caring for the excreta of sick who cannot be evacuated from camp. Contents of pail latrines should be buried or burned. (Tar paper —lining) Iron and wood urinal Wooden urinal rmm Tin urinal Plate 8. Urine Troughs. Disposal of Urine. For one night bivouacs, the straddle trenches may be used for disposal of urine as well as feces. But if the command is to remain any length of time urine troughs which drain into the deep pit latrines or into special soakage pits should be constructed. When the deep pit latrine is located in porous soil that readily absorbes liquids, the urine trough may drain into the pit. If the soil is heavy impermeable and does not readily absorb liquids, then the trough should drain into a urine soakage pit. Urine troughs may be made of wood or of galvanized iron. If the trough is made of wood it should be lined with tar paper so that the wood will not become soaked with urine. FIELD SANITATION 447 Troughs consist of an upright back (splash board) against which the urine is voided and a gutter to collect and drain the urine. (Plate 8.) At its low end this gutter should drain into the latrine pit or special soakage pits. All troughs should be washed down daily with hot soapy water and twice a week with two per cent cresol solution to control odor and prevent the deposition of urates which soon become malodorous. The soakage pit is about four feet square and four feet deep, filled with broken stone or coarse gravel from one to four inches in diameter. If rock or gravel is not available the pit may be filled with flattened tin cans, broken bottles, or pieces of concrete. (Plate 9.) Soakage pits should be ventilated in order to aid oxidation and thereby prevent odors. This is done by means of wooden ventilating shafts (4 to 6 inch boards nailed together to form a square shaft) that are placed in the pits on two sides, extending from about a foot above the surface to within six inches of the bottom. The top of the shaft should be screened against the admission of flies and refuse. Wooden shafts should have several holes bored through the side that faces the interior of the pit to facilitate the circulation of air. In place of wood, tile shafts or stove pipe may be used. For best ventilation the top of the pit should consist of fine crushed stone or gravel, rather than earth which becomes packed. Jar paper funnel Pluq ofqrassT Plate 9. Urine Soakage Pit. In the four corners of the soakage pit pipe urinals are placed. They consist of iron pipes inserted at an angle of about thirty degrees from the vertical and extending about one foot below the surface and thirty inches above. The mouth should consist of a tar paper funnel about 6 to 8 inches in diameter containing grass or straw. In the event that space is limited, as many as eight pipe urinals may be placed in each pit. Soakage pits serve not only to promote absorption of the urine but also help to oxidize the organic matter as it passes over the stones in contact with the air. The efficiency of the pit depends on the character of the soil and the depth of the ground water. In good absorbent soil a pit should last indefinitely, one pit serving 200 men. Soakage pits may be inclosed within the same canvas screen as the pit latrine, but in the event the trough urinals arc used the pit may be placed outside the screen while the trough is inside. All pits should be placed so far away from camp as not to constitute a nuisance and not to contaminate the camp water supply. 448 MILITARY MEDICAL MANUAL In the care of the pits the ventilating shafts should be kept clean and functioning, the top should be kept free of debris and the grass, straw, and tar paper funnels should be freuendy changed and the old ones burned. Oil should not be used in the pits as it clogs the soil and interferes with the absorption of the urine. When pits are abandoned the funnels and drains are removed. The top of the pit may be covered with a shallow layer of soil. At night urine cans are placed in the company streets and marked by lanterns, if the military situation permits. In the morning these are emptied into the urine pits and burned out with oil and hay. Urinating upon the ground should be strictly forbidden. In the tropics and jungles, ant heaps and nests of other termites have been used as ready made soakage pits and have been found capable of absorbing 300 gallons of waste liquids in 24 hours. In arctic and sub-arctic lands the disposal of human wastes, in a safe manner, is a problem of major importance. The soil in these regions is always water-logged and during the winter months is frozen solid to great depths. Soil excavations for straddle trenches and deep pit latrines is usually impracticable, if not physically impossible. When troops are on the march or in bivouacs that will not be occupied later, straddle trenches may be dug in the snow. When abandoned they are covered with brush or snow and properly marked. In extreme cold pail latrines may be used within a heated truck. In semi-permanent, or more or less permanent camps, pail latrines may be used. Solids and urine should be separated. The solids can be satisfactorily burned if mixed with sufficient dry, combustible material (wood chips, rubbish, etc.,) to afford proper incineration. The separated urine may be treated with a cresol solution to inhibit the growth of pathogens and then disposed of through holes in the ice into nearby streams or it may be buried in the snow or water-logged earth. Plate 10. Composting Manure. Manure. Horse manure affords a choice place for the breeding of flies and therefore presents a problem for the sanitarian and the medical officer. It may be disposed of in a number of ways: by composting, by drying, by incineration, by removal by contract or used as fertilizer. Picket lines should be thoroughly swept each morning and the manure removed for disposal before 10:00 a.m. The area about the picket line should be sprayed with oil and firmly tamped at least twice each week. Disposal by composting. The success of composting rests upon the fact that horse manure placed in piles, kept moist, and packed compactly quickly generates heat so that FIELD SANITATION 449 a temperature as high as 140 to 160 degrees F. is produced at depths greater than eight inches. Fly larvae are killed very soon by temperatures of 115 degrees F. or above. The manure should be piled on hard bare ground and beaten down each day. Before flies can breed in the top layer it is buried by fresh manure and becomes heated, killing the larvae. Accordingly very few flies can breed in such heaps. The generation of heat is facilitated by moisture, so in very dry weather the heap should be moistened daily. If manure does not accumulate fast enough to prevent the surface layers breeding flies the heap may be covered with a thin layer of puddled clay or soil or even with oiled burlap, or the sides may be stripped at intervals of three days and the manure buried. Larvae in the outer layer may be killed by spraying with one of the following larvacides: (a) 2% solution of cresol in a mixture of 1 part kerosene and 4 parts fuel oil. (b) 2% solution of cresol in soapy water. (c) Waste motor oil. (d) Crude oil. These are given in the order of their efficiency. If the manure is to be used for fer- tilizer the above larvacides will destroy its fertilizing value. Under such cimcumstances a larvacide of 1% solution of sodium arsenite should be used. Any flies that manage to survive this composting process will migrate into the sur- rounding dry soil to pupate. This migration may be prevented by digging a ditch one foot wide and one foot deep on the four sides of the compost pile and filling the ditch to a depth of three or four inches with a light fuel oil. The area around the compost heap should be smoothed off for a space of four feet on the four sides and the soil packed down with crude oil weeklv. Drying manure. When manure is disposed of by drying it is spread in thin layers over the ground, one to two inches thick. All lumps should be broken up and the manure spread evenly. Flies cannot breed in dry manure, so care should be taken that the layer is thin enough to receive the full effects of the sun. When dried the manure may be stacked or burned, or be left as fertilizer. This method can onlv be used in a dry climate. Burning manure. Manure may be disposed of by burning. This may be accomplished by making windrows or stacks, or by incineration. If the former two methods are used, the manure is sprayed with crude oil and burned. Some fuel oil will be saved if the manure is spread out to dry prior to stacking before burning. Tf prepared incinerators are used thev may be of the same kind used in the disposal of garbage, or more open ones may be emploved. An easily constructed and efficient manure incinerator may be made out of railroad rails (or any long iron bars) elevated on bricks or piers and set as a grid. Care should be taken not to tramn manure into the ground around the incinerator and thus create a breeding place for flies. Manure incinerators or compost piles should be located over 1000 yards from camp. Fly traps baited with a putrefactive bait should be kept in the vicinitv of the compost pile. Garbage Disposal. Garbage consists of waste food and the non-edible portions of food- stuffs, together with waste materials resulting from their preparation. It should not in- clude tin cans, rubbish, or sweepings. (See Plate 12.) The amount produced is from two ounces to one pound per man per dav, averaging 0.8 pound per man in large camps or about six to eight tons for an infantrv division daily. Of this amount 65 to 80 per cent is water and the rest solids. About 85 per cent of the solids is combustible. In bivouacs or temporary camps disposal of garbage is best accomplished by burial— construction of trenches of two to three feet in depth and of sufficient size to accommo- date the garbage and allow a back-fill of one to two feet of dirt. Shallow covering will allow more rapid decomnosition but may be uncovered by storm drainage; therefore, a sufficient back-fill must be used. The area used should be over 200 feet from camp. Crude oil should be spraved on the garbage after unloading. At the noon-time halt on marches, waste food and drink mav be disposed of by burial with the human wastes in the straddle trench latrine. This eliminates the need for a separate garbage pit. In temporary camps when burial space is not available incineration must be resorted to, and that is accomplished by an open type of incinerator (Plate 11). A barrel-and-trench garbage incinerator can be easily constructed from an old garbage can or by molding clay 450 MILITARY MEDICAL MANUAl Plate 11. Stack and Cross Trench Incinerator. Figure 1. One method of labelling garbage cans for the collection of classified garbage. Garbage stand with Concrete Base. Figure 2. Garbage stand made entirely of planks. Plate 12. Garbage Stands. FIELD SANITATION 451 around a wooden barrel, placing grates in the bottom. Garbage should be drained as much as possible and then the solid garbage should be fed slowly into the incinerator from the top. (See Plate 13.) A hot fire is made on top of the grate and is required constantly. Disposal of the waste liquid is discussed below. In large camps and permanent stations garbage is frequently disposed of by contract to farmers and contractors. Some camps having over 500 troops can dispose of garbage by maintaining a hog farm; this requires rigid sanitary control to avoid becoming a nuisance. However, it is an economical method of disposal, and a personnel of 500 will support 10 to 15 hogs with edible garbage. Garbage may be disposed of as a sanitary fill. At the end of each day, all garbage placed on the fill should be covered with one foot of earth to prevent the escape of odor and to protect the garbage from insects, rodents and small animals. Garbage from 10,000 men for one year will cover an acre to a depth of six feet. Straw, grass or cloth F-Sand -Holes -Pocks 'Filter grease trap Plate 13. A Garbage Strainer and a Soakage Trench Showing Filter Grease Trap. Disposal of Liquid Wastes. In camps, liquid waste must be disposed of by soakage pits or trenches or by hauling away in cans and emptying at some isolated spot. Most of these wastes, especially those from the kitchens and messes, are heavily charged with grease which, if not removed, clogs the soil, prevents absorption, and gathering on the surface makes an unsanitary nuisance. In order to remove such grease it is necessary to construct grease traps. Soakage pits are the best means of disposal of waste liquids. Pits for such purposes are made exactly like urine soakage pits except for the urine pipes and funnels. Where there is a substratum of impermeable clay, of rock, or the ground water level is very close to the surface, soakage pits cannot be used and in their stead soakage trenches arc made. 452 MILITARY MEDICAL MANUAL The soakage trench (Plate 13) is made by digging a pit two feet square and one foot deep. From each corner trenches are dug six feet long, being one foot deep at the pit end and eighteen inches deep at the extremities to provide for a flow outward from the pit. These trenches are about one foot wide. The hole is filled with broken stone, loose rubble, broken bottles and the like. A grease trap is installed in the center of this system. No ventilation is necessary as the pit and trenches are so shallow. The principle by which these pits operate is the same as that of a sewage purification system by contact beds. A film forms on the contact material (loose rock) which contains many aerobic bacteria. These act on the contained organic matter of the liquid and oxidize it. Two soakage pits four feet square and four feet deep will, in ordinary soil, take care of the waste liquids from kitchen and mess of a full war-strength infantry company (200 men). They should be used on alternate days. Each pit should be used one day and allowed to rest on the following day. Two soakage trenches of the dimensions given above will do the same. In impervious soil more pits will have to be constructed. These soakage pits and trenches are usually located in the vicinity of the company messes. yU=r-yTH—^=~=r--—_r~ Surface a cum fj of arease Pipe or troughs board Plate 14. Baffle Grease Trap. The pits may become sluggish in their absorption owing to collection of too much grease and organic matter. This may be remedied by a ten per cent solution of caustic soda or calcium hypochlorite applied in five gallon doses on alternate days until corrected. It may be necessary to loosen the surface of the soakage pit with a pick. Grease traps are of two kinds, filter traps and baffle traps. The filter grease trap may be made from a galvanized iron pail or a large tin can with many holes punched in the bottom. The can, pail, half barrel, tub, or whatever is used is filled as follows: On the bottom is a layer of gravel, next is a layer of sand, and above that is a mass of straw, hay, grass, or cloth which filters out the coarsest fragments in the liquid such as crumbs, pieces of vegetables, and meat, etc., as well as retaining part of the grease. Such a trap is placed in the center of a soakage pit with the bottom buried about two inches below the surface. All waste water is poured through the trap. (Plate 13.) A baffle trap is a container (half barrel or wooden box) that is divided into two chambers, an influent and an effluent chamber, by means of a baffle plate. The lower FIELD SANITATION 453 edge of the baffle plate does not come to the bottom of the barrel but is separated from it by a space of about one inch through which water passes from one chamber to the other. A pipe or trough leads from the effluent chamber to the soakage pit nearby. (Plate 14.) The baffle trap should be kept filled with cold water at all times. The warm waste liquids are poured into the influent chamber where the grease rises to the surface and is prevented from passing to the effluent chamber by the baffle plate. Some form of coarse filter should be placed over the mouth of the influent chamber in order to catch the larger fragments of food and debris. The retained grease is removed at intervals by skimming of! from the surface of the influent chamber. The skimmings should be destroyed by fire or buried. The grease trap should be washed daily with hot, soapy water. In bivouacs and camps of very short duration waste water should be disposed of by dumping on the surface of the ground or into shallow open trenches. Trenches should be back-filled with earth when abandoned. In the arctic regions liquid kitchen wastes are disposed of through holes in the ice directly into streams or by evaporation. Other Wastes. Incombustible wastes should be hauled to some regular dump at least 1000 yards to the leeward of camp. Bottles and tin cans should first be burned in order to destroy the organic matter in them and then smashed or punctured so that they cannot hold water and serve as a breeding place for mosquitoes. If they cannot be burned, they should first be thoroughly freed from their contents by rinsing them with hot water or steam. -Hot- clear, water- IHotsoapu water. soapy water Plate 15. Washing Mess Kits in the Field. Papers and rubbish which can be readily burned should be burned. They should be collected in separate cans and not mixed with the garbage, especially if the garbage is to be fed to animals. Carcasses should be sold when practicable. Otherwise they should be disemboweled, the intestines punctured to release gas, and the viscera buried. The carcass is then dragged over this spot, the body cavity filled with combustible material, and the whole soaked with oil and burned. The carcass becomes charred and is unattractive to flies. It should then be buried. Salvage material which is of no future value should be demolished as not to hold water and serve as breeding places for mosquitoes. Such is especially applicable to oil 454 and fuel containers, truck bottoms, fender5, or other articles which wiJJ retain water after a storm. Dumps should be kept orderly; that is, all organic and combustible material should be burned, all other materials covered, and surface drainage provided by means of ashes or dirt. If used over a long period, the top soil should be seeded with grass as completed. MILITARY MEDICAL MANUAL Top bar 1 ReQ. Bottom plate 2 Req. Support plate 2ReqJ Trap end with opening for© IReo.® t •’ without •’ ” ® lReo.® I Door 1 Req i Inside screen end 2 ReoJ Plate 1G. A Practical Fly Trap. FIELD MESSES The company mess is a very potent factor in the transmission of intestinal dis- eases, and to a lesser degree, of respiratory diseases. Furthermore, the character of the mess has a decided influence on the morale, physical fitness, and natural resistance of the individual. The basic consideration of mess sanitation is cleanliness. The essen- tial features in proper mess sanitation are inspection and supervision of food handlers; inspection, protection from dirt and flics, storage, and preparation of food; cleansing and protecting from dirt and flies of mess gear and kitchen utensils; control of flies; and exclusion from the vicinity of the mess of any factors which might result in the con- tamination of food. The normal field ration may be supplemented by local purchase of vegetables and fresh fruits. It is important that the ration be adequate, the menu varied, and the food well FIELD SANITATION 455 cooked. If necessity demands the purchase of meats, the medical officer or veterinarian should closely inspect it for any indication of inferiority or contamination. Cleanliness of Food Handlers. Food handlers should invariably maintain rigid personal cleanliness, especially in the field where hygiene demands more effort. The unit com- mander is responsible for the physical examination of all permanent food handlers. (Par. 12, AR 40-205 and Par. 37, FM 21-10). The term permanent food handler applies to all persons who are permanently assigned to duties that pertain to cooking and serving meals, as well as dish washers and kitchen helpers other than temporary (Set up] Suspended meat cage- (Closed Collapsible fly-proof meat safe Meat safe Tin lined meat safe Plate 17. Improvised Meat Receptacles. /rvnyw kitchen police. Unit commanders are required to send the names of all permanent food handlers to the surgeon. These men arc then examined for clinical evidences of venereal disease, acute or chronic respiratory diseases, evidences of other communicable diseases and, if the surgeon deems it advisable, the stools arc examined for causative organisms of the various intestinal diseases, nose and throat cultures are made and serological work performed. The names of the men free from evidences of disease are then sent to their unit commander and posted in a conspicuous place in the company mess. These food handlers must be observed carefully by the unit commander and surgeon to detect any indication of disease or failure to maintain proper personal hygiene. Cleaning Mess Kits. Mess kits are used in the field, each soldier being issued one for his own use. It consists of a meat can, knife, fork, and spoon. Each man is required 456 MILITARY MEDICAL MANUAL to clean it after every meal, and this like all other utensils used in the preparation of food must be thoroughly washed and sterilized in boiling water. This is done as follows (Plate 15): Three large galvanized iron cans are filled with boiling water, the first two containing boiling soapy water and the other boiling clear water. Each man scrapes his mess kit and dumps the food scraps into a garbage can supplied for the purpose. He then passes his kit through the boiling, soapy water and then through the second container with boiling, soapy water. He then passes his kit through the boiling clear water and dries it by shaking it in the air. The water is kept as near boiling as possible throughout the entire process. The water should be changed after 100 mess kits have passed through, if in any way practicable. If boiling water cannot be prepared in the field, the water should be as hot as possible. Following the system outlined above, the third can or a fourth can, if available, should contain a solution prepared by dissolving one ounce of Calcium Hypochlorite in twenty-five gallons of water. This chlorine solution will satis- factorily sterilize the mess-gear, if allowed to remain in the solution for two minutes. A method of providing heat for many purposes in the field is to take a No. 10 can, punch a number of /2 to % inch holes in the upper half, fill it one third with sand and pour in one-half can of gasoline. This can is placed in a small trench excavated in the earth. Over this is placed the container which is to be heated. The trench should be long enough to allow about two inches of air space for draft at the sides of the container and deep enough to provide about two inches clearance between the top of the can and the ground surface. The device may be ignited by dropping a flaming match into the gasoline in the No. 10 can. Fly Control. Fly control is important to field messes as well as in permanent garrison. Flies are controlled by destruction of breeding grounds, by trapping, swatting, poisoning, fly sprays, and by fly wires and paper. A practical form of fly trap is shown in Plate 16. Mess tents should be screened in camps of some duration, such as summer camps or rifle ranges. Screened meat cages that are hung above the ground and screened meat safes may be improvised from boxes (Plate 17). Every effort should be made to avoid having food come in contact with flies. It is a difficult task in the field where many adverse factors influence cleanliness. However, the care of safe-guarding food from fly contamination is small in comparison to the effort necessitated in caring for those sick with intestinal diseases. Foods should not be allowed to stand unprotected but should be placed in their proper places. This is true of staples such as sugar as well as fresh foods. Whenever a fly lights he may leave disease germs which have been carried from some source of bacterial growth. Sanitary Inspection of Messes. The principal purpose of a sanitary inspection of a mess is to determine the existence and nature of any defects which would result in contamination of the food and the transmission of disease-producing organisms to the troops, or which would impair the nutritive value or lessen the acceptability of the food as served to the troops. The following outline may be followed in making a complete sanitary inspection of a mess. It is suggested as a guide only: Attendants: Is mess sergeant qualified for position as to— Knowledge of food requirements and preparation of food ? Ability to maintain discipline? Business ability? Are cooks adequately trained? How? Have food handlers all had “food handlers’ ” examination and been certified as to health condition by the surgeon? Are certificates of these health examinations posted in the mess hall in a prominent place? Are food handlers cleanly as to— Clothing? Hair? Hands (inspect fingernails)? Personal habits? Care in washing hands after urination and defacation. Is there a convenient washroom for food handlers? Menus: Does food served correspond with menu posted? Are menus well balanced and amount of food adequate? Check file of menus and mess account balance sheet. Note:—Daily food supplied each man should yield at least 3000 calories, provide at least 100 grams of protein, and contain adequate vitamins. Food supplies: Meat and fish: Source. Quality. Freshness Handling. Storage. Preparation. Milk and dairy products: Same consideration as meat. Has bacteriological and chemical analysis been made? Is milk raw or pasteurized? Fruit and vegetables: Is supply adequate and satisfactory? Arc men educated to their use? Are vegetables, which are to be served raw, adequately washed in running water then dipped in scalding water? Canned foods: Is supply satisfactory? Arc there swellers, springers or leakers present? Bread and bakery products: Source. Quality. Delivery method. Storage. (Elevated and isolated screened containers of adequate size.) Food storages: Refrigerator: Is space adequate? Is temperature below 450 F? Condition and sufficiency. Cleanliness. Disposal of drip water. Pantries: General neatness, cleanliness, and adequacy of storage facilities. Vegetable storage: Have vegetable bins been provided? Condition of vegetables in storage. Do facilities for storage guard against un- due wastage by rotting? Food preparation and serving: Refer to cooks’ training. Is food served in a reasonably attractive manner? Could you eat and enjoy the meals served and as served to the men in your organizadons? If not, what corrections are advisable? Police: Dishwashing: Does the method meet the requirements of Army RegulaUons? (W.D. Circular 76- I94I) Are trays, dishes, and utensils clean? Look between fork dnes and around hilt of knife. Is there evidence that all dishes and uten- sils have been properly sterilized and air dried ? FIELD SANITATION Kitchen utensils: Are pots and pans kept grease free? Arc they properly stored when not in use? Are knives and forks clean? Look around handles and hilts. Are racks, can openers and knife sharpeners kept scrupulously clean? Are ranges kept clean? Is fuel supply adequate? Kitchen police: Cleanliness of floors, walls, and ceilings. Are dirty rags allowed to accumulate on ledges, top of bread box, top of re- frigerator, etc.? Are personal belongings of mess attendants allowed to accumulate in kitchen? Waste disposal: Does the handling of garbage and other wastes in the kitchen facilitate proper sorting and immediate removal to garbage cans at the garbage rack? Is vegetable preparation and peeling carried out in a neat and satisfactory manner? Is waste properly sorted and kept in proper receptacles? Ashes. Combustible trash and tin cans. Edible garbage for piggery. Ncnedible garbage. Are empty cans crushed and perforated before going to the trash can? Has a trash and garbage stand been provided? Is it kept clean? Is the surrounding area kept dry and free from soil pollution? Is waste removed at reasonable intervals? (daily) Are clean containers provided at reasonable in- tervals? (daily) How and by whom are containers washed? How are wastes disposed of: Ashes to dump? Location of dump? Combustible trash burned? Where? Garbage incinerated? Or sold? If garbage is sold, are terms of contract being met as to— Frequency of collection? Method of collection? Cleanliness of cans? Insects and rodents: Is mess screened adequately? Is there a supply of fly swatters or other fly destroyers? Arc they used? Have fly traps been provided and arc they kept properly baited and set up for use? Are roaches and other insects present? If so, what method is being used to control them? Are rodents troublesome? What steps have been taken for their destruction? 457 Meat and Food Products. Except in an emergency, food products of animal origin such as meat and meat products, poultry and eggs, fish and other seafoods, as well as all dairy products, usually arrive at the consuming organization after careful and thorough inspections by various civil and military inspecting agencies that have had as their purpose the protection of the health of troops by preventing the introduction of deteriorated or contaminated products into organizational messes. Appropriate Army Regulations place the responsibility for the inspection of food products of animal origin on the Veterinary Corps of the Medical Department whose 458 MILITARY MEDICAL MANUAL purpose is to protect the health of the troops by preventing the purchase or issue of meat and dairy products which, by reason of their source, nature, handling, or condi- tion, may be unsafe or unsuitable for food purposes. As a sanitary procedure, this is a direct extension of the sanitary service maintained by the Medical Department which assures a safe sanitary product up to the point of issue to troops. However, when improperly handled and stored, meat and meat products are subject to rapid deterioration and during the time products remain in the company kitchens, messes, or refrigerators, very careful supervision should be exercised by medical officers to assure the use of only sanitary products. Spoilage of Meat. Meat is considered to be unsound which has deteriorated or under- gone any undesirable changes. The meat of a healthy animal is free from bacteria, and all bacterial decomposition is due to contamination subsequent to slaughter. It is not practicable, however, to prevent a certain amount of contamination during the handling of meat so that all fresh meat is more or less contaminated with bacteria and fungi. Where the meat is properly handled, the contaminating organisms are nonpathogenic but they may cause spoilage of meat. Under insanitary conditions the meat may be contaminated with pathogenic organisms. In meat which has been thoroughly dried and properly chilled, the bacteria crow slowly and the bacterial penetration is delayed while a moist and improperly chilled product is conducive to rapid bacterial growth and penetration. Bacteria may penetrate rapidly and deeply into the tissues by growth along moist surfaces between muscular tissues or through open vessels causing areas of de- composition in the deep parts of the tissues and around the bones without evidence of surface deterioration. Preservation of Meats. In order to prevent or retard bacterial invasion resulting in decomposition, products must be stored in a temperature which is not conducive to bacterial growth. Meat which has been properly handled prior to receipt will usually remain free from decomposition for from 6 to 10 days if immediately placed in a tem- perature of about 35° F. However the average ice box or refrigerator maintains a temperature of from 45° F. to 55° F. and is not satisfactory as storage for more than 48 hours. It is essential that meat under refrigeration be hung in such a manner as to allow free circulation of air around it. Covering or wrappings should be removed to hasten chilling process. If adequate refrigeration is not available, meat must be cooked and served immediately. Refrigerators. A refrigerator or ice box should be desirably located, preferably away from heat of stoves or direct rays of the sun. It should be cleaned every day and well iced. Doors should be kept closed to conserve refrigeration. Meat should not be stored in the ice compartment and never in contact with ice as the ice may not be clean, also the meat will become wet and this hastens spoilage. Drain pipes should be sanitary and open. Food compartments should not be overcrowded and meats should be un- wrapped and so placed as not to retard circulation. Other foods should not be placed under or in contact with meat. The temperature of a refrigerator should be maintained below 45° F. A good thermometer should be used in each refrigerator. Temporary camps. In temporary camps, meat and meat and dairy products may be stored for a short time in watertight containers and immersed in springs, or streams, care being taken to prevent contamination. Food may also be placed below the sur- face of the ground in underground ice boxes. Disease transmission. Any disease, the causative organisms of which can be conveyed by food to a point of invasion within the body, may be transmitted by food. The diseases most frequently transmitted in this manner are those belonging to the intestinal group such as typhoid fever, the food infections, dysenteries, and diarrheas, but food may also be the transmission agency for other diseases such as tuberculosis, scarlet fever, and diphtheria. Diseases due to a pre-formed toxin, of which botulism is an example, may be caused by food in the sense that the food carries the toxin from the point of origin in infected food to the alimentary tract of man. Meat poisoning, botulism, The inspection of meat offers; but little safeguard against FIELD SANITATION 459 the meat poisoning group of bacteria and botulism, or sausage poisoning, for the reason that the micro-organisms may pervade the meat without in the least changing its appearance, color, flavor, or odor. Thorough cooking will destroy the infection and eliminate the danger of meat poisoning and botulism but the cooking must be thorough and it must be remembered that the bacillus botulinus grows well in cooked foods. Sanitary Inspections of Meat. Assuming that all prior inspections have shown the product to be acceptable up to the point of issue to the consuming organization, a further and final safeguard is essential in order to assure that deterioration or con- tamination has not occurred subsequent to issue and prior to consumption. This is accomplished by the sanitary inspection of products exercised by the responsible medical officer. The sanitary inspection within the company or organization mess should in- clude the appearance of a package or product as an indication of prior handling, evi- dence of prior official inspection, as well as evidence of contamination, deterioriation, and adulteration. Inspecting officers should be familiar with the appearance, color, odor, flavor, consistency, and other factors in order to determine acceptable sanitary conditions. Color. The color of fresh meats depends mainly upon kind, age, conditions at slaughter, and part of the carcass from which derived. Choice fresh beef should be a bright cherry red; veal should be pinkish brown; mutton, a dark pink or red; lamb, a light pink, and pork, a light pink. Odor. Meat should be free from any abnormal odor. Decomposed meat may be detected if it has a strong, sour, disagreeable, musty, mouldy, or other off color. Putrid odors arc usually due to ammonia or hydrogen sulfide. Rancidity of fats may be determined by the odor or flavor. A steel trier or knife may be used as an aid in the examination for odors, passing the trier into the tissue especially in the vicinity of bone and withdrawing for evidence of decomposition. Consistency. Sound meat should be reasonably firm to the touch and should barely moisten the finger. Meat should not be flabby or pit on pressure. If upon, examination, meat or meat food products are found to be affected with an unsoundness of slight or limited extent, which in the opinion of the inspector can be removed by trimming, wiping, or other manipulation, this action should be taken followed by reinspcction to determine condition of the product. If the unsoundness involves any considerable proportion of the carcass or cut and in all doubtful cases, the carcass or cut should not be used for food. The removal of surface rancidity or sourness may be accomplished by wiping with a dilute vinegar or baking soda solution. Cured meats. Cured meats showing deep tissue decomposition, insect infestation, rancidity, sourness, or extensive mold or slime should not be used for food. Slight degrees of mold or slime may be removed by washing or wiping the surface with a dilute vinegar or soda solution. Canned meat foods. Canned meat foods should be examined carefully for evidence of defective containers allowing contamination of the contents or of improperly pro- cessed contents resulting in spoilage dangerous to health. Defective cans are readily detected and are classified as leakers, swellers, or springers (AR 40-2200). Leader. A leaker is a can presenting a defect through which air may enter or the contents escape. If the defect is small, leakage may be indicated only by the removal of the vacuum and the dis- appearance of the concavity in the ends or sides of the can. Sweller. A sweller is a can which contains gas in suflicient quantities to produce bulging or dis- tention of the sides or ends. The gas is usually due to contamination with gas-producing organisms resulting in incomplete sterilization or infection subsequent to sterilization. Springer. A springer is a can in which gas within the can is suflicient to cause a disappearance of the normal concavity from one end or side. External pressure on the flattened or bulging side causes the other end or side to flatten the bulge. All leakers, swellers, and springers should be rejected for food. Canned food showing any evidence of spoilage such as off colors, decomposed portions, foul odors, etc., should not be used for food or even tasted. Botulinus toxin may be accompanied by a foul rancid-butter odor, but dangerous quantities of the toxin may be present even in the absence of such odors. Poultry and Eggs. The term poultry includes chickens, ducks, geese, turkeys, and such other domestic birds as may be used for food. Poultry is generally subject to the same kind of contamination as meat products, though the tissues of poultry may afford a more suitable medium for the growth of organisms. While the diseases common to poultry are not readily communicable to man, very careful post mortem inspections are necessary in order to prevent the consumption of food contaminated with organisms pathogenic for man. Inspection. Poultry will usually be received freshly killed, chilled, or frozen and should be undrawn with head and feet on unless processed under supervision of Federal inspection agencies when they may be accepted fully drawn. Evidence of decomposition, slimy or sour carcasses, or any other unsoundness render the carcass unfit for food. The term egg usually includes only chicken eggs and while they do not ordinarily serve as a transmitting agency for disease-producing organisms, it is possible for micro- organisms to pass through the porous shell or reach the interior through a break in the shell. Inspection. Eggs are inspected for freshness, soundness, cleanliness of the shell, color, and size. Candling and breaking are used to test the freshness or soundness of eggs. In candling, the unsoundness is indicated by mixing of the white and yolk, adherence of the yolk to the shell, blood rings, abnormally colored yolks, movable air cells, discolored whites, or foreign bodies. Unsound eggs should not be used for food. If, upon breaking, a considerable proportion are unsound, the entire lot should be discarded. An efficient candling apparatus may be easily constructed by placing a lamp or electric light bulb in a can, shoe box, or other receptacle through which has been cut a hole about the size of the small end of an egg. The egg is placed to this hole through which the light shines allowing the inspector to determine the internal condition of the eggs. Fish and Sea Foods. From the time fish are caught until finally consumed they should be handled, transported, and stored under proper and sanitary conditions. Otherwise, rapid deterioration characterised by putrefactive decomposition will occur. The flesh of fish may contain chemical poisons which will produce illness in man or it may serve as a transmitting agency for disease-producing organisms. Most of the fish so affected are found in the tropics. The toxic substance is usually found in the ovaries and eggs but may also be found in the head and liver. Inasmuch as the toxic substance is not removed by cooking, the most careful supervision must be exercised to assure the removal of these portions of the fish. In some localities, various types of fresh water fish (pike, perch) may contain the encysted larvae of the fish tapeworm which, when ingested in a viable state, develop into the adult forms in the intestines. Thorough cooking will destroy the larvae. Smoking, drying, salting, or freezing will not destroy the larvae. Sound, fresh fish which have been properly handled and packed in ice may be held in storage at a temperature of 32° F. for 10 to 14 days. However, strictest care should be exercised to prevent variation of temperature. Should fish be defrosted they should be consumed promptly. Fish should be defrosted gradually in a cooler or refrigerator and not exposed to heat or soaking in either hot or cold water as this action will lessen the palatability and food value. Inspection. In the inspection of fresh chilled fish, certain characteristic indications of soundness should be sought. If a fish is fresh and sound, the following conditions will be noted: Gills. Bright red, usually closed, no abnormal odor. Eyes. Prominent appearance, transparent cornea. Scales. Adherent. Sf{in. Free from malodorous slime, not discolored. Flesh. Firm, only transient indentations by pressure with fingers. Body. Stiff, tail rigid. Carcass. Will sink in water. The carcass of any fish showing evidence of unsoundness, injury, or contamination should not be used for food. Many individuals exhibit idiosyncrasies to fresh shellfish, such as oysters, clams, crabs, shrimp, etc., which are usually manifested by urticaria, nausea, and vomiting. These symptoms should not be confused with those of food poisoning. Inasmuch as oysters thrive best in water, the salinity of which is less than sea water, many of the producing areas are located where the sea water is diluted with fresh water. Some of these areas may be contaminated with the effluents of sewage systems. The production and handling of oysters are governed by State laws and regulations insofar as factors which result in contamination, deterioration, or adulteration are concerned and the shipment in interstate commerce is prohibited by Federal laws. The use of oysters or other sea foods should be confined to products handled under jurisdiction of State or Federal agencies. Oysters or other shell fish foods should not be served without cooking. Inspection. Oysters may spoil or become stale after being shipped or they may become contaminated during transportation. Hence, a piece inspection should be made for evidence of spoilage, staleness, or adulteration. Oysters whether in the shell or shucked are highly perishable. They deteriorate rapidly when improperly handled and present a characteristic, disagreeable odor or a gassy or milky appear- 460 MILITARY MEDICAL MANUAL FIELD SANITATION 461 ancc. Oysters may show a green or pink discoloration and while there is no evidence that they are detrimental to the health of the consumer, they are generally regarded as undesirable for food and should not be used. Ordinarily, only canned crabs, clams, shrimps, and lobsters are used in Army messes, but should they be furnished fresh, the inspection is, in general, the same as for oysters. It is considered that all canned sea foods have been prepared under official supervision of civilian or military inspection agencies and that the quality of product and method of processing are satisfactory. However, deterioration of the canned product is subject to spoilage or damage and the product should be subject to sanitary inspection prior to use. Inspection. The inspection is made by examination of the unopened can and the contents of suspected or selected cans. If the contents of the can are sound, the ends of round cans and the sides of square or flat cans are concave. Should the ends or sides become flattened or bulged, it may be due to a defect in the can allowing air to enter, or to decomposition of the contents with gas formation. Cans presenting defects through which air might enter or contents escape or which “bulges” or “swells” as the result of gas formation should be rejected for food. Upon inspecting suspected cans, care should be taken when opening the can not to damage contents. The contents should be carefully examined for abnormal odor, appearance, or taste indicative of decomposition. The inside surface of the can should be inspected for evidence of black discolorations due to chemical reaction. Any abnormal odor or appear- ance should be considered as indicative of decomposition and as a cause of condemnation. Milk and Dairy Products. Mil\ is a most important agency of transmission for certain pathogenic organisms. It is usually served in an uncooked state and, consequently, many of the organisms which it may contain will be viable when ingested, therefore strict sanitary supervision during all stages of production is essential. When possible, the use of milk should be confined to establishments operating under supervision of the Army veterinary inspection service. A dairy farm examination consists of an investigation into the sanitation of the dairy farm establishment and all parts, equipment, employees’ health and hygiene of dairy animals, methods of operation, and products concerned. Inspection. Under certain conditions it may be necessary to investigate the conditions under which milk is produced. All bovines on the dairy farm should be free from disease as shown by a thorough physical examination conducted by a qualified veterinarian. The barns should be well ventilated, pro- viding at least 3 square feet of window space and 500 cubic feet of air space for each animal. Manure must be removed and disposed of in such a manner as to prevent fly breeding. All milking utensils must be of non-absorbent material, in good repair, and properly sterilized. Milk must be prompdy cooled within 1 hour after milking to 50° F. and maintained at or below that temperature until delivered to the pasteurizing plant (AR 40-2230). All personneel concerned with milking or handling of milk should be familiar with the necessity of strictest sanitary precautions and be required to undergo careful periodical physical examination to assure freedom from contagious or communicable disease. Pasteurization is the heating of all particles of milk or milk products to a temperature of not less than 143140 F. and holding at such temperature for not less than 30 minutes in approved pasteurization apparatus. The hygienic condition of fresh milk depends to a considerable degree upon the conditions existing at the source of supply. Insanitary milk due to diseased animals or contamination at the source is correctible only in part, therefore it is necessary that milk be obtained from healthy cows and produced and handled under hygienic conditions even when it is pasteurized. Inspection. Inspection of pasteurizing plants requires, in addition to a thorough knowledge of the pasteurizing process, an adequate understanding of the equipment, its construction, installation, and operation. Pasteurizing plants should have in satisfactory operation vats or holders in which the tem- perature of the milk is raised to at least 143/4° F. and held for 30 minutes, automatic devices for registration of the pasteurizing temperature, coolers wherein the milk may be rapidly cooled to 45° F. or less after pasteurization, automatic bottling and capping machines, automatic bottle washers, and facilities for cleansing and sterilizing all parts of the pasteurizing equipment with which the milk comes in contact. All milk bottles should be sterilized before being filled and all pasteurizing equip- ment sterilized immediately before being used. Cleanliness throughout is essential in the operation of a milk plant. Pasteurization plants should be efficient and meet all sanitary requirements as to con- struction, equipment, personnel, products, and methods of operation. An ample supply of safe water and steam for cleansing and disinfecting purposes is essential. Doors, windows, and other openings should be screened and kept in good repair. Mil\ issued to troops for beverage and cooking should be grade A pasteurized. When this is not obtainable, grade B pasteurized milk may be used. The use of bulk and raw milk should not be countenanced. If grade A or grade B pasteurized milk is not avail- able, evaporated milk should be used. Inspection. Samples for bacteriological and chemical analysis should be frequently obtained for laboratory tests. These should be packed in ice and prompdy transferred to the laboratory. If 462 MILITARY MEDICAL MANUAL laboratory facilities are not available locally, a sample should be furnished corps area laboratory for analysis (AR 40-310). Use a sample of 1 quart of milk and pour it 25 times between sterile con- tainers. Then add 1 cc of commercial formalin to the quart of milk and agitate thoroughly. Fill sample bottle flush with lower end of stopper and fasten securely. Label specimen, furnishing follow- ing information: Station from which sent, date of collection, nature of specimen, specific examination required, name of establishment from which milk was obtained, and the word “formalized.” Milk should be placed in clean refrigerated storage at a temperature of 45° F. promptly upon receipt. Underground ice or cooling box may be utilized for short storage periods. Bottled milk should not be submerged in water for cooling because the contraction of the contents accompanying the cooling process may create a sufficient vacuum within the botde to suck in water around the edge of the cap resulting in possible contamination. Condensed mil\ is primarily fresh milk from which a part of the water has been re- moved and to which sugar may or may not have been added. It should be stored at temperatures below 60° F. and above freezing and the cases should be occasionally turned in order to offset the tendency of the fat to separate and of the milk to solidify. Long storage is undesirable due to tendency of acid content of milk to react on metal of the container producing off flavors, solidification, or swells due to hydrogen gas. Inspection. Deterioration of condensed milk is evidenced by the formation of gas, the development of abnormal tastes or odors, or by discoloration. Cans presenting the above conditions should be re- jected for food. Certain of the constituents of milk may settle out to form precipitates, however, this docs not necessarily indicate that the milk is unsuitable for food. Such supplies should, however, be very carefully examined for evidence of other conditions which would render the product unfit for food. Butter is the fat derived from milk or sweet or sour cream, formed into a mass to- gether with water and small amounts of other natural constituents of milk, such as curd, lactose, and acid. It is essential that the production of butter be safeguarded in the same manner as the production of milk. Butter exhibits a marked tendency to absorb odors and tastes from other substances and for this reason should not be stored in the same place or close to odorous substances such as fish, cheese, or certain vegetables. If butter is to be held for any considerable length of time it should be placed in cold storage at a temperature of from 5 to 10 degrees below zero F. where it may be held for as long as 6 months without deterioration. Butter should not be held at temperatures of from 20° F. to 30° F. for longer than 1 month and storage space should be kept dry and clean. Inspection. Sanitary butter should be clean, sweet, of an agreeable aroma, palatable, of fine texture and grain, and should not contain adulterations, insects, or foreign substances. It is bright in color and of a light straw shade. CLEANING AND DISINFESTING DEVICES Bathing Facilities. Ablution benches where the men can wash should be constructed half way between the latrines and the company tents. These benches need not be very elaborate, but the drainage from them should be carefully planned so as to be well spread over the ground in a system of branching trenches and ditches. Improvised shower baths may be made out of five-gallon gasoline cans or from a barrel (Plate 18). All pits, ditches, and bathing areas as mentioned above should be at least 100 feet from any source of drinking water. Laundry Facilities. Soldiers should be encouraged to keep their clothing clean, especially underwear and socks. In over night camps or bivouacs of short duration the men wash their clothing at designated places in nearby streams. In camps of longer duration laundry benches should be provided. The same care of drainage water should be taken as that described above for bathing. Every opportunity should be taken to dry wet clothes. Socks may be hung on the outside of the pack while marching. Tents with stoves should be strung with wires or a screen of burlap erected around the stove, inside of which wet clothes are hung. If possible all clothes should be dried in the sun, especially socks, in order to destroy fun- gus growths (athlete’s foot). Disinfection may be required in some instances. Large steam disinfectors are sup- FIELD SANITATION 463 plied to large commands. These consist of big pressure sterilizers or autoclaves, weighing some nine thousand pounds, mounted on iron wheels, in which at least one atmosphere of pressure may be developed. See discussion under “Lice”, Capter IV. Sanitary Survey and Report. A sanitary survey is a study of the conditions of a military camp or post which are either favorable or unfavorable to the health of its personnel. A sanitary report is the summarized information obtained from a sanitary survey, in- cluding conclusions and recommendations as indicated. Plate 18. Improvised Shower Bath. Sanitary surveys have three functions. The first is to learn—to collect information. The second is to teach—to inform the commander and others as to the sanitary conditions and to spread the idea that good health is possible and that a healthy army is a strong army. The third is to utilize the collected facts as a basis for action, as a means for discovering sanitary short-comings, and as a guide in making recom- mendations for improvements. Certain basic features of any community or military post must be considered: social factors, economic conditions, environmental conditions, and local prevalence of diseases. The health of a command is influenced a great deal by the health conditions of its adjacent civilian population and community. Personal inspection and study must be given to all these considerations, and a physical inspection of the sanitary installations and factors affecting sanitation of the command must be made. A definite scheme of making the survey should be written or thought out clearly before attempting it. Information should be secured from local health authorities, visiting civilian physicians, hospitals, dairies, packing houses, water supply and purification plants, and sewage disposal plants. Features which can be improved by the command should receive closer study. The proper recommendations are then made. Defects and deficiencies of military installa- tions can usually be corrected. The medical officer making a sanitary survey does not possess the authority to order the institution of corrective measures except when such authority is delegated to him 464 MILITARY MEDICAL MANUAL IXIANUDE '£> GAPjJAGEL inCinLQATOC. "A5I4 DUMP- 1000 V65 fPOM r AMD Plate 19. Diagram of a Proper Sanitary Layout for a Battalion Camp. DEEP DITCH LATCINES WITH URINE SOAKAQE PITS> PICKET LINE * TPASI4 mcinLDAToe TCASH- 0AAS SHOVx/FG 0ATHS ABLUTION TABLES NIGHT UCINAL CANS INFICMABV AHD PBOPI4YLACTIC STATION FIELD CANGES WITH 5ULLA&F PIT UNDEB PACT OF CANGE WATEP- COMPANY OFFICECS' TtriTS C.O AHD STAFF T OFFICEDS' LATDII1E T~ FIELD SANITATION 465 by proper military headquarters. His function is advisory and not one of command. The report may be either oral or written. There are several types of sanitary reports; special, monthly, and general. Special reports: Special reports cover occasional emergencies, usually in written form, and will be rendered as necessity demands. Their purpose is to place immediately before commanding officers information regarding grave sanitary defects, epidemics, or other serious conditions that are affecting or may immediately affect the health of the command. In all such reports appropriate recommendations for the correction of existing defects or for prevention of extension of epidemics or threatening epidemics should be incorporated. Monthly reports: Monthly reports are rendered for each station or tactical command in the field v/ithin three days after the end of each month. The purpose of the report is to keep the commanding officer and higher administrative authorities in touch with current sanitary and health conditions within a station or command and with defects which may influence the health of the command. To insure uniformity the following headings, numbered serially, are used in rendering these reports: (1) Environmental sanitation: This includes any changes or additions to drainage system, public buildings water supply, disposal of wastes, food supplies, methods for eradication of disease-bearing or other insects, or other matters connected with en- vironment that have occurred during the month. If no changes have occurred, the statement “Satisfactory” will suffice. (2) Personal hygiene: Report of physical inspections as to whether or not there are new cases of venereal diseases. The status of immunological procedures should be included. (3) Undue prevalence of acute communicable diseases: Report endemics or epi- demics of any of the acute communicable diseases that may occur, their origin, the means of probable dissemination, and special measures instituted for their control. If none, the statement “None” will suffice. (4) New or improved administrative measures and sanitary appliances: Report improved or new sanitary appliances, health conservation or administrative measures of proven or potential practical value, either in garrison or on field service. If these have been the subject of special reports, attach copies thereof. If none, the statement “None” will suffice. (5) Subjects not covered under other headings. (6) Recommendations: Recommendations must be made for correction of all sanitary irregularities, for the improvement of existing or the institution of new appliances or for the adoption of administrative measures for the protection of the health of the command. If there are none, the statement “None” will suffice. The veterinary sanitary report, the report of the nutritional status of troops, and the reports of the venereal disease control officer are not rendered as separate reports, but are incorporated in the one monthly sanitary report. General report. The purposes of general reports are to inform higher authorities re- garding sanitary conditions and related matters as viewed by medical inspectors of corps, department, or tactical command, or by general medical inspectors. They con- tain facts, conclusions, and recommendations concerning efficiency of Medical Depart- ment administration and personnel, care of equipment, sufficiency of hospitalization, and other allied subjects. Disposition of Sanitary Reports. The final dispositions of the above reports in addition to the file copy retained of each at the originating command are as follows: Special: To station or other commander send two copies; file one copy as an exhibit to go forward with the monthly report. Monthly: Send in duplicate to The Adjutant General through channels. General: Original through inspector’s immediate superior to the Surgeon General and in duplicate to the station commander. Sanitary reports are very powerful instruments in maintaining a high degree of sanitary efficiency and excellence. 466 MILITARY MEDICAL MANUAL Sanitary Order. Upon arrival in camp a camp sanitary order is necessary in order to designate the layout of the various sanitary devices in their relation to the rest of the camp’s interior economy, as well as to lay down the sanitary rules and regulations by which the life of the camp is to be governed. Plate 19 shows a suitable layout for a battalion camp with its sanitary devices and the correct distances from the tents at which each is established. Terrain features will not always permit such an arrangement. The camp sanitary order is usually drawn up by the senior medical officer of the command and by him submitted to the commanding officer who publishes it as an order. In general it fixes the responsibility for sanitary conditions in the camp, outlines the status of the surgeon, designates proper inspectors and police officers, lays down the rules governing the water supply and sterilization of water, and the conduct of messes together with the handling of food and the control of permanent food handlers, outlines the methods for the disposal of wastes and human excretions, the disposal of manure, the control of insects, the disinfestation of clothing, the care of tentage and quarters, the location and function of the venereal prophylactic station, the periodic physical inspection of troops (Army Regulations require a monthly physical examination in which the detection of concealed venereal disease is only a part), enjoins observance of the rules of personal hygiene, designates the location of the medical tent or dispensary, and gives such other information or instructions as may be required for the preservation of the health of the command. A detailed outline of the contents of a camp sanitary order, with references to pertinent Army Regulations, appears below: Headquarters Inf., Camp Place Date General Order No.— i. General. The following provisions for the sanitation of this command are published for the information and guidance of all concerned: a. Responsibility of the unit commander for the sanitary conditions of the command. b. The surgeon of the command: Duties and responsibilities in all matters relating to the health of troops and sanitation. c. The medical inspector: Authority and general duties. Mis reports to be made direct to the surgeon of the command. The general police officer when one is designated. His relation to the surgeon and to the medical inspector of the command. d. Water supply: Where obtained for drinking purposes, cooking, watering of animals, bathing and washing of clothes. Only water from authorized sources to be used. Flagging of streams. In- stallation, care, and protection of water sterilizing bags. Chlorination of water. (Par. io, AR 40-205). AND CARRIERS CONTACT -FOOD AND WATER- INSECTS — SUSCEPTIBLES Plate 1. Factors in the Control of Communicable Diseases. Transmission of communicable disease by a special transmitting agent occurs where the susceptible person’s only contact with the sick person is through some intimate car- rier of the germs of the disease. Examples of this mode of transmission of disease are: the mechanical transmission of typhus fever by lice, the biological transmission of malaria by the mosquito, and the transmission of typhoid fever by the healthy human carrier. A "carrier” is a person who, without displaying visible symptoms of harboring a com- municable disease, disseminates to others its specific micro-organisms. The diseases which are known to be transmitted by “carriers” are as follows: Cholera Diphtheria Dysentery (amebiasis) Dysentery (bacillary) Meningococcic meningitis Paratyphoid fever Pneumonia Scarlet fever Tvphoid fever Vincent’s infection As distinguished from a “carrier,” the term "inferred person” designates a person in whose tissues the etiological agent of a communicable disease is lodged and produces symptoms. Factors Influencing Communicable Disease. Several factors which may affect the severity and the dissemination of communicable diseases may be grouped into three gen- eral classifications: the degree of individual resistance to the given disease; the time of recognition, whether detected in the early stages of dissemination or after the exposure of many susceptibles; and the climate or environmental conditions which may enhance or adversely affect the individual resistance, or favor or limit the transfer of organisms causing disease from one individual to another. Individual Resistance. Each person has a certain degree of natural resistance to in- fection by the communicable diseases. This resistance is relative, some having more than others. Resistance to disease is also “general” or “specific.” The person of good physique and robust health is likely to have a good general resistance to many diseases. Specific ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 473 resistance, or immunity, applies to certain diseases and may be acquired in several ways, as related below: First: By having suffered an attack of a disease which confers a degree of immunity which will protect the recovered individual from another attack of the same disease. Smallpox is an example of such a disease, because individuals who have recovered from smallpox have not been known to have smallpox again during their lifetime. Second: By repeated exposure to small doses of infectious material by which a resistance is built up without the individual every being actually sick with the disease. Many individuals have been repeatedly exposed to diphtheria patients without ever contracting diphtheria themselves. It is believed that the exposure to small amounts of infectious material can be tolerated without developing the major symptoms of the disease. The presence of the infectious material, however, stimulates the formation of antibodies in the blood against the particular disease; and, if the next dose of infectious material is not too large, this antibody formation is increased even more. By this process being repeated several times, the individual apparently developes sufficient immunity to resist doses of infectious material large enough to produce severe symptoms in the unprotected indi- vidual. Measles, chicken pox, scarlet fever, and mumps seem to fit into this classification in respect to some persons. Third: By artificial immunization by means of vaccination against a given disease. The immunization may be produced either by the introduction of the dead organisms or the toxic material of such organisms into the human body. Typhoid fever organisms, for instance, are cultured, then destroyed, and made into a vaccine which is inoculated intramuscularly. The presence of these dead organisms stimulates the atibody forma- tion of the individual concerned, and for a period of several years he has an increased resistance or immunity to typhoid fever. Smallpox immunity has been definitely ac- quired by artificial immunization. Many other diseases have given favorable indica- tions that they can be controlled or lessened in their severity through these means. There are many other factors which contribute both to an individual’s general resistance to disease or the lack of such resistance. Previous environment, age, vitality, and race are among the more recognized ones. Previous environment has much to do with the amount of resistance to disease a soldier has acquired by the time he enlists into the military service. In general, recruits from populous communities have been more frequently and more intimately exposed to in- fective material of many kinds than those from thinly populated areas. For example, the recruit who has always lived in the city very rarely reaches adult life without having had measles, while the young man who has always lived on a farm, and has had very few contacts with people other than his immediate neighbors, may or may not have had measles. Age is a factor in the resistance of an individual because as individuals mature they attain more and more resistance, reaching their maximum in late middle life. Age in- creases both natural and specific resistance—physical stamina is greater, and antibody formation has been under process for all diseases to which the individual has been ex- posed. When physical stamina becomes lessened materially, as in the later years of life, the general resistance is decreased in spite of immunities acquired. Vitality is another important factor in disease resistance. Men who are weakened by lack of adequate and proper food, by exposure to wet and cold, by physical or mental exhaustion, by confinement in close quarters, and by lack of proper exercise, are apt to become sick from whatever communicable disease is prevalent, unless they have specific immunity to it. Racial resistance to some disease is known to vary. The white race, for example, has a greater resistance to pulmonary tuberculosis than negroes. Malaria is said to be tolerated better by the negro than the white person. Part of this racial resistance is hereditary and part is environmental. 474 MILITARY MEDICAL MANUAL PREVENTION AND CONTROL OF COMMUNICABLE DISEASES Purpose. Preventive medicine, which includes measures for both prevention and con- trol of communicable diseases, is formulated and health measures executed in accordance with the mission of the military force. These measures should be correct, feasible, and practicable. They should not interfere with the accomplishment of the military mission of the command. If, however, there is an epidemic of a communicable disease in a com- mand, the control of this disease would be of paramount importance in order to prevent the loss of valuable manpower. The early consideration and use of preventive measures will often provide a protective barrier against disease and prevent epidemics. Preventive Measures. In addition to the natural resistance of the individual, there are many precautionary measures which should be taken in order to prevent the outbreak and spread of communicable disease. These measures may be divided into four general classes: First. Providing an environment that will prevent or limit the dissemination of infec- tive material: proper housing—ventilation, heating, lighting, and cleanliness; insect con- trol; and rodent control. Second. Measures designed to maintain the health and vitality of the soldier: proper food, clothing, exercise, rest, sleep, and personal hygiene. Third. Specific prophylactic treatment to confer immunity; artificial immunization against smallpox, typhoid, tetanus, yellow fever, cholera, diphtheria, and other diseases against which specific immunity has been effective. SOURCE PRINCIPAL TRANSMISSION AGENCIES CONTROL OF TRANSMISSION AGENCIES PROTECTION OF SUSCEPTIBLES VENTILATION OF BARRACKS. BED SPACING IN SQUAD ROOM. CUBICILED BEDS. PREVENTION OF CROWDING. AIR ISOLATION OF CASE 8. CARRIERS. QUARANTINE OF CONTACTS. WARM CLOTHING. PER- SONAL CLEANLINESS IMMUNIZATION. CONTACT BY AIR HANDS FOOD AND MESS EQUIPMENT HANDS PERSONAL CLEANLINESS CASE OR CARRIERS FOOD and MESS EQUIPMENT DISINFECTION OF DISHES & MESS EQUIPMENT. SANITATION OF KITCHENS. CLEANLINESS AND SUPERVISION OF FOOD HANDLERS. PROTECTED TROOPS Plate 2. General Factors in the Control of Respiratory Diseases. Fourth. The isolation of the sick, the quarantine of contacts, separating them from the well in order to prevent further spread of the disease. The effectiveness of this measure is dependent upon the early recognition and diagnosis of the sick. Environmental Measures. A healthy environment is obtained by the proper housing of troops and the physical and chemical destruction of those pathogenic organisms that affect human beings directly or indirectly. The factors of housing involved in the pre- vention and control of disease are ventilation, heating, plumbing, screening, and lighting. The sanitation of the buildings occupied by troops is the responsibility of the unit com- mander; the construction and repair, and the ventilating, heating, and lighting facilities arc responsibilities of the Engineer Corps. The medical officer of the unit makes recommendations based upon inspections in order to insure the observance of proper ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 475 sanitary measures and maintenance of conditions which will promote and preserve the health of the troops. Ventilation. Adequate ventilation is obtained by the use of proper methods of heating, correct construction of buildings, and the avoidance of overcrowding. Ventilation of the squad room need not be a difficult procedure. If the prescribed bed space is used, and if beds are arranged head to foot (see Plate 3), the occupants of the room will not so readily transmit pathogenic organisms to one another. Sixty square feet of floor space for each bed and 600 cubic feet of air space per man should be allowed exclusive of space utilized for wall lockers, foot lockers, furniture, and fixtures. The windows should be opened on top on one side (leeward) of the squad room, and at the bottom on the opposite side (windward). This is the most effective method of ventilation in Plate 3. Head to Foot Sleeping Arrangements. the ordinary squad room. Mechanical air conditioning methods are not employed, as yet, in the ventilation of barracks or quarters. They are occasionally installed for the ventilation of operating rooms in hospitals and in other special enclosures. It is not improbable that air conditioning will be used more extensively in the future to include barracks and other military establishments. Ventilating facilities should be adequate and used. Officers of an organization should inspect the men’s sleeping quarters at night to see that they are well ventilated. Most cantonment barracks as constructed at the present time are heated by hot air and depend for proper circulation of air on pressure within closed windows. The heating plant is located at the end or side of the building. Fresh air from outdoors is drawn in through the furnace where it is heated. A large blower fan then forces this heated air through air ducts opening in all parts of the building. Each opening has a damper whereby the flow of air may be regulated. Once regulated these dampers should not be changed. A large exhaust fan draws air through an opening near the floor and re- turns it to the furnace room. There a system of dampers permits a part of the air to be released outdoors and recirculates the remainder of the air through the furnace. All windows must remain closed to permit this system to operate efficiently. If windows are opened the distribution of air will be uneven and the furnace will be overtaxed. A variety of thermostats, dampers and switches makes this system requiring rather skilled operation. When the furnace is not in operation, ventilation is obtained by the conven- tional window system. This modification of the hot air furnace method of heating and 476 MILITARY MEDICAL MANUAL ventilating does not apply to the comparatively few cantonment barracks which have steam heat and in which the conventional window ventilation is always employed. Overcrowding, though unavoidable at times, should never be condoned. It contributes to epidemics by increasing the number and intimacy of contacts, as well as by lowering the vitality of individuals. In extreme emergencies the minimum allowance may be re- duced to 500 cubic feet of air space and 50 square feet of floor space per man. Ventilation of tents used as quarters is also important. The hood of the tent should be open to allow air to escape. Side walls should be raised sufficiently to allow air to enter at the bottom of the tent. The tent walls should be rolled daily, permitting the interior to air thoroughly. The tent should be taken down, or furled, periodically and the interior exposed to direct sunlight. Sunlight has a definite bactericidal effect, and therefore when the interior of a tent can be exposed directly to sunlight the dissemina- tion of bacteria is decreased. Heating. Proper heating is the process of raising the temperature of cold air within quarters occupied by troops to about 70 to 72 degrees Fahrenheit with a relative humidity of 50 per cent, and then maintaining this temperature and humidity within the zone of comfort. The “zone of comfort” is that range of the combined effect of temperature, humidity, and movement of air within which there is no discomfort due to either warmth or cold. The term “effective temperature” as pertains to heating includes humidity and movements of the air. The optional effective temperature to provide the average winter comfort zone ranges from 63° F. to 71° F. The average summer comfort zone is some- what higher, ranging from effective temperatures of 66° F. to 75° F. Since physical efficiency is decreased by improper temperature, humidity, and move- ment of air (i.e., improper effective temperature), the air conditions of occupied quarters should be determined and then adjusted, if necessary, to insure maximum comfort. Upon entering a room a person can note at once the state of air conditions of which those who have been in the room for some time may be unaware. If improper a sense of discomfort is noted—stuffiness, lack of freshness, excessive warmth. The temperature should be adjusted according to the work performed and the clothing worn by the individuals. Where soldiers are actively engaged physically, the effective temperature may be lower than where their duties are sedentary. Light. Light aids health by providing a sense of brightness and cleanliness, stimulating morale, and increasing a desire to maintain hygiene and sanitation. Adequate lighting facilities should always be provided where men read or carry on clerical work. The con- tinued use of poor light will cause impairment of vision. The minimum window (light) space for a squad room should equal about 20 per cent of the floor space, provided there is no obstruction to light entering the building by adjacent buildings or other external objects. Natural illumination is better than artificial light. Housing sanitation or cleanliness. Improving the environment by the use of control measures to destroy or curb the activities of pathogenic micro-organisms injurious to man is important in preventive medicine. These measures include: cleaning or policing, disinfesting, disinfection, and fumigation. Cleaning or policing a building signifies the removal by scrubbing and washing, as with hot water, soap, and washing soda, of organic matter upon which and in which bacteria may find favorable conditions for prolonging its life and virulence; also, the removal by the same means of bacteria adherent to surfaces. Painting a surface could be included in this class of cleaning measures. Rooms previously occupied by infected per- sons should be cleaned prior to admittance of other occupants. Disinfesting is a process of destroying insects and animals which are known to be cap- able of conveying infection. The measures of destruction include the use of dry or moist heat, gaseous agents, poisoned food, trapping, and allied measures. “Debusing” refers to the process by which a person and his personal apparel are treated so that neither the adults nor the eggs of Pediculus corporis or Pediculus capitis survive. Men are required to bathe and shave; wearing apparel is steamed. Disinfection is the process of destroying the vitality of pathogenic micro-organisms by chemical or physical means. It may be concurrent or terminal to the infection. The use ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 477 of a disinfectant, such as cresol solution, to scrub a bed which has been occupied by a person with a communicable disease is an example of disinfection. Fumigation is the process by which the destruction of insects, such as mosquitoes and body lice, and animals, such as rats, is accomplished by the employment of gaseous agents. Hydrocyanic acid gas is the most effective agent of fumigation. Other agents quite commonly used are sulphur dioxide, carbon disulphide, and carbon monoxide. Insect Control. Insect control is essential for the maintenance of health, especially in warm climates. They are factors in the transmission of disease serving either as hosts for certain diseases or as mechanical carriers of disease organisms. Flies are the most common insects which are known to affect the health of humans. They are filthy in their habits and spread disease by transferring germs on their append- ages or in their excretions from one place or person to another. In this way the house fly is capable of transmitting any of the pathogenic bacteria. The most common bacteria it transmits are the intestinal disease producers. The transmission of protozoal infesta- tions endameba histolytica and ascaris lumbricoides may also be attributed to flies. Flies breed in and live on putrescent material of any kind—garbage, feces, manure, and other wastes. Fly control is best accomplished by the elimination of their breeding places. Adult flies are destroyed by fly traps, swatters, poisons, fly paper, and fly sprays. A fly is attracted by food and it is by means of contaminating food that most of the diseases carried by flies are transmitted to man. Therefore protection of food from contact with flies is important. Screening of windows and doors is necessary for both mess halls and barracks. The control of flies with respect to messing and field sanitation is dis- cussed in Chapter III. Mosquitoes spread certain communicable disease by furnishing a biological link be- tween the person sick with the disease and a well person. Like flies, they are best eliminated by destroying their breeding places and habitations. As they must have water in which to breed, drainage of standing water, or oiling water that cannot be drained, destroys their breeding places. The elimination of tall grass and underbrush destroys their habitations. Screening of sleeping quarters and the use of mosquito bars (bed nets) should be enforced. For men on duty when they are subject to constant attack by mosquitoes head nets and gloves are a useful measure. Diseases transmitted by mosquitoes are: Dengue (Aedes egypti and Aedes albopictus). Equine Encephalomyelitis (Aedes egypti and other member of the tribe). Filariasis due to Wuchereria bancrofti (Culex fatigans and Aedes variegatus). Malaria (Anopheles). Yellow fever (Aedes egypti). The Medical Department is responsible for mosquito investigation, reporting of con- ditions which require mosquito control, and for recommendation of control measures. The Quartermaster Corps is responsible for materials. The Engineer Corps is re- sponsible for construction, equipment, and labor, including the operation and mainte- nance of control measures. The Medical Department may act in an advisory capacity for technical procedures. Chiggers or red bugs are very troublesome to our troops in the Southern States. They are the larvae or the first active stage of a large scarlet soil-inhabiting mite. The chiggers found in the United States are not known to carry disease but they produce extreme annoyance by their bites. The intense itching caused by these pests often interferes with sleep and the poison injected may cause fever and a loss of appetite. Infection is usually introduced as a result of scratching. Closely woven garments with boots worn over the trousers will exclude many of the chiggers. Leggings if properly fitted over the shoes offer much protection. Dusting the clothing and body, especially from the waist down, with sulfur gives almost complete protection. One should lightly dust sulfur on the skin, underclothes, and socks before going into chigger infested areas. The effectiveness of the sulfur increases after it has been applied for 2 to 3 days in succession, at which time it can be relied to give reasonably complete protection. Chiggers may be removed by a sharp instrument if detected early and before they are firmly attached. The bitten area should be touched with 7 per cent iodine. 478 MILITARY MEDICAL MANUAL Bedbugs are not definitely known to transmit any disease, but they have been accused of carrying kala-azar, plague, anthrax, relapsing fever and typhus. Both male and female bedbugs suck blood. They can live as long as nine months without food. They are very sensitive to temperature and are apparently more numerous in the cold than in hot climates. Fumigations of 6 to 12 hours’ duration with hydrocyanic acid gas generated from 1 pound of sodium cyanide per each 1000 cubic feet of space have given excellent results in most barracks. To fumigate safely it should be done by trained personnel and buildings should be separated from other buildings by a dis- tance of 15 to 20 feet. Liquid insecticides are effective against bedbugs if applied thoroughly and frequently and forced into places where the eggs are deposited. Power sprayers operated by electricity are best used for this purpose. Roaches may be troublesome in mess halls and kitchens. It has been shown that di- sease organisms may be carried on the legs of roaches and that the same organisms can be found in their feces passing through the alimentary tract uninjured. For immediate elimination of roaches in tight rooms, fumigation as described for bedbugs, is very successful. Sodium fluoride powder is the best all around remedy. It remains effective indefinitely in dry situations but in very damp places it may cake over and become useless. The powder should be applied in the evening, and it is best not to clean it up for two or three days. Borax and pyrethrum powder or a pyrethrum kerosene spray is also effective, particularly if vaporized by a power sprayer. Ants have been incriminated experimentally in the spread of typhoid and cholera and food must be protecicd from their depredations. They may be kept from food on tables by tying kerosene soaked rags around the legs of the tables. If the place of entry into the barracks or mess hall can be traced, a small sponge soaked in sweetened water, placed near the entrance, will attract the ants and when the pores of the sponge are filled with them, it may be dropped in boiling water and the process repeated. Nests may be destroyed by digeing up earth over and around them for several inches, pouring in about a pint of gasoline or kerosene and setting it afire. Lice have been a problem to the military for hundreds of years. They carry typhus fever (epidemic type), trench fever and relapsing fever. There are three varieties of lice, the head louse, bodv louse, and pubic louse. Body and pubic lice are also known as “cooties” and “crabs” respectively. The best protection against lice is cleanliness of person, clothing and bedding. Individuals who bathe daily and who do not sleep in their clothes have little to fear from louse infestation. There are three general methods of disinfestation: heat, chemicals and storage. Heat is the most practicable and generally most efficient disinfesting agent. Articles made of felt, leather or webbing are seriously damaged by heat and are best disinfested by chemical means; such as by sponging them with a 5% Cresol solution. Large organizations may be disinfested in a permanent establishment such as a delousing plant. A delousing plant is established by the Quartermaster where there are large concentrations of troops. The clothes are disinfested in large steam sterilizers while the soldiers are examined, shaved, scrubbed and thoroughly cleaned up before they are permitted to put on clean clothes. There is also an Army unit called the Quartermaster Sterilization and Bath Battalion which is designed for unit disinfestation of men, their clothing and equipment in the field. This organization will operate wherever there is a need for its services. It may operate a fixed delousing plant; or it may utilize its mobile equipment to set up a temporary establishment. There are simple improvised devices which may be set up by individual companies or smaller units in the field if no facilities are provided by higher authority for dis- infesting the men. These devices are the so-called Serbian barrels which, while they may differ in design, are the same in principle. The Serbian barrel consists of a container for the material to be <’ First World War • No Racofd .OFFICIAL RECOGNITION RESPONSIBILITY OF UNIT COMMANDERS VENEREAl DISEASES Adm*tiion» to Sick Raport .Annuel Retat Par 1000 Strength. United S*atet Army. Since 181P Plate 5. Graph of Venereal Disease Admissions. U. S. Army, 1819-1940. The Venereal Disease Problem. Control of venereal diseases has been, and still is, one of the most difficult sanitary problems confronting the Army and one of the most serious problems affecting the efficiency of troops. These diseases are prevalent in civil communi- ties, and are brought to military communities by persons in the military service as a result of sexual intercourse. Exposure to infection, and the consequent acquisition of a venereal disease is, therefore, an act on the part of the individual. Few men die from the imme- diate effects of venereal disease, but many are rendered inefficient and non-effective for long periods. These diseases may easily render a large part of any command entirely unfit for field service. For the daily average during the year 1918 there were 10,788 men and officers absent from duty on account of venereal disease. Our military authorities have long recognized the gravity of the venereal disease situation. In 1910, die Surgeon Gen- eral of the Army stated: “The venereal peril has come to outweigh in importance any other sanitary question which now confronts the Army, and neither our national optimism nor the Anglo-Saxon disposition to ignore a subject which is offensive to public prudery can longer excuse a frank and honest confrontation of the problem.” Now, more than 32 years after that statement was made, civilian authorities, too, are aroused to the gravity of the venereal situation and are taking steps to combat it. Responsibility for Venereal Disease Control. Until 1923, the responsibility for the control of venereal diseases was vested almost entirely in the Medical Department of the Army. In that year an Army Regulation was published which for the first time placed the 484 MILITARY MEDICAL MANUAL question of instruction and prevention where it belonged—on unit commanders. There is no doubt that a great deal of the credit for the radical reduction in venereal diseases effected, following the publication of those orders in 1923, belongs to the activity of unit commanders in their endeavors to provide healthful sports and decent diversion for their men when off duty. At the present time commanding officers of all grades, from the highest to the lowest, are keenly aware of their responsibilities in this matter. The result of this awareness is graphically shown in Plate 5. The Army’s venereal disease rate in 1942 was 37.8 cases per 1000 men, compared with the 1941 rate of 40.5. The syphilis rate in 1942 was 5.9 per 1000; gonorrhea 29.7. While the activities of the company commander in the control of venereal disease in his company are largely of an adminis- trative and disciplinary nature, the company commander is one of the most important factors in the control of those diseases. His attitude toward such control will be reflected by the actions of his men. All company officers should, therefore, be well versed in the nature of the venereal diseases and the means by which they can be controlled. The Venereal Diseases. The four venereal diseases are: gonorrhea, chancroid, syphilis, and lymphogranuloma inguinale. All are infectious diseases. These diseases are more prevalent among colored persons than among whites. Gonorrhea is almost invariably transmitted among adults by sexual intercourse. About three days after exposure the victim first notices a burning on urination, followed in 24 to 48 hours by a yellowish discharge from the penis, which may continue for several weeks. In the untreated case, the discharge may continue for several months. At any stage of the case in which gonorrheal germs may be found, the disease can be transmitted during sexual intercourse. Gonorrhea is both a local and a general disease. Its most obvious effects are on the mucous membrane of the urethra. The germs may be carried by the blood stream to the joints where they produce gonorrheal arthritis, a very disabling type of rheumatism, or they may be carried to the heart where they produce gonorrheal heart disease. The germs often get into the testicle, causing a long and painful disability which may result in sterility. The most dis- tressing complication in gonorrhea of the eyes. In this affliction, the germs have almost always been carried to the eyes by fingers soiled with secretions from gonorrhea infected genitals. Most cases of gonorrhea of the eyes result in blindness. Chancroid, also known as “soft chancre,” is transmitted by sexual intercourse. About three days after exposure one or more small sores appear on the penis. These sores grow larger quite rapidly and within two or three days the whole head of the penis may be involved. The lymphatic glands in the groin are usually affected; these swollen, infected glands are “buboes” (commonly called “blue-balls”) and almost invariably break down, leaving large, open sores. Chancroid sores and chanceroid buboes heal very slowly, the victim being disabled for several weeks or even for months. In about half the cases of chancroid, a syphilitic infection is also present. Syphilis is most frequently acquired through sexual intercourse. The initial sore, called a “chancre,” or “hard chancre,” normally appears on the genital organs, usually about the head of the penis. Infection may take place by non-venereal direct contact, such as by kissing a person who has active syphilitic sores in the mouth. The initial sore (chancre) is found at the point of infection, generally about three weeks after exposure. By the time the chancre is of noticeable size the syphilitic infection has been carried by the blood stream to every part of the body. A few weeks later, in the untreated case, syphilitic sores appear in the mouth, a syphilitic rash usually appears on the skin and buboes may appear in the groins. In a few years the heart and blood vessels will have been seriously damaged, and the brain and nervous system will have been invaded and changed by the syphilitic infection. Untreated cases of syphilis never recover from the disease. Such cases not only never recover, but they also transmit the disease to their children, this being one of the very few diseases transmitted from parent to offspring before the birth of the latter. “The sins of the father are visited on the sons, even to the third generation.” Lymphogranuloma inguinale. Lymphogranuloma inguinale is a specific infectious disease transmitted by venereal contact. It may, however, be transmitted in other ways, ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 485 as the secretions and discharges from the lesions are inefective. It is the so called “fourth venereal disease,” and since June, 1937 has been reported by the Medical Department as a venereal disease following instructions issued by the War Department to that effect. The incubation period is from one to seven weeks, the average being about three weeks. The initial lesion is usually on the glans penis or prepuce in the male, it being a papular infiltration which may be accompanied by prostration, headache, and pyrexia. In several weeks, the inguinal glands (most commonly unilateral) become enlarged, painful, and coalesce into a mass with distension of the overlying skin which becomes a dark purplish red. Soon isolated softened areas appear, which rupture, and a sero-purulent fluid (infective) exudes from the multiple sinuses. The intensity of the disease may vary. However, all cases of adenitis become chronic, causing much scarring which may be extensive. The mortality is low, but the morbidity is high and the period of convalescence may be weeks, months, or years in duration. Diagnosis is confirmed by the use of the Frei intra-cutaneous test, which is the injection of the specific antigen intracutaneously in the forearm. In 24 to 48 hours a positive test will reveal an area of erythema one to several inches about a papule approximately 8 to 10 millimeters in diameter. A negative reaction has a small area of erythema (with a papule less than 7 millimeters in diameter, usually 3 to 5 millimeters). A control injection of an equivalent amount of normal saline solution may be used. The test will be positive in the early stage of adenitis. This disease is prevalent in the tropics, especially among the prostitutes. It is compara- tively rare within the United States. Because of its recognition and positive differ- entiation from the so-called non-venereal bubo it is placed under the same measures of control as other venereal diseases. An attack of the disease does not confer im- munity, and the susceptibility is universal. There is no specific cure, the best recom- mended procedure being the surgical removal of the involved glands before suppuration. When secondary infections occur they are treated locally, with similar general measures as for other infectious diseases. Treatment of the Venereal Diseases. The venereal diseases can be cured if the victim will present himself promptly to a reliable doctor for treatment. Self treatment, or something obtained from and upon the advice of the clerk in the drug store, will likely be entirely ineffective. Quack doctors are not so much interested in effecting a cure in such cases as in prolonging the treatment for their own financial benefit. Communicability. The venereal diseases are communicable; every case comes from some other case. They are transmitted by direct contact. To prevent their spread the chain—source of infection, susceptible material, and contact between them—must be broken. A previous attack does not confer immunity, and there is as yet no specific immunizing agent such as we have in typhoid fever or smallpox. Sources of Venereal Disease. The primary, or direct, source of venereal disease is usually the infected woman who practices illicit sexual intercourse. In the majority, such women are prostitutes. It is extremely rare that these diseases are innocently transmitted from soldier to soldier. The secondary, or indirect, source of venereal disease is the infected male population, civil and military. General Prevalence of Venereal Disease. The prevalence of venereal disease in the civil population of the United States cannot be accurately determined. Studies show that more than 75 per cent of all prostitutes are infected; the chances that a prostitute will escape all venereal infection are remote, although she may not be capable of transmitting the infection at all times. Information obtained during the World War showed that 5.6 per cent of the men who presented themselves for military service were the victims of active venereal disease. It is estimated that at least 10 per cent of all civilian males are the victims of active venereal disease at any given time. During the present “National Emergency” 6 per cent of physical rejections were due to venereal disease. Obstacles to the Control of Venereal Disease in the Army. The spread of venereal disease among troops is influenced by a number of factors that do not obtain in other 486 MILITARY MEDICAL MANUAL communicable diseases. The primary source of infection, that is, the infected woman, and the major portion of the secondary source of infection, the infected male, are beyond direct control by military agencies. It is therefore evident that the fullest co- operation of the civil authorities must be obtained in order to make any material reduction in the basic sources of these diseases. General Control. Fundamentally, measures for the control of venereal diseases are designed either to prevent exposure to venereal infection or to prevent the develop- ment of the infection in the exposed individual. Prevention of exposure consists of control of prostitution, educational measures, recreational measures, and deterrent laws and regulations, and the abatement of active cases among military personnel. Preven- tion of development of infection in the exposed individual consists of chemical prophylactic treatment, the effectiveness of which is dependent on the training and discipline of the command. In order to strengthen and augment the program of venereal disease control to meet new conditions created by the present war, an officer of the Medical Corps, specially trained in this field and designated as the “Venereal Disease Control Officer” is as- signed as assistant to the surgeon of the following commands: Each division; each army, headquarters communication zone; General Headquarters; each service command; each department; each station complement serving 20,000 or more troops. This officer establishes and directs, through the surgeon, a comprehensive and unified program for reducing the non-effectiveness resulting from venereal disease (letter, WD AGO February 6, 1942. He prepares and forwards through military channels as an appendix to the monthly sanitary report a statement of all pertinent information con- cerning his activities for the period. Control of Prostitution. Control of prostitution is accomplished by two generally recog- nized methods—regulation and suppression. Regulation does not actually regulate but serves to promote rather than to limit the spread of venereal disease. Regulation is no longer countenanced anywhere in the United States as a legitimate means of controlling prostitution. Control by suppression does not eliminate the prostitute, as prostitutes are always present in any civilian community of any considerable size. It does, however, greatly reduce exposure to venereal disease by the elimination of open houses of prostitution, and it restricts the activities of the prostitute by rendering the practice of prostitution more difficult and the prostitute less accessible. Suppres- sion of prostitution is a police function of the civil authorities. The laws which make prostitution illegal also facilitate the enforcement of measures for the direct control of venereal disease by civilian health authorities. In controlling sources of venereal disease in civilian communities adjacent to military communities, the military author- ities can influence and promote that control through cooperation with civilian authorities in ways which vary with and depend upon the local economic and political situations. Such influence is usually exerted by the higher military commanders, but company officers frequently have opportunities to lend their support to such movements. During the World War the welfare organizations and the public health bodies throughout the country united in their efforts with those of the Medical Department of the Army to help prevent these diseases among the men in the army while serving in this country and in France. Saloons were closed to soldiers, and no vice resorts were allowed in the vicinity of military camps. In July, 1941, Congress passed the May Act which enables the Federal government wherever necessary to take over from the local authorities the policing of areas near military stations. Military Control by Prevention of Exposure. Education. Educational measures are for the primary purpose of reducing the number of exposures to venereal infection by providing the individual with accurate information regarding the spread of venereal diseases, their effects on the human body, and the methods of prophylaxis. Most of this instruction should be given bv medical officers and by company commanders of the troops concerned. (See AR 40-235.) Standing orders require that every soldier, upon enlistment or reenlistment, be given instruction every 6 months in “sex morality” or “sex hygiene.” This instruction is usually divided into three parts: the moral ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 487 aspects, the medical aspects, and the administrative aspects. These different subjects are usually presented to the men by a chaplain, a medical officer, and a company commander, respectively. This instruction should be comparatively brief, sincere, and in simple terms. The efficient and alert company commander will not be satisfied with perfunctory instruction of his men but will seize opportunities to simply, clearly, and briefly drive home the essential points. Troops are best instructed by their im- mediate officers; a soldier will take an interest in the instructions of his company officers but will resent “preaching” from other sources. The instruction which troops receive should include: (1) Information concerning the local environment; the preval- ence and danger of venereal disease in the adjacent civil community. (2) The danger from venereal disease to themselves and their associates, and to thir wives and children. (3) The standing orders requiring prophylaxis after exposure. (4) The use and abuse of prophylaxis. (5) Punishment they may expect for failing to report the contraction of a venereal disease. (6) The fact that continence does not weaken them physically or sexually. (7) Their duty to the government and to themselves. Recreation. Recreational facilities for soldiers are extremely important. Well equipped day rooms, reading rooms, service clubs, and gymnasiums; athletic contests, motion picture shows, band concerts, dances, or any other activities which provide wholesome interest for troops and serve to keep the soldier in the military community, reduce the number and length of periods during which he must find or provide his own entertain- ment, thereby reducing the opportunities for and number of exposures to venereal in- fection. Abatement of sources of venereal disease. In military communities, since part of the indirect source of infection is the soldier with venereal disease, every effort is made to decrease the sources of infection by the prompt detection of cases of those diseases among the personnel, placing them in quarantine and effecting their cure. To this end, standing orders require that troops will be inspected at least once each month for physical defects of all kinds, including venereal disease. These inspections are made by a medical officer, who should always be accompanied by a company officer of the unit concerned. Chemical prophylaxis. Realizing that in spite of all the efforts to prevent it some men will expose themselves to venereal infection, the army furnishes “prophylactic treat- ment” for the prevention of the development of the venereal diseases. This prophylaxis is accomplished by the use of chemicals that destroy the various germs that cause the venereal diseases and do not harm the person treated. The treatment must be used after each exposure to these infections. It should be noted that this type of prophylaxis is quite different from the immunizing treatments mentioned in connection with certain other communicable diseases. The venereal prophy'actic treatment properly admin- istered within an hour after actual exposure is 90 per cent (or more) effective in pre- venting the development of venereal diseases. If the treatment is delayed for 5 or 6 hours after exposure the protection is only about 50 per cent effective. The prophylactic facilities are furnished and operated by the Medical Department. The soldier must not be permitted to administer the treatment by himself. The at- tendant should insist on complete accuracy of each step in the treatment. The steps are as follows: 1. The genitals are examined for signs of venereal disease. If there is any suspicion, the attendant should not give prophylaxis until a medical officer has seen the soldier. The medical officer should respond promptly to such a call. 2. The soldier is then made to urinate. 3. The penis, scrotum and adjacent parts of the body are then washed thoroughly with liquid soap and warm water. The foreskin must be retracted and every part thoroughly washed. 4. The soap is flushed off with a 1-1000 Bichloride of Mercury solution and every part of the penis and scrotum aijd surrounding skin is washed off with the bichloride. The penis is allowed to dry by evaporation. 5. One dram of a fresh 2% Protargol solution is then injected into the urethra. 488 MILITARY MEDICAL MANUAL This is done slowly. The solution is retained in the urethra for five minutes by the clocf{. The meatus should be held tight enough to retain the fluid while allowing an occasional drop of protargol to escape. 6. After the time limit of 5 minutes has expired, the pressure on the meatus is re- leased and the protargol solution is allowed to escape without pressure on the urethra to expel the last drop, which it is desired should remain. 7. About Zz dram of calomel ointment is then picked up with a tongue depressor and the attendant smears it over the surface of the penis while the soldier retracts his foreskin. The calomel is thoroughly rubbed into the penis, particularly about the meatus, head, shaft, around the scrotum and surrounding body area. The rubbing is continued until the ointment has disappeared, leaving only a greasy film. The foreskin is then drawn over the head of the penis to protect the ointment from being rubbed off. 8. The attendant then provides toilet paper or a paper towel to be wrapped around the genitals so as to protect the clothing. 9. The soldier is then directed not to urinate for a period of 4-5 hours after the treatment. Local Commanders will inform all men going on pass of the availability of the prophylactic supplies but enlisted men will not be required to have them in their pos- session if they do not desire to accept them. (War Department Circular No. 53, February 23, 1942.) There are several individual prophylactics manufactured commercially. Some one of these will be stocked by post exchanges. They are not as efficient as the treatment given in prophylactic stations but are of great value for soldiers who are unable to get to a station within an hour after exposure. Even after using one of these tubes or con- dums a soldier should report to a prophylactic station. Cleanliness. If a soldier has exposed himself and has used no condom nor had access to a station, he should empty his bladder, and then scrub his genitals and the surround- ing skin areas with soap and water. This may serve to prevent infection. Punitive measures. (1) Any individual who knows or believes that he has con- tracted a venereal disease must report that fact to his immediate commanding officer without delay. Trial by court martial or other disciplinary action is discretionary with the commanding officer. No disciplinary action is authorized for failure to take pro- phylaxis or. for having contracted a venereal disease. (2) Any person in the military service who loses time from duty because of a venereal disease forfeits his pay during the time so lost and must make good the time lost. Physical inspections. The periodical physical inspections which are conducted at least once each month for all enlisted men below the' first three grades include inspection for evidence of venereal disease. Additional inspections may be arranged if it is be- lieved that some men may be concealing venereal disease. These are most effective if conducted early in the morning or just after return from outdoor activity. Treatment. All cases of venereal disease should be promptly sent to the hospital or dispensary for treatment. Early treatment ofTers far better chances of cure than does delayed treatment. Self-treatment or treatment by unskilled indivdiuals are both in- effective and dangerous. Action to reduce high venereal rate. In case a command has an excessively high venereal rate at any time, stringent control measures may be necessary. These may include all or part of the following: Placing houses of prostitution and all places selling liquor, out of bounds. Patrolling of restricted districts by military police. Limiting all passes to 4 hours and granting no passes after 9 p. m. Classifying passes. Routine bed check. Army Regulations on Control of Venereal Diseases. Army Regulations 40-235, para- graphs 1 to 7 inclusive, are herewith included to furnish information about the pre- ventive measures against the venereal diseases and the manner of putting them into ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 489 effect. They will also assist the reader in maintaining and completing the required records and returns pertaining to venereal diseases. 1. Education in Sex Hygiene, a. "Responsibility of commanding officer. Commanding officers of all grades are responsible for promoting education in sex hygiene among military personnel. b. Instruction of officers. In all troop schools conducted under the provisions of AR 350-2600, and at the Air Corps Training Cente- for student officers and flying cadets, a course of instruction of sex hygiene will be given, commencing with the school year 1939-40. In such courses there will be stressed the duties and responsibilities of unit commanders in the prevention and control of venereal disease among the members of the unit, and the best methods of accomplishing this prevention and control. c. Instruction of enlisted men. At least twice each calendar year and at intervals of approximately 6 months, the commanding officer of each basic unit and detachment will arrange and personally supervise suitable instruction in sex hygiene and the prevention and control of venereal disease for all enlisted men of his command. These instructional periods will be conducted informally; questions and discussions by the enlisted men will be encouraged. A medical officer designated by the post commander will discuss the nature and gravity of venereal diseases, their effect on mental and physical fitness, the importance of earlv discovery and treatment, and the means of avoiding them. The unit or detachment commander will present the broader social aspects of the problem and will call attention to the harmful influence of such diseases on military efficiency through the absence of men undergoing treatment. A chaplain will discuss the moral aspects. d. Instruction of recruits. The instruction prescribed in c above will be given to all recruits as soon as practicable after enlistment. 2. Physical Inspections. In the physical examinations of military commands prescribed in AR 615- 250, special attention will be directed to the detection of venereal diseases. 3. Prophylaxis, a. Prophylaxis stations. (1) Establishment. Commanding officers will require that a sufficient number of prophylactic sta- tions be established at suitable locations in each military command. When facilities permit, and necessity therefor exists, such stations will also be established in adjacent civilian communities. Prophylactic sta- tions will be conducted under the supervision of the surgeon, and will be administered by selected and reliable enlisted men who have received thorough training in their duties. b. Prophylactic materials for individual use. Post exchanges will have available for sale at as low a price as practicable suitable materials for individual prophylaxis for venereal disease. The composition and quality of these materials will be prescribed by the commanding officer upon the recommendation of the surgeon. c. Responsibility of individual. Any individual who exposes himself to venereal infection will employ individual prophylactic materials as a measure of protection against infection and in addition, whenever practicable to do so, will report at once to the nearest military prophylactic station for such cleansing and prophylaxis as may be prescribed by the War Department. 4. Forfeiture of Pay. Forfeiture of pay by persons in the military service of the United States who are absent from duty on account of the direct effects of a venereal disease due to misconduct is provided for in act May 17, 1926 (44 Stat. 557); 10 U. S. C. 847b; M. L., 1929, section 1442. For details regarding the administration of the act, see AR 35-1440, 40-1030, and 345-415. 5. Disciplinary Action. Persons in the military service will not be subjected to trial by court- martial or other disciplinary action upon charges of having failed to take prophylactic treatment after illicit sexual intercourse, or having contracted venereal disease, or of having thus incapacitated them- selves for duty. Any individual who knows that he has contracted, or has reason to believe that he may have contracted a venereal disease, will report the fact to his immediate commanding officer without unnecessary delay in order that proper medical treatment may be given. Trial by court- martial or other disciplinary action for failure so to report is discretionary with the commanding officer. 6. Reports and Records Required, a. Special reports. (2) The surgeon will render to the commanding officer of the station a monthly venereal disease report comparison of the current prevalence of venereal disease with that prevailing during the previous monthly periods in the corps area, or expeditionary force, and in the Army as a whole, together with pertinent information relating to control measures of proved value. 7. Segregation and Treatment. Every case of venereal disease will be promptly subjected to treat- ment, but not necessarily excused from duty unless, in the opinion of the surgeon, it is considered desirable. A list of those treated but not excused from duty will be kept both by the organization commander concerned and by the surgeon, and such individuals will be required to report to a medical officer for systematic treatment until cured or discharged from the service. Individuals in the infectious stages of venereal diseases will be hospitalized, held in working quarantine, or restricted to the limits of the station, as may be recommended by the surgeon. CHAPTER V MILITARY HYGIENE Definition. Military hygiene is the science of preserving and promoting the health of military personnel. It is the system of securing and maintaining proper personal hygiene by individual members of a military organization. Personal Hygiene. Personal hygiene refers to those measures or precautions which every person should observe for the purpose of maintaining his own health and physical well- being. It requires the application of a few common-sense rules, the observance of whole- some habits, and the avoidance of excesses of all kinds. It is a phase of the larger subject of Hygiene which deals with the principles and laws of health. These principles and laws are basic and made by Nature. Accordingly, they never change. Community cleanliness is merely the result obtained within a compact group in which all members obey the principles of personal hygiene. An important by-product is the prevention of the spread of communicable disease. Therefore, the application by each individual of health-saving, personal hygiene measures is the cornerstone of the maintenance of group health and of the field of preventive medicine. Personal hygiene is the basis of military hygiene. Responsibility for Applying Hygienic Measures. Personal hygiene is an essential part of the daily life of the soldier. He is a part of a large and compact unit of men. The health of the man who sleeps or walks beside him may be affected by his neglect or carelessness. The function of the Army in war is to win battles, and they may be won only by strong, healthy, vigorous men. Constant observance of the laws of good health becomes an important responsibility for all Army units and for the individuals who constitute them. It is Army custom that the individual soldier is held rigorously responsible for the hygienic care of his own person, for his personal equipment, and the area which he occupies. As he must live in a clean, wholesome environment, because decency, self- respect, and efficiency cannot exist in the midst of unclean surroundings, such practices must be followed uniformly by all members of the unit. The leaders of military units, from the smallest to the largest, are held responsible that this condition is attained. The squad leader is responsible that all members of his squad adhere to the principles, the platoon leader for his platoon, the company commander for his company, and the practice continues throughout all echelons of command. Thus, the Army system is based upon individual observance of the laws of personal hygiene; but, as in all other matters, the leaders of units are required to insure obedience within the group for which they are responsible. This system establishes military hygiene. Responsibility of the Medical Officer. The medical officer is not responsible for enforce- ment of this system for that duty falls upon organization commanders. But he has very important duties in connection therewith. Above all others he is expert in his knowledge of hygienic requirements. He is a staff officer and adviser to his commanding officer in all medical and health measures. His status presents a duty and opportunity to exert an important influence over the health measures in use by the officers and men of the organization. By inspection he can determine the hygenic laws which are being violated. By instruction he will be able to improve the knowledge and understanding of the officers and men of the unit of which he is a part. In this way the medical officer may exert a profound influence in the improvement of hygienic conditions affecting the lives and physical welfare of the men of the command whose illnesses will otherwise reach him for treatment and cure. Importance. The appetite has been man’s chief guide to his dietary requirements and remains one of our most dependable indicators. While it is unsafe to depend on its guidance alone it is, nevertheless, a more reliable guide than speculation or too narrow NUTRITION 492 MILITARY MEDICAL MANUAL scientific dogmatism. We know that when appetite is lost it is a warning of mental or physical disorder. Certain conditions other than disease influence digestion. The earliest indications of mental or physical irregularity may be manifested by the loss of appetite, combined with disorder of the alimentary tract. This is evidenced most sharply in children who seem to be safeguarded by nature from the excessive use of food. It is well known that emotional states and the condition of the mind affect nutrition. Disturbances of the nervous system such as worry, remorse, jealousy, heavy responsibility and the like, adversely affect nutrition and should be avoided. Eye strain is another deleterious factor; a capricious and faulty appetite often arises from this cause. Ocular defects and refractive errors should be corrected. Improper posture and improperly fitting clothes (trouser belt or field equipment belt) affect the blood circulation in the liver and abdominal organs, consequently impairing digestion and nutrition. Eating immediately before or after bathing or exercise is not a healthful practice. The digestive organs are depressed temporarily as a result of bathing and physical exertion. Dietary Requirements. The requirements for a healthy adult with regard to the various food components are as follows: At heavy labor At rest Proteins (roughly flesh) . . . . 180-210 grms. 75 grms. Fats 105-135 grms. 30 grms. Carbohydrates (starches and sugars) . . . . 480-540 grms. 360 grms. Salts 30- 45 grms- 15 grms. FOOD REQUIREMENTS FOR AN ADULT (IN GRAMS). In calories the fuel requirements for the body are as shown in the table: Normal Extra 10% for Load Road needs worf{ Total waste o Level or un- dulating 2064 900 2964 3260 50 lb. do. 2064 1172 3236 3560 50 lb. Ascending 100 feet per mile 2064 2110 4174 4590 CALORIES REQUIRED BY A MARCHING SOLDIER. Vitamins. Vitamins have been proven to be necessary constituents of the diet, lack of them causing a variety of so-called deficiency diseases. The purity and synthesis of the most important vitamins have been established. The commonly recognized ones together with the diseases resulting from their de- ficiency are described below: Vitamin A deficiency will cause xerophthalmia, night blindness, susceptibility to infection, and lack of proper growth. This vitamin is found chiefly in animal and vegetable fats, green vegetables, and egg yolk. Vitamin Bx (thiamin chloride), the antineuritic vitamin, is found in the outer layer of grains. A deficiency causes beriberi. Vitamin Z?2 Complex consists of a large number of separate factors. The chief of these are: Riboflavin, a deficiency of which causes ariboflavinosis; Pyridoxine hydro- chloride, lack of which produces muscle disorders; Nicotinic Acid and Pantothenic Acid, the antipellagra group; and several others essential for growth and for the health of skin and mucous membrane. These vitamins are found in large amounts in liver and yeast. Vitamin C (ascorbic or cevitamic acid) is our chief protection against scurvy. It is essential in the maintenance of sound bones and teeth and aids in resisting infection. It is found in abundance in citrus fruits, tomatoes, and milk. Vitamin D, the antirachitic vitamin, is our protection against rickets and osteomalacia. It is necessary for the proper metabolism of calcium and phosphorus, being found in fish liver oils and irradiated foods. Ultraviolet light or sunlight is beneficial in de- ficiencies. MILITARY HYGIENE 493 Vitamin E (alpha-tocopherol) is valuable in certain reproductive and neuromuscular disorders. In a concentrated form it is present in wheat germ oil. Vitamin K is necessary for the coagulation of blood, deficiencies being found in certain liver and gall bladder disease. Diets which include a mixture of the following foods will contain enough vitamins to satisfy the requirements of the body: milk, butter, eggs, spinach, whole grains of any kind, dried beans, tomatoes, raw cabbage, citrus fruits, lettuce, raspberries, liver, fish, and meats. Vitamin C may be destroyed by cooking, others to a slight degree only. Vitamins are not lost by foods during storage. Adequate Diet. Food should be agreeable to the taste and appetite and should be well and tastily cooked. A proper menu should include an abundance of green vegetables in order to supply the necessary vitamins as well as acids, salts, and extractive matters. They also add bulk to the intestinal contents by virtue of their contained cellulose and therefore serve as important stimulants to intestinal contractions and promote normal bowel action and excretion. Fruits also are an important dietary article for they not only add bulk to the diet but also have an advantage on account of their organic acids. These acids aid in preserving the acid-base equilibrium in the body tissues. That is, they help to preserve the neutrality of the blood and tissues. Sugar and starches supply the main fuel for the combustion in the body. Sugar is a necessary part of the diet but when taken early in the meal lessens the appetite and embarrasses the digestion. Fats and oils in moderate amount are a necessary part of any diet and are required even in warm climates. Emulsified fats may be absorbed by the intestinal tract without digestion, hence are easily assimilated. Salts of sodium, potassium, calcium, magnesium, and ammonium are essential to the human body and must be supplied. The lack of ordinary table salt in the diet is soon felt and the craving for it becomes almost unbearable when it is denied. Animals will travel for miles and risk their lives to visit salt licks, and among savages and inland peoples salt is a highly prized commodity. Salt is necessary in cellular nutrition and in the production of gastric juice. Water forms the bulk of the human body and requires constant replenishment. Most people drink too little water. Water may be taken with meals but food should not be washed down by draughts of water since this inhibits starch digestion and enables the in- dividual to swallow morsels of food too large for the stomach to manage comfortably. Condiments add taste to the food but used in excess are harmful. Other stimulants should, for the most part, be avoided. Coflee, tea, and cocoa in moderation are ac- ceptable dietary additions. Constipation. Constipation arises usually from a diet that is deficient in bulk, from a sedentary mode of life, from improper carriage and body tone, and from neglect to respond to the impulse to evacuate the bowel. The remedy lies in the correction of these defects and the cultivation of regularity in habits. The deleterious effects of constipation are well known. If chronic constipation exists the advice of a medical officer should be obtained in order to avoid dangerous com- plications. If definite pain is noted in the abdomen, the use of a cathartic should be avoided until and if administered by the physician. When the services of a medical officer are not available, a plain luke-warm water enema given slowly may be used without much danger to obtain temporary relief. Rules for Regulation and Control of the Diet, and matters pertaining thereto, are sum- marized as follows: Keep the mouth clean and healthy to avoid spread therefrom to the alimentary tract. Visit the dentist periodically to avoid the possibility of any dental defect and to insure complete cleanliness. Correct any body defects that affect nutrition, such as emotional conditions, eye defects, and errors of posture. Avoid eating immediately before or after hearty exercise or after bathing. 494 MILITARY MEDICAL MANUAL Satisfy dietary requirements as to proteins, fats, carbohydrates, salts, water, and vitamins. Have the calory (fuei) intake adequate to the needs. Have enough bulk in the diet and secuie a daily bowel movement by hygienic living and regularity in habits. be careful of uncooked and unsanitary foods. They may contain disease germs. Eat food regularly and in moderation, eating it slowly and masticating it thoroughly. Most people eat too much. Food should be kept from flies and insects that may carry disease. Mess kits and dishes should be washed in boiling water to cleanse them and to kill any disease germs. Cooks and mess attendants should observe scrupulous cleanliness in all these respects in their persons. Food that seems stale or spoiled should not be eaten. Do not eat in dirty lunch rooms and restaurants. An abundance of water should be taken, but too large an amount should not be taken when overheated. An adult should consume at least eight glassfuls daily. There is little danger of taking too much. Remember that water forms fully two-thirds of the body weight or about ten gallons in an average individual. Be careful not to drink unclean water which might contain disease germs. Do not drink cold water rapidly when overheated or drink anything excessively hot at any time. Coffee, tea, and cocoa in moderation are not harmful and in many instances prove very beneficial. Intoxicating liquors are harmful. Drink from your own glass and eat from clean dishes. Do not exchange pipes, cigars, musical instruments played by the mouth, and gas masks with others. Do not be careless in the disposal of the excretions of the body. These create a nuisance, serve as a breeding place for flies, and may spread disease. If there is any question about your physical health or any matter about personal hygiene, consult a medical officer who will assist you and nature in maintaining the health that is your birthright. DENTAL HYGIENE Care of the Mouth. Physicians have identified well over 100 forms of micro-organisms in the mouth. The presence of a warm, moist environment, with fragments of food lodged between the teeth to serve as a nutrient material, creates an ideal condition for their development. It is important to the soldier that adequate attention be given to the care of the mouth, including the teeth and the gums. The teeth are very important in the maintenance of adequate nutrition, and, in turn, adequate nutrition is very important to the teeth. The teeth should be well brushed and the mouth rinsed at least twice each day, especially on retiring for the night. Brushing teeth should be performed with a rotary motion in order to free all foreign material ad- hering to the gum surfaces and to exercise the gums. If a tooth brush is not available the gums and teeth should be rubbed with the finger, using the same rotary motion suggested for the tooth brush. Dental floss or tape should be used to remove foreign matter lodged between the teeth. The tooth brush should be dried thoroughly between brushings. A frequent change of tooth brush is necessary to insure effective brushing and cleanliness. If a mirror is available, the individual should use the same care in brushing his teeth as in shaving, making certain that all surfaces are covered. Certain tartar deposits will not come off by brushing and must be removed by a dentist. Nutritional deficiencies manifest themselves by a diseased condition of the teeth, gums, and mouth. The soldier will have little opportunity for control of this matter as he is dependent upon the ration furnished by the government. Alert to the dangers, however, the medical officer in his inspections should determine whether it is a local or general condition, taking adequate steps to have the soldier visit the dentist or to admit him to the hospital if the condition warrants it. If the diet is inadequate or faulty, the medical officer should make suitable recommendations to the responsible commander of the soldier’s unit. MILITARY HYGIENE 495 The medi al officer, as well as the dental officer, must be watchful for diseases of the gums. Th. soldier who fails to practice dental hygiene is particularly susceptible to of die gums and carious (decayed) teeth. Pyorrhea Areolaris, commonly called pyorrhea or dental abscess, is the most frequent manifestation of dental sepsis. There are many theories as to the etiology, but all seem to agree that the disease starts as a disease of the gums or gingivitis. It may progress to the extent that the individual involved suffers from general debility, anemia, and loss of weight and strength, depending upon the resistance and tolerance of the patient to the infection. In the early stages pus forms along the margins of the gums and later there are deeper seated dental abscesses. Dental hygiene is specific prophylaxis. Vincent’s Angina, a highly contagious disease commonly known as trench mouth, may sweep through a command through the medium of inadequate mess kit sterilizing facilities. It is most frequently encountered in the individual who does not practice hygienic principles. It may have an insidious onset, since the organisms causing this disease are so frequently found in presumably healthy mouths. Although the disease is not seriously disabling in most cases, the lesions are sufficiently serious to demand every effort to prevent them. Because of its contagion, medical and dental officers must be alert to detect early cases and check sterilization of individual eating utensils in fact as well as in theory. The hygiene of the skin is necessary for the normal function of its heat regulating and excretory mechanisms. Personal cleanliness is the most desirable of good habits and the mark of a superior person. The man who is attentive to cleanliness of his body, his clothing, his environment, and his food and drink takes the best insurance against sickness. Special attention is necessary for those parts of the body which are exposed to dirt and where perspiration occurs most freely. Routine bathing should include hygiene of the mouth and teeth. A clean body should be clothed in clean garments; clean underwear should follow every bath. Sleeping in underwear should be avoided when it is possible to wear night clothes. Cleanliness is chiefly a matter of habit. The person who really wishes to be clean will find a way to accomplish his desire even under the most discouraging circumstances. Bathing is beneficial, not only on account of cleanliness but also for its physical stimu- lation. Neglect of bathing causes obnoxious body odors, promotes the development of skin diseases, and increases the chance of lice infestation. At least two baths a week should be taken; a daily bath is preferable and is definitely necessary in the warmer climates. During the bath special attention should be given the armpits, genitals, crotch, and feet. Shower baths are more sanitary than tub baths; tepid water is preferable to a cold bath. A daily cold bath is a fine tonic. The cold bath (below 65 degrees Fahrenheit) acts as a stimulant. The proper time to take such a bath is before (but not immediately before) breakfast. The first reaction is to contract the extraneous vessels. Respirations are increased in depth and fre- quency, the pulse is slowed, and the nervous system stimulated. Warm baths (90 to 98 degrees Fahrenheit) have the opposite action from cold baths. The skin vessels are dilated, perspiration is induced, pulse and respirations are in- creased in frequency, and the body temperature is raised. Such baths are very soothing and sedative. They remove muscular soreness and are most agreeable after severe physical exercise. Warm baths also help to induce sleep. Hot baths (above 98 degrees Fahrenheit) should not be taken except on medical advice. If taken over too long a period they are very depressing and in some instances may produce unexpected complications. Cleansing baths require the use of soap to remove the dirt, grease, or secretions of the body. Medicated and scented soans are of little value. Practically all good grades of soap on the market have equal value. In order to get good results ample soaping must be used in a warm bath, and the soap then thoroughly rinsed away. Shaving one’s self is much safer than patronizing the average barber. The practice of CARE OF THE SKIN 496 MILITARY MEDICAL MANUAL using the same accessories on several people is dangerous because sterilization may be lacking or inadequate. Washing the hands is a “must” before eating meals and after visiting the latrine. Cooks and mess attendants (food handlers) must constantly be aware of this require- ment and observe it invariably. Clean, individual towels should be used wherever practicable. A piece of clean paper is better than a dirty towel. If neither is available the hands should be rinsed in clear water, then dried by evaporation. Cartridge or kerosene tin with perforated bottom Cartridge or kerosene tin with - perforated bottom Wooden floo 'slight slope Wooden, trough Plate 1. Improvised Shower Bath. Care of the Hair. The hair should be cut short and kept neatly combed. The head should be brushed night and morning until there is a feeling of warmth in the scalp. Brushes should be kept clean. Frequent shampooing to remove dandruff and dirt should be practiced. Head gear should not be so tight as to impede the circulation of the scalp. Plate 2. Toe Nails Properly Trimmed. Care of the Nails. The nails should be kept cut short and clean. The nails of the toes should be cut straight across as shown in Plate 2. This important precaution, if ob- served, will avoid most of the trouble from ingrown toe nails. The cuticle of the nails should be pressed back at least once a week, thereby preventing hangnails which are the source of serious infections. If the skin is dry, any good skin cream or hand lotion rubbed into the cuticle will keep it soft and prevent chapping and breaking. A MILITARY HYGIENE 497 nail brush should be used to clean the fingernails, followed by the use of a blunt instru- ment to remove any material which is lodged under the tips of the nails. Clothing. Clothing that is loosely woven and is capable oi holding considerable air in its meshes is a poor conductor oi heat and consequently teels warm, for this reason wool is especially valuable ior clothing. Another advantage of wool is its capacity tor absorb- ing moisture without feeling wet. Evaporation proceeds slowly irom woolen clothing, and as a consequence chilling ot the body is prevented. Elannel underclothing for this reason is the most valuable in changeable climates. Some individuals find it necessary to wear such underclothing even in the tropics to prevent undue evaporation after excessive perspiration. The color of clothing is important. Dark cloth absorbs heat, and white reflects it. For this reason light colored clothing is used in the tropics. Cheap aniline dyes in the cloth may produce skin irritation. Underclothing should be washed frequently and be well dried. Damp garments afford excellent soil lor the growth of micro-organisms. Clothing should not be allowed to restrict the circulation. For this reason collars, belts, garters, and leggings which fit tightly should be avoided. Rubber raincoats are useful as a protection against rain and wind. Since they are im- permeable to air they are not useful in active occupations and while undergoing exertion. Cloth which is air-permeable but waterproof is better. In cold weather operations, one must dress properly so as to conserve the body heat. A space of dry air next to the body keeps the heat in. Consequently, inner clothing should be of a loose, spongy weave, flexible and porous enough to hold a thick insulating layer of dead air. Outer clothing should not be heavy, stili or bulky but should be of a texture that will act as a windbreak and enclose the warm air in the inner clothing. It should be loose enough not to interfere with tree blood circulation and sufficiently porous to prevent the moisture of perspiration from condensing and freezing on the inner surface. Several layers of light clothing are much warmer than a single layer of equal weight. Under clothing should be ol pure wool with separate undershirt and long drawers. The usual pattern of overcoat is no good in extreme cold. It allows air to escape at the bottom, wrist, front and collar. A turned up high collar collects snow like a funnel. For cold weather operations, the outer coat or the parka should have a hood and a drawstring or belt. Provision should be made to close the front opening securely against air escapes. Sleeves should close snugly but not tightly at the wrist. The hood of the parka should not be worn close around the face. The typical Eskimo hood merely covers the ears and leaves the whole forward half of the head unprotected. The first improvement usually tried by a white man is to have the hood come farther forward so as to fit snug about the face and leave but a small part of it exposed. The result is that if the hood comes out to the cheek bones and to the point of the chin, a circle of hoarfrost forms on the face along the edge of the trimming of the hood, and presently the skin under the hoarfrost ring freezes. On the other hand, if the face is completely bare there is a sufficient distance between the nose and mouth on one side and the trimming of the coat on the other so that the breath in very cold weather freezes before it reaches the trimming of the coat and settles upon it in the form of snow, which can be brushed off, rather than in the form of ice as when the trimming is only an inch or two from the face. Fingers numbed from cold greatly impair a soldier’s efficiency and gloves warm enough for habitual wear are too bulky for the proper handling of instruments or weapons. It is also essential to protect the wrists in very cold weather if the hands are to be kept warm. The most generally suitable protection for the hands and wrists consists of the following combination: A loosely woven woolen mitten extending well above the wrist is worn next to the hand. The mitten should be so constructed as to provide a thumb compartment, a trigger finger compartment, and a compartment large enough to accommodate all fingers and the thumb comfortably when the trigger finger is not in use for firing purposes. 498 MILITARY MEDICAL MANUAL The mitten may suitably constitute the inner lining of a gauntlet which is worn over the mitten in very cold weather. The back of the gauntlet should preferably be con- structed of light water repellent (not waterproof) material the palm and gripping surface of the finger compartment of pliable leather. The gauntlet should extend above the wrist and be provided with a closure at its upper extremity. This closure should not restrict circulation, yet it should give protection against cold. The wearer should be able to fire his personal weapons without removing the gauntlet. Clothing selected for jungle service should have a minimum capacity for heat absorp- tion and a maximum capacity for the circulation of air to permit the evaporation of perspiration from the body. The wearing of clothing wet with sweat for long periods of time may result in fungus infections or skin irritations such as prickly heat. Prickly heat or heat rash may be prevented by scrupulous cleanliness of the skin, by daily bathing in water in which baking soda has been added, by the use of borated talcum powder, and by daily change of clothing. Tight fitting clothing is not desirable since such clothing is hot and restricts move- ment. The woolen olive-drab shirt, regulation khaki trousers, canvas leggings and field shoes are suitable for jungle service. A heavy, loosely woven cotton shirt is better than the woolen one since it resists snagging and fungus rot better and is cooler. The head should be protected from the rays of the sun by a hat which permits free circula- tion of air about the scalp and which is broad enough to protect the face and neck from the sun’s rays. The tropical helmet meets these conditions. For combat the steel helmet is worn. The piesent authorized clothing, both summer and winter is suitable for desert operations. The summer uniform, however, might be modified to conform more to the British or German type—the principle characteristics of which are the light weight material, open necked, short sleeved shirts, shorts, and wool half stocking. This uniform allows a free circulation of air around the body, has no ill effects on the health of the troops, and does not result in excessive sunburn. It does not expose large parts to attack by sand flies. Because of the wide temperature range and the cool nights some sort of woolen garment is needed for wear at night during the hot season. A woolen band around the stomach even on the hottest day seems to be absolutely necessary in order to prevent a so called “stomach chill.” Head gear used by desert troops must have two necessary characteristics, namely, provision of air space and a shield for the eyes. The steel helmet is of course worn during combat. Care of the Feet. If the soldier cannot march he is of little value. The condition of the soldiers’ feet is most important to the Army. Battles may be won or lost because of the marching ability of the troops. The condition of the feet of the men of an organization is the direct responsibility of its commanding officer, who is required to inspect them frequently. Every effort must be made to prevent and correct foot disabilities. Relatively serious defects usually require medical treatment, and men having such defects are hospitalized and treated. However, the occurrence of many of the disabling minor defects of the feet can be prevented by proper shoe and sock fitting and the care of the feet. The fit of shoes is of the greatest importance. A well-fitting pair should have the inner sides nearly parallel; the outer sides should have a gentle curve inward, and the toes should in no case be pointed. They should be about % inch longer than the foot (Plate 3). The leather should be moderately thick and pliable and the heels broad and low. It must be remembered that marching and field shoes must be fitted with the knowl- edge that when a pack is carried by the soldier the foot is spread out and enlarged. Marching also causes the foot to swell. Field (service) shoes should therefore be larger than ordinary civilian or garrison shoes. Only the standard Army shoe should be worn by the soldiers, and it must be fitted as described in the following paragraph. The fitting of each pair of shoes is supervised by a company officer. Each shoe is fitted to the foot of the wearer so that no undue constriction or pressure will occur MILITARY HYGIENE 499 at any point when the foot is expanded by the superimposed weight of the body and pack. Shoes are also fitted so that at no point is there sufficient space between the shoe and the foot to permit chafing. Owing to the structural irregularities of the foot and variations in standard shoe sizes, shoes can be properly fitted only by actual test. Testing may be accomplished either with a shoe fitting machine, or by hand, and is done under the direct supervision of an officer. The shoe fitting machine is a device for measuring the size of the foot when bearing weight and for proving that the size selected is the proper one. These machines are issued as required. Instructions for their operation accompany the machines or are issued by the proper headquarters. 1. Effect of too short a shoe. 2. Effect of pointed toe shoe. 3. A good foot in a well fitted shoe. Plate 3. Anatomical Study of Shoe Fitting;. Shoes may be fitted without a machine. (See Plate 4). The shoe should be laced snugly; the wearer with a 40-pound burden on his back then places his entire weight on one foot. To determine the correct width, the leather of the shoe in front of the instep above the ball of the foot should then be grasped between the fingers and thumb. As the finger and thumb are brought together the leather should be loose enough to prevent the fingers slipping easily over the surface but not sufficiently lax to produce a wrinkle. If it wrinkles under the grasp, the shoe is too wide, and if there is no looseness apparent it is too narrow. The proper length of the shoe is determined by the space between the end of the great toe and the end of the shoe, which should be not less than three-quarters of an inch clear space when all the body weight plus that of a 40-pound burden is borne by the foot being fitted. This space is measured by pressing down the leather with the thumb. The width of the thumb may be con- sidered as representing the desired clearance between the toe and the end of the shoe. New shoes should not be used on a march. Shoes should always be “broken in” first. They may be waterproofed with neatsfoot oil. Waterproofing shoes makes them im- permeable to air; therefore, men whose feet tend to perspire should not use waterproof leather. Shoes may be broken in rapidly by standing in about 2(4 inches of water for five minutes and then walking about, allowing the shoes to dry on the feet. Fitting of the socks and the choice of socks is but little less important than the shoes. The best socks for general field service are light weight woolen. Like shoes, they must be properly fitted—large enough to permit free relative motion of the toes but not so large as to wrinkle when the shoes are worn. The proper sock size of woolen socks for a given shoe is indicated in the accompanying table. Cotton socks shrink less after washing and should accordingly be one-half size smaller than shown in the table. Socks should be changed frequently; on the march a clean pair of socks should be put on every day. It is advisable to change socks and shoes twice a day whenever Correct Too wide Too narrow Correct Too short Plate 4. Shoe Fitting. MILITARY HYGIENE 501 TABLE OF SOCK SIZES, WOOL SOCKS Shoe size Corre- sponding sock size Shoe size Corre- sponding sock, size 5 9 10 54 954 12 5K2 10 6 io54 654 11 11 12 54 7 n 54 754 12 8 i 1154 1254 13 854 13 practicable, in order to keep the feet dry and to allow the shoes to air out. The shoes and socks should be exposed to the sun during the interim to permit destruction of any possible fungi of athlete’s foot. Socks with holes should never be worn on the march. Bathing the feet deserves special attention. Rinsing off all the soap from the feet and drying them well about and between the toes will assist in preventing many of the BUSTER BUSTER NEEDLE PROPER METHOD OF OPENING A BLISTER NEEDLE ADHESIVE PLASTER THIN GAUZE BLISTER COMPLETED DRESSING Plate 5. Care of Blisters on Feet. 502 MILITARY MEDICAL MANUAL cases of so-called “athlete’s foot.” In this connection exposure of the feet to the air and mild progressive doses of sunshine increases the resistance of the skin to infection. The use of dry, clean socks and shoes is necessary after bathing and drying the feet. At the end of a march the feet should be washed, preferably in cool water, and rubbed briskly with a towel. Foot powder (available for issue to the troops) prevents chafing of the feet and assists in keeping them dry. The nails after bathing are soft and if they need trimming it is a good time to do so. Blisters of the feet are most frequent among recruits who are not accustomed to long marches and who have not learned the essentials of the proper care of their feet. They are first manifested as a reddened, tender area; at this stage, if such areas are well covered with smoothly applied adhesive plaster, further damage may be prevented. When the blisters contain fluid they should be opened with a sterilized needle inserted through the undamaged skin just outside the margin of the blister. The fluid is allowed to escape, but the loosened skin should not be removed. The area should then be well covered with one or two layers of sterile gauze and then covered with zinc oxide (adhesive) plaster, smoothly applied (Plate 5). The gauze prevents adhesion between the loosened skin and the adhesive plaster. A man can march with a blister which has been properly treated. Company officers should know how to treat blisters on the feet. Blisters on the feet are prevented by the use of well fitted shoes and socks and proper hygiene of the feet. For operations in the jar North. The average soldier will need shoes about two sizes larger than those worn during warm weather. He should wear two pairs of light wool socks, a pair of heavy knitted wool socks, a burlap boot sock and an insole of felt or preferably of burlap. Too much emphasis cannot be placed upon the importance of having the shoes fit loosely. It is better to discard a pair of socks than to bind the feet too tightly. Shoes should not have a permanent lining of fleece, felt or anything that will collect moisture. The Eskimo foot gear consists of a caribou skin sock with the fur turned in, and a caribou skin boot with the fur of the sole turned in also and the fur of the leg turned either in or out. This makes ideal foot wear not only in the matter of warmth but also in lightness and comfort. Eskimos also wear foot gear (“mukluk”) with the sole of rawhide made from the skin of a bearded seal, and' uppers of reindeer skin ending in a drawstring just below the knee. The fur is on the outside. Rawhide thongs bind the “mukluk” snugly at the ankle. For extreme temperatures, a boot of commercially available substitutes should be made according to the “mukluk” pattern and issued to troops. Light rubber bottoms of non-freezing type of rubber and calfskin uppers, with the hair outside, will answer the purpose. “Mukluks” are suitable for snowshoeing. In the absence of a burlap boot sock, a strip of burlap cut from a gunny sack can be wound loosely outside the socks and over the feet and ankles. Dried grass stuffed loosely into the shoe outside of the socks also makes a splendid insulating material. Indians and Eskimos frequently employ this method of keeping their feet warm, throwing away the used grass every night and replacing it with fresh grass in the morning. Men will occasionally find it necessary to wade across shallow streams or overflows while wearing shoes that are not waterproof. In temperatures of extreme cold, shoes may be made temporarily waterproof by dipping them into the water and quickly withdrawing them so that a thin coating of ice covers the leather. Individuals can then wade quickly across. The ice will soon crack off the shoes. This is a well-known expedient among the Eskimos. For operations in jungle. Before beginning jungle operations men should be provided with new shoes that have been well oiled to protect them against wet rot. The feet of the men must be inspected frequently for jiggers, evidences of hookworm infestation and especially for trichophyton’s (“Dhobie”). A plentiful supply of socks should be available and troops should be required to change socks frequently. Before wading streams, the men should remove their shoes and hang them around their necks or shoulders. This MILITARY HYGIENE 503 helps to save shoe leather during the dry season. During the “rainy season” this is of no value, as the shoes are continuously wet anyhow. Where the waters are suspected of being infected with the cercariae of the Schistosoma, the men should not be permitted to wade barefoot thru the stream. In fact, even clothes unless waterproof, are no protection to the wader. If possible—particularly for engineers working in such water—protection should be provided by wearing rubber thigh boots and rubber gloves. HYGIENE OF THE RESPIRATORY APPARATUS Respiration is one of the characteristics common to all living animals, for it is essential for the chemical changes of metabolism upon which life depends. The body may survive for long periods of time without food but only a few moments without oxygen. The con- dition of the body and mind will affect the respiratory rate, increasing or decreasing the rate of oxygen and carbon dioxide to the needs of the tissues. Involved in the act of respiration are the nose, throat, trachea, bronchi, and lungs. Health of these vital structures is necessary for proper metabolism. A healthy nose requires no treatment by means of sprays, nasal douches, and the like. Catarrh of the nose and accessory nasal sinuses is caused by exposuring to cold, to dust, and to atmosphere that is too dry, such as in heated houses. The best defense is a healthy body, the avoidance of over-exposure to cold and dust, and the artificial addition of moisture to air that is too dry (air-conditioning). Allergic reactions of the mucous membrane may occur with swelling of the lining tissues of the nose, or obstruction may be due to a mechanical defect requiring a surgical procedure. If persistent, medical advice should be sought. Serious infections of the hair follicles on the inner surfaces of the nose may result from the picking of dried secretions which are adherent to them. It is better to moisten the hairs and clean the surfaces with a soft cloth. Picking the nose is a very unhygienic habit. If infection does occur do not open the infection without consulting a physician as infections of this part of the face improperly treated may lead to fatal results. The nose performs an important function in warming or cooling the air before its entrance to the lower air passages. Obstruction which causes mouth breathing, such as enlarged adenoids, should be removed by surgical operation. This should be done as early as detected to prevent formation of other nasal affections and to lessen the susceptibility to upper respiratory disease. When frequent inflammation and soreness of the throat occur, the individual should have his thoat inspected by a medical officer who can determine whether the tonsils are the cause. He can decide whether it is advisable to have them removed. Infected tonsils may cause halitosis (unpleasant breath) or may be the source of other body ail- ments due to the distribution of infective organisms to the blood stream. Upper respira- tory infections may lead to more serious complications such as bronchitis and pneumonia. The purity of the air inhaled is of vital importance to the health of the lungs. Dust is detrimental to health, and dusty atmospheres should be avoided. Nose breathing rather than mouth breathing will remove many of the dust particles and bacteria since they lodge on the hairs inside the nose. In ordinary amounts they are removed by the reverse action of the ciliated epithelium in the bronchial tree that works mucus and dust particles to- ward the throat and mouth, and by coughing. Irritating substances will cause sneezing, initially, and coughing and sneezing if inhaled in greater concentration. Pathogenic microbes are constantly inhaled. Among these are the germs of pneu- monia, influenza, and tuberculosis. The best defense against these diseases depends on the maintenance of a high standard of bodily health. One should avoid being with the sick unless duty requires it. “Droplet infection” is the means of the spread of respiratory diseases. One should be careful in coughing and sneezing; in attending the sick guard against exposure through these means. Fresh air is necessary at all times and should be sought in abundance. All rooms should be well ventilated and plenty of fresh air allowed to enter at night. The old superstition about “night air being dangerous to health” is faulty. 504 MILITARY MEDICAL MANUAL Deep breathing exercises are of value in preserving health. The best exercises, how- ever, are those which develop the entire body and not the lung capacity alone. Among those are: running, calisthenics, drill, boxing, vaulting, volley-ball, swimming, hand-ball, squash, baseball, tennis, golf, and football. Vigorous walking is an excellent exercise in which all may indulge wherever stationed, and therefore no officer or soldier should offer as an excuse the lack of equipment for securing adequate exercise. CARE OF THE EYES The eyes are one of man’s most priceless possessions and should be protected and maintained in normal health as long as life exists. With them most of his pleasures and joys of life become a series of happy pictures that build up a book of not so easily for- gotten memories. Injuries to the eye may be very serious if they involve a penetration of the eyeball. Protective glasses should be worn while engaged in an occupation, such as work on an emery wheel, in which foreign particles may be thrown off to penetrate the eyeball or tissues surrounding the eyeball. The removal of foreign bodies from the eye is related in Chapter VI. Never rub the eyes, as there may be disease germs on the hands. The conjunctiva is very susceptible to infection or injury. Eye strain from visual defects not only causes local symptoms referred to the eye but constitutional ones such as headache, nervousness, indigestion, insomnia, and dizziness. It goes without saying that usual defects and muscular unbalance of the eyes should be promptly corrected. In reading and close use of the eyes the lighting conditions are important. The light should be on a level with the top of the head and should illuminate over the shoulder. The proper reading distance is about fourteen inches from the eye. The book should be held nearly on a level with the eyes. Reading in the recumbent position should not be practiced. There is extraordinary strain on the muscles of downward rotation, and the flexing of the neck causes congestion of the eyeballs. Color blindness is usually inherited but may be due to injury or disease. The presence of adequate vitamins is now considered necessary for the proper color perception. Night operations require special training of the troops in observation in the dark. As all individuals do not adapt their eyes to darkness at the same rate of speed, it is desirable for commanders to know what persons have faulty night vision. Certain factors are essential for dark adaptation. Oxygen is necessary and troops going to high altitudes, even as low as 4000 feet, should carry an additional supply. The diet should have sufficient vitamins A and D. Deficiency of either oxygen or vitamins will impair night vision, but an excess of either will not give keener perception. The time period for dark adaptation can be shortened by avoiding bright lights, noise, and fatigue. CARE OF THE EARS The ears comprise the auditory apparatus and the sense of equilibrium. Disease of the ear often manifests diseases in other parts of the body. Personal care of the ears will assist in preventing affection due to local injury and disease. Wax or cerumen often collects in the ear. It decreases hearing and may cause in- flammation of the auditory canal. Dizziness sometimes arises from this cause. Careful syringing with hot water (105 degrees to 115 degrees Fahrenheit) is the proper pro- cedure for removing the wax. For further details about removing foreign bodies from the ear see Chapter VI. Scratching the ears, or the habit of inserting the fingers vigorously into the external auditory canal, may be the cause of spreading mycosis infections into the canal and to the ear drum. Handling of the ears should be done with clean hands, and the canal should be kept free of obstruction. Difficult removal should be done only by a physician who has the proper instruments. Earaches sometimes arise from exposure to cold air or cold water. Nasal douches are at times the cause of inflammations of the ear. The treatment of earache more properly MILITARY HYGIENE 505 belongs in the realm of medicine rather than hygiene. Suffice it to say here that the application of external heat and the use of warm sterile water for syringing may be beneficial and clear up the condition. If, however, earache is combined with infection of the throat there is possibility of infection of the middle ear. This condition deserves immediate and constant attention by responsible medical authorities. Therefore, in caring for the ears, cleanliness by gentle procedures, the avoidance of excess exposure to cold, and the prevention or removal of foreign material are the es- sential features of their hygiene. The waste products of activity appear to be a prime cause of sleep. It is during sleep that nature repairs the damages incident to the day’s activities. It is therefore readily apparent that an adequate amount of sleep should be secured by a person if he expects to maintain efficiency and preserve his vitality. The average person requires seven to eight hours of sleep in twenty-four hours, and it should be taken at regular intervals. To obtain the utmost benefit sleep should be had under favorable conditions—fresh air, clean bedding, and no crowding of sleeping quarters. SLEEP PHYSICAL EXERCISE Purpose. The effect of exercise on the muscles is to exhaust the material necessary for contraction and the accumulation in the muscle of waste substances produced by its ac- tivity. The blood supply to the muscle is greatly increased. The value of muscular exer- Correct posture <£m Incorrect* Incorrect Plate 6. Correct and Incorrect Body Posture. cise lies partly in the fact that the education of nervous centers which have to do with the perception of ideas and with intellectual operations would be extremely incomplete in the absence of education of the centers connected with muscular movements. Exercise also stimulates the heart, accelerates breathing and aerates the lungs, dilates the blood vessels 506 MILITARY MEDICAL MANUAL of the skin, and causes sweating thus stimulating excretion of waste products through the skin, and increases the appetite and promotes digestion. Posture, i he normal posture, without drooping of the shoulders or twisting of the trunk, is the one in which there is the least possible strain or friction no matter what the amount of physical labor. Consequently in this position there is the greatest amount of physical efficiency. Any departure from the normal means waste of energy and lessened efficiency of the individual, both mental and physical. The position, in the army termed “the position of the soldier,” is the normal position of the body. (Plate 6.) The proper use of exercises, such as obtained in drill and in calisthenics, will improve and correct the posture by stimulation and employment of muscles that are not used in the ordinary roles of occupation. A well performed training exercise will involve to some degree all the muscles of the body. WEIGHT AND HEALTH There is a very close relation between weight, health, and longevity. There is a proper weight for every height, and if one weighs very much less or especially very much more than is normal he is more subject to disease and the chance that he will not live as long as if his weight were normal. Consideration must be given of the bony structure and frame of the individual, because his weight may be considerably more than his height would indicate, but still he may not be fat (obese). Obesity is the primary cause for detrimental effects of overweight above the normal standard as shown in the accompany- ing table. This table gives the ideal proportion in height (inches) and weight (pounds) for young men with the average type of bony and muscular frame: TABLE OF NORMAL HEIGHT AND WEIGHT FOR A YOUNG MAN Height (inches) Weight (pounds) Height (inches) Weight (pounds) 6o 120 70 156 61 122 7i 161 62 125 72 168 63 128 73 175 64 131 74 182 65 135 75 189 66 139 76 197 67 143 77 205 68 147 78 213 69 I51 A sudden drop in weight to the extent of ten pounds deserves immediate medical in- vestigation. Exercise and climatic changes will account for small variations in weight; however, the weight should be closely guarded and maintained as near the ideal as the body frame will permit. HYGIENE OF THE GENITO-URINARY SYSTEM The genitourinary system of the male is a complicated mechanism which suffers quickly from abuse. Cleanliness of the external genitalia is extremely important, since the crotch perspires freely, and this moisture tends to collect dust and dirt particles. The moist area also provides a good media for the culture of fungus infections, and caution should always be taken after a bath to dry this area before drying the feet, where athletes’ foot disease may be present. If the foreskin is long, care should be taken to remove the collection of material around the tender portion of the penis by rolling back the foreskin and washing the parts with warm water and a mild soap. Thorough drying with a soft towel should follow. Failure to clean the under surface of the foreskin may lead to infection and abscess formation. The operation for the removal of the redundant portion of the fore- skin (circumcision) is not difficult and not disabling. The individual with an excessively long foreskin who has difficulty in maintaining cleanliness should subject himself to this MILITARY HYGIENE 507 type of operation. In some cases it will tend to relieve irritation which may cause priapism and incite masturbation. Sexual Hygiene. The force of the sex impulse reaches its maximum between the ages of twenty and twenty-five. The vigor of the sex instinct and the powers of control are hereditary, but the vigor with which a man will apply the brake rests upon his enthusiasm in support of the idealism in which he was reared. A large proportion of mankind has masturbated to some extent at some period in their lives, and probably less than ten per cent of such masturbators have been physically injured by the habit. Masturbation is indulged in excessively more often than sexual intercourse since the latter requires the consent of two individuals and opportunities which are comparatively hard to find. Relief from this habit is best obtained by absolute purity of thought, and subsequent marriage, to regulate sexual hygiene. Encouragement to continence should be supplemented by active physical and mental exercise, sanitary living conditions, and social contacts that avoid sexual stimulation. The happily married man rarely complains of any disorder of the genito-urinary system. No instruction in this subject can equal that of the parent, whose moral influence outweighs all the angles of amateurishness. Every man has the right to know the essentials and importance of sex life, and what is not learned from the pure source will invariably be completed from the wrong source. Venereal Disease. Sexual indulgence by young unmarried men is responsible for an immense amount of disease and suffering. This is true not only among the men them- selves, but also in later years among their wives, to whom they give the disease although they may believe they have been cured, and among their children, to whom the malady may be transmitted even before birth. Abstinence from sexual intercourse is the only sure means of maintaining sexual purity and hygiene. While it is a common belief that the sexual act is necessary to maintain the health or powers of man, this is a fallacy having no foundation in scientific fact. If the individual about to participate in illicit sexual intercourse would first consider that venereal disease attacks more than half of the young men, affects thousands of children, and hundreds of thousands of women, that his chance of remaining free after intercourse is less than 30 per cent, he would at least take all the preventive and pro- phylactic measures available. Gonorrhea causes at least 50 per cent of the involuntarily sterile and destroys the power of procreation in man as well as in woman. Add to that the perils of syphilis, chancroids, and lymphogranuloma inguinale and it would appear there is little reason for failure to take necessary precautions, or better still abstinence. If, in spite of the moral and physical prohibitions against it, illicit sexual intercourse has been indulged in, then a prophylactic treatment should be taken. This is for the benefit of the person himself and for the good of the group as a whole. Treatments should be taken as soon after intercourse as practicable, certainly not later than two hours after initiation of sexual intercourse. One hour afterward has proven to be the maximum limit to which full benefit from prophylaxis is received. Sexual information should be sought from the proper sources, and especially accurate information regarding the spread of venereal diseases, their effects on the human body, and the methods of prophylaxis. For further details about venereal diseases, their pre- vention and control, see Chapter IV. CONDITIONING OF TROOPS In modern warfare troops must be carefully trained for the special tasks that confront them and for service in every part of the world. Task forces intended for the desert and jungle require a period of gradual conditioning of at least 6-8 weeks to become acclimated to the increased temperatures, to the greater power of the sun’s rays; and in the jungles, to the heavy rains and humidity. As a further hardening process, two or three months additional training under actual jungle or desert conditions must be carried on before troops can be considered ready for special operations in jungle or desert warfare. It is reported that the Japanese trained for about one year on the tropical island of Hainan, off the China coast, before starting their operations in the 508 MILITARY MEDICAL MANUAL Philippines and Burma. The Germans trained the men in their Afrika Korps by exposing them to extremes in temperature, to long hours in tanks, to long periods without water, to a fierce unending wind sandpapering their faces with desert sand and to actual hardships in the desert. Special Problems of Jungle, Desert, and Extreme Cold. Jungle. In the tropical jungle the soldier is exposed to high temperatures, high humidity and the burning rays of the sun. He must be protected against poisonous plants, noxious insects and poisonous reptiles. The humidity and temperature cause considerable sweating and loss of salt from the body. This may produce heat cramps unless additional * salt is added to the food and water. Chilling of the body will occur unless wet clothing is changed as soon as possible and the body dried during the change. Men should sleep off the ground and under a mosquito net. The head should be protected from the rays of the sun by a hat which permits free circulation of air about the scalp and which is broad enough to protect the face and neck from the sun’s rays. A head net must be worn. Gloves which are impervious to mosquito bites should constitute a part of each soldier’s equipment. Raincoats are impractical; however, a small poncho of light weight, water proof fabric is highly desirable in rainy weather. Shoes should be well oiled to protect them against wet rot. Where the waters are suspected of being infected with the cercariae (larvae) of the Schistosoma, the men should not be permitted to wade barefoot through the stream. In fact, even clothes unless waterproof, are no protection to the wader. Enteric fevers are a serious cause of non-effectiveness among military personnel in the jungle. The use of water and food from native sources should be prevented. Every precaution must be taken to insure proper cleaning and sterilization of the mess gear. Insect borne diseases constitute a major problem for troops operating in the jungles and of these malarial fevers head the list. Chemical prophylaxis against malaria is not recommended as a routine measure. It is only carried out in emergencies when screen- ing is lacking or defective and when troops operate in highly malarious districts with- out any possibility of applying effective control measures against the mosquito. Quinine and atabrine do not prevent infection but they do keep the men on their feet and achieve the object of keeping them fighting and bringing them back again from the malarious district before the active symptoms of malaria are manifested. Five to fifteen grains of quinine given daily for 7 days under the supervision of an officer, at the time of the evening meal, is the usual procedure in prophylaxis. The soldier is then given a rest period of several days with no drug. Atabrine may be substituted, giving 3 grains every three or four days. Special duty men working in kitchens or on picket lines at dawn or at dusk or men sitting around company canteens at night, should be carefully protected by requiring them to use gloves, head nets and chemical prophy- laxis to prevent infection, as they are much more exposed. Leeches both terrestial and aquatic may become quite a nuisance to troops and sand flies may be more irritating than mosquitoes. Venomous reptiles are a constant source of danger and troops must be cautioned against walking around barefoot, against placing their hands on ledges and logs where they are unable to see what is there. In each squad there should be at least one man qualified in giving emergency treatment against snake bites. Every native village must be assumed to be infected with every type of venereal disease, intestinal and insect borne disease. Villages and native huts must therefore be shunned by troops, and patrols must be placed to see that troops do not enter for pleasure purposes. Camping in the vicinity of native villages is an undesirable procedure. The camp should be at least one mile away and swampy areas must also be avoided. Desert. In the desert the soldier is exposed to a temperature of 130° F. in the shade during the day and to a chilly cold at night. He must protect himself from heat exhaustion and sun stroke and from the whirling sand that sifts into everything. Head gear used by desert troops must have two necessary characteristics, namely, provision for air space and a shield for the eyes. Special individual equipment which will add to the comfort and efficiency of the men are goggles, respirators, sun glasses, MILITARY HYGIENE 509 neck cloth, nose cloth and fly switches. Goggles and respirators are a necessity for all vehicle drivers, and will add to the individual comfort of others, particularly during sand storms. Good sun glasses are desirable for all individuals, but must be provided for all aircraft and antitank gun crews and lookouts. The Arabs, as a result of centuries of desert life, wear a cloth to protect the back of the neck from the rays of the sun, and a cloth over the nose to protect the lungs from sand and dust during storms. Horse fly switches are in almost universal use among the British desert forces, for protection against the clouds of sand flies. An adequate water supply is a problem which dominates all others in desert operations. Restricted water consumption must become a habit developed through training. Many of the sources of water supply in the desert furnish water of a rela- tively high salinity. Troops must become accustomed to drinking such water par- ticularly since it is necessary to add salt to the normal supplies to make up for losses due to excessive perspiration. Hot sugared tea reduces thirst. Smoking increases the desire for water. In emergencies, men conditioned to desert conditions can operate for as long as five days on a quart of water per man per day, if traveling is done at night, and they can find shade during daylight hours. On such a ration combat effi- ciency is seriously lowered. It should be understood that except during actual combat, the bulk of the troops are normally not in the desert proper, but in areas closely adjacent to it. In such areas native populations predominate, sanitation is poor, and many diseases thrive; of particular importance to our troops are the dysenteries, malaria, sand fly fever and the venereal diseases. Bacillary dysentery, in particular, has been prevalent among troops serving in Libya. In those areas in which sanitary regulations have been strictly enforced there have been no epidemics. Malaria is present in all areas adjacent to the desert and is found in most oases. Permanent mosquito measures while desirable, are not practicably, and secondary and individual measures must be used. Segregation of troop quarters from native populations, rigid use of mosquito bars, sleeping boots, gloves, head nets, proper screening, daily early morning spraying and the prophylactic use of quinine or atabrine when indicated will prevent excessive losses from this disease. Body lice are prevalent among the natives and typhus epidemics have occurred in the past in all settlements near possible desert theatres of operations. A large number of men also suffer from multiple sores during the hot season. The cause is obscure but the association with very hot weather is definite and it would seem to be a matter of infection predisposed by a shortage of water for washing, sweating and possibly flies. Many parasites are found in these areas but of particular interest to the medical officer are the Schistosomes. Medical officers must take every precaution to the end that our troops do not become infected. They must impress commanding officers with the im- portance of the problem and they must recommend the avoidance of any kind of personal contact with water that may be infested. All unfiltered water from infested sources is dangerous unless it has been stored for at least 48 hours after being drawn. Methods of clarification either by sediment action with alum or filtration through cloth or sand filters do not hold back the cercariae (infective forms of this disease)—which are known to penetrate through three feet of sand. However, chlorination which pro- vides a residual of 1 p.p.m. of chlorine after a thirty minute waiting period provides a safe water. Zones of extreme cold. In zones of extreme cold men are subject to chilling, to frost bite, to freezing and to snow blindness. When cold they become dull and less keen. Scurvy is a dietary deficiency disease from which we have much to fear in these areas if it is not possible to maintain a ration of fresh meats, fruits and vegetables. Violent exertion and overheating may cause the soldier to freeze to death. In such cases, the inner clothing becomes saturated with moisture from perspiration. Water is a good conductor of heat and the moisture laden clothing soon draws the heat out of the body and then freezes hard. To keep the face from freezing it must be smooth shaven. If a beard is worn, the moisture of the breath congeals on it and makes the face an ice mask separated by an air space of a quarter inch from the skin. This makes it 510 MILITARY MEDICAL MANUAL impossible to get at the skin to thaw it out if it should begin to freeze. The secret of dealing with frost bite of the face is to keep the hands warm and when the weather is severe to run the hands over the face every few minutes to see if any part of it is frozen. Frozen parts should not be thawed out by the application of snow. Hands and wrists must be protected with warm gloves and mittens. When the hands are not in use, holding a handful of dried grass or straw in each hand will aid in retaining warmth. A pocketful of dried grass is well worth carrying along. Tight shoes result in frozen feet. The average soldier will need shoes about two sizes larger than those worn in warm weather to make room for the bulk of the socks that must be worn to keep warm. It is better to discard a pair of socks however, than to bind the feet too tightly. Blankets are insufficiently warm for extreme cold weather. Down filled sleeping bags are the warmest protection for their weight obtainable. They must be thoroughly dried out however at least every ‘three days because moisture tends to con- dense in them. They should not be placed directly on the snow. When arising after lying down, sitting or kneeling, men should be taught to dust snow from their clothing so that it will not thaw and cause dampness. Going to sleep while cold and tired is not dangerous but beneficial unless the soldier is completely exhausted. The sleep will rest the tired man and the cold will waken him before he freezes. He may then move about to reestablish circulation and take another nap. In temperatures below minus 30°F., deep, rapid breathing resulting from exertion, sometimes causes frosting of the lungs. While this condition is usually not fatal, it may incapacitate a man for several days. The air entering the lungs will be less cold if the men breathe simultaneously through the nose and mouth, placing the tip of the tongue against the rooof of the mouth, and allowing the air to flow around it when inhaling. The reflection from snow surfaces causes snow blindness unless snow glasses are worn. This may occur in overcast as well as in sunny weather. Amber or yellow goggle are superior to blue, green, smoked or any other variety. The Eskimo goggles are made of pieces of wood with two narrow slits for the eyes, each large enough for a half dollar to be slipped through. If no glasses are available and improvised ones along the Eskimo pattern cannot be made, some protection will be afforded by blackening the skin around the eyes. In operations in extreme cold, there is great danger from carbon monoxide poisoning from ill ventilated quarters. Louse infestation is common and heated shelters should be provided where men at least take sponge baths with soap and warm water. Facilities for washing underclothes and socks should also be furnished. Where men are infested, disinfestation must be promptly and energetically carried out. Mosquitoes are verv abundant in the arctic and subarctic, they bite viciously and thev are of large size. Their seasonal peak of activity is in July when the sun shines 24 hours a day. In the great majority of places, because of the wide areas of swamps and wet ground, the ordinary methods of control such as drainage, clearing and oiling are not practicable. Only in more or less permanent bases could an attempt be made to institute these measures. Ffforts must therefore be concentrated on personal pro- tection. All the measures used in the jungles are applicable here except the chemical prophylaxis, since mosquitoes in the far north are onlv pests. CHAPTER VI FIRST AID Definition. First aid includes the immediate, simple measures or precautions which are taken by a sick or injured person, or by others present, pending the arrival of a doctor. A little knowledge applied with judgment and common sense constitutes the best and most efficient first aid measure. Purpose. The subject of first aid is of vital importance to the medical officer, to the enlisted men who assist him, and the troops they serve. The medical detachment of the infantry regiment consists of 126 men, all of whom must be adept in the rudiments of this subject in order that they may perform their missions effectively. Similarly, but to a lesser degree, officers and men of line units must be instructed in first aid so that in emergencies, in the absence of Medical Department personnel, con- structive measures may be applied to save life or reduce the hazards of injury. This re- quirement poses a difficult task which falls to the medical officer. If he has well- instructed men about him as assistants, when the time comes that wounded men in large numbers arrive for medical care he will be able to attend more of them efficiently. He cannot perform his battle mission alone and unaided. Thus, unlike the civilian prac- titioner, the medical officer must assume the additional and more difficult task of training a large number of men in this subject. The purpose of this chapter is to serve as a guide in this difficult training process. It is based upon Army experience, and the subjects discussed can be taught successfully to soldiers. The methods presented are practicable, but it is fully realized that there are others which may accomplish as good results. The medical officer will draw deeply upon his own knowledge, experience, and skill, adding other subjects which will be necessary to meet the unusual conditions which may be encountered. It is not sufficient to select accurately the subjects and procedures to be taught. The instructor will fail unless he uses teaching methods appropriate to the personnel available to him. The soldier is a practical man. He does not aspire to become a doctor, nor will he absorb knowledge in the same manner or to the same degree as the student in medical school. Nevertheless, when taught by efficient methods, he can learn these things and learn them well. Each subject must be broken down into its essential elements, and each carefully explained in language, non-technical in nature, which the soldier can understand. A detailed demonstration of the subject explained must then be given to show the soldier exactly what is to be done. Thus he learns with his eyes as well as his ears. He is then ready to undertake practical application and perform the task which has been explained and demonstrated. Finally, since he may be responsible for human life pending the availability of a medical officer, he must be tested to insure that he is equipped with at least the minimum skill to justify entrusting him with the heavy responsibility he must bear. All this forces the medical officer to plan his instructional task, secure the necessary equipment for demonstration and practical work, and be certain that he is otherwise adequately prepared. There will always be a shortage of time. He may anticipate a turnover of personnel with a constant influx of new men. He must conduct his training program while performing the routine task of caring for the normal numbers of sick and injured to be expected during periods of training. The reward which accrues to the medical officer who trains his men well is material in character. He will be able to perform more medical tasks; he will be able to do them better as he can free himself from many simple tasks; and, finally, he can do them more easily and quickly. One of the most important functions of the medical officer is the training of medical department enlisted men. In teaching first aid subjects, the group performance method of instruction is superior to other methods. It consists for four steps or phases, namely: TRAINING IN FIRST AID SUBJECTS MILITARY MEDICAL MANUAL 512 explanation, demonstration, imitation (application), and correction of errors. Proficiency is accomplished by repeated instruction and application. A demonstration of the group performance method of instruction in the application of the Army Leg Splint serves as an excellent example: ARMY HINGED HALF-RING THIGH AND LEG SPLINT Text References. FM 8-50: (When revised) Splints, Appliances and Bandages. TM 8-220: (when revised) Medical Department Soldier’s Handbook. The application of the Army Hinged Half-Ring Thigh and Leg Splint should be preceded by instruction which has begun with elementary anatomy and physiology and has progressed through elementary medical aid. This should be followed by instruction in the various kinds of fractures, their diagnosis and complications with special reference to shock. The importance of early splinting, precautions regarding splints and a demonstration of standard types of splints should be covered in the unit Plate 1. Demonstration Team for Application of the Army Hinged Half Ring Thigh and Leg Splint. 1. The operator, 2. The first assistant, 3. The second assistant, 4. The patient. school. The instruction can then progress to the actual application of the Army Hinged Half-Ring Thigh and Leg Splint. Troops Required. One officer, instructor in charge; one noncommissioned officer, assistant instructor; one demonstration team of 4 men for each group of 24 students or fraction thereof undergoing instruction. Each member of the demonstration team is placarded and designated as shown in Plate 1. NOTE: The No. 4 man or “patient” in each demonstration team should wear an old pair of salvaged trousers which can be slit by the operator in the step “Dress Wound,” so that the simulated wound (a spot on the anterior surface of the middle FIRST AID 513 third of the left thigh marked with mercurochrome or iodine previous to the demon- stration) can be properly inspected and dressed. (Putting the dressing over the trousers might give the wrong impression of medical aid technique to newly-trained troops.) Equipment Required. The equipment required for each demonstration team is as follows (See Plates 2 and 3): (1) One, litter, complete with slings, Item 78440 (or one of any other type of litter available). (2) Three, blanket, O.D. wool, 90 by 66 inches, Item 99090. (3) One, Splint, Army Leg, Half-ring, Hinged, Item 37500. (4) Two, Splint support and footrest, Item 37515. (5) One, Packet, first aid, instructional, Item 20310. Plate 2. Equipment required for demonstration or application of the Army Leg Splint. (6) One, Bandage, muslin, 3 inch, Item 20080. (7) One, Splint strap adjustable, traction, Item 37455. (8) Six, Bandage, triangular, compressed, Item 92040. (9) Six, pin, safety, large, Item 78770. (10) One, Litter bar, complete. (Item Number not available.) Instructional Aids. One large chart showing steps of application for the Army Hinged Half-Ring Thigh and Leg Splint (See Plate 4). Four oil cloth placards, numbered 1, 2, 3, 4, respectively, for each demonstration team used (See Plate 1). NOTE: The salvaged trousers worn by the demonstration team “patient” and the mercurochrome or iodine spot painted on his left leg to simulate the wound are properly classed as “instructional aids.” Procedure. The group performance method of instruction is particularly useful in teaching certain basic and technical subjects. The number of students that can be instructed at one time is limited only by their ability to hear the instructor and see the demonstrators. A large number of students should always be divided into small groups, the number of groups depending upon the number of trained demonstrators 514 MILITARY MEDICAL MANUAL 1?edr DASE - IQ Peeh ©c -4 Paces 1PACC- blanket 1 ITTC.D 2PAcr-s 3PACfS I^Feet- OC. fePaces 4pack GPins {afc-ty PACC-S SPLINT SUPPORT £/KE>T REST SPLINT SUPPORT £/ FOOT REST MUSLIN - liANDAGC FIRST AID PACKET vo TRIANGULAR COMPRESS RAMn&rr-^ LITTEP BAD TRACTION STRAP LEG cm mi 6PACES Fronf— Plate 3. Diagram showing space and equipment required for each team of demonstrators or students. The positions of the team members and of the equipment at beginning of introduction to application, is indicated. FIRST AID 515 available. The smaller the individual group the more effective will be the training. If the individual groups be large and cannot clearly see the actions of the demon- strators, they should be permitted to leave their positions at the litter and form around the demonstrators in such a manner as will allow all to see equally well. A very definite order is observed in using the group method of instruction. First, a procedure or operation is broken down into its logical steps. Then the instructor explains the first step (EXPLANATION). Secondly, the demonstration team demon- strates the first step (DEMONSTRATION). Third, the students imitate the first step (IMITATION). Fourth, the instructor and his assistants correct the errors, if any, made by the students in imitating the first step (CORRECTION OF ERRORS). The instructor then explains the second step and the demonstration team demonstrates it, etc. Each of the steps of the operation is handled consecutively and similarly by the four Plate 4. Chart showing steps in application of Army Hinged Half-Ring Thigh and Leg Splint. phases of the group method: (1) EXPLANATION, (2) DEMONSTRATION, (3) IMITATION, and (4) CORRECTION OF ERRORS, until the entire operation has been completed. Before the arrival of the group to be instructed the required number of litters, blankets and sets of equipment should be opened and arranged as shown in Plate 5. The equip- 516 MILITARY MEDICAL MANUAL ment listed on page 514 is placed in proper position for the demonstration team and for each team of students (See Plate 3). The demonstration team marches to its litter at the head of the group of litters. They check their equipment. The demonstration team is formed for instruction as per Plate 1. The men are numbered 1, 2, 3, 4, from right to left. The officer instructor in charge directs the formation of the class. The students are assigned to their positions, 4 students to each litter. The students in groups of four take their positions at their respective litters facing the demonstration team. The instructor has the demonstration team count off after which the student teams count off. The student teams check their respective equipment. (In subsequent periods of instruction, the students should be rotated through the four numbered positions). Introduction to Step-by-Step Application of Army Leg Splint. The officer instructor introduces the period of instruction by explaining that the subject is the application of the Army Hinged Half-Ring Thigh and Leg Splint. He enumerates its uses and explains that, for instructional purposes only, the entire operation has been broken down into simple steps and that on the battlefield the splint would be applied without any perceptible adherence to a strict step-by-step technique, although the general sequence of actions would be essentially the same. He explains the way in which the step-by-step method works and he instructs the students to stand at parade rest while he explains each step. He states that he will then call the demonstrators to attention and order them to proceed, at which time they will demonstrate the step. He will then call the class to attention and order them to proceed with the imitation (application), each student of each team doing the respective job assigned to him in the explanation of the step. When finished with a step, each student will return to his former position and stand at parade rest, unless ordered otherwise. At this point the instructor and his assistant will correct any errors. He sets the stage for the ensuing action by explaining that the ideal treatment for fractures of the thigh and leg is to “Splint them where they lie.” This, however, is not always practicable and the Army Leg Splint is usually not applied in areas forward of the battalion aid station. In transporting the patient to the aid station the two legs may be tied together to aid in the immobilization of the fracture. At this time the instructor explains that the “patient” is assumed to have suffered a compound fracture of the middle third of the left femur and has been brought to the aid station on the undressed litter. He instructs the number four man of each team to lie on his back on the litter in front of his team with his feet toward the number one man. The “patient’s” left trouser leg is slit at the seam so that the thigh is exposed, making visible the mercurochrome or iodine mark previously placed there to simulate the flesh wound. The instructor then proceeds with the application of the Army Leg Splint, using the following 10 steps (See Plate 4, Chart): (1) Dress litter. (2) Apply Traction Strap; initiate traction. (3) Dress wound. (4) Apply splint; secure traction strap. (5) Splint support. (6) Support leg. (7) Foot rest. (8) Place patient on dressed litter. (9) Fix splint with litter bar. (10) Cover patient. Step No. 1: Dress Litter (See Plate 6). The litter is dressed by the No. 2 and No. 3 men. No. 1 steps to the right so that students’ vision is not blocked. A litter is said to be “dressed” when the blankets have been arranged on it as follows: The first blanket is placed on the litter lengthwise so that one edge corresponds with the outer FIRST AID 517 Student Army Leg Splint Teams CHART 3 STEP? CHART IO STEPf DEMONSTRATION TEAM Plate 5. Suggested arrangement for group performance method of instruction. 518 MILITARY MEDICAL MANUAL Plate 6. Step No. 1, Dress Litter. Numbers 2 and 3 Completing the Dressing of the Litter. Plate 7. Step No. 2: Part I, Showing traction strap in place. FIRST AID 519 (or far) pole of the litter and its upper edge is even with the head of the canvas. The second blanket is placed lengthwise on the first so that one edge corresponds with the inner pole of the litter and its upper edge is again even with the head end of the canvas. It is then folded back upon itself once in the same manner as the first blanket. The free edges of each of these blankets hang over opposite sides of the litter and there should be four thicknesses of blankets on the litter. The third blanket is folded to form a pillow for the patient, if the latter is not in shock, and is used as a pillow until the last step. Step No. 2: Apply Traction Strap. Initiate Traction (See Plates 7, 8, and 9). The instructor, holding up a traction strap, identifies its parts: (1) The loop, (2) the retention strap and buckle, (3) the extension strap and swivel. The No. 2 man then applies the adjustable traction strap to the foot of the injured limb without moving the foot and without removing the shoe. The loop is slipped over the toes and the forward half of the foot and placed around the foot, encircling it at the instep in such a manner as to bring the buckle to rest just posterior to the external malleolus. The retention strap is passed back of the ankle from the medial side to the lateral side and secured in the buckle. The swivel with the long traction strap attached is slid on the loop until it rests under the middle of the instep of the shoe. The instructor holds up the Army Hinged Half-Ring Thigh and Leg Splint and identifies the following parts: (1) The short inner rod, the long outer rod and the notched distal end; (2) The half-ring and the hinges; (3) The anterior web strap and its buckle. The No. 1 man takes the Army Leg Splint and adjusts it, placing the Plate 8. Step No. 2: Part II, Placing right hand through splint. half-ring at a right angle to the bars of the splint so that when applied the short bar of the splint will be on the inner side of the leg and the concavity of the ring will be directed upward. In order to effect this, he places the splint next to the litter alongside the injured leg, with the ring at the proximal end of the thigh, the shorter rod down, and the concavity of the ring directed toward the injured leg. The No. 2 520 MILITARY MEDICAL MANUAL Plate 9. Step No. 2: Part II, Traction Initiated. man then initiates traction as follows: Having applied the traction strap to the foot of the injured leg, he kneels at the feet of the patient, facing the patient, and the No. 3 man kneels at the side of the patient. The No. 2 man then places his right hand between the rods of the leg splint and grasps the heel. He grasps the toe with the left hand and, keeping his arms straight at the elbows, exerts a steady pull to produce the necessary traction. This manual traction must be continued until the traction strap has been secured to the end of the leg splint (STEP NO. 4). The No. 3 man slides his hands under the calf and thigh of the injured leg to support it until the supporting bandages have been applied in Step No. 6. Plate 10. Step No. 3: Dressing: the Wound. Step No. 3: Dress Wound (See Plate 10). The instructor, holding up a First Aid Packet, instructional type, identifies it as the dressing which will be used in this step. While the No. 2 man continues manual traction and the No. 3 man supports the injured leg, the No. 1 man inspects the wound of the left thigh and applies an occlusive sterile dressing. No. 2 and No. 3 man cautiously raise the injured leg FIRST AID 521 Plate 11. Step No. 4: Rolling the Army Leg Splint into Position. high enough to allow the No. 1 man to apply the dressing and to inspect and dress any wound on the under surface of the leg. (The instructor explains that the trousers of the “Patients” in the student group will not be cut, but that for the purpose of saving time the dressing will be applied over the “Patients’ ” trousers. He cautions that this should never be done in actual practice). Plate 12. Step No. 4: Securing the Splint in Place with the Interior Web Strap. Step No. 4: Apply Splint and Secure Traction Strap (See Plates 11, 12, and 13). While traction is maintained by No. 2 and the leg and thigh are supported by No. 3, the No. 1 man applies the Army Leg Splint to the injured leg by rolling it under the leg and thigh from without inward, the short rod to the inner side. The half-ring, with the concavity directed upward is pushed firmly against the tuberosity of the ischium in order to effect counter-traction. The operator is careful to avoid 522 MILITARY MEDICAL MANUAL possible injury to the patient’s scrotum and testicles from pressure by the splint. When the splint is correcdy placed, the No. 1 man secures it by buckling the anterior web strap. Fixed traction is then effected in the following manner: No. 1 grasps the free end of the long traction strap, brings it down over the notched distal end of the Plate 13. Step No. 4: Securing Traction Strap. splint, then folds it back upon itself and inserts it through the metal ring of the swivel. He then pulls on the free end of the strap until the required traction is obtained and secures it to the notched distal end of the splint with an ordinary cinch knot. Plate 14. Step No. 5: Securing the Splint Support. Step No. 5: Splint Support (See Plate 14). The instructor, holding up a SPLINT SUPPORT, explains that it is identical with the FOOT REST which will be used later and identifies its parts: (1) The base (or closed end), (2) the splint end (or open end), (3) the arms. No. 1 fastens the splint support to the side rods of the Army Leg Splint with the arms of the support directed toward the patient and the base on the litter. This relieves the No. 2 man, enabling him to assist in the next step. No. 3 continues to support the leg and thigh. Step No. 6: Support Leg (See Plate 15). The instructor explains that the supports FIRST AID 523 Plate 15. Step No. 6: Supporting the Leg. Plate 16. Step No. 7: Securing Foot to the Foot Rest. 524 MILITARY MEDICAL MANUAL are BANDAGES, Triangular, compressed—not the heavy triangular bandage with tape ties used as arm slings. He unrolls one and mentions that they are not to be unfolded. He also mentions that they are used instead of ordinary muslin bandages because they do not roll forming a narrow, constricting, uncomfortable cord. No. 1 and No. 2 arrange 5 compressed triangular bandages, unrolled but not unfolded, on the splint to form a cradle for the leg—two under the thigh, one under the knee, and two under the leg. These are all applied in like fashion, as follows: The bandage is placed over the bars of the splint and under the leg. The ends of the bandage are reversed, by crossing them under the splint, and are then brought up and over the bars of the splint and tied together over the outer bar. No. 3 is then free to assist further in the succeeding steps of the application of the leg splint. (The instructor here remarks that the leg must be supported in every case in this way, regardless of the location of the fracture; muslin bandages 5 inches wide may be used in place of compressed triangular bandages, if the latter are not available; the wound dressing should not be incorporated in any of the leg supports). Plate 17. Step No. 8: Lifting Patient. Step No. 7: Foot Rest (See Plate 16). No. 1, assisted by No. 2 then attaches the foot rest to the rods of the splint just below the foot, with the base (or closed end) of the support directed anteriorly and the arms directed away from the patient. The foot rest is pushed up against the foot until the foot is at right angles to the leg. The foot is then secured to the foot rest by means of a triangular bandage in order to support and fix the foot in its proper position and to prevent foot drop. Step No. 8: Place Patient on Dressed Litter (See Plates 17, 18, and 19). No. 2 and No. 3 take their positions alongside the patient on the side of the injured leg. No. 2 toward the head of the patient, No. 3 toward the feet. No. 1 assists from the opposite (uninjured) side. All three men kneel on that knee which is nearer the patient's feet. No. 3 passes both forearms under the patient’s legs, carefully supporting the splinted leg. No. 2 passes one hand under the patient’s hips and thighs, and the other hand FIRST AID 525 Plate 18. Step No. 8: Placing Dressed Litter Under Patient. * Plate 19. Step No. 8: Patient on Dressed Litter. 526 MILITARY MEDICAL MANUAL under the patient’s shoulders. All lift together, slowly and carefully, and place the patient upon the knees of the No. 2 and No. 3 men. As soon as he is firmly supported there, the No. 1 man relinquishes his hold and removes the undressed litter. Exposing the lower 5 inches of canvas, he slides the dressed litter underneath the patient. No. 1 resumes his former kneeling position opposite No. 2 and No. 3 and prepares to assist in lowering the patient. The patient is now gently lowered upon the dressed litter in such a way that the base of the splint support rests upon the canvas of the litter about 1 Yi inches from its lower edge. Plate 20. Step No. 9: Securing Litter Bar in Place. Step No. 9: Fix Splint With Litter Bar (See Plates 20 and 21). The instructor holds up the litter bar and identifies its parts: (1) smooth under surface, (2) grooved upper surface, (3) cam end, (4) cam lock, (5) securing strap, and (6) buckle with buckle catch. He then demonstrates how the buckle attaches to the buckle end of the bar and how it is locked in place by the buckle catch. No. 3 holds up distal end of splint so that base of splint support is about 3 inches off the canvas of the litter. No. 2 passes litter bar under the litter to No. 1 man who places litter bar across lower end of litter resting on both poles. The grooved surface is directed upward and its cam end is on the side of the injured leg and allows the base of the splint support to rest easily in the groove. The cam lock handle will be on the side of the bar toward the patient when the left leg is splinted and on the side away from the patient when the right leg is splinted. At this point the bar may be straight across the litter, at right angles to the long axis of the litter or slightly angulated. Regardless of whether the bar is straight across the litter or angulated, No. 2 then secures the bar tightly to the litter by fastening the buckle to the litter bar (see Plate 20). No. 2 locks the buckle in place by hooking the catch on its under surface over the side of the litter bar. The buckle should be so adjusted on the securing strap that when buckled the securing strap is under considerable tension, sufficient to prevent any movement of the bar on the litter. Finally, No. 1 FIRST AID 527 Plate 21. Step No. 9: Locking Splint Support in Litter Bar. Plate 22. Step No. 10: Placing' Third Blanket Over Patient. 528 MILITARY MEDICAL MANUAL fastens the cam lock, thus fixing the base of the splint support securely in the groove of the litter bar. Step No. 10: Cover Patient (See Plates 22 and 23). Nos. 2 and 3 fold the third blanket once lengthwise and place it over the patient, the upper edge under the patient’s chin. The free edges of the first two blankets are folded over the third and secured in place, using three safety pins to the body portion and three safety pins to the portion of the blankets enclosing the patient’s feet and the lower end of the splint. This gives four thicknesses of blankets over and four under the patient, thus assisting in the prevention of shock by conserving the patient’s body heat. Plate 23. Step No. 10: Step Completed. Patient Beady for Transportation. STANDARD RULES OF FIRST AID In order to insure and increase efficiency there are several principles and rules to be observed in the administration of first aid: Keep cool: a life may depend on your ability to keep calm and not get excited. It will help you to employ the most rational treatment. Examine the patient gently, being careful to avoid touching a wound with anything unclean, such as dirty fingers, dirty clothes, or dirty water. Chec\ hemorrhage quickly either by compression or tourniquet. Use the cleanest materials available to avoid infection. Make application at the site which will stop hemorrhage and cause least damage. Send for a doctor or ambulance if necessary. Do not try to do too much, but make the patient comfortable and keep him quiet until the doctor arrives. Keep the crowd bac\: enlist the aid of a willing assistant to do this while you render first aid. Then act quickly but quiedy, being systematic in your examination and treatment. Loosen clothing and keep patient warm. Most emergencies will indicate the increase of heat, rather than the application of cold. FIRST AID 529 THE SPANISH WINDLASS Pig. 1. Muslin Bandage. Fig. 3. Applying Hitch to the Foot. Fig. 5. Side View, Ankle Hitch in Position. Pig. 2. How to Hold Muslin Bandage. Fig. 4. Adjusting Hitch into Position. Pig. 6. Spanish Windlass. Plate 24. Tlie Ankle Hitch and Spanish Windlass. Substitute for Step No. 2. A piece of muslin bandage about one yard long is held in the left hand, one-third falling to the left. Pick up the long end with the right hand and form a loop. Drop the long end over the loop as if to tie a single knot but do not bring it through the loop. The hitch is now ready to apply to the foot. Hold the hitch with the left hand at the point marked "B** and with the right hand at the point marked “F”. Place that part of the loop marked “O’* over the foot at the point marked "C” in the diagram. (Plate 24, Pig. 4.) That part of the loop marked “D” under the instep and that part of the loop marked “E” is placed back of the h«ei at the point marked “E”. Draw the hitch into position and apply the Spanish windlass. 530 MILITARY MEDICAL MANUAL Splint jracture cases where they lie, using the most satisfactory means of splinting. If the fracture is compound, bandage with sterile material before splinting. Do not give anything by mouth if there is injury to the abdomen. Alcoholic stimu- lants are not ordinarily advocated. The use of these may incriminate the- injured if the accident is investigated by military or civil authorities. In most cases where indicated at all, the use of water, hot coffee, or similar liquids is beneficial. Relieve pain wherever possible. Place the patient in the most comfortable position and if his condition will permit, remove him carefully to a clean, quiet area away from curious spectators. Treat the patient primarily, giving him the advantage of the best knowledge you have. His general condition initially may not tolerate much physical treatment. Remember that shock is a very serious condition, and careful handling may save life. Avoid trans- portation immediately if the wounded will suffer more shock or injury incident thereto. This is particularly true of fracture cases or back injuries. BANDAGING The application of bandages is an art which, like all other arts, improves with ex- perience and the interest and skill of the operator. It is used in first aid, orthopedics, and surgery. Purpose. Bandages are used for the following purposes: To apply pressure to various parts of the body in order to control bleeding. Plate 25. Triangular Bandage Used as a Sling. To hold surgical dressings, medicinal applications, or splints in place. To hold or immobolize a part in order to afford support and protection, as in the case of injured limbs. In so doing they may also be used to correct a deformity. To promote the absorption of fluids or exudates. To support weakened blood vessel walls and to prevent edema and swelling. To protect open wounds from infection. FIRST AID 531 Bandages may be made of various materials, the most common being gauze, zinc oxide adhesive plaster, muslin, crinoline powdered with plaster of Paris, rubber, absorbent cotton, felt, and elastic webbing. Careful selection should be made of the proper material for bandaging. The types of bandages are selected for the purpose for which they are to be used. The most common of these types with a brief discussion of their uses are: The triangular bandage. (See Plate 25.) Used as a sling to support the arm or hand, or to hold dressings in place on the shoulder, hand, foot, hip, or buttocks. Substitutes for the triangular bandage are the handkerchief bandage, the tailed bandages, T-binders, and the cravat. Plate 26. Bandages for Head and Arm. The roller bandage is most commonly used. It may be prepared or purchased in sizes varying from to 12 inches in width and 1 yard up in length. The size of the bandage should vary according to the part of the body being bandaged. Roller bandage is used especially on the head and limbs. (See Plate 26.) Adhesive plaster (Zinc oxide tape) is considered a type of bandage since it is used to retain many types of dressings in place by virtue of its adhesive qualities. It is prepared as a roller bandage and is used as such. The mole-skin adhesive is used, especially in traction for fracture cases, because it is stronger and does not lose its elasticity when subjected to tension for a long period of time. Army First Aid Dressings. The shell wound dressing, which is a larger dressing used in the field, is supplied to the personnel of the Medical Department. This type of dress- 532 MILITARY MEDICAL MANUAL Plate 27. First Aid Packet (Old Style). Plate 28. First Aid Packet (New Style). ing consists of compresses made from a yard of sterile gauze, folded to measure 6 by 9 inches and with attached bandage 3 inches wide by 48 inches long. In addition, there is one bandage 3 inches wide by 5 yards long, and two safety pins. The whole is wrapped in waxed paper and is known as the “shell wound dressing.” This dressing is comparable in its use to a large abdominal pad, and it can be used for this purpose. The individual first aid packet is included in the field equipment of every officer and soldier in the military service. It is carried in a separate, small web pouch attached to the pistol or cartridge belt of the officer or soldier. At present there are two types of first aid packets for issue, commonly known as the “old” and the “new.” The differences between them will be briefly described. Eventually all will be of the new type. The old type packet contains two sterile dressings, each wrapped in waxed paper ready to apply to a wound, and two safety pins. A printed set of instructions is enclosed in each packet. Each dressing consists of a pad or compress of gauze, folded to by 7 inches, which is securely sewed to the middle of a gauze bandage which is 4 by 84 inches. (See Plate 27.) The pad of gauze is folded in such a way that it can be readily opened to a larger size by breaking a single retaining thread. These two dressings and the safety pins are enclosed in a sealed metal container 1 by by 4 inches which is opened by pulling on the metal ring attached to the sealing strip. When the packet is inserted in its carrying pouch the ring should be “down” (at the bottom of the pouch) so that when the packet is pulled out for inspection it will not be accidentally opened. A piece of blue paper on each dressing indicates the side to be kept away from the wound. The new type packet contains a single sterile dressing wrapped in waxed paper. No safety pins or instructions are provided. The dressing consists of a pad of cotton and gauze, folded to 4 by 7 inches. The metal container has a sealing device different from the old type which makes it easier to open and also makes it less likely to be accidentally opened. (See Plate 28.) The container is about the same size as the one for the old style packet. Rules for Bandaging. Rules for bandaging are the result of experience and will assist in securing comfort, durability, and neatness. In addition, there will be greater ease in application, economy in time and materials, and a neat completed appearance. Place the patient in a comfortable position. Place the injured part in the position in which it should remain after the application of the bandage. Before applying a bandage to any part, see that the part is clean. Place cotton or other suitable dressing between opposing skin surfaces, i.e., between the fingers and toes, behind the ears, between the arms and body. The same principle is applicable where bandages or a cast may cause irritation from pressure. Bandage from the extremity of the limb and work toward the trunk. Hold the bandage firmly and avoid dropping it. Never allow the bandage to unwind excessively; use it gradually as needed, keeping the roll part uppermost. Secure the bandage firmly by making at least two turns around the part, fixing the bandage by the second turn. Bandage evenly and smoothly, neither too loosely nor too tightly. If too loose the bandage will not be retained, and if too tight the circulation of the part may be impeded. Check the tip of the limb for color and warmth to make certain that the circulation is not reduced. Caution must be used over inflamed or painful areas. Children tolerate less pressure than adults. Be careful around the flexed portions of the limbs where the blood vessels are near the surface. Avoid the use of excess bandage. Extra turns increase pressure as well as heat and discomfort. Secure a finished appearance by even overlapping and by placing the crosses and reverses in a straight line. Secure the last turn by tying or with a safety pin, or anchor with a clean piece of adhesive tape. The use of the first aid packet should be well understood by each officer and soldier. Always use the first aid packet belonging to the injured soldier. Carefully remove the paper cover from the dressing without unfolding the'bandage or the pad and hold FIRST AID 533 534 MILITARY MEDICAL MANUAL by grasping the outside rolls of bandage between the thumb and fingers of each hand, the back of the dressing toward you. The back of the dressing is marked by a piece of colored paper. Open the pad by pulling on the two rolls of bandage and apply the inner surface of the pad to the wound, still holding one roll of bandage in each hand. (See Plates 27 and 28.) Then wrap the bandages around the injured member and over the pad in order to prevent the dressing from slipping. Tie the ends of the bandage together or fasten with a safety pin. A second dressing if necessary may be applied over or next to the first. A head dressing is more difficult to apply than one on an a n or leg. Head bandages are kept from slipping by passing turns under the chin, behind the ears, over the crown, and by the use of safety pins. WOUNDS A wound is a breach of the skin or the flesh, or both, usually caused by external violence. The type of wound depends upon the shape and size of the injuring element. It may be described as a break in the continuity of any of the tissues of the body, but the term is commonly limited to the injuries of the skin, mucous membrane, and other soft tissues. Types ot Wounds and Their Treatment. The types of wounds with respective treat- ment for each are as follows: Incised wounds bleed freely, the amount of bleeding depending on the region injured and the size and number of blood vessels cut. The margins of wounds of this type usually separate widely. They should be treated by checking hemorrhage (see under hemorrhage), the removal of any foreign body, sterilization of the wound (iodine), and occluding of the margins. This latter may be accomplished by drawing the edges together by a firm bandage, by adhesive tape strips or by sutures if these are available. In extensive wounds the part should be put at rest by slings or splints. Lacerated or contused wounds are caused by blunt instruments and large heavy objects. The hemorrhage is usually slight since the vessels are torn irregularly. Sometimes the vessels are torn from their sheaths and may be seen pulsating on the surface. The injury is frequently so extensive as to cause the death of large areas of tissue. Shock is apt to be severe. These wounds must always be regarded as infected and therefore should never be closed. They should be packed open with sterilize gauze and anti- septics, the hemorrhage controlled, the associated shock treated, and the part put at rest. Exposed vessels should be caught and ligated as they may open and bleed at any time. Punctured wounds are caused by penetrating instruments, from a pin to a bayonet or pick axe. The external opening may be small while internal injury, to arteries, nerves, and organs, may be severe. This type of wound is frequently infected since the drainage is not good. The treatment follows that already outlined for lacerated wounds. Gunshot wounds vary with the character of the projectile. Military rifle and machine gun bullets have a very high velocity and tremendous striking power. At ranges under 500 yards', the effects on the soft tissues are frequently explosive. At longer ranges the wounds of entrance and exit may be drilled so clean as to be hardly noticeable and if escaping vital structures, very little damage may result. Shrapnel wounds are caused by lead shrapnel balls about the size of marbles. They are not ragged or sharp and are not as apt to carry portions of clothing deep into the wounds as high explosive. The severest forms of wound infections usually result from the introduction of dirty clothing into the tissues. High explosive wounds are particularly destructive. The shell particles are jagged and sharp and may do extensive damage after entering the body. The wound of entrance is usually small, much smaller than it would seem possible for the fragment to enter. The destruction of the deeper tissues may be very marked, and these wounds are usually infected. Pistol wounds are somewhat similar to shrap- nel wounds. The first aid treatment follows that given for other types of wounds, viz, application of the first aid dressings, control of hemorrhage, splinting the part, and combating shock. FIRST AID 535 In gunshot wounds of the joints the extremity should be splinted. Emergency opera- tion may be required later to remove foreign bodies in the joint cavities. Wounds of the abdomen usually require early operation. Such cases should be given emergency treat- ment, receive nothing by mouth, and be moved promptly to the nearest hospital. Extensive wounds of the chest are very serious. It is important to fill the defect in the chest wall at once with ample dressings and packs. Unless the lung is promptly com- pressed and immobilized, death may rapidly supervene from changes in intrathoracic pressure and mediastinal flutter with the production of paradoxical or pendulum breath- ing. When the chest cavity is opened by a wound, air rushes in and destroys the in- trapleural negative pressure on that side. When respiration is attempted the negative pressure in the uninjured side sucks the mediastinum toward that side and air rushes in through the wound in the chest wall of the injured side. As a consequence the uninjured lung is compressed and is unable to get enough air through the trachea and bronchial tubes. When expiration occurs the reverse takes place. The force of expiration is not expended in squeezing air out of the normal lung because it is lost by the shifting of the mediastinum into the injured side forcing air out of the wound. Instead of a firm bony cage we have a box, one side of which is flexible (the mediastinum), which shifts back and forth like a pendulum (hence pendulum breathing). Consequently air can neither get in or out of the normal lung in sufficient quantity, and the injured person dies of asphyxia or heart failure from the violent motions of the mediastinum. The rule in gaping wounds of the chest is: Plug the deject in the chest wall at once with whatever comes to hand. Never mind sterility if no sterile supplies are available— use the man’s shirt if nothing else is handy. But whatever you do fill the gaping chest wound at once. 3 FANG WOUNDS - INCISIONS WITH KNIFE OR RAZOR U-RUBBER BULB ■OURNIQUET -GLASS BELL SUCTION AFTER INCISION LEG —: Plate 29. Treatment of Snake Bite. Poisoned or injected wounds result from the stings of insects, the bites of snakes, wounds of poisoned darts or arrows, the bite of a rabid dog, or most commonly, infection from micro-organisms. Injected wounds seldom require first aid treatment except in unusual circumstances (isolated camps, exploring trips, etc.). In such instances the infected area should be opened widely and drained. Whenever there is any indication of infection of the skin, which is manifested by redness, inflammation, and tenderness on pressure upon the area involved, the application of a saturated solution of hot magnesium sulphate (Epsom salts) by means of soaking or the use of packs is recommended. This is the safest therapy and in most instances the best type of therapy for pyogenic infections. If the 536 MILITARY MEDICAL MANUAL injury is on a leg or arm, immerse or pack the entire limb to include the thigh or upper arm. If Epsom salts is not available, use boric acid or ordinary table salt in saturated solutions. Snake bite is a comparatively rare accident but requires prompt attention when it occurs, since the venom is very rapidly absorbed into the system. Apply a tourniquet close to the wound, on the side toward the heart. With a knife or razor blade, make a (H) cut through the fang marks (fang wounds), as shown in Plate 29 so that the wound will bleed freely. If a suction apparatus is available suck out the wound with it. Otherwise suck the wound strongly and spit out the blood and poison; there is little danger in this to the person doing it unless he has cracks, sores, or cuts on the lips or in the mouth. Alcoholic liquors are not only useless but actually are harmful in the treatment of snake bite. The bites of scorpions, poisonous spiders, and other poisonous insects are treated in the same manner as are snake bites. Other insect bites may be painful but generally are not dangerous. Local applications of baking soda or ammonia may be helpful in controlling pain and swelling. Dog bites may be dangerous. A person bitten by a mad dog or other rabid animal should be sent at once to a doctor for treatment. The rabid animal should not be killed at once but should be impounded and turned over to a veterinarian for observation and disposition. If unable to secure the services of a medical officer immediately, the follow- ing treatment is suggested: Careful, patient, and prolonged cleansing of the wound with water and soap and subsequent irrigation of the wound with warm salt solution. If the wound is so irregular or deep that all parts of the wound cannot be reached, the wound will have to be enlarged sufficiently to permit thorough cleansing. The regular Pasteur treatment is advised as a safety factor to combat any possibility of virus enter- ing the deeper tissues. It should definitely be used where cleansing treatment has been delayed or inadequate. Plate 30. Improvised Slings for Injuries of the Arm. Rules for First Aid Treatment of Wounds. Each type of wound may need some specific individual treatment, but there are some general rules which will aid in giving proper first aid treatment to accidental wounds: Never touch the wound with anything unclean—dirty hands, non-sterile bandages, or anything dirty as severe infection may result. Do not wash a wound with unsterile water. The wound is apt to be deeply infected by FIRST AID 537 such attempts at cleansing. Treat the wound with iodine or other antiseptic. Use only one kind of antiseptic. Expose the wound by cutting away the clothing if necessary. Avoid contaminating the wound with soiled clothes. Apply a first aid dressing, and bandage firmly to control bleeding. Support the injured part—A sling for the arm using the coat or shirt sleeve (Plate 30), a splint for the leg—if the wound is large. Patients with contaminated wounds should receive antitetanic serum or tetanus toxoid at the earliest opportunity (Battalion aid station.) Look at the soldier’s identification tag to see when he had his last dose of tetanus toxoid. Before giving antitetanic serum in- quire from the patient if he has ever been treated previously with any injection which included horse serum. If so, his treatment should be administered under the close super- vision of a medical officer. HEMORRHAGE Hemorrhage, or bleeding, is the escaping of blood from the circulatory system such as occurs when a blood vessel is severed in a wound. The blood is a circulating fluid used as a vehicle to carry nourishment to and remove wastes from all parts of the body. It is contained in a closed system of blood vessels, the arteries, capillaries, and veins, and is carried through the circulatory system by the pumping action of the heart. To accom- plish its physiological function, the circulating fluid is maintained at a slight pressure. If a large blood vessel is cut, especially a large artery, only the quickest and most accurate measures will prevent the injured person from bleeding to death in a few minutes. Types of Hemorrhage,. Blood flowing from a cut artery comes out in jets or spurts and is bright red in color. This is arterial hemorrhage. The apparent color of the escaping blood is relatively unimportant as it is often mixed with the darker venous blood escaping from veins which were cut at the same time as the artery. The spurting is important and is unmistakable. Blood flowing from a cut vein comes out in a steady, comparatively slow stream. This is venous hemorrhage. Venous blood is darker in color than arterial blood. If only capillaries or small veins are cut the blood flows slowly or appears to ooze out. Severity of Hemorrhage. While severity of bleeding cannot be accurately classified, the following is a very rough method for estimating the gravity of a given case of bleeding or hemorrhage: If the blood drips from the wound the loss of blood is not likely to be serious, and the bleeding will probably stop very soon of its own accord. If the blood flows from the wound in a small, steady stream, up to about twice the diameter of the lead in an ordinary pencil, or if spurting in a very small stream, the loss of blood should be looked upon with some concern but not with alarm. The bleeding will probably stop soon of its own accord or promptly upon the application of a dressing to the wound. If the blood flows from the wound in a large stream (larger than that indicated above) or spurts in more than a very small stream, the loss of blood should be looked upon with considerable concern. Steady pressure to the wound or the more active and more elaborate measures for the arrest of hemorrhage will have to be used. If the blood flows or spurts in a relatively thic\ large stream the situation is very serious and must be dealt with promptly and vigorously, including hand or tourniquet pressure over the main arterial trunk supplying the affected part. Some parts of the body are more richly supplied with blood vessels than other parts; the head and face, the hands, and the feet are examples. (See Plate 31.) Even slight wounds affecting these parts of the body bleed profusely for a minute or two, but unless one of the larger vessels is cut the hemorrhage is usually not dangerous. The person rendering first aid in such cases must not be confused by the amount of blood desposited on the skin surface during the first few minutes of bleeding but must be guided by how much the wound itself is actually bleeding. Effects of Hemorrhage. The effects of hemorrhage are twofold. One effect is a loss of the fluid elements of the blood and body. The total quantity of blood in the body is 538 MILITARY MEDICAL MANUAL about 5 quarts. The loss of as much as one-fourth of this amount is very serious. The blood pressure drops and the body is dehydrated. This explains the extreme thirst caused by hemorrhage. Another effect is the loss of the red cells, which are the oxygen- carrying components of the blood. With the loss of these cells the supply of oxygen to the tissues is greatly diminished and serious consequences may arise. Children and old persons are subject to severe hemorrhage, although children tend to recover quickly while the elderly do not. Bleeding which lasts over several days, even with a loss of large quantities of blood, seems to be tolerated better than a sudden extensive hemorrhage of a lesser amount. F:9E Fig 3 Fig 1 Plate 31. Locations of Main Arteries. Symptoms. The patient becomes very anemic; the tissues are shrunken as a result of the dehydration; the pulse increases in rate and the respirations become quick and sigh- ing; the skin grows cold, clammy, and pale; and the patient feels faint, suffocated, and is very restless. There may be ringing in the ears and dimness or loss of vision together with fainting. Thirst is often excessive and the patient constantly calls for more water and air. Methods of Controlling Hemorrhage. The body has only as much blood as it needs, and any loss is detrimental. A small amount of blood may be lost without permanent injury to the body, but if a large amount is lost death results. Loss of blood is the thing most to be feared when an individual is first wounded, and the necessary measures must be taken to stop or greatly reduce this loss. The following are some of the simple methods of arresting hemorrhage: Natural method. First, and probably the most important, the severed blood vessel has FIRST AID 539 the remarkable power of self-closure. The blood, immediately upon escaping into the air, coagulates or hardens, forming clots which plug the severed ends of the vessel. Ordinarily, by this natural method, the flow of blood from a wound will stop within three minutes. The temporary arrest of arterial hemorrhage results from three factors: (1) Coagulation of blood in and around the vessel. If it were not for the ability of the blood to coagu- late a person would bleed to death from the merest scratch. This may occur in hemo- philia, a disease in which the coagulation of the blood takes place very slowly. Coagula- tion of the blood is influenced by many factors. Loss of blood tends to increase the Subclavian artery Carotid arteru Brachial arteru jFemoral artery Plate 32. Checking Hemorrhage by Digital Compression. coagulability of the blood. (2) Weakening of the heart beat. This results from an anemia of the brain centers and is a fortunate provision since it lessens the flow of blood and permits coagulation to occur. For this reason stimulants should never be used until the bleeding has been properly controlled. (3) Changes within the artery. These consist of retraction of the elastic artery in its sheath, allowing a clot to form in the sheath, and contraction of the open mouth of the vessel allowing a clot to form within the lumen of the artery. General pressure The second method for arresting hemorrhage, and probably next in 540 MILITARY MEDICAL MANUAL importance, is to place a pad or compress of gauze over the wound and secure it there with a bandage. If a bandage is not available the compress may be held in place by hand for about ten minutes. When the bleeding appears to have stopped leave the compress in place; if you remove it to inspect the wound you will probably dislodge the formed clots and start the wound bleeding again. Elevating the injured member also helps to stop the flow of blood. Specific pressure. The third method for arresting hemorrhage is to shut off the flow of blood to the affected part by manual compression over the main vessels until a clot can form in the wound. The location and courses of the main arterial trunks are shown in Plate 31. The proper places to apply pressure to these trunks are shown in Plate 32. The effects of compression on the flow of blood from the wound should be carefully noted, in order to be sure that pressure is being exerted in the right place. Compression should be continuous for 10 to 15 minutes, after which it may be gently released, but again applied if the wound resumes bleeding. The tourniquet. The fourth method for arresting hemorrhage is the use of the tourniquet. The tourniquet is a mechanical device used instead of, or to replace, manual compression of a main arterial trunk. It consists of a firm pad and a tight band to hold the pad in place and press it down upon a large artery and so interrupt its flow of blood. Usually, a tourniquet will have to be improvised. The pad may be a tight wad of cloth, or some hard object, such as a block of wood or a smooth stone, wrapped in soft material. The band may be a handkerchief, necktie, belt, or similar article that will make a strong, flat band. A broad rubber band is more effective and less painful than non-elastic bands. The pad is placed over the area to which pressure is to be applied; the band is placed around the arm or leg, over the pad, and is tightened by hand or the assistance of a “twist.” (See Plate 33.) The tourniquet is a most useful device, the prompt use of which Plate 33. Use of Tourniquet, has saved many lives. But in unskilled hands it is dangerous and should be used with the greatest caution. The most common abuses in using the tourniquet are: unnecessary, too tight, hidden, and left on too long. A tourniquet should never be used when its application is not necessary. It is quite common to see a misapplied or unnecessary tourni- quet on an injured extremity that, instead of arresting hemorrhage, has the effect of pre- venting the natural stoppage of the bleeding. A tourniquet should never be tighter than is necessary to check the bleeding; it is painful at best. Not oftener than every half hour, nor less often than once an hour, carefully and gradually loosen the tourniquet and note whether bleeding starts again. If it does, tighten the tourniquet again. A tourniquet should never be hidden by clothing or a bandage so that it might be over- looked or forgotten. Mark “Tourniquet” plainly on the patient’s emergency medical tag. If he is conscious, also caution him to tell medical attendants that he has a tourniquet on. He will usually not fail to do so. Remove the tourniquet as soon as its use becomes unnecessary to control the hemorrhage. If a tourniquet is left on con- tinuously for as long as six hours amputation of the extremity may be necessary. FIRST AID 541 FRACTURES A fracture is a broken bone, usually resulting from external violence. Fractures are very common injuries in war and in highway, industrial, and other accidents. They occur most frequently in the bones of the extremities. Types of Fractures. There are two general classes of fractures; simple fractures, in which the skin is not punctured, and compound fractures, in which the skin is punctured by the bone itself or by the agent producing the fracture. (See Plate 34.) Fractures may be transverse, oblique, spiral, longitudinal, comminuted (several pieces), impacted, multiple (more than one fracture), and complicated (artery, nerve or soft tissues are damaged). Symptoms of Fracture. Indications of fracture are: Signs of local injury, such as pain, swelling, and bruising. Abnormal mobility of the part. OPENING TO THE BONE AND THROUGH SKIN rVymnnimd Simple Plate 34. Types of Fractures. Loss of function in the affected limb. Crepitus or grating of the bone ends. Deformity of the part. First Aid Treatment of Fractures. The immediate danger in the case of fracture is that the sharp, jagged edge of the broken bone, in moving about, will lacerate the arteries, veins, nerves, and muscles or will perforate the skin and become compounded. Such trauma from the bone ends add greatly to shock and may, by severing large nerves, produce permanent paralysis. If a fracture becomes compounded the time of healing is greatly prolonged and frequently the usefulness of the limb or the life of the patient is endangered. Fractures, therefore, should be handled very gently, and patients should not be moved until well splinted and immobilized. In splinting a fracture the joints 542 MILITARY MEDICAL MANUAL above and below the fracture should be included in the splint to secure the maximum immobility. A splint is a piece of stiff or firm material, such as a board, limb of a tree, bayonet, thick magazine, or other suitable object, to which the injured member is bound or ban- daged so as to prevent movement of the bone fragments. The principles of the splint are illustrated in Plate 35. Plate 35. Principles of the Splint. “Splint him where he falls” is the keynote of the best first aid treatment of fractures. First, gently straighten out the limb to approximately its natural contour or appearance; generally, the easiest and best method is by a gentle, steady pull of the limb in the direc- tion of its long axis. This is called “traction.” The previously padded splint is then placed, further padded, and bandaged at enough points to insure that there will be no Plate 36. Types of First Aid Splinting. movement of the broken bone. Padding should not be placed over the site of the frac- ture but above and below it. Splints must be long enough and stiff enough to accom- plish their function. A very short or weak splint is useless and may even do harm. Bandages must be snug but not so tight as to interfere with the circulation of the blood. Never waste time trying to diagnose or “set” fractures as a part of first aid treatment. Even the medical officers do not try to make an accurate diagnosis or set fractures under such circumstances. If there is any doubt as to whether or not a bone is broken it should be splinted. Although the normal appearance of the limb has not been restored, nor the broken parts replaced in correct relative position, much has been accomplished in preventing further injury and in the relief of pain. Leave the rest to the medical officer. After hospitalization more elaborate traction splints or casts are applied to retain the proper apposition of the bone fragments. Plate 36 shows some of the more important types of improvised splinting. Fracture of the Clavicle. Tie the shoulders back by means of a T-shaped spint or use a Velpeau’s bandage. (See Plate 37.) A sandbag or similar weight may be placed on the tip of the affected shoulder unless it causes too much pain to the injured person during transportation. If used it should be anchored securely during transportation. Fracture of the Upper Arm. Apply two splints, one in front, the other behind, if the lower part of the bone appears to be broken. If the fracture appears to be in the middle or in the upper part, apply one splint to the inner side and one to the outer side. Splints may be applied all around the arm. Support by a sling. (See Plates 25 and 30.) The broken arm may also be bound to the side of the body. If a hinged traction splint is FIRST AID 543 available it should be used. (See Plate 38.) It permits the most comfortable trans- portation. For fractures of the humerus near the elbow the Velpeau bandage may be used. It provides immobilization with flexion of the elbow. Fracture of the Forearm. Place the forearm horizontally across the chest, thumb up; apply a splint to the inner side and one to the outer side of the forearm, both extending from the tips of the fingers to include the elbow joint. Support the forearm with a sling. In the absence of splint material the forearm may also be bound to the body. (See Plates 25, 30, 36, and 38.) First Step Finished Bandage Plate 37. The Body as Splint for Fractured Arm or Collar Bone (Velpeau’s Bandage). Plate 38. Hinged Traction Arm Splint. Plate 39. Improvised Splint for Fractured Pelvis. Fracture of the Wrist (Colles’ Fracture). Place the forearm and the palm of the hand on a splint which has a roller bandage or similar enlargement on one end. The palm of the hand should rest upon the roller bandage. The fracture can usually be reduced by MILITARY MEDICAL MANUAL 544 Application to fractured thigh Armu Leg Splint Boot Rest (Splint) {Spanish^ 4 Windlass SplirrLSupport .Litter Bar Service litter Poliquin hitch. Collins hitch Plate 40. Use of the Hinged Half-Ring Army Leg Splint for Fractured Thigh. grasping the hand of the patient with your opposite hand as in a handshake; then, aided by your other hand on the patient’s forearm, exert steady traction until the wrist is straight. After reduction maintain the traction until the splint above mentioned is applied, securing it firmly but not too tightly by a roller bandage. Check the finger tips to insure proper circulation after application of the splint. Support the forearm with a sling. Fracture of the Hand. Bandage the hand over a roll of bandage placed in the palm. Support the hand with a sling. Fracture of the Ribs. Firmly strap the affected side with adhesive tape, extending over the mid-line back and front. If adhesive tape is not available, use roller or muslin bandage going around the chest. Fracture of the Spine. Extreme care must be used in handling back injuries; when the spinal cord is involved paralysis is present and injudicious handling may increase the injury to the cord. The patient should not be moved until a litter or board has been pro- cured. The door of a house is an adequate splint for transportation. Bring the splint to the patient, place him on it with utmost care, sliding the door under him and taking precautions not to move or bend the spine (lift patient flat, face down). Then transport him, face down, to the nearest medical installation with minimum changes of position. Fracture of the Pelvis. The best method of transportation support for pelvic fractures is the use of a hammock type of sling. If the fracture involves the acetabulum, the splint should include the thigh of the affected side. (See Plate 39.) Fracture of the Thigh. Apply a long splint on the outer side extending from the arm pit to beyond the foot, and another splint on the inner side extending from the crotch to beyond the foot (See Plate 39). The injured leg can be bound to the sound one if splint material is not available. It should be noted in this as well as in the first aid treatment of fractures of other long bones that an effort is made to immobilize the joint above and the joint below the fracture. If necessary equipment is available the Army hinged half-ring leg splint should be applied. It may also be used for fractures of the lower leg (See Plate 40). Application of the Army hinged half-ring leg splint is described in the section “Training in First Aid Subjects,” page 512. Fracture of the Lower Leg. Apply two splints, one on the inside and one on the outside, each extending from above the knee to beyond the foot (See Plates 40 and 41). Many other improvised splints can be used for fractures of the leg, such as a bayonet, a rifle, a blanket roll, a pillow, or binding the injured limb to the other leg. FIRST AID 545 Plate 41. Use of Blanket Roll as Improvised Splint for Fractured Leg. Treatment of Compound Fractures. The fracture itself is given the same type of first aid treatment as outlined in the case of simple fractures. The complicating wound and bleeding are treated aseptically and a bandage applied before application of the splint. The three different conditions which have to be given treatment at practically the same time are: bleeding, wound, and fracture. The principal precautions to be observed in dealing with compound fractures are: Handle with the greatest of gentleness. Use the utmost surgical cleanliness possible. Do not try to do too much. 546 MILITARY MEDICAL MANUAL Two types of injuries which are closely related and often confused with fractures are sprains and dislocations. They are caused by external violence directly or indirectly to the affected part of the body. Either may accompany fractures. Sprain. A sprain is a tearing or stretching of the ligaments of a joint or of the tendons of muscles that insert close to the joint. A sprain should be treated by putting the af- fected member at rest and by application of cold packs when practicable to limit the effusion and swelling about the joint. Avoid bandaging too tightly at first as swelling may impair the blood supply and cause more damage. When the swelling has subsided, the application of hot compresses may be used to increase circulation and stimulate healing. Strength of the joint can then be increased by the use of adhesive plaster strapping to limit the motion of the joint during early convalescence. (See Plate 42.) Dislocation (Subluxation). A dislocation is a condition in which the articular surfaces of bones are partially or completely separated from one another. In dislocation of the jaw the mouth is held wide open and cannot be closed. Treat by padding your thumbs, then pressing downward and backward against the lower molar teeth until the mandibular condyle is free and snaps back into place. Do not persist in reducing the dislocation as a first aid measure but secure the services of a medical or dental officer. SPRAINS AND DISLOCATIONS Plate 42. Adhesive Strapping of the Ankle for a Sprain, In dislocation of the shoulder the top of the shoulder is hollow and not rounded out as on the opposite side; the elbow sticks out from the side and when the affected hand is placed on the opposite shoulder the elbow cannot be brought against the chest. If re- duction is attempted it should be done very gently. Occasionally, careful manipulation or traction with the heel (without shoes) of the operator in the axilla will slip the bone into place. If not, an anesthetic is required and Kocher’s method may be tried. This consists of grasping the elbow with one hand and the wrist with the other while the patient is recumbent. Pull gently to get slight extension; rotate the arm firmly and steadily outward as far as it will go with the elbow pressed to the side. Next draw the elbow steadily forward and upward as far as it will go with with the arm still rotated outward. Finally, bring the hand across the front of the chest and place on the tip of the opposite shoulder while the elbow is drawn across and brought against the chest. The arm should then be bandaged to the side. Backward dislocation of the elbow is the most frequent. The joint cannot be moved; it is in a semiflexed position and the displaced bones project prominently behind. To reduce, place the knee in the bend of the elbow, pull the arm forward against the knee and slowly and forcibly bend the forearm to a right angle. It is bandaged in this posi- tion. Do not be rough and in case of doubt do not attempt reduction. Dislocation of a finger is usually reduced easily by gentle steady traction on the affected finger. The patient should be seated or recumbent during the manipulation in order to fix his position and insure steady traction. Dislocation of other joints may occur, and involve the wrist, hip, \nee, and an/fie. Dislocations of the knee are reduced without much difficulty by flexing the thigh, apply- ing traction and manipulating the knee joint, pushing the bones in place. The knee must be splinted afterwards. Frequent dislocation of one or more of the semilunar car- tilages of the knee joint will require operation, tightening the ligaments or removing the cartilages to secure permanent cure. Dislocations of the wrist and hip are rare. Dis- location of the ankle requires surgical procedure for correction. FIRST AID 547 Severely injured or seriously sick persons should be carried on a litter whenever pos- sible; it is usually better to let them lie until suitable transportation is available. Severely wounded soldiers, or those suffering from shock, should be carried on the service litter. TRANSPORTATION OF THE SICK AND WOUNDED (FM 8-35) Fig. 1. The “Supporting Carry.” Fig. 2. The “Arms Carry.” Fig. 3. The “Straddle-back Carry.” Plate 43. Manual Transport of Wounded by One-Man Carry. Manual Transport. The injured or sick who are unable to walk may be moved short distances without the aid of a litter. Patients not too seriously wounded may be assisted in walking, or be carried by one man. If the litter bearer has no assistant he proceeds as follows; turn the patient on his face, step astride his body facing his head; place hands under his armpits and raise him to his knees; clasp him around the waist and raise him to his feet (Plate 44, Figs. 1-4). If he is conscious and can walk with assist- ance, seize his left wrist with your left hand and draw his left arm around your neck. Support him with your right arm around his body, his left side resting against bearer’s body. (See Plate 43, Fig. 1.) This method is known as the “supporting carry.” It cannot be used with an unconscious person. To transport a patient “by arms carry,” proceed as in last case in raising him to the erect .position, then pick him up as shown in Plate 43, Fig. 2. 548 MILITARY MEDICAL MANUAL Plate 44. Fireman’s Carry. FIRST AID 549 The easiest method of one man carry is by the “Fireman’s Carry.” Raise the patient to his feet as previously described. While supporting him erect pass around and face him. Grasp his right wrist with your left hand and pull forward; stoop and pass your right arm between his legs, at the same time drawing him across your left shoulder. Pass the patient’s right wrist to your right hand, reach back and grasp his left wrist with your left hand and draw patient’s left arm around to steady him. The various steps from lying on the ground to the completed “carry” are shown in Plate 44. This method may be used to carry an unconscious person as well as a conscious one. In the “straddle-back carry” raise the patient to his feet as previously described, step in front of him, your back to patient, stoop and grasp his thighs, rise to position shown in Plate 43, Fig. 3, bringing the patient well up on your back. This method cannot be used except with the assistance of the patient. The usual method of a two-man carry is shown in Plate 45, Fig. 1, and is self ex- planatory. Serious injury to the arms or legs may preclude the use of this method. A seriously wounded man may be carried in a recumbent posture by two-man carry as shown in Plate 45, Fig. 2. Both bearers must be on the same side of the patient. He should be carried well up on the chests of the bearers. Transport by Litter. Usually the wounded man should be laid on his back on the litter, his limbs disposed naturally. “Bring the litter to the patient, and not the patient to the litter.” Tight clothing, especially collars and belts, should be loosened. Clothing may be cut to inspect and treat his injuries but should not be pulled off in a manner which will disturb the patient. Do not remove clothing, as it is needed to retain Fig. 1. The Saddle-back Carry. Plate 45. Manual Transport of Wounded by Two Bearers. Pig. 2. The Arms Carry. warmth. Cover the patient with a blanket or overcoat. An injured individual nearly always asks for water; give him liquids, preferable hot, unless the wound is in the abdomen. Do not give him liquor. He should be properly prepared for his journey so that he need not be disturbed again until he reaches the aid station. A patient having once been placed on a litter should not be removed from it until he reaches the hospital. Improvised litters. In the absence of a service litter, one may be improvised out of poles supporting a bed. The bed may be a blanket, overcoat, shelter tent, bedtick, poncho, bags, chicken wire, or other suitable article or material. It is best to form a framework by lashing two short poles across the ends of the long ones to keep them 550 MILITARY MEDICAL MANUAL Plate 46. The Wheeled Litter Carrier. Pig. 1. Carlisle Cacolet. Plate 47. Transport of Patients by Cacolet. Pig. 2. 1st Division Cacolet. FIRST AID 551 apart. The long poles should be about 7 feet, the short ones about 3 feet in length. An ordinary camp cot makes a very satisfactory litter. Adjuncts to the Litter. Every effort should be made to minimize the task of the litter bearers since the critical point in the chain of evacuation, within the division, lies between the casualty on the field and the most forward ambulance. The use of advanced ambulance posts and mechanical devices which will aid the litter bearers and accelerate the evacuation are recommended and employed whenever feasible. Plate 48. Placing Wounded on a Horse and Carrying on Horseback. The wheeled litter carrier is a valuable mechanical aid. (See Plate 46.) It is a col- lapsible, two-wheeled cart, capable of transporting one loaded litter. When employing the carrier over suitable terrain, the litter squad may be reduced to two men and yet be able to perform the same task with greater rapidity and less fatigue (FM 8-35). The Cacolet is a mechanical device used for transportation of patients upon an ani- mal. There are two common types of cacolet, one known as the Carlisle Cacolet and the other as the 1st Cavalry Division Cacolet. Both are fitted to the Phillips’ pack saddle, the former for two patients and the latter for one. For details of these devices see FM 8-35. Plate 49. Carrying Wounded on Travois. Horseback. The assistance required to mount a disabled man will depend on the site and nature of his injury. In many cases he is able to help himself materially in mount- ing. The horse, blindfolded if necessary, is to be held by an attendant. To load, the patient is placed on the horse from the near (left) side. The patient having been lifted is carried to the horse, patient’s body parallel to that of the horse and close to its side, his head toward the horse’s tail. He is then raised and carried carefully over the horse until his seat reaches the saddle, when he is lifted into position. One man goes to the off (right) side and puts the patient’s right foot into the stirrup. The other man puts the patient’s left foot in the stirrup. (See Plate 48.) 552 To unload, the patient’s feet are disengaged from the stirrup and his right leg swung over the pommel, one man going to the off side for this purpose after which he resumes his post at the left side. The patient is brought to a horizontal position, gently lifted over the saddle and carried backward until free of the horse, and lowered to the ground. The patient, when mounted, should be made as safe and comfortable as possible. A comrade may be mounted behind him to guide the horse, otherwise a lean-back may be provided, made of a blanket roll, a pillow, or a bag filled with leaves or grass. If the patient be very weak the lean-back may be made of a sapling, bent into an arch over the cantle of the saddle, its ends securely fastened, or some other improvised frame- work to which the patient is bound may be made. The Travois. The travois is a vehicle intended for transporting the sick and wounded when the use of wheeled vehicles or other means of transportation is impracticable. It consists of two long poles, one end of each pole being attached like shafts to the side of a horse, the free end dragging on the ground. Behind the horse, cross bars extend between these poles, holding them parallel and affording support for a patient. (See Plate 49.) A travois may be improvised by cutting poles about sixteen feet long and two inches in diameter at the small end. These poles are laid parallel to each other, large ends to the front and feet apart. The small ends should be about three feet apart, with one of them projecting eight or ten inches beyond the other. The poles are connected by two crossbars, the first of which is about six feet from the front ends and the second about six feet back of the first, each notched at its ends and firmly lashed to the poles. Be- tween the cross pieces the litter bed, six feet long, is filled with canvas or a blanket which is securely fastened to the poles and cross-bars, or filled with rope, lariat, or rawhide strips, stretching obliquely from pole to pole in many turns, crossing each other to form the basis for a light mattress or an improvised bed. A litter may be MILITARY MEDICAL MANUAL Figure 1. Side view. Plate 50. An Army Ambulance. Figure 2. Rear view. made fast between the poles to answer the same purpose. The front ends of the poles are then securely fastened to the saddle of the animal. A breast strap and traces should, if possible, be improvised and fitted to the horse. On the march the bearers should be ready to lift the rear end of the travois when passing over obstacles, crossing streams, or going uphill. Precaution. There is one definite consideration which must be kept in mind before transporting a sick or wounded person: “Will transportation be detrimental to the patient to such an extent that he may lose his life or be permanently disabled therefrom?” Often the necessary treatment must be given at the site where the accident occurred in order to prepare the patient for transportation. The time required and the factors FIRST AID 553 involved are dependent upon the weather, nature of the terrain, facilities for treatment, and the condition of the patient. Ambulance Transportation. There are various types of ambulances used in the mili- tary service: the metropolitan ambulance (general hospitals in the zone of the interior) and the motor field ambulance (station hospitals) the cross-country, Awheel drive, motor field ambulance; the four-animal drawn ambulance; and the two-animal drawn ambulance. The ambulance conforms in principal to the passenger automobile, afford- ing the maximum degree of riding comfort for distant transportation of the sick and Plate 51. Truck (2y2 ton) fully loaded with fifteen litter patients in a head to foot arrangement. Three patients are placed lengthwise on the bed of the truck. Plate 52. Truck (li/2 ton) fully loaded with ten litter patients. Two of the patientsi are placed lengthwise on the truck bed. wounded. (See Plate 50.) Care should be taken in the loading and unloading of patients from the ambulance to keep the patient level and to make all movements without jerking. The speed at which the ambulance may be driven depends upon the condition of the ground or roads over which it is driven. 554 MILITARY MEDICAL MANUAL If an ambulance is not available, a cot or litter may be suspended from the top of an Army truck. Someone must remain near the litter to prevent horizontal sway. If the truck has no top beams, cover the truck bottom with straw or grass before placing the litter thereon. In an emergency cargo trucks may be improvised to carry a large number of patients. Fifteen litter cases may be transported in a 2*4 ton cargo truck. (See Plate 51.) The litters are held in place by sliding 2" x 4" boards between the litter stirrups and the bows of the truck. The poles of the litters are made secure to the bows of the truck by with the litter slings. Ten patients may be transported in a similar manner on the 114 ton cargo truck (See Plate 52). Three to five patients may be transported on the 14-ton truck (jeep) which has special attachments for supporting litters. Some types of accidents occur more frequently in civil life than in the Army, and every person should know the principal signs or symptoms of common injuries and the simple first aid measures useful in their immediate care. The measures to be taken are all very simple and are generally effective. It is well for the layman to wish to aid those who have met with an accident, but he must apply the correct actions since the wrong thing may harm the injured person rather than help him. In case of doubt as to what to do, there is one important rule: Secure at once the services of a doctor. While waiting for his arrival measures should be taken to assist the patient to be comfortable. Shock. Shock is a condition of extremely depressed or lowered vitality, usually the result of a severe wound or injury but also caused from such conditions as fear, poison- ing by chemicals, excessive heat, lack of nutrition, and hemorrhage from causes other than external injuries. The degree of shock is usually greater in the old, the weak, or poorly nourished, the physically exhausted, or individuals with a highly impressionable nervous system. Shock is quite easily recognized. Its principal symptoms include: pallor of the skin; a cold sweat especially on the forehead; an anxious, frightened expression; sighing or ir- regular breathing; weak and irregular pulse; body temperature below normal (cold and clammy); and sometimes nausea and vomiting. The patient may become uncon- scious. The earliest first aid measures in severe injuries should always include anti-shock treatment, even though symptoms of shock may not have appeared. Following are the principal first aid measures to be taken to prevent, or combat, shock. Make the patient as comfortable as possible, lying on his back, limbs straightened out, with the head low and clothing loosened. Arrest hemorrhage (bleeding); reduce pain; dress wounds; splint fractures. If practicable move the patient to a warm room. In any event keep him warm and dry. Use blankets or clothing and hot water bottles, canteens filled with hot water, or other sources of external heat. Be careful to avoid burning him, as the victim of shock will often be too depressed to notice that he is being burned. Unless his injury is in the chest or abdomen give him hot drinks if he is conscious. Keep him perfectly quiet and permit him rest and sleep. In mild cases of shock, warmth and quiet are sufficient. In severe cases, however, active measures must be carried out as promptly as facilities will permit; death frequently follows inadequate anti-shock treatment. Pain in the Abdomen. Pain in the abdomen may be due to a variety of causes, many of which are serious. In any case where there is nausea and vomiting, accompany- ing or following pain over all or any part of the abdomen and with pain and tenderness in the lower right part of the abdomen, appendicitis should be suspected. Appendicitis may also occur without nausea. Always put suspected cases to bed and call a medical officer. As a general working rule, never give patients with abdominal pain or tender- ness food, water, a laxative, or an enema unless ordered to do so by a medical officer. Fainting. Except as a symptom of severe shock this condition is seldom dangerous. Lay the patient on his back with the head lower than the rest of the body if practicable, loosen clothing, give plenty of fresh air, and give stimulants (when consciousness is FIRST AID IN COMMON EMERGENCIES FIRST AID 555 regained) carefully and slowly. A cold compress on the head is beneficial. This is usually placed on the forehead or the back of the neck. Sprinkling cold water on the head and face may be done in lieu of a compress. The arms and legs may be rubbed, rubbing from the hands or feet toward the body. Aromatic spirits of ammonia inhaled or taken by mouth in small doses are considered useful. Concussion of the Brain. Concussion of the brain is a shock caused by abrupt violent force against the skull, injuring the brain but with insufficient force to fracture the skull. The patient is pale and weak, always dazed and sometimes unconscious. He should be examined carefully for evidences of a fractured skull—bleeding from the internal ears, bleeding or escape of cerebro-spinal fluid from the nose or mouth, evidences of paralysis of eye muscles, face, or extremities. Treat as you would for shock. Compression of the Brain and Fractured Skull. This is a much more serious condi- tion than the above. If the compression is due to hemorrhage from the arteries of the dura (middle meningeal artery) there is usually immediate unconsciousness following the injury, followed by return to consciousness. This in turn gives way to a gradually increasing stupor with symptoms of slowly developing paralysis. Operation (sub- temporal decompression) is the treatment required. First aid treatment consists chiefly in keeping the patient quiet and treating for shock. Fractures of the base of the skull can usually be recognized by bleeding and escape of cerebro-spinal fluid, from the ears and nose, together with paralysis of the various cranial nerves (eyes, face) or of the limbs. There is usually compression of the brain which is evidenced by a rising blood pressure, a slow and falling pulse, and slow breath- ing. These cases should be kept quiet and treated for shock. A rising blood pressure and gradually slowing pulse, particularly if the compression can be localized by areas of paralysis, calls for a decompression of the brain. Lumbar punctures to relieve pressure may be performed. Apoplexy. This is due to a rupture of a blood vessel in the brain. It seldom occurs below the age of 50. The patient suddenly falls, is usually unconscious, and is paralyzed. Paralysis of the face may be recognized by a drooping of the corner of the mouth on that side and a smoothing of the wrinkles. If an arm or leg is paralyzed it falls quickly and heavily when dropped on the bed while the opposite arm drops a little less heavily (even if the patient is unconscious), due to muscular elasticity. The treatment consists of rest and quiet. No stimulation should be given at first lest the bleeding be increased. Epileptic Convulsions. Epilepsy is a nervous disorder in which there is very little warn- ing of an approaching convulsion. The individual usually cries out and immediately falls in a severe convulsive fit. The limbs stiffen out for a few moments and then clonic contractions usually begin in the extremities, followed by foaming at the mouth and complete unconsciousness. Nothing can be done to avert the fit. The only treatment is to prevent the patient from injuring himself in the fall or in his convulsive move- ments. The tongue is frequently severely bitten. To prevent this it is well to pad a spoon handle, tongue depressor, rolled towel, clothes pin, or the like and insert be- tween the teeth during the attack. Do not try to hold the patient in his struggles but place him on a mattress or other soft object to prevent his injuring his head or limbs by striking them against a hard object. After the convulsions the patient may remain unconscious from a few minutes to several hours, appearing as though in a deep sleep. The pulse should be checked to note the general condition of the person afflicted. This will also assist in differentiating epilepsy from other conditions. After the convulsions cease, inspection of the tongue for possible injury, and the presence of a foamy sub- stance in the mouth will often determine the diagnosis. If the patient is questioned after awakening he will usually admit a history of previous attacks. Unconsciousness. Unconsciousness may result from any one of a number of causes, the more common ones being: fainting, head injury, concussion of the brain, severe alcoholic intoxication, apoplexy, epilepsy, diabetes, chronic kidney disease (uremia), wound shock, electric shock, toxemia, and thermal accidents. In cases where the type and cause of the unconscious state are unknown, and the unconsciousness persists for more than a few 556 MILITARY MEDICAL MANUAL minutes, send for a doctor; place the patient in a comfortable position, the head level with or below the body, the limbs naturally disposed; loosen tight clothing; give the patient plenty of air; keep him quiet; and isolate him from all persons not actually needed to help him. Never attempt to give liquids to an unconscious person. Asphyxiation. Asphyxiation is a condition of unconsciousness due to suffocation or interference of any kind v/ith the oxygenation of the blood. Several causes of asphyxia are as follows: Mechanical obstruction preventing air from reaching the lungs. Strangling external pressure on the respiratory passages. Foreign bodies in the respiratory passages of sufficient size to embarrass respiration. Water or fluids (edema) in the respiratory passages, such as occurs in drowning or diseases of the larynx. Inflammation and swelling of the throat or the presence of an obstructive membrane as in diphtheria. Weakness or spasm of the respiratory muscles. Whooping cough, poliomyelitis, paralysis of the upper part of the spinal cord, and convulsions. Dysfunction of the respiratory center of the medulla. Degenerative cardio-reno-vascular diseases or heart failure. Inhalation of smokes and poisonous gases. Sufficient inhaled concentrations of irritating or toxic smokes, illuminating gases, gasoline motor- exhaust fumes (carbon-monoxide), ammonia fumes, and war gas fumes. The treatment of asphyxiation depends upon its cause. However, in the maiority of the cases, artificial respiration is most commonly used. The cause must be removed before artificial respiration will be able to restore respiration. The pulmotor or other mechanical means of artificial respiration should be used by experienced operators only and with due consideration of the condition of the respiratory tissues. Artificial Respiration. Artificial respiration is the assisting of or starting of respiration in a person in whom it has ceased (the new-born is an exception). The methods used must supplement the respiratory apparatus of the individual involved, ft is one of the most important procedures a first aid operator should know. There are several known methods: Schafer, Sylvester, Howard, Laborde, and the mechanical respirators. The Schafer method. Experience has indicated that the Schafer method is the easiest to administer and has proven to be the most effective and least injurious first aid measure. Mechanical respirators are not usually available immediately. Schafer de- scribes his method as follows: “It consists in laying the subject in the prone posture, preferably on the ground, with a thick folded garment underneath the chest and epigastrium. The operator puts himself athwart or at the side of the subject, facing his head, and places his hands on each side over the lower part of the back (lowest ribs). He then slowly throws the weight*of his body forward to bear upon his own arms, and thus presses upon the thorax of the sub- ject and forces air out of the lungs. This being effected, he gradually relaxes the pres- sure bv bringing his own body up again to a more erect position, but without moving the hands.” The movements are repeated regularly and should average about twelve to fifteen per minute, therefore requiring about 5 sconds for each manipulation. To avoid too rapid procedure the use of the following words are advocated. As pressure begins on the chest sav, “One thousand one. one thousand two, one thousand three,” at the end of which release the pressure: withhold the pressure but hold the hands on the back while you repeat, “One thousand one, one thousand two,” at the end of which reapply the pressure slowlv, throwing the weight of the body forward on your arms. If the patient is small and you are large, be careful that you do not injure the patient by using all vour weight for. pressure. Continue your efforts to revive the patient for an hour or more. The pressure should be extended downward and forward, thereby simulating the function of the lower respiratory muscles and diaphragm. Do not give up, but FIRST AID 557 persist until a doctor arrives. He can determine by examination if your further efforts will restore life. Drowning. A person suffering from submersion is commonly spoken of as having been “drowned.” It should never be assumed that the person removed from the water is dead unless he is definitely known to have been submerged for a long time. No fatal Plate 53. The Schafer Method of Artificial Respiration. Plate 54. First Step in the Resuscitation of the Drowned. time limit of submersion can be given since it varies with the individual case. Also, to excited eye-witnesses a few seconds, let alone a couple of minutes, seem like hours. The “drowned” person has stopped breathing and to resuscitate him his breathing must be started by artificial means. As soon as the victim is out of the water turn him face down- ward, step astride him, and grasping him around the body near the hips lift him so that 558 MILITARY MEDICAL MANUAL his head and chest hang well down; hold him in that position for at least 15 or 20 seconds to allow the water to drain out of his air passages. Then start artificial respira- tion at once, on the ground or in a boat. Do not waste time in removing clothing, seeking signs of heart action (life), or removing the patient to a more convenient spot. Continue the artificial respiration until he breathes well of his own accord, or until quite sure the case is hopeless. Either circumstance may require from an hour to three hours of artificial respiration. After he begins to breathe, watch carefully to see that he does not stop, and continue to assist him if necessary. A dry feather or a mirror held in front of the patient’s nose will indicate whether artificial respiration is actually being produced, and will also show when the patient begins to breathe naturally. External heat may be applied while the resuscitation efforts are being made, taking care not to burn the patient. Do not attempt to give him liquids of any kind until he is conscious; then give stimulants and keep him warm. Make no attempt to move him until he is breathing naturally. Prevention of drowning accidents. Observation of the following, simple ten com- mandments will prevent many drownings: Don’t swim immediately after eating; wait at least two hours. Don’t go swimming alone unless you are an expert. Don’t swim if overheated. Don’t swim if you know you have heart trouble. Don’t continue swimming when exhausted. Don’t wade into water with your hands above your head; you may step into a hole and you should be ready to stroke. Don’t struggle if caught in a swift current or undertow; the force of the current will bring you to the surface. Don’t fight or struggle if you “swallow water”; clear your windpipe of water first. Don’t cry for help in fun; you may really need it some time. Don’t dive without knowing the depth of the water. War Gas Poisoning. Symptoms produced by gas in chemical warfare and the treat- ment of gas casualties are discussed in Chapter VIII. Choking. A person being suffocated by a substance lodged in his windpipe (usually food) gasps for air, clutches at his throat, and may cough violendy. His face turns blue, and he exhibits great fear. Prompt removal of the foreign body is necessary or death will ensue, unless the supply of air reaching the lungs is sufficient for life. Have a doctor called at once, telling him the circumstances briefly so that he may bring the proper in- struments. Cause the patient to cough and slap him violently on the back between the shoulder blades. If this is insufficient, hold him with his head and chest down and again slap him on the back. Sometimes a foreign body lodged in the throat can be re- moved by inserting a finger into the throat, dislodging the object. The patient may then cough it out. Alcoholic Intoxication. Alcoholic intoxication is a condition in which there is a vary- ing degree of unconsciousness which results from imbibing an excess of alcoholic liquids. A person unconscious from alcoholic intoxication is “dead drunk.” In severe alcoholism the face is flushed, eyes are red and bloodshot, pupils dilated, breathing slow and regular, and the breath is heavy with the odor of alcohol. Voluntary movements are usually un- coordinated. The individual may be stuporous or unconscious; if so, he may be aroused but quickly returns to his stupor or unconsciousness. The most important thing to be remembered about alcoholism is the possibility that the unconscious state may be due to some other cause even though there is an odor of alcohol. Ordinarily, alcoholism does not require any particular treatment. Vomiting may remove some of the alcohol from the stomach; it may be induced by having the patient drink copiously of warm salt water or mustard water. A cup or two of strong, black coffee, or one-half to one teaspoonful of aromatic spirits of ammonia in water, are useful in helping to sober a drunken person. Bed rest is valuable and usually necessary. Thermal Injuries. Thermal injuries are injuries to the body caused by excessive heat or cold. Chemicals, in addition to their toxic effect, may produce a thermal injury. FIRST AID 559 The effect of heat or cold may be either general or local. Some of the common thermal accidents and the first aid treatment to relieve them are as follows: Sunstroke is a rather rare condition but quite alarming when encountered. It results from exposure to the direct rays of the sun or other source of high temperature. Usually the victim is unconscious, his face is flushed, his skin is very-hot and dry, his breathing labored, and his pulse rapid and strong. Call a doctor at once. Move the victim to a cool, shady spot; loosen his clothing, and apply ice or cold towels to his head and body. Do not give him any stimulant, even if he is conscious. The victims of such a thermal accident often have a preceding headache, dizziness, and nausea, and a feeling of being oppressed by the heat. Should they go in time to a cool, shady spot and lie down, actual sunstroke may be prevented. Heat exhaustion is a rather common condition, usually the result of continued ex- posure to heat and humidity, indoors or outdoors. The victim of heat exhaustion is in a state of shock, as described above. The treatment is the same as for shock. Heat exhaustion is a preventable condition. Men who are losing large quantities of body fluids by profuse sweating should take a small amount (a quarter teaspoonful) of table salt with each meal. Burns and scalds. Burns are injuries caused by hot solids or flames coming in contact with parts of the body. Scalds are injuries caused from hot liquids. Burns are classified as first, second, or third degree, depending upon the amount of damage to the body tissues: First degree burn—redness of the skin. Second degree burn—blistering and redness of the skin. Third degree burn—charring and destruction of the deeper tissues. First and second degree burns are also usually present in proximity to third degree burns. The immediate effect of a burn is the local effect; if sufficiently painful and extensive it will cause shock. After absorption of the toxic products of a burn, the resultant toxemia may produce vital changes in the liver and kidneys, making treatment of the patient very difficult. Proper first aid treatment will do much to prevent such com- plications later. The treatment of burns and scalds is similar. Treatment of burns and scalds. Carefully remove the person burned to an area of relative cleanliness where the clothing can be gently removed from the affected part with- out increasing the chance of future infection. If the burn is extensive (third degree burn) a doctor’s services should be secured immediately as the correct, early treatment may prevent possible permanent disability. Do not apply grease, salve, oil, or any house- hold remedy. Use nothing on the burn that will be difficult to remove afterwards. If the patient insists that something be used apply bicarbonate of soda as it is easy to remove. Place clean linen under the patient and protect the burned portion from the drafts of air by a frame or cradle holding the covers off the body. Keep the patient warm and as comfortable as possible until the doctor arrives. Treat for shock if indicated. If the burn is not extensive or severe (first or second degree) a tannic acid ointment (5 per cent) or a picrate ointment may be applied to the affected area. Bandages should be sterile and placed on very loosely. Do not open blisters. Precautions in case of fire. Keep cool, do not get excited. If a person’s clothing is on fire make him lie down or throw him to the floor or ground. Smother the flames by wrapping him in a blanket, rug, coat, or similar article. If your own clothing catches afire when you are alone, lie down on the floor and roll up as tightly as possible in a rug, blanket, or similar article, leaving only the head out. If there is nothing in which to wrap yourself, lie down and roll over slowly, at the same time beating out the fire with the hands. If caught within or obliged to enter a house which is full of smoke, cover the mouth and nose with a wet cloth or handkerchief. Remember that there is less smoke within 6 inches of the floor than above that level, so when you can no longer breathe in an upright position get down and crawl with the mouth close to the floor. Electric shocks and burns. Electric shocks and burns result from contact with wires or equipment carrying a high tension current. The most important thing to do is to re- 560 MILITARY MEDICAL MANUAL move the person from such contact. This is always dangerous and should not be attempted until the rescuer has some way of insulating himself, otherwise he may re- ceive as severe a shock or burn as the person he is trying to rescue. First, take steps to have the power cut off. Stand on a heavy rubber mat, or dry boards, and protect the hands with some insulating material such as heavy rubber gloves, several thicknesses of dry cloth, or other non-conductor, before attempting to separate the victim and the source of the current. It may be easier to push the wires aside, or the victim away from the source of electricity, using a long piece of dry wood while standing on a dry or insulated platform. Electric shock causes symptoms similar to wound shock and is treated the same way. It arrests respiration if the shock is severe, and artificial respiration must then be used. Electric burns are treated the same as burns from other causes. Injuries from freezing. The first effects of extreme cold are pain and a sensation of cold followed by numbness, stiffness, a great drowsiness, and a desire to lie down and sleep. If yielded to, this desire for sleep may lead to death unless the person receives ade- quate and careful treatment. The most common injury resulting from freezing is that of frost-bite or chilblain, affecting parts of the body which are exposed and have the least circulation. The rational treatment of freezing and frost bite must be based upon the safe restora- tion of the physiology of the tissues involved. The traditional treatment for freez- ing and frost bite is irrational. Vigorous rubbing with snow or ice (the traditional treat- ment) is poor because the small veins and capillaries in the frozen part or parts are already filled with small ice-crystals and the tissue is stiff and brittle. The part looks white or bluish-white. Since the circulation has ceased in the frozen part, any heat applied to it will not be conducted away. The tissue will be more sensitive to heat, and more easily damaged by heat if it is used to thaw the part. No temperature higher than the normal temperature of the body should be used in the treatment of frost bite. The person suffering from freezing should be removed to a moderately warm shelter and permitted to reestablish gradually the normal circulation without undue physical disturbance. When the patient can swallow, mild stimulants such as warm liquids may be given. The affected frozen part or parts should be immersed in water at a temperature of 99.5 degrees Fahrenheit—no higher—and allowed to remain without massage or manipulation until well thawed. Infection must be guarded against carefully after thaw- ing as the tissue vitality is very low and the danger of infection is markedly increased. When breathing has stopped artificial respiration should be used. When circulation has been reestablished to all parts of the skin, the temperature of the room can be gradually increased to normal room temperature (72 degrees F.). Wrapping the patient loosely in clean sheets and using gradually increased temperatures of water sprinkled on the sheets serves as a satisfactory method where room temperatures cannot be con- trolled readily. In either case all clothing should be removed from the patient. Poisoning. Poisoning is the effect produced by the action of poisons on the body, either internally or externally. Poisons are substances either in the form of liquid, solid, or vapor, which by their physiological action are injurious or destructive to life. They may be divided into two. general classes: Corrosive poisons. Produce burns (corrosive action) whether taken internally or applied externally. Most common are the caustic acids and alkalies. Non-corrosive poisons. Produce their effect by: Physiological action on the nervous system either stimulating or depressing the medullary centers, or affinity for the nerve tissue. Primary effect on the gastro-intestinal tract, causing irritation, inflammation, and swelling of the alimentary tissues. NOTE. Some poisons such as phenol and phosphorous may produce corrosive action and also produce a general effect on the body, whether taken internally or applied ex- ternally, if in sufficient amounts. Treatment of poisoning. There are few conditions which require more prompt action and where the effects of first aid may be more life saving than poisoning. The treatment, FIRST AID 561 providing there is no evidence of caustic action, consists of giving an emetic (produces vomiting) or using a stomach tube, the administration of a cathartic, and the use of an antidote. A specific antidote should be used if the poison taken is known; otherwise ad- minister a general antidote which will neutralize the majority of poisons. The destructive result of the poison before it was neutralized is then treated, whether it be local, general, or both. If there is evidence of caustic action, such as burned lips or tongue, do not give an emetic. Administer instead soothing oils, such as olive oil, cotton-seed oil, castor oil, and milk, internally. Give the proper antidote, if known. If an emetic is given to a patient suffering from corrosive poisoning the burned areas might rupture during vomiting. Since the poison is corrosive it would burn on the way up as well as down, thereby increasing the degree and extent of corrosive injury. If the proper antidote is not known, raw eggs and milk, flour and water, or hot strong tea, serve as antidotes. They also produce least irritation to the stomach mucosa and do not invoke vomiting. General antidote. A general antidote is one that is given in cases where the nature of the poison is not kpown. However, it should be determined whether corrosive action has occurred. Tannic acid (which is abundant in tea) is a precipitant of alkaloids and therefore antidotal to most of the vegetable poisons. Albumin which is found in eggs and milk is antidotal to mineral poisons. Special antidotes. Special antidotes are used to counteract certain specific poisons. For example: hydrated oxide of iron for arsenic poisoning, salt for nitrate of silver, magnesium sulphate (Epsom salts) for phenol and sugar of lead, copper sulphate for phosphorus, and potassium permanganate for opium. Emetics. An emetic is a substance which induces vomiting. Useful emetics are: mustard, ipecac, tartar emetic, zinc sulphate, or salt in hot water. The finger stuck down the throat may induce vomiting. Do not use an emetic or stomach pump in case of corrosive poisons. Common poisons and their antidotes. Some poisons are encountered more frequently than others. A few of these are listed with a brief description of antidotes and treatment, many of which, it is realized, will be unavailable for first aid treatment. Acids, mineral. Give solutions of sodium carbonate, magnesium oxide, lime water, chalk, plaster from the wall mixed with water, starch, milk, white of egg, or oil. Use no stomach pump. Acid, carbolic (phenol). Stomach tube or emetic, alkaline liquids, white of egg, Sodium sulphate or other soluble sulphates to hasten elimination from the circulation, warmth, and stimulants. Acid, hydrocyanic. Empty stomach, flush stomach with hydrogen peroxide, inject 1.0 c.c. hydrogen peroxide solution subcutaneously every 5 to 10 minutes until circulation improves, cold water on chest and inhalations of ammonia for respiration, atropine hypo- dermically and aromatic spirits of ammonia for circulation, artificial respiration, and fresh air. Aconite. Wash stomach or give emetic, tannic acid by mouth, stimulate heart, atropine subcutaneously, fresh air, artificial respiration. Alcohol, ethyl. Stomach lavage, or emetic, strong coffee, keep body warm and head cold, aromatic spirits of ammonia and ammonia to nose for respiration, and artificial respiration. Alcohol, methyl (wood alcohol). Follow above. Also give pilocarpine hydrochloride %-/2 grain, rectal injections salt solution, hot coffee, warm baths then cold effusions. Alkalies. Do not use stomach tube. Emetics—Copious drinks, tepid water, vinegar and water, orange or lemon juice, olive oil, whites of eggs, barley water, gruel, milk or linseed tea. Arsenic. Stomach lavage, official arsenic antidote (ferri hydroxidum cum magnessi oxide), oil, gruel, starch, mucilages, eggs, relieve pain with morphine. Belladonna (atropine). Stomach lavage or emetic, tannic acid, /2 grain pilocarpine, relieve pain, give stimulants. 562 Carbon monoxide. Artificial respiration in fresh air. Aerate the lungs as soon and completely as possible. Chloral hydrate (“knock out drops”). Empty stomach at once, 5 to 10 grain doses of citrated caffeine, stimulate heart, keep awake, artificial respiration in event of respiratory failure. Chloroform. If swallowed evacuate stomach, stimulate circulation, adrenalin into the heart if it has ceased to beat, hot and cold douches, and artificial respiration. Cocaine. Evacuate stomach, strong tea, inhalations of amyl nitrite, morphine for ex- citement, oxygen for asphxia, artificial respiration. Iodine. Wash out stomach, abundance of boiled starch, sodium thiosulphate, 20 grains, relieve pain. Lead compounds. Empty stomach, magnesium sulphate, milk and other demulcent drinks, morphine for pain. Mercury and copper compounds. Empty stomach, white of eggs, milk or chopped raw meats, potassium iodide 10 to 20 grains, every 2 to 3 hours, relieve pain, fresh water. For copper salts give pure potassium ferrocyanide 15 grains in glass of water. Mushrooms. Stomach tube, or emetics, castor oil and copious enemas, atropine hypo- dermically, stimulate, keep warm. Opium and its derivatives. Siphon out stomach and wash stomach with potassium permanganate solution, tannic acid, administer strong coffee, caffeine and atropine as physiological antidotes, keep awake, artificial respiration if breathing fails. Phosphorus. (Ratpoison and matches). Lavage stomach, wash stomach with water containing 4 c.c. of oil turpentine; charcoal or lime water, magnesium sulphate. Do not give fat or oil. Pilocarpine. Wash stomach or give emetic, tannic acid, atropine as physiological antidote. Silver compounds. Wash stomach with salt water, give salt solution, white of egg, or milk, relieve pain. Strychnine. Use stomach tube or emetic if time permits, control convulsions at once with chloroform or ether followed by chloral hydrate, morphine, or bromides. Give tannic acid by mouth. Veronal. Wash stomach with tannic acid solutions, castor oil, enemas, hot and cold douches, stimulate heart, morphine for excitement during recovery. MILITARY MEDICAL MANUAL FOREIGN BODIES In the Eye. Search the corners of the eye with a good light; foreign bodies over the pupil are hard to see. Evert the lower lid and examine it; evert upper lid (Plate 55) and examine. Foreign bodies may be removed by a cotton swab on a match stick. Never rub an eye having a foreign body in it. If the eye has been splashed with an acid, flush it with an alkaline solution such as soda water or lime water. If splashed with an alkali, use an acid solution such as diluted vinegar or lempn juice. In the Ear. Foreign bodies in the ear are usually insects, cinders, or vegetable matter. If a live insect enters the ear, hold a light near the ear, which will often cause the insect to come out. If not, lay the head on the opposite side and pour a few drops of light oil into the ear. This may kill the insect and float it out. An insect or cinder may be flushed out with water. Never use liquid to flush out vegetable matter, as this may cause it to swell to a larger size. In the Nose. Foreign bodies in the nose are easily expelled by closing the mouth and the other nostril and forcefully expelling air through the affected nostril. If the object is not vegetable matter the nostril may be syringed with warm water, which will often wash the foreign body out. If none of these methods are effectual the foreign body may be gently pushed back through the nose into the nasopharynx and recovered through the mouth. In the Throat and Larynx. Foreign bodies in the throat and larynx may be very FIRST AID 563 serious. If they completely cut off the air, asphyxia will result in a very short time. Attempt to dislodge the particle by making the patient cough and slapping him on the back between the shoulder blades. A child should be dangled by its heels and shaken in Plate 55. Removal of Foreign Bodies From the Eye. an effort to dislodge the foreign body. Frequently the object may be reached by passing a finger down the throat. If none of these treatments are of avail an emergency tracheotomy may be necessary. CHAPTER VII MEDICAL ASPECTS OF CHEMICAL WARFARE This chapter contains basic information on chemical agents, their behavior on the human body, the recommended first aid care and medical treatment of chemical injuries. Chemical warfare is used because of the effects that it is able to produce on the enemy personnel and animals. When gas casualties occur, they are produced in large numbers. This is particularly true if the agents are used in high concentrations with an element of surprise, against ill equipped and poorly trained troops. The term “gas” as used in warfare is used in a very general sense, including any chemical substance, solid, liquid, or true gas, which is employed for its poisonous, ir- ritant or vesicant effect on the body. In general these substances are dispersed into the air as vapors or as poisonous smokes which make the air dangerous to breathe. Some of' the agents, particularly the vesicant agents, will exert their vesicant effects on any portion of the body with which they come into contact in either the liquid or vapor form. A report from the British West Riding Casualty Clearing Station, which admitted 248 gas casualties in World War I, states: “The majority of cases of gas poisoning re- ceived at this hospital showed no sign of that condition.” Medical officers often had difficulty in determining whether they were dealing with men suffering from gas poisoning or not. This should stimulate all of us to make every effort to learn as much as possible about the gas casualty. For the tactical employment of chemical warfare agents and the measures of defense which are used to reduce their effectiveness see Chapter IX, Part I. CLASSIFICATIONS Several different classifications of chemical agents are possible according to the par- ticular characteristics considered. The three main systems of classification are those according to: 1. Physiological action 2. Persistency 3. Tactical use These three systems overlap at points in that a single agent may appear in more than one place in a single classification. However, the physiological classification is the one we are principally interested in from a medical standpoint. Physiological Classification: Lun% Irritant. An agent which, when inhaled, causes irritation and damage of the respiratory tract. Example: Phosgene. Vesicant. An agent which, on contact with the skin, produces erythema, blistering or necrosis of the skin. Example: Mustard. Lacrimator. An agent having its most pronounced action on the eyes, causing a copious flow of tears and intense, though temporary, eye pain. Example: Chloracetophenone. Irritant Smo\e or Sternutator. An agent usually disseminated as an extremely fine smoke or dust, and which when inhaled causes intolerable sneezing, coughing, lacrima- tion, headache, and nausea, all these effects adding up to produce temporary physical prostration. Example: Diphenylaminechlorarsine (Adamsite). Systemic Poison. An agent which, on absorption into the blood stream, directly inter- feres with physiological processes, such as utilization of oxygen by the body. Example: Hydrocyanic acid. An agent may act on the body in more than one way: i.e., Mustard vapor when inhaled is a lung irritant and when in contact with the skin is a vesicant agent. 566 MILITARY MEDICAL MANUAL Physiologically, the chemical agents are classified as: 1. Lung Irritants. a. Chlorine—Cl b. Phosgene—CG c. Chlorpicrin—PS 2. Vesicants. a. Mustard—HS b. Lewisite— c. Ethyldichlorarsine—ED 3. Lacrimators. a. Chloracetophenone—CN b. Chloracetophenone solution—CNS c. Chloracetophenone solution—CNB NOTE: In addition to the chloracetophenone, the British symbol of which is CAP, the British use two other lacrimators: (1) Ethyliodacetate (symbol—KSK). This is a dark brown, oily liquid with an odor resembling that of amylacetate (Banana oil). (2) Brombenzylcyanide (symbol—BBC). As employed in war, BBC is a heavy, oily, yellow liquid with a penetrating bitter-sweet odor, which is fairly persistent. 4. Irritant Smo\es. a. Adamsite—DM—Diphenylaminechlorarsine b. Sneeze gas—DA—Diphenylchlorarsine 5. Systemic Poisons. a. Hydrocyanic Acid—NCN b. Arsine—As H3 c. Hydrogen Sulfide—H2S d. Carbon Monoxide—CO Classification by Persistency. The length of time an agent will maintain an effective concentration in the air at the point of release is called the persistency of that agent. 1. Persistent agent: An agent which, under favorable conditions, produces concentra- tions against which protection is required for longer than 10 minutes. Example: Mustard. 2. Non-persistent agent: An agent against which, under the above conditions, no protection is is required after 10 minutes. Example: Phosgene. Classification by Tactical Use. a. Casualty agent. An agent which, in the commonly used concentrations, will produce casualties among enemy personnel. Example: Mustard. b. Harassing agent: An agent used to force the enemy to wear masks or take other protective measures which interfere with his normal activities. Example: Irritant smokes. c. Screening agent: An agent which produces a dense obscuring smoke, in air, thus reducing visibility in combat. Example: White phosphorus. d. Incendiary: An agent which upon ignition generates sufficient heat to ignite com- bustible material with which it comes in contact. While primarily used to destroy material, incendiary agents will cause casualties among troops hit by the burning agent. Example: Thermit. In the treatment of casualties resulting from exposure to chemical agents, we should realize that gas poisoning, whatever the chemical agent used, usually does not per- manently poison the patient or chronically impair his health. It is necessary to insist on this throughout lest the patient be allowed to develop a morbid trend and drift into neurasthenia and general debility. It is also of utmost importance that medical officers apply to themselves and to their men all possible means of protection—individual, collective and tactical—in order that they do not become contaminated and thereby become casualties. This is particularly true when dealing with an agent like mustard gas, for in low concentrations this agent has the property of desensitizing the olfactory nerves and, as a result, one could remain in this low concentration for an extended period of time and not realize its presence, and become a casualty through the cumulative action of the agent. MEDICAL ASPECTS OF CHEMICAL WARFARE 567 LUNG IRRITANTS Practically all chemical agents act as lung irritants under some conditions, but with chlorine, chlorpicrin, and phosgene this power to produce lung irritation under field conditions is their main characteristic. A latent period of reaction of from 1 to 12 hours or more may intervene between exposure and onset of symptoms. This is not true with high concentrations of chlorine, which may cause instantaneous death. The general knowledge that a latent period exists may lead to malingering and will tax the diagnostic ability of the surgeon. The fact that a cigarette is unpalatable during the latent period helps to detect malingering. However, suspected lung irritant cases must be given the benefit of the doubt and a 24 hour observation period is the usual procedure. These agents cause irritation and damage to the respiratory passages with resulting inflammation and devitalization of the air cells in the pulmonary alveoli. The inflam- matory process spreads to all the lung tissues and causes a pouring out of fluid from the pulmonary circulation. This condition results in “pulmonary edema,” which interferes with the air cells making the proper interchange of oxygen and carbon dioxide, and contributes to the development of an anoxemia. The edema is entirely different from that which we see in cardiac decompensation for instance, because here there is chemical damage to the tissues lining the alveoli, and chemical damage to the blood vessels. Multiple thrombi in the lung and increased viscosity of the blood both interfere with pulmonary circulation and add to the anoxemia. The increased resistance to the pulmonary circulation plus anoxia of the cardiac muscle leads to cardiac failure. Initially the load is thrown on the right side of the heart and later there is a general cardiac collapse. Respiratory embarrassment becomes more and more evident as the fluid accumulates in the alveoli and finally in the air passages. Asphyxiation re- sults. The man actually drowns in his own fluids. All of these agents are much alike, all contain chlorine, but the big difference is that they attack different levels or parts of the respiratory tract. It is most improbable that chlorine will ever be used in the field again. PHOSGENE— CG. Physical Properties. At low temperature phosgene is a clear, colorless liquid, which in warm weather will form a gas or vapor under field conditions. The vapor density of phosgene as compared to air is 3.4. Due to this high vapor density a phosgene cloud will hug the ground until it is much diluted with air, unless it is carried upwards by convection currents. Persistency. Since phosgene is a gas under ordinary summer conditions, it will have practically no persistence and will disappear from any given locality as fast as the wind blows in that particular place. In cold winter weather when it is in the liquid form, if sprayed or splashed on the ground, it will have a slightly greater persistency than in warm weather, but even in winter its persistency will range between one and ten minutes. Tactical Use. Phosgene is used tactically to produce casualties. It may be utilized up to within thirty minutes of the time friendly troops expect to occupy the target area. Detection. Phosgene is best detected by means of its odor which is strong and un- mistakably and is variously described as being like insilage, new mown hay or cut corn. Protection. The service gas mask affords complete protection against phosgene. Pathology. The delayed reaction of this agent is outstanding, even relatively high concentrations may be breathed without irritation of the respiratory passages, thus allow- ing the gas to come in contact with the most distant bronchioles and alevoli of the lungs. Phosgene is extremely toxic and has a cumulative effect even in low concentrations. The severe pulmonary edema which ensues on inhalation is caused by hydrolysis of the gas to produce carbon dioxide and release hydrochloric acid. The acid is most irritating, increasing the permeability of the alveolar and capillary walls and causing pulmonary edema. The loss of edema fluid leads to hemoconcentration and marked increase in the viscosity of the blood. Pulmonary thrombosis is common. These factors throw a tre- 568 MILITARY MEDICAL MANUAL mendous load on the right heart, cause a decrease in the oxygen content of the blood and an accumulation of carbon dioxide. This is the characteristic blue stage of asphyxia. The blue color results from the oxygen lack and is manifested by vaso-dilation of the superficial capillaries due to the accumulation of carbon dioxide. The pulmonary edema progresses and the carbon dioxide, being more soluble in the waterlogged tissues than is oxygen, passes out ot the blood stream into the edema fluid. The patient then lacks the natural stimulus to the respiratory center or an acapnia develops. He is unable to breathe deeply or even make a fight to maintain his own breathing. (J. S. Haldane.) The cardiac muscle becomes more and more anoxic and general cardiac failure results. The decrease of carbon dioxide in the blood allows a constriction of the superficial capillary vessels and the patient assumes the grey color characteristic of the “grey type asphyxia.” Another explanation of the pathology in the grey stage is that there is no decrease in the carbon dioxide content of the blood but the respiratory center, due to over stimulation, becomes resistant and fails to respond. As the patient goes into shock there is a splanchnic dilation and the blood leaves the superficial vessels and goes to the deeper circulation accounting for the change of color of the skin. Symptoms. During the latent period of 12 to 24 hours the patient is absolutely symptomless. You will have difficulty in convincing him that he has been gassed and that absolute rest is imperative. The pulmonary edema develops suddenly and dra- matically, or it may come on gradually. The usual chain of symptoms is redness of the eyes, flushing of the face, increased respiratory rate but inability to breathe deeply, and occasionally a slight cough. The cough is uncommon because there is slight irritation to the upper respiratory tract. Physical examination of the chest will be negative during the latent period. In the more severe cases, as the symptoms progress the patient attempts to cough up the bloody, frothy sputum, and the face takes on a deep cyanosis with increased engorgement of the veins of the neck. Even at this stage chest examination may be negative. We do sometimes find an increased per- cussion note; intensified breath sounds, and vocal fremitis; fine rales may be heard over the back and sides and in the axillae; and rough ronchi over the upper chest. The patient may suddenly or gradually go into the grey type of asphyxia, developing general cardiac failure, with fall in blood pressure, collapse of veins of the neck, and cold clammy skin, with a greyish leaden hue, usually associated with an accumulation of fluid in the respiratory tract. Occasionally the blue stage is so transitory that it will pass unrecognized and the patient go directly into the grey stage. Diagnosis. Diagnosis is based upon history of exposure and the onset of the symptoms as described above. First Aid. First aid is the insistance on absolute rest for the phosgene case and general measures to prevent shock. The medical officer makes his recommendation and the commanding officer decides whether he can comply with that recommendation. Medical Treatment. Complete rest is imperative. Apply heat by blankets, extra coats, and hot drinks. Venesection (bleeding) is indicated in the blue cases, and oxygen should be given when it is available. Even when these patients become restless or apprehensive it has been found that they do badly on alcohol or morphine. Morphine should never be given to the phosgene case. This dictum is based on experience in the First World War Barbiturates in small, guarded dosage may be used. Venesection is universally beneficial during the blue stage. First, it helps to decrease the number of alveolar and capillary thrombi. Second, because of the pulmonary cir- culatory resistance and increased viscosity of the blood, bleeding helps to relieve the load on the right side of the heart. Third, the total amount of carbon dioxide in the blood stream is decreased. 400 to 600 c.c. of blood should be withdrawn as early as possible, and another 500 c.c. may be removed 6 hours later and the procedure may be repeated later if necessary. Venesection should never be used in the grey or collapse stage. It would seem logical at first glance that because of the marked increase in the vis- cosity of the blood that some type of dilution such as intravenous plasma, gum acacia, MEDICAL ASPECTS OF CHEMICAL WARFARE 569 hypertonic glucose, pectin would be indicated. Whole blood transfusions or saline might seem to be indicated. It would seem that the osmotic pull exerted by most of these sub- stances would decrease the amount of fluid in the lungs. Such is not the case. If we will remember that the chemical damage to the alveolar and capillary walls is still present, then we will realize that putting more fluid into the blood stream will only furnish more blood to leak through into the lung tissue and increase the pulmonary edema. Experimentally it has been proved that intravenous fluids such as plasma, pour right through the damaged walls of the capillaries because of their increased permeability, and can be recovered quantatively from the alveoli. Intravenous fluids are contraindicated. Cardiac stimulants, such as digitalis, caffein, and coramine are of little or no value in combating the cardiac failure. It is much like flogging a horse bogged down under a heavy load and already doing all that he can. Oxygen will relieve the cardiac muscle anoxia and venesection will relieve the load on the heart. Oxygen. We can never say when or where oxygen will be available for field use be- cause of the weight of the oxygen cylinders and problem of transporting them, but when it is available it can be used to great advantage once the pulmonary edema and anoxemia develop, because of the interference of the gaseous exchange in the lungs. Clinical ex- perience has shown that there is no advantage to using oxygen-helium since there is no bronchial spasm or occlusion. Also, oxygen-carbon-dioxide mixture is said to have no advantage over plain oxygen. The administration of oxygen by using the efficient nasal mask for 3 or 4 minutes out of every 15 will suffice as a rule. Treatment must be continued night and day as long as cyanosis lasts. The nasal catheter or funnel may be used when nothing better is available. An efficient method of administration used in France during World War I was the employment of oxygen balloons. These were oblong balloons made of rubber much like the texture of the gas bag on a modern anesthetic machine. They had a short tube attached with a flanged opening at the loose end, so that it could be held in the mouth by the patient. The balloon was sealed by means of a clamp on the rubber tube opening that was readily released. The nose of the patient was clamped, the mouthpiece placed in his mouth, and the operator forced oxygen into the lungs by pressure on the balloon when administering to a casualty in the grey stage. Artificial respiration was thus simulated by applying and releasing pressure on the oxygen balloon. 5. Artificial respiration as we ordinarily think of it, i.e., by applying and releasing pressure on the thoracic cage, is contraindicated. Prognosis. The prognosis should always be guarded because of the insidious nature of the poisoning. The milder cases recover without sequelae. 80% of the deaths occur during the first 48 hours after exposure. If the casualty lives through this critical period he will usually survive. When death does occur after some days, it is due largely to broncho-pneumonia. Occasionally chronic pulmonary diseases, such as bronchitis or bronchiectasis are sequelae of phosgene poisoning. Statistics on follow-up studies of World War I cases lead us to believe that pulmonary tuberculosis never results from this gas, although psychosomatic pulmonary complaints often continue for years. The prognosis is much more grave for the grev or pallid cases than for the blue cases. CHLORPICRIN—PS Physical Properties. Chlorpicrin in the pure state is a colorless, oily liquid; the plant run product has a faint yellow color. It is practically immiscable with water which makes separation easy. It is not decomposed by water. Persistency. Chlorpicrin is more persistent but less toxic than phosgene, and is there- fore classified as a moderately persistent lung irritant. Its greatest advantage lies in its great chemical stability which makes it much more difficult to protect against than many other agents. In the summer it will persist one hour in the open and four hours in the woods, while in winter, twelve hours in the open and one week in the woods. Tactical Use. To produce casualties. Detection. Like phosgene, chlorpicrin is best detected by the odor which is described 570 MILITARY MEDICAL MANUAL as a sweetish odor somewhat resembling the odor of flypaper. Often chlorpicrin will be detected by its lacrimatory effect before it is detected by the odor. Protection. The service gas mask gives complete protection against chlorpicrin. Pathology. Chlorpicrin attacks the lung tissue in a manner similar to the action described for phosgene, although the pulmonary edema is less severe and pulmonary thrombi are less common. Like chlorine, and contrary to phosgene, chlorpicrin attacks the air passages. This causes edema of the epithelial lining of the bronchi and plugging of their lumina with a resultant pulmonary emphysema. Kidney damage and nephritis may be present. Symptoms. The symptoms are similar to those from phosgene except that there is more irritation of the respiratory tract, coughing, lacrimation, nausea and vomiting are more common. In fact this agent is sometimes referred to as the “vomiting gas.” Diagnosis. Diagnosis is based on a history of exposure, odor of flypaper on clothing, lacrimation, respiratory tract irritation, and pronounced nausea and vomiting. First Aid. The therapy is the same as for phosgene. Medical Treatment. The same as for phosgene. Prognosis. Sudden death is much rarer than from chlorine and the outcome is de- termined by the severity of the pulmonary edema present. Sequelae, such as chronic bronchitis and emphysema, may occasionally follow poisoning by chlorpicrin. CHLORINE—CL Physical Properties. Chlorine is a heavy greenish-yellow gas having a disagreeable chlorine odor and a powerful irritating effect upon the membranes of the nose and throat. It is one of the few truly chemical warfare gases. Most of the others are either liquid or solid at ordinary room temperatures. It is slighdy soluble in water. Persistency. Vaporizes almost immediately under field conditions. Drifts as gas with the wind but, being heavier than air, clings for some time in trenches, shell holes, woods and other low or protected places. Tactical Use. It is used as a casualty producing agent but, because it is so easy to pro- tect against chlorine, it probably will not be used again in the field. Detection. Chlorine is detected by its characteristic pungent odor. Protection. The service gas mask. Pathology. It is characteristic of chlorine to attack the epithelial lining of the upper respiratory tract, i.e., naso-pharynx, trachea and bronchi. It also attacks the eyes. It may cause considerable damage, even extensive necrosis to the mucous membrane, but the damage to the lung tissue itself and the resultant pulmonary edema are relatively less than from chlorpicrin or phosgene. Since chlorine is more irritating to the air passages and more soluble in the moisture there, spasm of the walls of the respiratory tract is commoner. Symptoms. When high concentrations of chlorine are inhaled there is no latent period as with the other lung irritants. Severe symptoms will be manifested immediately. Chlorine causes a stinging sensation of the eyes and lacrimation. There is a burning sensation in the throat, paroxysmal coughing and a feeling of suffocation. When lower concentrations are inhaled pulmonary edema supervenes (in a shorter time than from phosgene), sometimes as soon as 20 minutes after exposure. Diagnosis. 1. History of exposure. 2. Odor of chlorine 3. Irritation of eyes 4. Irritation of respiratory tract 5. Choking paroxysmal cough 6. Pulmonary edema 7. Persistent bronchitis First Aid. Same as for phosgene. Medical Treatment. The same in all respects as phosgene. MEDICAL ASPECTS OF CHEMICAL WARFARE 571 Prognosis. Sudden death may result from high concentrations. Prognosis is poor when pulmonary edema develops. Persistent pulmonary emphysema and chronic bronchitis are frequent sequelae. VESICANT AGENTS At the outbreak of World War I, over seventy vesicant compounds were known to science, yet only five were actually identified with the war. Of these but two, mustard and ethydichlorarsine, were actually used while the other three, lewisite, methyldich- lorarsine, dibromethylsulphide, were in the process of investigation or manufacture at the end of the war and were not actually used in battle. Mustard gas was used widely by both sides and proved to be so effective that it became the principal battle gas of the last year of the war. The vesicants are very soluble in the substance of animal Plate 1. A Chinese Casualty Caused by Gas That Was Laid by the Japanese. tissue, have weaker chemical affinities for living matter than the lung irritants; there- fore, they disintegrate more slowly and penetrate further into the tissues of the body, thus greatly enlarging their field of action. The vesicants are employed primarily for their action on the skin, although they also cause irritation to the eyes, respiratory tract and lungs. There are two types of 572 MILITARY MEDICAL MANUAL vesicant agents, i.e., those that cause surface irritation (mustard) and those that cause surface irritation plus internal poisoning. These latter are the arsenicals, lewisite and ethyldichlorarsine. Lewisite was first isolated and described by Professor Lewis of Northwestern Uni- versity, Evanston, Illinois. Although never manufactured in large quantities nor used during World War I, it has been used by the Japanese against the Chinese in the present conflict. (See Plate 1.) British Chemical Warfare Service. Plate 2. A Severe Mustard Burn Showing the “Doughnut” Shaped Lesion. MUSTARD—HS Physical Properties. Mustard is a heavy, oily liquid, the plant run product is dark and evaporates slowly. At ordinary temperatures high concentrations are not usually ob- tained by vaporation from the ground. Vaporation is hastened by airplane sprays and the explosion of shells containing liquid mustard. Mustard is practically insoluble in water, but is soluble in hydrocarbons and most organist soluents (gasoline, kerosene, carbon tetrachloride, carbon disulphide and even lubricating oil). In water the soluble fraction rapidly hydrolizes into non-toxic substances, producing hydrochloric and thiodi- glycol. Mustard is readily dissolved by rubber. Persistency. Summer—four to five days in the open, one week in the woods; winter— several weeks both in the open and in the woods. Tactical Use. To neutralize areas, to produce casualties, and to deny ground through threat of casualties. Mustard is best disseminated by means of a small caliber artillery shell; by searching fire so as to produce the greatest possible number of contaminated spots. This also pre- sents a greater surface for vaporation to take place from, and therefore high concentrations of the vapor are obtainable in the air. Due to the high persistency, is it not necessary to use this gas on occupied targets, but it may be utilized to deny ground through threat of casualties. Detection. Mustard gas is best detected by means of its odor in low concentrations. The odor is usually described as being like garlic, horseradish, or onions. In high concentration it is decidedly pungent and irritating. (Caution: In low concentration, mustard gas will desensitize the olfactory nerves so that one can remain in the con- taminated area without realizing the danger.) Protection. The gas mask is required for the protection of the face, eyes, and respiratory tract. Protective clothing and ointment are necessary for the rest of the body. MEDICAL ASPECTS OF CHEMICAL WARFARE 573 Pathology. When mustard in a liquid or vapor form comes in contact with the skin or mucous membrane it causes irritation and burning. It will attack the conjunctiva of the eyes and may attack the mucous membrane lining the respiratory tract, in which case the greatest destruction is caused to the upper respiratory tract, i.t., the nose, mouth, larynx, trachea and bronchi. In addition mustard does have lung irritant properties. There is edema of the epithelial lining of the bronchioles that leads to partial or com- plete obliteration of the lumina and eventually to a desquamation of the bronchiolar epithelium. This destruction is patchy in arrangement and not generalized throughout the lung. Pulmonary edema and emphysematous changes are seen in microscopic exami- nation of the lung tissue, but this likewise is a patchy arrangement and not generalized. Mustardized victims do not suffer the respiratory suffocation that we see in the phosgene patient, and when death occurs from mustard, it is due to a secondary injection and the development of bronchopneumonia, not directly to the mustard gas. There is an initial British Chemical Warfare Service. Elate 3. A Mustard Burn Showing Large Singular Blister, Surrounded by an Area of Erythema. leukocytosis and, although mustard is not generally thought to have a systemic reaction, we know that it attacks the bone marrow to some extent after two or three days and causes a leukopenia. The abundance of necrotic tissue in the wound and lack of ade- quate blood supply form a good culture media for bacterial infection. All of these factors, together with the easily accessible portal of entry for the organisms, may explain why they are so difficult to combat. If there is sufficient tissue destruction within the lungs, chronic bronchiectasis or even lung abscess may result, although this is certainly the exception rather than the rule. As to the skin vesication that takes place, it is undetermined whether it is due mainly to a specific effect on certain enzymes or a general effect on the structural elements of the tissues. We know that vesicants in general have a powerful inhibitory effect on carbohydrate metabolism. It is now believed that mustard acts as a whole molecule in causing the destruction of the skin and not by forming hydrochloric acid or because of the sulphur element present. 574 MILITARY MEDICAL MANUAL Mustard is highly soluble in lipoids and penetrates the skin along the hair follicles and in the sebaceous glands. The mustard molecule causes an irritation of the skin and capillaries in the affected area that results in a hypermia or redness. There is a loss of plasma through the injured walls of the capillaries that results in local edema. When only a vapor burn is sustained this may be so far as the pathological process goes, but if liquid or droplets of mustard are present the plasma continues to escape from the injured capillaries, the edema increases, and the skin in the center of the area be- comes very tight and the casualty becomes aware of the burn because of the onset of pain. The local loss of fluid becomes so great that there is a separation of the epidermis from the dermis and blister formation. When a considerable quantity of the mustard is present there may be so much tissue damage in the center of the burned area that tissues cannot react and we have the characteristic doughnut-shaped lesion (See Plate 2), with the severely damaged, white, indurated tissue surrounded by the vesicle formation of the less damaged tissues. The other characteristic type of lesion from a lesser amount of mustard is large, singular, tense blisters filled with clear fluid and surrounded by an erythematous area of tissue reaction to an even smaller concentration of the agent. (See Plate 3.) In the severe burns, after blister formation, there is an actual death of the cells with necrosis and ulceration. Pyodermia or secondary skin infection is common. The damage that mustard gas causes to the pigmentation layer of the skin results in a brownish discoloration, giving it a blotchy appearance. This has sometimes lead to these patients being referred to as “Chemical Lepers.” Symptoms. In many instances the first effect noticed is the irritation and inflammation of the eyes and eyelids. Mustard, either vapor or liquid, is painful in the eyes after a lapse of a few hours, depending upon the concentration. It feels like a grain of sand and causes smarting and copious lacrimation. The eyeball becomes glazed over with the increased flow of tears and has the appearance of ground glass instead of being crystal clear. Photophobia and blepharospasm are present. Characteristically, we see a capillary injection of the sclera that is eliptical in outline, i.e., it conforms to the shape of the palpebreal fissure, because that is the portion of the eyeball first exposed. The agent is then spread over the eye by the movements of the eyelids, and the capillary injection becomes generalized over the sclera. Eventually a chemosis develops. Liquid burns are very serious and lead to ulceration and destruction of the cornea. When the eyes have been protected by an eyeshield such as the British use, or the gas mask, the skin shows the first reaction, and that is a severe itching. The insidious onset of the skin reaction may be from one to six hours with liquid mustard and twelve or more hours with a vapor bum. In this delayed action mustard resemhles a sunburn or an X-ray burn. The time reaction depends to some extent on the skin sensitivity of the individual. During the delay period a mustard burn is absolutely painless, but after the erythema and the edema set in due to tissue reaction, the mustard burn is painful. The blisters that form are large, single, tense blisters, containing fluid and surrounded by an area of redness; or we may see the characteristic doughnut-shaped blister pre- viously described. The moist areas of the body and those parts subjected to friction are usually the most severely burned from mustard vapor; these are the perineum, genitalia, axillae, elbows, knees and neck. When mustard gets into the respiratory tract it causes sneezing, increased nasal secretion, and a hoarseness that is characteristic. Throat irritation, cough, nausea and pain in the epigastrium may develop later. Bronchopneumonia is a common complication. Diagnosis. The essential factors upon which diagnosis is based are as follows: 1. History of exposure. 2. Mustard (horseradish, onion, or garlic) odor on skin or clothing. 3. Eyes—Irritation, pain and redness of the conjunctiva. 4. Nose—Irritation, redness of the mucous membrane, and increased nasal secretion. 5. Mouth and throat—hyperemia, hoarseness. 6. Skin: a. Delay reaction 2-12-24 hours after exposure. b. Severe pruritis (itching). c. No pain during insidious onset. d. Erythema followed by blister. e. Large, singular, tense blisters containing clear fluid, surrounded by area of erythema. ./. Large doughnut-shaped lesions. g. Secondary pyodermia common. h. Does not burn structures beneath the skin. i. Pigmentation common. 7. Systemic: Tendency to attack bone marrow and white blood cells. 8. Mustard rarely causes death and then only due to complications. MEDICAL ASPECTS OF CHEMICAL WARFARE 575 British Chemical Warfare Service Plate 4. Showing the Time Element Involved in the Protection Given by Protective Ointment. First Aid. We cannot emphasize strongly enough that THE FIRST AID CARE OF THE VESICANT CASUALTY IS AN INDIVIDUAL PROPOSITION. He should remove all of the free mustard by blotting the contaminated area with a cloth or first aid bandage. Each individual soldier must carry his own protective ointment and be thor- oughly instructed as to the best method of applying it and, above all, the necessity for immediate application. (See Plate 4) If he waits until he can get to a medical officer the damage will have been irreparably done. When the clothing is contaminated it is desirable to remove it as soon as possible. Immediate removal of all the clothing is impracticable when the soldier must remain in the area. In that case the clothing would be left on as the resultant vapor burn would be less severe than a liquid burn from exposing the entire body to the agent. When small portions of the clothing are contaminated that portion of the clothing can be cut away and the underlying skin covered with protective ointment. 1. Eyes: a. Repeated or continuous irrigation of the eyes with plain water. The canteen cap can be used as an eye cup. b. The eyes must not be bandaged as the pressure may cause corneal irritation. c. The eyes should be protected from strong light. d. Protective ointment must not be used in the eyes or around the eyes. 576 MILITARY MEDICAL MANUAL 2. Skjn lesions: The immediate application of protective ointment by robbing it into the area, taking care not to spread the agent to uncontaminated areas. The ointment should then be wiped off and the procedure repeated two or three times. The protective materials, such as bleach solution or sodium hypochlorite (Dakins Solution), containing active chlorine should not be left on the skin for more than a few minutes. If protective ointment is not available an effective paste may be made by mixing 1 part bleach to 1 or 2 parts water. Dry bleach must not be used on a mustard burn as the heat generated will cause further injury. Medical Treatment. The definitive treatment of injuries caused by chemical agents does not differ from that of similar conditions occurring from other causes, except that the chemical agent must be removed or neutralized as soon as possible. The after treatment of a burn from mustard is the same as the treatment of any other burn of like degree. Eyes: Continuous irrigation, using 2% boric acid solution, 2% sodium bicarbonate, normal saline or plain water. 2% butyn may be used to relieve the pain. Shield the eyes from strong light but do not bandage them. Do not use borax, carbonate of soda or cocaine in the eyes. Cocaine causes corneal irritation, desquamation and ulceration. In severe conjunctival or corneal cases, when an iritis or keratitis is present a bland oil should be instilled, such as alkaline cod liver oil, castor oil with acriflavine or glycerin. Instill atropine ointment or 1% atropine solution every day until the symptoms of iritis subside. When the eye discharge becomes purulent 10% argyrol followed by boric acid solution should be used. One of the new sulfonamide opthalmic ointments may be tried. It is most important that we know whether the man has sustained a vapor burn of the eyes or a liquid burn of the eyes, because our treatment will be, in most cases, effective against vapor burns, but it will be much less effective against the liquid burns of the eyes. We must assure the man with a vapor burn that he is not going blind. Sbin: First, remove the excess mustard by blotting with dry pads, cloths, or waste. Second, sponge the area with a solvent such as alcohol, gasoline, kerosene, or benzine. Third, wash the skin area with soap and water. Fourth, apply a neutralizing agent, such as protective ointment, dischloramine “T,” Dakins Solution, or bleach paste. These agents should be removed after 2 or 3 minutes. If no excess mustard is present or if erythema is already present these steps are to be omitted. The burn would then be treated as a burn from any other cause. The blister may be left intact and painted with amyl salicylate solution. This solution tends to dry the blister and form a protective covering for the area. If a debridement is indicated the tannic acid treatment for ordinary burns is recom- mended for further treatment of these denuded areas. The tannic acid solution followed by 10% silver nitrate is also used to form an eschar. On flexor surfaces, where the tannic acid treatment is not applicable, triple dye solution or 1% gentian violet solution may be used. Cod liver oil ointment has its advocates, as do the new sulfonamide drugs, such as ointments, creams, sprays or powders. When the sulfadiazine, triethanola- mine, methocel spray solution is used be on guard for a toxic dermatitis. Prognosis. The prognosis is usually good. The vapor burns of the eyes rarely, if ever, cause blindness, while the liquid burns will cause a very high percentage of blindness. Vapor burns of the skin heal fairly rapidly, with no residual deformity. The liquid burns of the skin are slow in healing and secondary infection is common. The majority of deaths are from bronchopneumonia secondary to pulmonary irritation. The long-range prognosis is good. Although many prolonged after effects have been blamed on mustard, actually these are the exception. Once a man is free from septic complications, he should be discharged from the hospital to a convalescent center, where a well-ordered routine of exercise, employment, amusement and rest will quickly restore him to a state of physical fitness. Medical officers with special aptitude will find these cases a fertile field for restoring morale and mental fitness. MEDICAL ASPECTS OF CHEMICAL WARFARE 577 LEWISITE—M-l Physical Properties. The plant run product is a dark brown liquid. Lewisite is soluble in absolute alcohol, benzene, chlorine liquid, petrolatum, and many other organic solvents. It is practically insoluble in water but hydrolizes readily with the formation of hydrochloric acid and a solid, toxic vesicant oxide (chlorvinylarsenious oxide). Since this hydrolysis produces a solid, vesicant, and toxic oxide, it does not evaporate and therefore contaminated areas remain dangerous for long periods of time. The water supply in an area contaminated with lewisite may be poisoned by the oxide regardless of its slight solubility in water. Persistency. Lewisite is less persistent than mustard. Summer—twenty-four hours in the open, two to three days in the woods; winter—one week or more. The chief usefulness of this agent is under conditions that minimize hydrolysis, i.e., cold weather and hot, dry areas. Lewisite vapor is more effective than mustard vapor in cold weather, but the reverse is true in damp or wet weather. Tactical Use. To produce casualties. To deny ground thru threat of casualties. Plate 5. A Lewisite Burn on the Hand. British Chemical Warfare Service Detection. Lewisite has a faint, somewhat unpleasant odor, at first resembling geraniums, then biting. Smelling it causes a very disagreeable burning sensation in the nose and throat and sometimes violent sneezing, often accompanied by nervous depression. Protection. Service gas mask protects the face, eyes, and respiratory tract, but protective clothing and protective ointment will be required for the rest of the body. Pathology. The pathology caused by lewisite is much like that described for mustard, except that the action is much more rapid. The reaction takes place in a matter of seconds—not after a delayed period. The lesions progress through the stages of erythema, vesiculation, necrosis and ulceration. The blisters tend to be smaller and more numerous than we see in mustard burns. (See Plate 5). There is no area of erythema surrounding the blisters and the fluid in the blisters is cloudy. The lewisite is rapidly absorbed into the skin and converted into a water soluble called “lewisite oxide.” In the first 24 hours the lewisite is carried by the red blood cells and later arsenic can be found in all the tissues of the body. It is excreted by the liver through the bile passage into the intestine and in the urine via the kidneys. Lewisite causes damage to the capillaries, increasing their permeability and permitting a leakage of plasma, giving rise to a condition resembling traumatic shock. Inhalation produces 578 MILITARY MEDICAL MANUAL ulceration of the upper respiratory tract, secondary anemia and occasionally broncho- pneumonia. Because of the arsenical content the blister fluid is vesicant. Various toxic changes may be found in all the viscera, such as intense hemorrhagic necrosis of the lungs, liver and gall bladder. The tubules of the kidneys may become obstructed. Symptoms. The onset of symptoms is much earlier and they are more severe than with mustard. There is irritation, pain and conjunctivitis, sneezing, nasal irritation and increased nasal secretion. Erythema of the skin develops within 15 to 30 minutes after exposure and the bullae next appear, reaching their peak in 12 hours, or less. They contain a cloudy fluid and there is no area of erythema surrounding the blisters, (see Plate 6). Lewisite burns are painful as contrasted with the mustard lesions. The symp- toms of general arsenical poisoning appear when the agent is allowed to act untreated. Diagnosis. 1. History of exposure. 2. Odor of geraniums, then biting. 3. Eyes—prompt irritation, pain, and lacrimation. 4. Nose—sharp burning sensation, sneezing and increased nasal secretion. 5. Skin: a. Immediate reaction within 15 seconds. b. Pruritis mild. c. Rapid onset of severe pain. d. Blister covers the area of erythema. e. Blister fluid cloudy. /. Secondary infection of blister uncommon. g. Blister fluid is itself vesicant. h. Burns through the skin into the muscle. i. Pigmentation is less severe than in mustard burns. 6. Systemic: Attacks the red blood cells. May cause hemalytic anemia, liver degeneration and/or cellular debris in tubules of kidneys. 7. Result: Lewisite burns may result in death. 1 c.c. or 1/30 oz. on the skin will kill a man from the arsenic he would absorb. 8. Excretion: In bile and urine. First Aid. Eyes. Continuous irrigation with water. It is true that lewisite oxide which is itself irritating will be formed, but the mechanical removal by continuous irrigation will remove that also and lewisite oxide is less irritating than undiluted lewisite. If each individual soldier has eye solution Ml it should be used immediately. Sfiin. This is perhaps the most important phase of medical care of the casualty. Lewi- site has an immediate action beginning in 15-30 seconds. For the protective ointment to be of any benefit it must be applied within the first minute after exposure. The pro- tective ointment must be applied as described for mustard and 2 or 3 applications made. Medical Treatment. Eyes. Same as described for mustard. It has been suggested that .5% hydrogen peroxide be used in the eyes. Hydrogen peroxide is itself irritating to the eyes and probably would do more harm than good. Eye solution Ml is the treatment agent of choice when it is reasonably certain that lewisite is the contaminating agent. Eye solution Ml is used by dropping 2 to 4 drops of solution directly on the cornea of each eye and allowing it to remain. In case of blepharospasm the solution may have to be placed in the inner canthus and allowed to penetrate onto the cornea as best it may. The Eye Solution Ml is to be used once only and is not to be repeated. When eye solution Ml is not available, 2% sodium bicarbonate solution, normal saline or plain water may be used to irrigate the eyes. 2% butyn solution may be instilled to relieve pain and discomfort. S\in. Mechanical removal as described for mustard. After the skin has been thor- oughly washed with soap and water, all the blisters must be opened to prevent further absorption of the arsenic in the blister fluid. The skin surrounding the blisters should be protected by the application of vasoline because of vesicant properties of the blister fluid. The danger of systemic poisoning can be lessened by prempt application of 8% solution of hydrogen peroxide. The peroxide should be freely applied to the affected area with a swab for 2-3 minutes; and then a piece of gauze saturated with peroxide should be left in close contact with the skin for 1-2 hours, or longer if possible. The contaminated clothing should be removed as soon as practicable. The after treatment of the burn is the same as any other burn. When pulmonary irritation is present, sulfadiazine or sulfanilamide may be tried prophylactically or therapeutically to combat pneumonia; cardiac stimulants are used when indicated. Whole blood transfusions, liver extract and iron are indicated for the secondary anemia. Oxygen is useful to combat anoxemia. A high carbohydrate, high vitamin diet and adequate fluid intake and output help to combat arsenical poisoning. Prognosis. Lewisite is more dangerous than mustard. Vapor or liquid burns of the eyes are both serious. Vapor burns or liquid burns of the skin are always dangerous because of the likelihood of a fatal arsenical intoxication when untreated. Liquid burns are slow healing because they are deeper than mustard burns. The whole thickness of skin and even the underlying muscle tissue may be destroyed so that skin regeneration is impossible and a plastic closure of the burned area becomes necessary. Broncho- pneumonia is a dangerous sequel to lewisite inhalation. MEDICAL ASPECTS OF CHEMICAL WARFARE 579 British Chemical Warfare ServiceBggR^j Plate 6. The Difference Between Lewisite (Left) and Mustard (Right) Burns. REMARKS: The possibility of the enemy using a mixture oi mustard and lewisite must not be overlooked. The lesions of course would have the characteristics of lesions of both agents and the treatment would be a combination of the mustard and lewisite treatment. ETHYDICHLORARSINE—ED Physical Properties. ED is a colorless liquid that turns slightly yellow upon aging. It is soluble in alcohol, ether, ethylchloride, benzene, and acetone. It hydrolizes slowly to form ethylarsenious oxide and hydrochloric acid (the hydrolysis product is toxic, if swallowed). Persistency. Summer—one to two hours in the open, two to six hours in the woods; winter—two to four hours in the open, twelve hours in the woods. Tactical Use. To produce casualties and act as a harassing agent. Detection. The odor is vaguely described as being biting or irritant. (ED is difficult to classify according to its physiological action as it falls into three classifications. It acts as a lung irritant with a toxicity approximately equal to that of phosgene. It is also a power strenuator with about 1/5 the irritant effect of difenelchlorsine and it is also a moderately powerful vesicant agent with about 2/3 the skin irritant power and 1/6 the vesicant power of mustard. Protection. The gas mask and protective clothing. Pathology. Irritation of the eyes, nose, naso-pharynx, and lungs may occur. In fact any of the pathology described for lewisite may occur though vesication of the skin 580 MILITARY MEDICAL MANUAL is less than with lewisite or mustard. Arsenical involvement of the viscera occurs and post arsenical involvement of the nerve fibers are manifested. Paronychial swellings of the fingers is a common finding. Symptoms. The eye symptoms are similar to those seen from lewisite. The irritation to the mucous membrane of the nose may be immediate or delayed; and the delayed reaction may cause the untrained person to believe that his gas mask is ineffective or leaking and cause him to remove it, thus getting a larger dose of the agent. Other symptoms are very similar to those described for lewisite, except that there is less vesication. Diagnosis. Based upon the following factors: 1. History of exposure. 2. Pungent odor of skin and clothing. 3. Rapid onset of eye or respiratory tract symptoms. 4. Disappearance of respiratory irritation within an hour. 5. Blister formation similar to lewisite though less severe. 6. Presence of arsenic in blister fluid. First Aid. Same as described for lewisite and it must be instituted immediately. Medical Treatment. Same as described for lewisite. Inhalations of low concentrations of chlorine from bleach powder in a wide-mouthed bottle may relieve the respiratory symptoms. Prognosis. This agent is less effective under field conditions than is lewisite. There are usually no serious complications from exposure to ordinary field concentrations. Neurological disturbances and arsenical poisoning may follow exposure to very high vapor concentrations or to the liquid. Remarks. One final word on the vesicants. DON’T GIVE UP ON THE TREAT- MENT. Encourage the victim, fight infection, and arsenical poisoning, and be on guard for bronchopneumonia. Vesication from any unrecognizable agent should be treated as a mustard burn until definitely identified. These agents, the tear gases, are mainly employed because of the irritation that they produce in the eyes. However, under ideal climatic conditions, especially hot, humid areas when the pores of the skin are opened, they will also cause irritation of the skin. Irritation of the face and neck after shaving are a common experience upon entering a gas chamber, as is irritation of the moist areas of the body, such as the wrists, axillae, groins and ankles. A few individuals show a hypersensitivity to these agents and develop a considerable dermatitis even when exposed to low concentrations. LACRIMATORS CHLORACETOPHENONE—CN Physical Properties. In the pure state CN is a white, crystalline solid that has the pleasant odor somewhat resembling that of locust blossoms. The plant run product looks very much like light brown sugar. It is insoluble in water but soluble in alcohol. It is soluble in benzene to the extent of 40%. It cannot be hydrolized by water nor readily destroyed. A hot aqueous solution of caustic soda or washing soda will slowly destroy it. The odor is detectable at low concentrations. It is a harassing agent even in very low concentrations. The persistency is solid for days. The burning mixture, 10 minutes. Tactical Use. A harassing agent. Detection. Best detected by odor which is variously described as aromatic, locust blossom, apple blossom or ripe fruit. Protection. Service gas mask gives complete protection. Impregnated or impervious protective clothing is impractical for these agents because of the climatic conditions under which they would be used. MEDICAL ASPECTS OF CHEMICAL WARFARE 581 CHLORACETOPHENONE SOLUTION—CNS Physical Properties. This is a mixture containing CN, chlorpicrin, and chloroform. Persistency in summer—one hour in the open, two hours in woods; winter—six hours in the open, one week in the woods. Tactical Use. A harassing agent. Protection. The gas mask. Protective clothing impractical. CHLORACETOPHENONE SOLUTION—CNB Physical Properties. This is a mixture of CN, carbon tetrachloride and benzene. Persistency. Not determined. Tactical Use. A harassing agent. Detection. By the odor which is somewhat similar to benzene. Protection. Service gas mask. Protective clothing impractical. Pathology. (General) The pathology is transitory unless the cornea is damaged, then ulceration may result. When the liquid solution is spilled on the skin a severe burn may result. Symptoms. (General) There is a burning and stinging of the eyes. The irritation results in a copious outflow of tears, photophobia and blepharospasm. High concentra- tions will cause a maddening sensation of pins and needles sticking in the skin. Diagnosis. (General) is made by: 1. Odor of agent 2. Marked lacrimation 3. Predominance of eye symptoms 4. Mild skin irritation First Aid. (General) Individuals exposed should be quickly removed from the area if gas mask is not available and the tactical situation permits. They should face the wind with the eyes open and the clothing loosened. The effects of the agent are usually re- lieved about 20 or 30 minutes after removal from the area. The eyes must not be rubbed or bandaged. Medical Treatment. (General) The eyes may be irrigated with a 2% solution bicarbonate or 2% boric acid solution. The skin irritation will usually respond to soap and water followed by calomine lotion. Prognosis. There are seldom any after effects and these agents never cause death under field concentrations. IRRITANT SMOKES The irritant smokes are those chemical agents used to produce sensory irritation to the nose, throat, and eyes, and are dispersed with the aid of heat in clouds containing very fine particles, the smaller the size of the particles, the more severe the irritant action. These smokes are of no value for screening purposes. These agents do not cause death in field concentration, although they make the casualty wish that he might die. It has been said that we can get a good idea of the effects of irritant smokes if we visualize a patient suffering from a toothache, a head- ache, sinus trouble, bronchitis and seasickness all at the same time. Because of the delayed action of these agents, symptoms may not appear from mild exposure for several minutes after the mask has been put on. The victim believes his gas mask to be leaking and removes it too soon, inhaling more gas. ADAMSITE—DM Physical Properties. A solid agent which in the pure form is bright yellow in color. Plant run product is a dark greenish or brown color. It is soluble in water and only moderately soluble in most organic solvents. The hydrolysis product is a solid arsenic oxide which is very toxic when swallowed. Persistency. When dispersed by candles—10 minutes in the open both summer and winter. Tactical Use. A harassing agent. 582 MILITARY MEDICAL MANUAL Detection. DM has almost no odor to the average man and it usually is detected only by symptoms developing following exposure. A brilliant canary yellow cloud can be seen near the point of emission. Toxic effects are produced by quite invisible amounts. Protection. The service gas mask. NOTE: Because of the delayed action of the irritant smokes it is necessary in training troops in the use of the gas mask to instruct them not to remove the masks even if symptoms occur. Pathology. There is local irritation of the nose and accessory sinuses, throat and eyes. Symptoms. These consist of pain and a feeling of fullness in the nose and accessory nasal sinuses, a severe headache, accompanied by intense burning in the throat and pain in the chest. There is a copious flow of tears because of the eye irritation. Sneezing is violent and persistent. Nausea and vomiting are often present. Mental depression is marked. Diagnosis. This is made from the history of exposure, and the relatively rapid spontaneous improvement which occurs. First Aid. Remove to pure air if possible. Guard and forcibly restrain the patient, if necessary, to prevent his self-injury. When the victim vomits into his gas mask, instruct him to hold his breath, remove mask, wipe it and reapply. Medical Treatment. Aspirin for the headache, general rest, pure air, and make the patient as comfortable as possible. Prognosis. There are no sequelae and the symptoms usually disappear about 1 hour after removal to fresh air. SNEEZE GAS—DA Physical Properties. In the pure form DA is a colorless, crystalline solid; plant run product is dark brown, viscous, semi-solid mass. Persistency. Five minutes in summer or winter when dispersed by high explosives; detonation, ten minutes when disseminated by candles. Tactical Use. A harassing agent. Detection. No pronounced odor although to some it appears to have an odor similar to shoe polish. Protection. Best type of smoke filter in gas mask canister. Pathology. Temporary sensory irritation of eyes, nose and throat. Symptoms. These consist of a severe headache and feeling of fullness in the nose and sinuses, nasal secretion, burning sensation in the throat and tightness and pain in the chest. There is a marked conjunctival injection and irritation as well as lacri- mation. Due to the increased saliva flow, nausea and vomiting are common. This causes the individual to remove his gas mask, and he gets another dose of the gas. One outstanding symptom is the utter mental despair that these patients exhibit. They would rather die than continue to suffer such extreme agony. Diagnosis. History of exposure, symptoms as listed above, and rapid, spontaneous recovery. First Aid. Since these casualties exhibit suicidal tendencies they must be under constant guard to prevent them from harming themselves. They should be removed to pure air when possible, or the mask must be worn between spells of vomiting. Medical Treatment 1. Aspirin or acctophenatin for headache. 2. Irrigate eyes, nose and throat with borie acid solution or saline. S. Inhale diluted chlorine from wide mouthed bleach bottle. 4. A moderate dose of morphine ueay be necessary to help control the patient 5. 48 hours rest may be necessary to give patient mental rest. Prognosis. Effects usually wear off in an hour or two. No persistent after effects follow exposure to these agents. MEDICAL ASPECTS OF CHEMICAL WARFARE 583 These agents will have only a limited use because of the difficulty of building up concentrations under field conditions. There is practically ho possibility of hydrogen sulphide or carbon monoxide being used. Hydrocyanic add or arsine might be used under circumstances where a concentration could be built up, such as in a pill box or fixed fortification, within a ship or tank. The service gas mask gives complete protection against all except carbon monoxide and a special canister attachment is needed for that. SYSTEMIC POISONS HYDROCYANIC ACID Physical Properties. Clear colorless, highly volatile liquid. The vapor disperses readily in air. It is very soluble in water and alcohol. Water solutions do not turn litmus red. Persistency. Non-persistent. Tactical Use. A casualty producing agent. Detection. The odor resembles that of bitter almond. Protection. The service gas mask will protect against field concentrations, and in en- closed spaces, provided the mask is worn at the time the grenade or shell bursts. Pathology. This agent immobilizes the oxygen in the blood stream so that it can not be given up to the body tissues. This leads to tissue asphyxia, and depresses and paralyzes the central nervous system, beginning with the medulla, stimulating the vomiting, vagus and vasomotor centers. Symptoms. Symptoms come on immediately following the inhalation of high concen- trations. Vertigo, headache, cardiac palpitation, and dyspnea are shortly followed by coma, convulsions, asphyxiation and death. In dilute concentrations the patient has a sensation of constriction of the throat, unpleasant taste in his mouth, mental con- fusion, dizziness and labored breathing. Diagnosis. 1. Odor of bitter almonds. 2. Rapid onset of symptoms. 3. Chain of symptoms as described. First Aid. Remove the casualty from the enclosure to pure air at once. Institute artificial respiration when indicated. Amyl nitrite fumes should be inhaled for fifteen to thirty seconds every three minutes. Absolute rest and heat are indicated. Medical Treatment. Treatment must be started immediately to be effective. Amyl nitrite inhalations continued and a 1% solution of sodium nitrite slowly given intra- venously in 10 c.c. doses until a total of 50 c.c. is given in an hour. Epinephine may be employed to decrease the fall in blood pressure. 20 c.c. doses of 5% sodium thiosulfate should be given intravenously between the nitrite injections to a total of 500 c.c. if necessary. 1% methylene blue in 1.8% sodium sulfate in 50 c.c. doses to a total of 200 c.c. may be given intravenously instead of the sodium nitrite. Whole blood transfusion is indicated to offset the marked cyanosis from the methylene blue. Prognosis. The mortality of acute cyanide poisoning is very high, i.e., about 95%, because death usually occurs before therapy can be instituted or has time to be effective. If the patient survives the initial effects and is still alive after 1 hour he will generally recover. Sequelae are very rare. ARSINE Physical Properties. A colorless, inflammable gas produced by the action of water on the arsenides, calcium, magnesium, and sodium. Persistency. Non-persistent. Tactical Use. A casualty producing agent. Detection. Arsine has a characteristic garli'ollke odor and metallic taste. The possibility exists that the inhalation in concentrations not detectable or recognizable by odor may cause toxic symptoms. Protection. Protection Is afforded by the service gas mask. Pathology. Arsine produces no irritation of the skin or mucous membranes. It is 584 MILITARY MEDICAL MANUAL readily absorbed from the respiratory tract and even in low concentrations, not detectable by odor, may cause toxic symptoms. It attacks principally the red blood cells, causing hemolysis, conversion of part of the liberated hemoglobin to methemo- globin, and even destruction of these cells. The kidneys become blocked by the debris of the red blood cells and precipitation of hemoglobin in the tubules. Arsenical hepatitis is a common complication. Symptoms. When only a small quantity of the agent has been inhaled there will be mild symptoms, such as general lassitude, headache and possibly chills, nausea and vomiting. In higher concentrations there is added a pronounced hemolytic anemia and methemoglobinemia, a slatey cyanosis of the skin that later changes to jaundice bronze. The urinary symptoms are marked, characteristically being: hemoglobinuria, oliguria, anuria and uremia. Diagnosis. Based on essential factors: 1. History of exposure. 2. Cyanosis of skin. 3. Marked anemia. 4. Late jaundice. 5. Urinary symptoms: a. Urine deep brown to red color. b. Oliguria, anuria, uremia. First Aid. General supportive measures such as rest, heat, and immediate removal to pure air. Medical Treatment. Sodium bicarbonate or citrate drinks for alkalization; forced fluid intake to help diuresis and help keep the kidney open; should be given up to 4000 c.c. per 24 hours. Glucose solution is helpful to counteract the liver damage. Mercurial diuretics are contraindicated. Anemia calls for blood transfusions, iron and liver extracts. Prognosis. Even the more severe cases may recover; others may die within 2 to 6 days. When death occurs it is due to a severe anemia or kidney blockage and anuria. INCENDIARY AGENTS These agents, white phosphorus, thermit, electron and incendiary oils, simply cause deep thermal burns that are treated the same as any other severe burn. There is one exception and that is white phosphorus. This substance is identified by the odor of burnt matches, and in contact with the skin will cause severe burns. When the particles come in contact with the air they reignite, so we must keep the particles wet. The suggestion has been made that the particles be covered with mud, but this is inadvisable because it is not an efficient means of extinguishing the burning particles, and there is a great likelihood of introducing infection into the wound. WHITE PHOSPHORUS—WP Physical Properties. A pale yellow, translucent, crystalline solid of waxy consistency. It is extremely active chemically and combines with oxygen very readily. If left exposed to air at ordinary temperatures it at once begins to oxidize. Heat is generated at the same time, raising its temperature, thus increasing the rate of oxidation until it spontaneously bursts into flame. Tactical Use. Screening agent. Detection. Odor—like burnt matches. Protection. None needed against smoke. Fireproof suits against burning particles. Pathology. Any degree of burn from a first degree burn to complete destruction of the tissue. Symptoms. Pain, swelling, erythema, destruction of tissue. Diagnosis. The presence of a tissue burn and the white phosphorus particles with a burnt match odor and a tendency to rcignite on contact with the air. First Aid. This consists of extinguishing the blaze by keeping the part submerged in water or keeping the wound covered with a saturated cloth. Water from the canteen or even urine may be used if nothing better is available. MEDICAL ASPECTS OF CHEMICAL WARFARE 585 Medical Treatment. Consists of picking the particles of white phosphorus out of the wound while the part is still submerged in water, or at least wet. A 5% or 10% solution of copper sulphate may be used to form an airtight metallic coating over the phosphorus particles until they can be removed. The exact percentage of the copper sulphate solution is not important, just enough copper sulphate to make the water quite blue. After the particles have been removed the wound is treated as any other burn. Another method of emergency treatment has been suggested: First Stage: Remove the bulk of the free phosphorus and superficial acid with alkali powder (Formula 2a, 10% of heavy magnesium oxide, 5% of borax and 85% of sodium carbonate.) The burned area should be covered with water and the powder sprinkled on the wet surface, more water being added as necessary, to make a medium thick paste. Wash or wipe off and reapply as long as effervescence continues. Second Stage: Immobilize the whole of the remaining free phosphorus by using glycerin, copper sulphate paste (22.5% copper sulphate, 67.5% glycerin, 5% starch and 5% water.) Remove as soon as no smell of phosphorus is present. Third Stage: Neutralize the deepseated penetration of acid by reapplying powder (formula 2a), work into a paste with water and bandage the wound. Fourth Stage: Final treatment should not be employment of coagulation therapy (tannic acid, picric acid, silver nitrate), as the acid products would be sealed in the wound. The continued treatment should be alkaline and might consist ideally of Bunyon’s envelope treatment with hypochlorite solution. NEW WAR GASES—NITROGEN MUSTARDS A new series of war gases may be encountered. Their physical properties and toxicological properties are essentially similar. Classification. Vesicant agents, casualty producing agents and persistant agents. Properties. They vary from liquids to low melting solids, are colorless to pale yellow, and have faint odors varying from fishy or soft soap-like to practically odorless. Their volatility varies from much less to five times greater than that of mustard gas. Most of them are fairly readily hydrolyzed by water, but the products of hydrolysis are toxic. Detection. HS vapor detector, M4; by paint liquid vesicant detector, M5; and by paper, liquid vesicant detector, M6. These detectors do not distinguish the nitrogen mustards from other vesicant agents. Crayon, vesicant detector, M7, slowly turns a yellow color with liquid nitrogen mustard and rapidly turns blue with the other vesicants. Recognition. Odor is faint fish-like. Protection. Service gas mask—effective. Protective clothing. Impermeable clothing except that rubber gloves and rubberized fabrics are penetrated with greater rapidity by this agent. Pathology. General. Acts as vesicant to skin, eyes and respiratory system. Acts systemically to destroy leukocytes and as necrotizing agents to lymphoid tissue, the hemopoietic system and certain areas of the central nervous system. After mild ex- posures systemic reactions are unimportant. Eyes. Strong miosis. Conjunctivitis, edema and shedding of cornea. S\in. Vapors are about one-fifth as damaging as mustard vapors. Liquid blisters skin more rapidly and less severely than mustard. Respiratory tract. Similar to mustard. Nervous system. Salivation, lacrimation, broncharrhea, contraction of intestines and defecation. Tremors and flaccid paralysis in fatal cases. Gastro-lntestinal tract. Gastric distention and retention of food. Symptoms. Eyes most susceptible of tissues, even to very weak concentrations. (1) Mild. Lacrimation, smarting of eyes, intermittant erythemea and conjunctivitis. Photophobia. (2) Severe. Maximum damage in 24 hours or longer. Miosis marked, cornea edematous and cloudy and ulcerated, deep eye pain. 586 MILITARY MEDICAL MANUAL S\in. Like HS. Respiratory tract. Rhinitis, laryngitis, tracheitis, hoarseness to aphonia, cough, some lung edema, secondary bronchopneumonia. General effects. Headache, deep eye pain, mentally depressed and apprehensive, nausea, vomiting and salivation, leukopenia, marked tendency to hemorrhage and greatly lowered resistance to infection. First Aid. . General. Gas mask, remove contaminated clothing when practical. Eyes. Irrigate with water; eye and nose drops. S\in. Protective ointment, M4, wash with soap and water. Pontocaine compound ointment. Treatment. Same as HS, plus atropine 1/100 grain subcutaneously for G I or nervous system symptoms. Agranulocytosis not helped by pentnucleotide. Prognosis. Mild exposures recover in 2 to 4 weeks. Leukopenia of 2000 or less or flaccid paralysis usually fatal prognosis. EVACUATION OF GAS PATIENT Let us emphasize that by far the greater majority of soldiers who come in contact with a chemical agent will NOT be evacuated. If the protective ointment is used AT ONCE by the individual soldier and he wears his gas mask he will not become a casualty. Those who are caught without their gas masks or do not use the protective ointment, or whose clothing becomes grossly contaminated, may eventually become real casualties and then, on authority of a superior officer they would leave their posts and go to the battalion aid station for medical treatment. Most of the hydrocyanic acid cases will either be completely recovered or a fatality before they can be evacuated to the rear. The lung irritant cases who are to be evacuated must be litter cases and carried in the recumbent position during the entire period of transportation. It is the plan of the Medical Department of the United States Army that gas casualties will be treated at any of its medical installations in the theatre of operations but pro- visions for the immediate segregation of these cases must be incorporated in the standing operating procedures of each medical unit. Gas casualties when transported in am- bulances must be entirely separate from the other casualties. In the battalion aid station, regimental aid station, collecting station and clearing station decision must be made by the medical officer whether the case should be evacuated to the rear or retained at the installation. Those who get to the clearing station will receive the more comprehensive treatment. In addition to these medical units we now have medical gas treatment battalions under army control which arc dispatched as needed to augment the clearing or col- lecting stations mentioned above when gas casualties are especially heavy. Each clearing platoon of the medical gas treatment battalion consists of a bath section and two treat- ment sections. The ambulances for this unit could be furnished by the medical am- bulance battalion, motor. Any personnel handling gas casualties must be provided with the necessary protective clothing and masks. The clearing stations in the theatre of operations are necessarily mobile and must follow the tactical forces; therefore, careful selection is made of the patients for dis- position, each case being considered with judgment and discretion as to his prognosis. All slightly gassed cases who are expected to recover completely in a few days are kept at the clearing station and are returned to the front on recovery. Those cases which are the results of lung irritants must be kept at the sites of reception (normally the clearing station) wherever possible for a period of 48 hours until their maximum ill- ness is over and until they no longer require oxygen therapy. Then they would con- tinue back through the medical chain of evacuation. Cases which have been seriously gassed by mustard are evacuated to the rear as soon as their temporary needs have been provided. The early evacuation of the mustard case is carried out because mustard does not cause acute pulmonary edema and therefore does not present the difficulty of trans- MEDICAL ASPECTS OF CHEMICAL WARFARE 587 portation that phosgene cases do. They are sent from the clearing station to the evacuation hospital, where they go through a process of sorting, bathing, and assign- ment to the proper ward for gas patients. There is a new 400 bed motorized evacuation hospital in the process of development that is destined to replace the present surgical hospital. This unit will normally back up the division and may be located in the vicinity of the clearing station. Conceivably some of the gas casualties may go from the clearing station to this new unit. When possible the slightly gassed are separated from the seriously gassed and the mustard cases are separated from those suffering from pulmonary edema. Since gas casualties occur in great numbers, when they do occur, it may be necessary to set up a separate clearing station or evacuation hospital to care for them. Gas casualties go from the evacuation hospital to a general hospital for their final definitive treatment. They should be sent from there to a convalescent camp as soon as they are sufficiently recovered. Because gas casualties occur in great numbers, need complete segregation, careful handling, classification and special treatment, they add a very heavy burden to the evacuation system and medical department personnel in the theatre of operations. The development of a satisfactory air evacuation service for use in combat areas is a possibility to be considered. There are many types of surgical emergencies that would take precedence over the gas casualties. If the gas casualties are transported by air ambulance, it should have an air-sealed litter section in which the pressure could be kept at the desired constant level since any change in pressure will have its effect, par- ticularly upon the lung irritant cases. GAS TREATMENT EQUIPMENT 1. Hydrogen Peroxide Ml Skin contamination 2. Dichloramine T Solvent for vesicants 3. Amyl Salicylate HS blisters and edema 4. HTH Vesicant decontamination 5. Aspirin Sternutators—headache 6. Pontacaine Ointment Relief of skin irritation due to HS, CN, CNS, FH, CNB, etc. 7. Copper Sulfate WP; to stop burning 8. Soap Use when erythema present in vesicants 9. Protective Ointment M4 Vesicant skin contamination 10. Sulfadiazine Ointment Burns vs. infection 11. Sodium Bicarbonate a. Eye wash for any chemical agent b. Skin wash c. Nose and throat wash vesicants 12. Eye Solution Ml Ml eyes only 13. Amyl Nitrite HCN casualties BOTTOM TRAY Rear Hydrogen Peroxide 3% Solution Dichloramine T 20% (II Bottles) (12 Bottles) Amyl Salicylate (I Bottle) HTH (4 cans) Aspirin (I Bottle) Pontacaine Ointment 5% (4 tubes) CUSO4 Powder {I# Bottle) Soap—White Lily (2 Cakes) Front TOP TRAY Rear Sulfadiazine Ointment 5% (2 Tubes) Sodium Bicarbonate (I# Bottle) Eye Solution M I (10 '/2-oz. Bottles) Protective Ointment M 4 (II Tubes) Protective Ointment M 4 (49 Tubes) Pontacaine Ointment Chloroform (4 V4# Bottles) 5% (6 Tubes) Eye Droppers (I box) Amyl Nitrite (15 boxes ampules) Nose & Eye Drops (2 l-oz. bottles) MILITARY MEDICAL MANUAL 588 14. Chloroform a. Sternutators, i.e. breathing chlorine b. Solvent for vesicants 15. Nose and Eye Drops Sternutators, also relief of eye pain Gas Treatment Set 1. Chest—illustrated above 2. Rubber Gloves—(thick) 3. Impervious Aprons 1 Set/Battalion Aid Station 1 or more Sets/Collecting Station Gas Treatment Truc\ Kit Contains: 1. Protective Ointment M4 2. Eye Solution Ml 3. Dichloramine T 1 Kit/Tank 4. Hydrogen Peroxide 1 Kit/Armored Car 5. Pontacaine Ointment 1 Kit/Motor Convoy 6. Copper Sulfate 10°/o and small Forceps 7. Nose and Eye Drops (Neosynephrin, Pontacaine and Boric Acid) 8. Amyl Nitrite Gas Treatment Battalion—Medical Clearing 1. Gas treatment sets 2. Oxygen units 3. Bath units 4. Miscellaneous—Blood, Plasma, Glucose Solu. 500 changes clothing. CHAPTER VIII AVIATION MEDICINE AVIATION MEDICINE IN EVOLUTION Man has always dreamed of flying. After centuries of those dreams, with experiment and the development of other necessary knowledge, the airplane became the answer to his quest. With the discovery of the art a new strain was placed upon the human system for the doctor to analyze, determine the hazards, and proffer a means by which they might be re- duced in effect or entirely avoided. Thus the science of medicine has been made available to mankind in order to assure a greater safety and a more certain development of this tremendous achievement. Pilots are exposed to environmental factors with which they are entirely unfamiliar. Each is placed in control of a powerful mechanical device which may tax to the utmost his mental and physical stamina. Ever increasing speeds and altitudes attained in flight force a close study of the human equation of the pilot which may lead to the complete recognition of the necessary physical and mental qualifications of flyers. The aviator must return instantaneous and correct mental and physical responses to all situations which may con- front him, often with startling suddenness. The life of his passengers, the successful accom- plishment of a mission, and the preservation of his plane, as well as his own life, may hang upon this slender thread. The science of aviation presents complex problems which must be fully understood, its phenomena completely charted. In this necessary work the doctor will find again his chance to serve humanity. The following data traces the primary steps in medical knowledge from its inception, as it has been developed to meet the peculiar requirements of aviation. 1783 June 3. The first balloon flight without passengers was made at Annonay, France. In the same year the first effort was made to study the effects of flying upon life. Sheep and fowls were sent up a few hundred feet in balloons, the investigators discovering to their surprise that no ill effects resulted from the ascent. December 17. The first record of physical discomfort from altitude was made during a balloon ascent to 10,500 feet. The balloonist complained of the severe cold as well as pain in his right ear and jaw. 1786 Ballooning was recommended for convalescents and to promote longevity. The first handbook on aeronautics was published. The author, although not a doctor, believed the change from the hot and impure air near the ground to the cool, pure air aloft, which was said to be impregnated with aerial acid, was beneficial to the sick. He stated: “The spirits are raised by the purity of the air and rest in a cheerful composure. In an ascent all worries and disturbances disappear as if by magic.” Diseases such as tuberculosis and neuralgia he claimed could be cured by the therapeutic value of the atmosphere at high altitudes. 1800 Scientific records were made of the effect of altitude upon the human body. The ill effects were called “balloon sickness”. Doctors of medicine were among the pioneers in these early scientific studies. 1866-1870 Dr. Charles H. Blackley made a quantitative study of the pollen content of air. Oil- coated slides were exposed at ground levels to collect the pollens deposited by the force of gravity. Then, by means of sending these oil-coated slides aloft on kites, he exposed them at altitudes of from 1,000 to 1,500 feet. His experiments proved the abundance of fungus spores present in the air and the possibility that their allergic reactions were similar to those cf pollens. 1903-1911 In December, 1903, Wilbur and Orville Wright made four successful power-driven flights 590 MILITARY MEDICAL MANUAL in an airplane at Kitty Hawk, North Carolina. On February 10, 1908, the United States Army signed a contract with the Wright Brothers for the purchase of the first Army plane. On September 17, 1908, Lieutenant Thomas Self ridge, Signal Corps, was killed and Orville Wright severely injured at Fort Myer, Virginia, when their plane crashed. This was the first fatal accident resulting from flying. There was little medical interest in aviation except the spasmodic interest in the physiology of altitude. Although the speed factor was beginning to be added to that of altitude, no special physical examination was required for military aviators, and no physical examina- tion of any kind for civilian aviators was required during this period. 1912 February 2. The War Department published the first instructions concerning the physical examination required of candidates for aviation duty. In its preparation the Surgeon Gen- eral, collaborating with the Chief Signal Officer, devised a special preliminary physical ex- amination to be required of all candidates for instruction at the Signal Corps Aviation School. February 7. The draft of the plan for this special preliminary physical examination was submitted to the Secretary of War for approval. It was, in brief, as follows: All candidates for aviation duty to be subjected to a rigorous physical examination to de- termine their fitness for such duty. The examination to conform to the standard required for recruits, with the following additions: The visual acuity without glasses to be normal. Any error of refraction requiring correc- tion by glasses or any other cause diminishing acuity of vision below normal to be cause for rejection. The candidates ability to estimate distances to be tested. Color-blindness for red, green, or violet to be a cause for rejection. The following tests for equilibrium to be made to detect otherwise obscure diseased con- ditions of the internal ear: The candidate to stand with knees, heels, and toes touching. The candidate to walk forward, backward, and in a circle. The candidate to hop around the room. These tests to be made first with the eyes open, and then with the eyes closed, on both feet and then on one foot. Deviations of a persistent nature, either right or left, were held to indicate the presence of a diseased condition of the internal ear. Nystagmus, frequently associated with this condition, was also a cause for rejection. Any disease of the circulatory system, either of the heart or arterial system, respiratory system, or nervous system to be a cause for rejection. The precision of the movements of the limbs to be tested with special care. Any candidate whose history showed that he had ever been or was afflicted with chronic digestive disturbances, chronic constipation, or intestinal disorders tending to produce dizziness, headache, or impairment of vision to be rejected. October 8. The United States Navy published instructions governing the physical ex- amination required of their candidates for aviation duty which were similar to those used by the Army. There was added a group of exercises to determine the precision of the movements of the limbs. Should these exercises manifestly tire the individual he was re- quired to be further examined to discover the presence of a defect or deformity. A marked departure from normal blood pressure was considered to be a cause for rejection in the Navy test. 1913 A plan for the conduct of examinations and selection of pilots was instituted by Germany. 1914 Italy adopted a special physical examination for Army flyers. July. Civilian aviators in the United States, whose fame as flyers was well known to the public, had never been examined physically. AVIATION MEDICINE 591 1915 Great Britain made an analysis of her air casualties for the first year of the World War which showed that 2 per cent of the pilots met death at the hands of the enemy, 8 per cent from defective planes, and the remaining 90 per cent due to pilot errors. The British thereupon established a special “Care for the Flier Service,” whereby the aviators were selected with due regard to their physical and mental qualifications. At the end of the second year fatalities attributed to physical and mental defects were reduced to 20 per cent and at the end of the third year to 12 per cent. Thus Great Britain demonstrated the benefits of a special medical examination for flying personnel. 1917 April 6. The United States entered the World War. At this time the aviation personnel of the Army consisted of 65 officers and 1,120 enlisted men. In a little more than a year it was expanded to 14,230 officers and 124,767 enlisted men. The knowledge and experience of the Allies was placed at the disposal of the United States Army. April 28. The Air Service Medical was organized. Major T. C. Lyster recommended that a medical officer be placed in charge of the physical examination of all applicants for duty with the Aviation Section, Signal Corps. May. Form 609, A. G. O., which was later designated Form 64, A. G. O., (still used for recording physical examination of Air Corps officers) was prescribed for recording the physical examination for flying. May 11. Major T. C. Lyster, in addition to his other duties, was detailed to take charge of the aviation work in the Surgeon General’s Office. This assignment included the super- vision of administrative for the physical examination of all applicants for duty with the Aviation Section, Signal Corps. July. Sixty-seven Physical Examining Units were established in cities of the United States. September. Colonel T. C. Lyster was assigned to duty as the Chief Surgeon, Aviation Section, Signal Corps. October. The Medical Research Board and Medical Research Laboratory for the study of aviation medicine were organized. The Board consisted of Major John B. Watson, S.O.R.C., Major Eugene R. Lewis, M.R.C., Major William H. Wilmer, M.R.C., Major Edward G. Seibert, M.R.C., and Dr. Yandefl Henderson, a civilian. The purposes of the board were: (1) To investigate all conditions which affect the efficiency of pilots; (2) To institute and carry out, at flying schools or elsewhere, such experiments and tests as would determine the ability of pilots to fly in high altitudes; (3) To conduct experiments and tests to develop suitable apparatus for the supply of oxygen to pilots in high altitudes; (4) To act as a standing medical board for the consideration of all matters relating to the physical fitness of pilots. The board instituted six departments of the Medical Research Laboratory and appointed a director for each: Otology, Cardiovascular, Physiology, Psychology, Psychiatry and Neurology, and Ophthalmology. December. General Theodore C. Lyster and Major Isaac Jones were sent to Europe to investigate the work in aviation medicine as developed by the Allies of the United States. 1918 The Central Medical Research Laboratory, Hazelhurst Field, Mineola, New York, was completed and began operation. June. The laboratory space of the Central Medical Research Laboratory was enlarged to three times its original size. The officer personnel was much increased, barracks were erected for the enlisted men, and the work at the laboratory increased rapidly both in amount and importance. The laboratory also functioned as a training school for flight surgeons and for instructing physical trainers for their work at the several flying schools. Officers and enlisted men were instructed in the methods and duties of classification-units for selection of pilots. Aviators were given low-oxygen-tension tests, either in low pressure tanks or by means of the rebreathing machine. By this time the selection of the flier had been standardized, his care put in charge of flight surgeons, and the classification of the aviator recognized as a vital necessity for the efficiency of the Air Service, 592 MILITARY MEDICAL MANUAL The term “Chief Surgeon, Aviation Section, Signal Corps” was eliminated because the Air Service Division (Air Service Medical) was created as part of the Surgeon General’s Office. July 6. Branch medical research laboratories were established at twenty flying fields. The Manual of the Medical Research Laboratory was published by the War Department. August. In response to a cable from General Pershing, 34 officers and 15 enlisted men who had been well trained in laboratory methods sailed for Europe. Colonel William H. Wilmer headed the Medical Research Board of the American Expeditionary Force. He concluded that the board saved the lives of hundreds of aviators and, with the cooperation of the pilots, would save hundreds more. The board was created to advise, cooperate with, and assist aviators in saving themselves. October. The Air Service Manual was published. 1919 March 14. The Medical functions of the Air Service were returned to the administra- tion of a Chief Surgeon, Medical Section, Air Section, as had been the case during the early part of 1918. May. The first course of instruction for flight surgeons, eight weeks in duration, was given at the Medical Research Laboratory, Hazelhurst Field, Mineola, New York. It was the first systematic course of its kind. August-November. The Medical Research Laboratory and School for Flight Surgeons was moved to Mitchel Field, New York. The course for flight surgeons was extended to four months. 1920 The War Department published Document Number 1004, “Aviation Medicine in the American Expeditionary Force”. 1921 February. The War Department listed the Medical Research Laboratory and School for Flight Surgeons as a “special service school”. March. A fire destroyed many of the records and much of the equipment of the School for Flight Surgeons. During this year Dr. E. C. Stakman made the first quantitative tests of upper air pollens and spores during his investigation of the spread of black stem rust of wheat. In Louisiana, Dr. William Scheppegrel made a study of the concentration of pollen in the upper air. He recognized several types of pollen and concluded that spores were not responsible for hay fever. Since 1921 airplanes and balloons have been used to collect samples of fungus and spores, oil-slides or agar plates being used as a surface area for collection. These studies have fur- nished a major part of the present knowledge of air-borne allergens. 1922 April. The first group of medical officers of the Navy was graduated as flight surgeons. November 8. The Medical Research Laboratory and School for Flight Surgeons was changed to “The School of Aviation Medicine” by A.R. 305-105. 1923 The Adjutant General approved extension courses to be given by the School of Aviation Medicine. 1926 Lieutenant Colonel David A. Myers established by research the basic principles, from the human standpoint, on which the art of blind flying is founded. His work was done in collaboration with Lieutenant Colonel William C. Ocker, Air Corps, who is the father of blind flying. It was published in the Army Medical Bulletin of July, 1937. The first text book on Aviation Medicine was published by Colonel Louis H. Bauer. He was appointed Medical Director of the Aeronautics Branch of the Department of Com- merce which was created this same year. Medical examiners were appointed by the De- partment of Commerce throughout the United States so that the examination of private AVIATION MEDICINE 593 and student pilots, as well as commercial and industrial pilots, would be made promptly and with little inconvenience. June 30. The School of Aviation Medicine was moved from Mitchel Field, New York, to Brooks Field, San Antonio, Texas, where it occupied the “Big Balloon Hangar” until its next move. 1927 May. The School of Aviation Medicine was moved out of the balloon hangar into permanent quarters. 1929 October 7. Following a number of preliminary conferences stimulated by the Medical Section of the Aeronautics Branch of the Department of Commerce, the Aero Medical Association was organized at a meeting held in Detroit, Michigan. The announced pur- pose of this organization was to make a study of the new specialty, “aviation medicine.” It was decided at this meeting to produce a journal devoted to the study of the subject. 1930 The first issue of the “Journal of Aviation Medicine” was published. 1931 A pamphlet entided “Aviation Medicine” was published by direction of the Secretary of War at the Medical Field Service School. It is Army Medical Bulletin No. 26, copies of which can still be secured through the Book Shop, Medical Field Service School, Carlisle Barracks, Pennsylvania. October 30. The School of Aviation Medicine was moved from Brooks Field to Ran- dolph Field, San Antonio, Texas, the site of the Air Corps Primary Training Center. This location enabled it to function advantageously as a teaching as well as a research institution. 1933 Major Malcolm C. Grow, Post Surgeon, Fairfield Air Depot, Patterson Field, Ohio, advocated the establishment of a medical laboratory at Wright Field near Dayton, Ohio, to be a part of and to work with the Experimental Engineering Section of the Materiel Division of the Air Corps. He experimented on clothes suitable for flying and the effects of carbon monoxide gas from internal combustion engines. During the year Colonel and Mrs. Charles A. Lindbergh exposed 27 slides over Green- land and the North Atlantic. This study of pollens was projected by Dr. F. C. Meier of the United States Department of Agriculture. 1934 Colonel Malcolm Grow was transferred to the Office of the Chief of the Air Corps as Chief of the Medical Section. Captain Harry G. Armstrong, Medical Corps, was sent to Wright Field for the sole mission of establishing and supervising the research unit. 1935 May 29. The Chief of the Air Corps directed that a Physiological Research Laboratory be created at the Materiel Division of the Air Corps at Wright Field, Dayton, Ohio. This was promulgated for the purpose of continuing the experiments which Lieutenant Colonel Malcolm Grow had started in the spring of 1933 on his own initiative. Mis study of the various types of clothing and the relationship to high altitude flying helped to con- vince the Air Corps authorities of the need for a physiological research laboratory. 1937 January 1. The Physiological Research Laboratory was completed. Captain Harry G. Armstrong, Medical Corps, was announced as the Director, and Dr. J. W. Heim was placed in charge of research. (Further details ab®ut the laboratory are to be found in a later paragraph of this chapter.) The first issue of “Flight Surgeon Topics” was published by the School of Aviation Medicine. The chief purpose of this publication is to distribute to flight surgeons timely information on aviation medicine and related topics. 594 MILITARY MEDICAL MANUAL Dr. F. C. Meier, Department of Agriculture, who had promulgated many upper-air studies since 1931, originated the term “aerobiology,” for the science of allergy and bac- teriology of the air. Dr. Meier and Dr. E. B. McKinley, his co-worker, were lost with the Hawaiian Clipper while making studies over the Pacific Ocean. 1938 September 2, 3, and 4. The Tenth Annual Convention of the Aero Medical Association was held at Dayton, Ohio. At this convention the School of Aviation Medicine dis- played an exhibit of items important to aviation medical circles. October 13, 14, and 13. The School of Aviation Medicine provided an exhibit at the 46th Annual Convention of Military Surgeons of the United States which was held at Rochester, Minnesota. During this year upper-air studies (aerobiology) were conducted on a large scale by O. C. Bonham, botanist, during the ragweed season. Slides were made over nine states at elevation levels up to 9700 feet. These studies were made from planes of commercial air lines operating between Denver and New York. No heavy contamination was found to exist above 5000 feet, but allergens were located at 7500 feet and a few at 9000 feet. Planes with enclosed cabins were found to be relatively free from pollen contamination. Aerobiology, greatly facilitated by aviation, offers a new field for medical research. “Special Flying Cadet Examining Boards” were appointed to visit many colleges and universities to acquaint students with the army flying training program and to conduct physical examination of applicants for training as flying cadets. 1939 April 1. The Medical Section was re-designated the Medical Division and assigned to the Training Group, Office, Chief of the Air Corps, by order of the Chief of the Air Corps. 1940 Changes in Army Regulations provided that graduates of the School of Aviation Medicine would be rated as “Aviation Medical Examiners.” An aviation medical ex- aminer who has served a minimum of one year of active duty with the Air Corps after having received such qualifications and who has demonstrated that he possesses the required qualifications may be rated as “Flight Surgeon.” 1941 The War Department established eighteen branches of the School of Aviation Medicine at various Air Corps stations in the United States, the Panama Canal Zone, and Hawaii. 1942 March 2. War Department Circular No. 59, relative to the War Department re- organization designates the chief medical officer under the Army Air Forces as the Air Surgeon. THE FLIGHT SURGEON The Flight Surgeon is a doctor of medicine who has received additional training and experience in aviation medicine. He bears the same relationship to aviators as does the specialist in preventive medicine to mankind in general in that both deal with the pre- vention of disability and the maintenance of physical efficiency. At the present stage of development of the subject this training may be secured at the School of Aviation Medicine or one of its branches, all of which are operated by the Army. The main school is located at Randolph Field, Texas. All flight surgeons of the Army or Navy as well as the Medical Directors of the larger commercial air lines are graduates of this school who have been recommended by its faculty as qualified for the duty. The relatively few doctors of medicine in civilian practice who include this specialty are almost entirely drawn from the Medical Reserve Corps of the Army or Navy who have been trained and certified as qualified at this important Army school. It is a worthy and useful career for the air-minded medical man. AVIATION MEDICINE 595 Duties of the Flight Surgeon. It is a well established fact that many persons lack the physical or psychological make-up to function efficiently and with safety in three-dimen- sional space; therefore many people are unqualified to operate airplanes. The British proved this in the World War when, by identifying the cause of crashes, they reduced the accidents resulting from pilot failure by 50 per cent the first year of corrective methods and to less than 12 per cent during the second year. The aviator, and especially the military aviator, must have vision that is nearly perfect. It is essential that he have a strong heart and an efficient circulatory system in order that he may tolerate altitude and cold. He requires perfect neuromuscular control and co- ordination for the complicated manipulation of airplanes at all altitudes while in flight. He needs a psychological equilibrium capable of instant and correct judgement to meet the situations which develop in his routine duties. The detection and recording of these conditions is an important responsibility of the flight surgeon. One of the important duties of the flight surgeon is to examine candidates for flying instruction in order to eliminate all who do not clearly meet the standards which arc known to be necessary. In this way young men who are potential crash victims because of some physical or mental shortcoming which may be entirely unknown to them are saved from hazards they are not constituted to meet. It is not enough to make certain that flying candidates are physically and mentally qualified for the tasks before them. Aviators must be re-examined at periodic intervals and their health kept under close observation by a flight surgeon. In this way only may the diminution of any of these essential qualities be detected in time to prevent the hazards of the air which lead to crashes. It is desirable and necessary that the flight surgeon acquaint himself with the life and habits of each pilot under his medical super- vision to detect practices or conditions which may injure his physical or mental health in any way or which may affect his ability as a flier. The maximum safety to passengers, plane, and pilot may be obtained only when aviators are able to meet to a satisfactory degree the physical and mental requirements which experience and research have proven to be necessary. Further responsibilities of the flight surgeon are the classification of pilots for high altitude missions and the type of airplane to which the pilot is best suited. In the Army in peacetime the flight surgeon carries on the normal duties of the medical officer as well as his specialty. The preservation of health, the prevention of disease, and the care of the sick are no less important in the Air Corps than with the rest of the Army, and the same administrative duties are required. He must, however, become more thoroughly familiar with the administrative details pertinent to the handling of sick and injured in the Air Corps. He must constantly be alert to the activities of the officers of the Air Corps, socially as well as on duty, in order that he may determine or locate influences that might affect those officers who might indireedy come under his care. The duties of the flight surgeon are broad and in the special sense very detailed and specific, in order to bring many generalities to a fixed conclusion. Reaction and behavior must be recorded and scrutinized by experience and knowledge in order to protect human life and property and to keep our air force in the most efficient condition. Qualifications of the Flight Surgeon. The flight surgeon must be equipped with an extensive professional knowledge, experience and interest in his medical work, including a knowledge of psychology, psychiatry, ophthalmology, otology, cardiology, traumatic orthopedics, altitude physiology, and the special problems of aviation medicine. He must be thoroughly informed about the work of the airplane pilot. Certain personal qualifications are necessary. His character and professional attain- ments must be of such high standards as to inspire the confidence and respect of the flying personnel. The fliers will then realize that he can smooth out their various prob- lems and difficulties; that because of his interest, manifested by tact, sympathy, tolerance, and sincerity, they feel his aim is to keep them in such condition that they will be fit to fly. The flight surgeon must have initiative, be emotionally well-balanced, a good mixer, and of unquestionable character and good habits. He must be willing to fly with pilots 596 MILITARY MEDICAL MANUAL whom he finds physically qualified for flying. His knowledge of flying, of airplanes, and of Air Corps tactics must be such as to enable him to understand the problems, difficulties, and dangers of the pilot and to discuss them intelligently. Flight surgeons arc not made in a day, and, as in any specialty, their value increases with their experience. Practical experience will add much to his knowledge, and over a period of years the Army or Navy flight surgeons will have had many pilots under their care and supervision, learning their individual habits, qualifications, and characteristics. They will come to know these pilots so intimately that this knowledge may be the in- direct means of saving valuable lives and property by preventing crashes by pilots who arc borderline cases, and who would be removed from flying, at least temporarily, by experienced flight surgeons. As aviation medicine, a product of the World War, is one of the youngest specialties, the flight surgeons of today are comparatively young. Although years of experience with troops, hospitals, and the general practice of medicine increase his wisdom, the flight surgeon must never lose his sense of appreciation for the joys and sorrows of the young pilot. The flight surgeon must realize that as long as he is in the company of one more of the pilots under his care, he is never entirely “off duty.” He must study each pilot without prejudice or personal feelings, until he can detect the slightest departure from normal health, almost before the subject himself becomes aware of it. He must learn when to warn, when to comfort, and when to ignore. How to Become a Flight Surgeon. In accordance with Par 18, A.R. 350-500 the follow- ing information is extracted for reference: Selection and detail of officers and enlisted men for courses at the School of Aviation Medicine will be made upon recommendation of the Surgeon General and the Com- manding General, Army Air Forces. Officer students, so far as practicable, for each of the courses specified below will be selected from the classes of officers indicated in connection with those courses. Basic Course. Officers of the Medical Corps of the Regular Army. Officers of the Medical Corps of the National Guard and of the Medical Corps Reserve who are eligible in accordance with instructions of the War Department and who are willing to devote the necessary time to this course. Extension Course. Medical officers of the Regular Army, National Guard, and Or- ganized Reserves, in accordance with such policies as may be prescribed from time to time by the War Department. Graduate Course. Such graduates of this school as may be recommended by the com- mandant and the Surgeon General as having shown special aptitude for the study of medical subjects in their relation to aviation. Successful completion of the Basic Course of instruction for the complete period of four months, or the completion of the extension course of instruction and six weeks of the practical training given in the Basic course, and recommendation of the faculty of the School of Aviation Medicine qualify a medical officer as an aviation medical examiner. A year of active duty thereafter with the Air Corps is required for qualifi- cation as flight surgeon. The School of Aviation Medicine was established at its present site at Randolph Field, San Antonio, Texas in 1931. Randolph Field is the Primary Training Center of the Air Corps and offers an excellent location both geographically and functionally for the train- ing of flight surgeons and technical assistants to flight surgeons. Due to the recent increase in the Air Corps, eighteen branch schools are established at various Air Corps stations. Purpose. The School of Aviation Medicine was created to instruct medical officers of the Regular Army, National Guard, and Reserve Corps to perform efficiently the special duties of flight surgeons, in peace or war, and to coordinate such duties with other pro- fessional and non-professional activities which they may be called upon to perform as medical officers of the army. Origin and History. To continue the training of flight surgeons after the World War, THE SCHOOL OF AVIATION MEDICINE the School of Aviation Medicine was established in 1919 at Mitchel Field, Long Island, New York. The United States had in October, 1918, instituted a Medical Research Board to investigate all conditions which affected the efficiency of fliers. This early work was done at Hazelhurst Field, Mineola, New York, where the Medical Research Laboratory was established. Medical officers of the Army were detailed to this laboratory for special training in aviation medicine, and following such training these specialists served with various army aviation units. They became known as flight surgeons. In February, 1921, the Medical Research Laboratory and School for Flight Sufgeons was classified and listed as a special service school. In November of the following year the name was changed to its present one, ‘The School of Aviation Medicine,’ by A.R. 305-115. The school was moved from Mitchel Field, New York to Brooks Field, Texas in 1926. It was housed there in the “Big Balloon Hangar” until May, 1927, when more permanent quarters were provided. Upon the establishment of the Air Corps Primary Training Center at Ran- dolph Field, Texas, the school was moved in 1931 to its present location at Randolph Field. The building for the School of Aviation Medicine is adjacent to the station hospital building, permitting close professional contact with the local medical establish- ment. The School of Aviation Medicine in conjunction with the Primary Training Center functions as a teaching and research institution. Eighteen branch schools were established in 1941. Organization and Administration. The School of Aviation Medicine is under the juris- diction of the Chief of the Air Corps, and is supported financially by the Air Corps. The Surgeon General of the Army cooperates in arranging its program of instruction and in securing candidates for flight surgeons for the Air Corps from the Medical Corps of the Regular Army. The function of the school is three fold: (1) instruction and training; (2) investiga- tion and research; and (3) the conduct of extension courses. The personnel of the school includes a commandant, assistant commandant, executive officer, adjutant, instructors, enlisted men, civilian clerks, and technicians. The school is divided into four departments, each one in charge of a director who is a member of the faculty: Ophthalmology and Otology, Aviation Medicine, Psychology, and Neuro- psychiatry. These departments have specific objectives with reference to the training and instruction of flight surgeons: Ophthalmology and Otology. To instruct student officers in: The fundamentals and the basic factors of ophthalmology, such as the anatomy, his- tology, physiology, and pathology of the eye and its adnexa. The diagnosis and the treatment of common occular affections. The special diagnostic methods and instruments utilized in the examination of the eye. The anatomy and physiology of the nose, throat, and ear, with special attention to the labyrinth. The diagnosis and treatment of the common affections of the ear, nose, and throat. The care and maintenance of the flier; ophthalmological and otological aspects. The procedure of conducting the examination of the eye, ear, nose, and throat for flying, in accordance with A.R. 40-110. Aviation Medicine. To instruct student officers in: The diagnostic methods especially applicable to the physical examination for flying. Abnormalities and anomalies of general bodily function, with special reference to the cardiovascular system. The ill effects of low oxygen pressure on flying personnel and methods employed in preventing anoxia at high altitudes. The cause and prevention of fatigue. The physiology and hygiene of muscular exercise. The organization and function of the Air Corps and of the Medical Department on duty with the Air Corps. Airplane accidents with special reference to: The common accidents and injuries resulting therefrom. Demonstration of, and instruction in, the use of crash tools. AVIATION MEDICINE 597 598 Methods of splinting. The use of orthopedic appliances as temporary fixation and treatment before and during transportation. The care and maintenance of the flier; general physical aspects. The preparation of records, reports, and returns which pertain exclusively to the Medical Department on duty with the Air Corps. Technical subjects pertaining to aviation, Air Corps tactics and organization, to- gether with a sufficient number of demonstration flights in various types of air- craft in order that the student may better understand and appreciate the problems of the pilot; all by selected Air Corps instructors. The procedure of conducting the general physical examination for flying in accord- ance with A.R. 40-110. Psychology. To instruct student officers in: The methods and subject matter of psychology. The methods of determining the psychological fitness of applicants for flying train- ing by means of neuropsychic examinations, reaction time tests, and flying adapt- ability tests. The methods of detecting beginning psychological inefficiency in flying personnel. The care and maintenance of the flier; psychological aspects. The procedure of conducting the psychological examination for flying in accordance with A.R. 40-110. Neuropsychiatry. To instruct student officers in: The fundamentals of psychological conception of mental disease. The psychopathic personalities and their reactions. The minor psychoses. The frank psychoses. The care and maintenance of the flier; neuropsychiatrical aspects. The procedure in conducting the neuropsychiatric examination for flying in accord- ance with A.R. 40-110. Courses of Instruction. The instruction and training which the school gives to officers of the Medical Corps of the Regular Army, National Guard, and Reserve, include: The organization and administration of the Medical Department as related to special requirements of the Air Corps. The principles and technique of physical examination for flying training and tests of fliers. The application of tests for physical efficiency. The physical care of fliers. The medical specialties as related to aviation medicine, including neuropsychiatry, physiology, ophthalmology, otology, psychology, and cardiology. The instruction and training given to selected enlisted men for specialists’ courses is made up of those subjects required for proficiency as first, second and third class tech- nicians of the Medical Department and for qualification as assistants to flight surgeons. The Basic Course of instruction for the Regular Army medical officers who are selected to attend the school for the purpose of becoming flight surgeons covers a period of four months. During peacetime two basic courses are conducted annually, commencing July 15th and December 1st of each calendar year. At present, the basic course has been reduced to three months’ duration. On completion of the course, Army aviation medical examiners proceed to Air Corps military establishments. Army extension courses in aviation medicine and allied subjects of the basic course of instruction are conducted by correspondence for medical officers of the Regular Army, Reserve Corps, and National Guard, requiring approximately two years to complete. Upon successful completion of the correspondence course, the medical officer may apply for attendance to the resident’s course of practical training to complete qualification for a flight surgeon. The supplementary resident’s course of six weeks’ duration is given at the school for MILITARY MEDICAL MANUAL AVIATION MEDICINE 599 the practical training of Medical Reserve Corps and National Guard officers who Lave completed the correspondence courses to enable these officers to qualify as flight surgeons. This practical training is given during the latter part of each basic course; upon suc- cessful completion a certificate of graduation as an aviation medical examiner is awarded. The purpose of each of the above courses is to fit officers of the Medical Corps of the three components of the Army of the United States to perform efficiently the duties of a flight surgeon in the professional, administrative, and personal relations: Selection of candidates for flying. Care of the flyer. Classification of the flier. Including the year 1940, over 550 medical officers have graduated and been qualified as aviation medical examiners and flight surgeons on completion of one of the above courses. This number has more than doubled during the year 1941 and 1942. A graduate course of instruction is given to graduates of the school as may be recom- mended by the commandant and the Surgeon General as having shown special aptitude for the study of medical subjects in their relation to aviation. During peacetime two specialists’ courses of three months (6 weeks’ course at present) each are given for selected enlisted men of the Medical Department of the Army, each of whom upon graduation receives a certificate as a specialist qualifying him as an assistant to a flight surgeon. This rating places them in position to accept ratings as first, second, or third class technicians in the Medical Department. Besides the above course the school carries on many research projects in aviation medi- cine and the physical qualifications of flying personnel. Much research work is con- ducted in conjunction with the Physiological Research Laboratory at Wright Field, Dayton, Ohio. The necessary detailed information relative to the provision, selection, and detail of students to the School of Aviation Medicine may be found in A.R. 350-500. Application to attend the School of Aviation Medicine should be forwarded to The Adjutant Gen- eral, United States Army, Washington, D. C., through military channels. THE PHYSIOLOGICAL RESEARCH LABORATORY The Physiological Research Laboratory was create< to conduct research pertaining to the development of equipment and materiel required to permit Air Corps personnel to function under the adverse and often abnormal conditions experienced in flight. Origin and History. In October, 1918, during the World War, the United States Army instituted a Medical Research Board for the purpose of investigating all conditions which affected the efficiency of fliers. The board carried on its studies and investigation in the Medical Research Laboratory, Hazelhurst Field, Mineola, New York, which was com- pleted and began operation the same year. In 1919 the establishment moved to Mitchel Field, New York, where the institution was known as the Medical Research Laboratory and School for Flight Surgeons, since, in addition to carrying on research, a course was given for flight surgeons. Army regulations changed the name to “The School of Aviation Medicine” in 1922, after which the research work conducted was carried on secondarily to the operation of the school. When the service school was transferred to Brooks Field, Texas, and later to the Air Corps Primary Training Center at Randolph Field, Texas, so much advancement had taken place in aviation that there became a need for research in the equipment and materiel in order to permit the pilots to function normally under the added strain and hazards of speed and high altitude flying. With these considerations in view, the need for a research laboratory such as was operated during the World War and until 1920 became increasingly clear to Lieutenant Malcolm C. Grow, Medical Corps, then Surgeon of Patterson Field, near Wright Field, Dayton, Ohio. On his own initiative in the spring of 1933 he started some work at Wright Field. Each day, on completion of his regularly assigned duties at Patturson Field, he spent the rest of the day at Wright Field. Although no laboratory equipment was avail- able, he experimented on aviation clothing, using several types of furs. Lambskin leather was found preferable to cordovan for outside covering of pilot garments because of its 600 MILITARY MEDICAL MANUAL lighter weight. He also brought about the adoption of the ski-pants type of trouser with a snug cuff at the bottom. Later, in 1934, Colonel Grow became Chief of the Medical Section in the Office of the Chief of the Air Corps, and Captain Harry G. Armstrong, Medical Corps, was sent to Wright Field for the sole purpose of setting up and supervising a research unit, Colonel Grow having convinced the Air Corps of the value of this laboratory. On May 19, 1935, the Chief of the Air Corps directed the Chief of the Materiel Division, Wright Field, to create the Physiological Research Laboratory. This laboratory was completed January 1, 1937. The Physiological Research Laboratory is located at Wright Field, Dayton, Ohio, in the Main Engineering Experimental Laboratory building of the Materiel Division of the Air Corps. It contains: an office; physiological, biochemical, and high altitude laboratories; operating room; balance room; and stock room. A centrifugal force laboratory is located in a portion of the balloon hangar. The various rooms are separated by steel and glass partitions and are completely air-conditioned, providing a suitable environment for gas analysis and other measurements requiring a uniform temperature. The biochemical laboratory is provided with all facilities for complete blood analysis and studies of a chemical nature. The large altitude chamber is of cylindrical construction and divided into three sections. A central compartment opens on either side into two end compart- ments, the central compartment serving as a lock through which entrance from the out- side can be made to the other sections without disturbing the pressure conditions within. The chamber can be evacuated to the equivalent of 80,000 feet and can be refrigerated to —65 degrees Fahrenheit. The centrifugal force laboratory contains installations whereby forces twenty times the normal acceleration of gravity can be produced. The office contains a library of standard medical books, reference works on aviation medicine, and appropriate current periodicals. All of the laboratories are fully equipped with the pertinent apparatus and devices to carry on their respective research. The Physiological Research Laboratory is under the direction of an officer of the Medical Corps, who is termed the director. A doctor is in charge of the research. The work of the laboratory is coordinated with the research of the Materiel Division of the Air Corps located at the same field and also with the research work of the School of Aviation Medicine at Randolph Field, Texas. Numerous projects have been completed since the laboratory was started, and many are undergoing continuous study. Research in the physiological requirements of high altitude flying is now one of the important projects of this laboratory. It presents a broad field for experimentation on the effects of cold, decreased atmospheric pressure, diminished oxygen supply, and allied climatic changes. In view of the many unsolved problems confronting aviation, due to more efficient performance of airplanes, the Physiological Research Laboratory will prove of great value in the advancement of aviation. A new era in aviation is here. Large, multi-motored ships, manned by crews and flying at greater altitudes, are commonplace at present. Substratosphere flying will become a common occurrence. The construction of ships with sealed cabins, in which the barometric pressure at sea level is simulated, will allow the occupants to exist as comfortably and safely in the rarified atmosphere of great altitudes as they do on the ground. All this not only involves intricate engineering details but many physiological problems as well. The Physiological Research Laboratory at Wright Field, in charge of a flight surgeon, is conducting studies on physiological requirements for sealed high-altitude enclosures and on numerous other projects which affect the health and safety of Air Corps personnel. Many new books on aviation medicine have been published rccendy. In- formation relative to these books and to recent developments in the field of aviation medicine is published in the Journal of Aviation Medicine. It is the official publication of the Aero Medical Association of the United States. The office of Duplication is located at 2642 University Avenue, St. Paul, Minnesota. Part III Medical Tactics and Administration CHAPTER I ATTACHED MEDICAL PERSONNEL WITH UNITS OF THE INFANTRY AND CAVALRY DIVISIONS Introduction. This chapter deals with the duties of those members of the Medical Department who are designated in War Department Tables of Organization as “attached medical personnel.” Each major component of the infantry, armored, motorized, and cavalry divisions, as well as other organizations, is furnished a fixed quota of officers and men of the Medical Department who, in the usual case, are referred to collectively as the Regimental Medical Detachment. This personnel accompanies the unit to which attached in all tactical operations, functions under the immediate control of its com- mander, and is not to be confused with the medical battalion, or medical squadron which forms an organic part of the infantry, armored, or cavalry division. In our Army the scheme of evacuation provides that men who become battle casualties receive their first treatment at the hands of the attached medical personnel. For this reason it has been truly said that they form the very backbone of the medical service available to combat divisions. The strength, organization, and method of operation of attached medical personnel varies according to the nature and organization of the unit to which it is attached. The discussion of the organization and functions of the division medical battalion, or equi- valent unit, is presented in Chapter II. In this chapter, for purposes of convenience and ready reference, the discussion of attached medical personnel is presented for various types of divisional organizations in the order listed below. Detachments with Units of the Infantry Division. Detachments with Units of the Cavalry Division. The Interior Economy of the Attached Medical Personnel. Duties of Commissioned Personnel. Employment of the Attached Medical Personnel with Infantry. Employment of the Attached Medical Personnel with Units other than Infantry. Organization and Employment of the Attached Medical Personnel with the Armored Division. Organization and Functions of the Regimental Medical Detachment. General. The regimental medical detachment is organized as follows: Headquarters section. One battalion or squadron section for each battalion or squadron of the regiment. Veterinary sections for organizations having animals. The headquarters section of the medical detachment is organized to provide adminis- trative, supply, and communications service for the battalion medical sections. Its usual organization includes the regimental surgeon, the assistant regimental surgeon, two dental surgeons, and such enlisted personnel as the surgeon may deem necessary. The regimental surgeon is the senior medical officer. He directs and supervises the medical and dental services of the regiment and coordinates the veterinary services through the veterinarian in the organizations having animals. When necessary the headquarters section establishes and maintains a regimental aid station and dispensary for the care and treatment of troops located in the vicinity of regimental headquarters. It replaces the battalion or squadron medical section when it is necessary to keep them mobile or to permit them to keep contact with the unit supported. The battalion or squadron section of which there may be one or more, is designed to function as a tactical unit. It consists of the battalion surgeon, the assistant battalion sur- geon, and available enlisted personnel. In general, the total enlisted strength of any battalion or squadron section is approximately twice the strength of the headquarters section. 604 MILITARY MEDICAL MANUAL DETACHMENTS WITH UNITS OF THE INFANTRY DIVISION The Regimental Medical Detachment with an Infantry Regiment. The medical de- tachment with an infantry regiment consists of 9 officers and 103 enlisted men. It is divided into a headquarters section and 3 battalion medical sections. (See Plates 1 and 2). Headquarters section. The headquarters section consists of the regimental surgeon (major), 2 dental officers (a captain and a first lieutenant), 1 technical sergeant, 1 ser- geant, 23 technicians, and privates first class or privates. (T/O 7-11). The sergeant is in direct charge of supply functions. If a regimental aid station is established he assists in applying dressings. MEDICAL DETACHMENT Infantry Regiment 9 Officers 103 Enlisted Men HEADQUARTERS SECTION 1 Medical Officer 2 Dental Officers 25 Enlisted Men 1ST BATTALION SECTION 2 Medical Officers 26 Enlisted Men 2D BATTALION SECTION 2 Medical Officers 26 Enlisted Men 3D BATTALION SECTION 2 Medical Officers 26 Enlisted Men REGIMENTAL AID STATION GROUP I Officer 6 Enlisted Men HEADQUARTERS GROUP 2 Officers 5 Enlisted Men COMPANY AID GROUP 14 Enlisted Men BATTALION AID STATION GROUP 2 Medical Officers 6 Enlisted Men LITTER BEARER GROUP 12 Enlisted Men COMPANY AID GROUP 8 Enlisted Men Plate 1. Functional Organization of the Regimental Medical Detachment with an Infantry Regiment. The 23 technicians and privates first class or privates are medical, surgical, dental, and sanitary technicians, clerks, and chauffeurs. One of these enlisted men serve as the com- pany aid man for the service company, two as company aid men for the headquarters and headquarters company, and three for the antitank company. The equipment, new pattern (97300) of the headquarters section listed in the Medical Department Supply Catalog as changed by Changes 1942, consists of: Blanket set, small each 1 (97465) Case, tent pins each 1 (97515) Chest, MD., No. 1 each 1 (97565) Chest, MD., No. 2 each 1 (97570) Cocoa Unit each 1 (97655) Lantern set each 1 (97775) Splint set each 1 (97815) Water sterilizing set each 1 (97940) Water sterlizing set, case, canvas, empty (97945) ea. 1 Bucket, canvas, collapsible, QM ea. 2 Cheesecloth or gauze, 36 inches wide yards 2 ATTACHED MEDICAL PERSONNEL 605 Reagents: box 1 Calcium hypochlorite, QM tubes 50 Orthotolidine, QM tubes 36 Litter, aluminum pole each 6 (99350) or Litter, (old type) each 6 (78440) Tent, pyramidal, 11x16x16 feet, complete, (with pins and poles) each 1 Miscellaneous: Axe, handled, chopping, single bit, standard grade, 4-pound each 1 Pick, handled, railroad, 6- to 7-pound each 1 Shovel, hand, D-handle, round point each 1 Rope, l/2 inch, 40 feet each 1 Flag, Geneva Convention (Red Cross) marker, with case and staff each 1 Bucket, general purpose, galvanized, without lip, 24 gage, 14 quart each 3 The transportation of the headquarters section consists of: 1 *4-ton truck 1 %-ton trailer 1 1^4-ton cargo truck 1 2 3 4 5 6 7 1 Unit Technician 1 grade Headquarters section 3 battalion sec- tions (each) Total detach- ment Enlisted cadre Remarks 2 1 1 3 4 Captain First lieutenant <11 11 X 1 4 4 .... » Drives truck, J£-ton. b Drive trucks. •Includes 6 company aid men 3 for antitank com- 5 3 2 9 S 1 1 1 pany; 2 for headquarters and headquarters company; 1 for service company. d Dental. 7 Medical (673) __ .. (1) (1) 3 (1) 3 g 1 9 Medical (673) 1”. (1) (3) 1 (3) to 1 •Includes 8 company aid men. 11 (1) (1) 3 12 1 The serial number symbol shown in parentheses i? an inseparable part of the spe- cialist designation. See AR 615-26. 13 (1) 24 (3) 6 15 ' 33 41 (1) (2) 14 15 16 17 18 Technician, grade 41 Technician, grade 51., ,. Private, first class. (lncmdlDg Private J 5 23 (*1) (2) 4 6 19 5 20 b 2(12) (2) (36) / (2) \ (5) (1) 21 5 } (1) (1) 22 23 (1) 1 24 4 | (6) (4) (4) 25 20 Surgical technician (861) 5 i (®8) (•10) j (10) t (22) 27 (1) (9) (1) (9) 28 29 25 26 103 13 30 28 28 112 13 31 1 2 7 32 1 2 7 33 1 1 Plate 2. T/O 7-11, March 1, 1943. Organization of the Regimental Medical Detachment of an Infantry Regiment. Battalion medical section. One battalion medical section is provided for each battalion of the infantry regiment. Each section consists of the battalion surgeon (usually a captain), the assistant battalion surgeon (usually a first lieutenant), a staff sergeant, a corporal, and 24 technicians, privates first class or privates. The battalion section is further divided into: 606 MILITARY MEDICAL MANUAL An aid station group, a litter bearer group, a company aid group. The battalion aid station group consists of 2 medical officers, 1 staff sergeant, 1 cor- poral, and 4 privates first class or privates. The staff sergeant is in charge of the enlisted personnel and is a surgical assistant and dresser. He may be placed in charge of the property, the exchange of medical and surgical supplies, water purification at the aid station, and the preparation of hot stimulants. The corporal is an assistant dresser, has charge of the sterilization of instruments, the giving of hypodermic medication (under the immediate supervision of the medical officer in charge of the station). One private first class or private is assigned to clerical duties. He prepares and keeps the station blotter, which gives all the required information concerning the cases which pass through the station. Two privates first class or privates are chauffeurs of the trucks assigned to the bat- talion medical section. They may be used for general utility purposes around the aid station or wherever their services are required. The litter bearer group consists of 12 privates first class or privates. In garrison or camp this group is chiefly employed in and about the camp dispensary. In combat the members of this group function as litter bearers, carrying wounded by hand from the company areas to the battalion aid station. They operate within the zone of action to which assigned, locating the men who have become casualties. They remove all seriously wounded promptly from the field to the aid station, direct and assist the walking wounded to the aid station, and assist the aid station group in moving and reestablishing the aid station. They also act as a channel of communication between the company aid men and the battalion surgeons and vice versa. The litter bearer group may be divided into 3 four-bearer litter squads or 6 two- bearer litter squads. Each squad carries a litter. Each litter bearer has two medical pouches. The right hand pouch contains adhesive plaster, bandage scissors, safety pins, iodine swabs in a metal container, gauze bandages and a flask with cup for aromatic spirits of ammonia. The left hand pouch contains a pencil, a book of emergency medical tags, and first aid dressings. The company aid group consists of 8 privates first class or privates, 1 being attached to each platoon as follows: 1 per rifle platoon, 1 per platoon of heavy weapons com- pany, and 1 per antitank platoon. They follow their respective platoons in battle, administering immediate emergency treatment. They direct the walking wounded to the aid station, indicating the shortest and safest routes thereto. They facilitate the work of the litter bearer squads by marking the location of seriously wounded or moving them to locations, sheltered and in defilade if possible, where the wounded may be found and evacuated more readily. The company aid men send information to the battalion surgeons relative to the tactical situation near the front line, locations of wounded, etc., by messages carried by the litter bearers or walking wounded. Each company aid man is equipped with two medical pouches. The contents of each is identical with that carried by the litter bearer group. The equipment, new pattern (97205), of a battalion medical section of the infantry battalion consists of: Blanket sets, small each 2 (97465) Case, tent pins each 1 (97515) Chests, Medical Dept., No. 1 each 2 (97565) Chests, Medical Dept., No. 2 each 1 (97570) Cocoa units each 2 (97655) Lantern sets each 2 (97775) Bucket, canvas, collapsible, 10 qt. each 1 (99140) Splint sets each 2 (97815) Water sterilizing set. See list for headquarters section each 1 (97940) Litters, aluminum pole each 12 (99350) or Litters, wooden pole each 12 (78440) ATTACHED MEDICAL PERSONNEL 607 Tent, wall, small, complete with fly, pins, and poles each 1 Miscellaneous: Axes, handled, chopping, single bit, standard grade, 4 pound each 2 Picks, handled, railroad, 6- to 7-pound each 2 Shovels, hand, D-handle, round point each 2 Ropes, Zz -inch, 40 feet each 2 Flags, Geneva Convention (Red Cross) marker, with case and staff each 2 The transportation of the battalion medical section of the infantry battalion consists of two 14-ton trucks, and two 14-ton trailers. The company aid men ride on the trans- portation of the company to which they are assigned. The trucks and trailers of the battalion medical section transport the medical equipment of the section. The unit surgeon rides with the battalion headquarters. The Medical Detachment with Artillery. General. The medical detachments with artillery are organized in accordance with the functions and composition of the unit served. The transportation furnished the medical detachment is such that contact can be maintained with the unit with which it operates. The unit surgeon and unit commander will use the medical personnel to the best advantage for the mission or missions to be performed by the command. Full advan- tage will be taken to use unit transportation for the evacuation of casualties, and to avoid litter carry. The ultimate practical solution of functional organization of the medical detachment therefore falls upon the decision of the unit surgeon to fit the plan of his commander. Consideration should be given to furnishing adequate medical service during operation of standing operating procedures. 1 2 3 4 5 6 7 1 Unit Tech- nician grade Head- quar- ters section 3 regi- mental sec- tions (each) Obser- vation battal- ion section Total Remarks 2 1 3 3 1 3 1 11 1 4 a 1 The serial number symbol shown in pa- rentheses is an insepa- rable part of the spec- ialist designation. A 6 15 6 (1) (3) (2) 0) (7) 7 fers to an occupational specialist whose quali- fication analysis is found in AR 615-26. A number above 500 refers to a military occupational special- Medical (673) (2) 34 0) (7) 1 ” 12 13 Technician, grade 4| Technician grade 5linduding 14 15 Private j (10) (7) (1) (1) (2) (3) (U (1) (3) (5) (5) (3) 1 42 l 60 (35) (25) (4) (4) (5) (10) (3) (5) (10) (18) a) a) (i) (i) Department, 1942. 5 20 Technician, medical (123) 5 (1) (1) 23 surgical (225) 6 (i) (1) (1) (2) 25 0) 26 6 39 16 139 27 8 43 17 154 29 Q Truck, command and 2 1 7 30 2 1 7 Plate 3. T/O 6-50, April 1, 1942. Organization of the Medical Detachment, Field Artillery Brigade. The Medical Detachment of a Field Artillery Brigade. The medical detachment of the field artillery brigade is organized into a headquarters section, three regimental sec- tions and an observation battalion section, a total strength of fifteen officers and 139 enlisted men. (See Plate 3, T/O 6-50.) The Medical Detachment of the Division Artillery of the Infantry or Motorized Divi- sion. The medical detachment of the infantry or motorized division is organized into a 608 MILITARY MEDICAL MANUAL headquarters section and four battalion sections with a total strength of 6 officers and 47 enlisted men. (See Plate 4, T/O 6-10.) For functional organization of the medical detachment, division artillery, Infantry or Motorized Division, see Plate 5. The Regimental Medical Detachment with the Artillery Regiment, 155-mm Howitzer, Truck-drawn. The medical detachment with an artillery regiment, 155-mm howitzer truck-drawn, is divided into a headquarters section and two battalion medical sections. (See Plates 6 and 7.) 1 8 t 4 6 6 1 Unit Techni- cian grade Head- quarters detach- ment 4 battal- ion de- tach- ments (each) Total Remarks 2 1 1 3 dl 1 5 * Drives truck, ?4-ton. d Dental. For equipment see T/B 6-10-M for head- quarters detachment; T/E 6-25-M for battalion 4 Total commissioned 2 1 6 6 Technical sergeant, Including _ _ 1 1 6 Medical (673) (1) (1) 4 7 1 8 (1) (4) 1 9 Sergeant, including. 1 10 Medical (673).- (1) (1) 4 svmbol shown in paren- theses is an inseparable part of the specialist designation. See AR 615-26 11 Corporal, including 1 12 Medical (673) (l) 8 (4) 4 11 13 14 16 16 17 Technician, grade 4) Technician, grade 5l!n„ln,,)ri(J 5 Private, first class.. ( * Private - J Driver, truck, light (345) (1) (1) (1) 9 13 (1) 18 5 1) 19 5 a) (4) 20 medical (409) (M) U) (2) 21 4 (4 (9) (12 (5) 22 5 (1) 23 (3) U) 24 (1) 26 7 10 47 26 9 11 63 27 1 1 6 28 1 1 6 Plate 4. T/O 6-10, March 1, 1943. Organization of the Medical Detachment, Division Artillery, Infantry or Motorized Division. Headquarters section. The headquarters section consists of the regimental surgeon, one dental officer, a technical sergeant (platoon leader), 1 technician grade 4 (surgical technician), 1 technician grade 5 (dental technician), and 4 privates first class or privates (1 chauffeur, 1 ambulance orderly, 1 medical technician, and 1 basic). The assignments and duties of the commissioned and enlisted personnel are analogous to those of like personnel with an infantry regiment. Battalion medical section. Each battalion medical section consists of a battalion sur- geon, a staff sergeant (section leader), a corporal (medical), 2 technicians grade 5 (1 medical technician, 1 surgical technician), and 12 privates first class or privates (5 battery aid men, 3 chauffeurs, 1 medical technician, 1 surgical technician, and 2 basics), a total strength of one officer and 16 enlisted men. The assignments and duties of the battalion surgeon and the enlisted personnel are analogous to those of like personnel with an infantry battalion. The section is divided into: A battalion aid station group which consists of a medical officer, a staff sergeant, a corporal, and 9 privates first class or privates. When necessary a litter bearer group is drawn from the aid station group. Transportation. The equipment and transportation of the medical deatchment is shown in Table of Organization 6-31 (Plate 6). ATTACHED MEDICAL PERSONNEL 609 MEDICAL DETACHMENT Division Artillery 6 47 HQ DET (b) 2 7 BN SEC 105-mm HOW I 10 BN SEC 105-mm HOW I 10 BN SEC 105-mm HOW I 10 BN SEC 155-mm HOW I 10 HQ AID STA GP 2 7 BN AID STA GP I 10 LITTER BEARER GROUP Plate 5. Functional Organization of the Medical Detachment, Division Artillery, of the Infantry or Motorized Division. The Regimental Medical Detachment with the Artillery Regiment, 105-mm Howitzer, Truck-drawn. The regimental medical detachment with the artillery regiment, 105-mm Howitzer, truck-drawn, is identical in function, organization, and equipment with that 1 2 3 4 5 6 7 1 Unit Techni- cian grade Regi- mental section 2 battal- ion sections (each) Total En- listed cadre Remarks 2 1 3 <*1 1 3 <> Dental. 4 symbol shown in pa- 6 6 (1) (1) 2 (1) 2 separable part of the specialist designa- 7 8 (1) (2) 2 (2) 2 9 10 Medical (673) a) (2) [ 1 (2) occupational special- ist whose qualifica- tion analysis is found in AR 615-26. A number above 600 refers to a military occupational special- ist listed in Circulars Nos. 14 and 67, War Department, 1942. 11 12 13 14 15 Technician, grade 5| Private, first class fmcludLng Private 6 12 1 17 (10) (7) (1) (1) (2) (3) (1) { $ 1 (5) (3) } 1 (i) (i) (i) 17 18 Technician, dental (067) Technician, medical (123).. 6 19 6 (1) 20 0) a) i (1) Technician, surgical (225).. Technician, surgical (225).. 22 23 5 (2) a; 24 (i) (2) w 25 7 16 39 7 26 9 17 43 7 27 1 1 3 28 Q Truck, K-ton, command 1 2 29 1 2 Plate 6. T/O 6-31, April 1, 1942. Organization of the Medical Detachment, Field Artillery Regiment, 155-mm Howitzer, Truck-drawn. 610 MILITARY MEDICAL MANUAL MEDICAL DETACHMENT ARTILLERY REGIMENT 155-MM. HOWITZER TRUCK-DRAWN 4 Officers 39 Enlisted mer HEADQUARTERS SECTION 1st BATTALION SECTION 2d BATTALION SECTION I Officer 16 Enlisted men I Officer 16 Enlisted men 2 Officers 7 Enlisted men REGIMENTAL AID STATION GROUP BATTALION AID STATION GROUP UTTER BEARER GROUP BATTERY AID GROUP 2 Officers 7 Enlisted men I Medical officer 11 Enlisted men 5 Enlisted men Plate 7. Suggested Functional Organization of the Regimental Medical Detachment with an Artillery Regiment, 155-mm Howitzer, Truck-drawn, T/O 6-31, April 1, 1942. MEDICAL DETACHMENT ARTILLERY REGIMENT 105-MM HOWITZER, TRUCK-DRAWN 4 Officers 39 Enlisted men REGIMENTAL SECTION 1st BATTALION SECTION 2d BATTALION SECTION 2 Officers 7 Enlisted men I Officer 16 Enlisted men I Officer 16 Enlisted men BATTALION AID STATION GROUP LITTER BEARER GROUP BATTERY AID GROUP I Medical Officer I I Enlisted men 5 Enlisted men Plate 8. Suggested Functional Organization of the Regimental Medical Detachment with an Artillery Regiment, 105-mm Howitzer, Truck-drawn. T/O 6-21, April 1, 1942. of the 155-mm gun regiments. The total strength is 4 officers and 39 enlisted men. (See Plates 8 and 9). Regimental section. The regimental section consists of the regimental surgeon, one dental officer, a technical sergeant (platoon leader), a surgical technician grade 4, a dental technician grade 5, and 4 privates first class or privates (a medical technician, an ambulance orderly, a chauffeur, and a basic). The assignments and duties of the com- missioned and enlisted personnel are analogous to those of like personnel with an in- fantry regiment. ATTACHED MEDICAL PERSONNEL 611 1 2 3 4 6 5 7 8 8 10 a 12 13 14 15 16 17 18 16 20 21 22 23 24 26 26 27 28 26 1 2 3 4 A 6 7 Unit Techni- cian grade Regimen- tal section 2 battal- ion sec- tions (each) Total En- listed cadre Remarks Major . 1 dl 1 3 d Dental. The serial number symbol shown in pa- rentheses is an insepa- rable part of the special- ist designation. A number below 500 re- fers to an occupational specialist whose quali- fication analysis is found in AR 615-26. A number above 600 re- fers to a military occu- pational specialist listed in Circulars Nos. 14 and 67, War Depart- ment, 1942. 1 Total com miss 2 1 4 Technical sergeant, including l (1) 1 (1) 2 (2) 2 (2) 1 4 12 17 (10) (7) (1) (1) (2) (3) (1) / (1) l (3) (5) 1 to 2 (2) (2) Platoon leader (65 Staff sergeant, inclu 8ection leader (652 Corporal, including. ) i (i) i a) 14 (5) (3) Technician, grado 4 Technician, grade 5 Private, first class.. includ- ing.... } 6 1 } * (1) (1) (1) Orderly, ambulance (696) . Technician, dental (067).... 5 5 (1) (1) Technician, medic Technician, surgic Technician, surgic Technician, surgic a!(123).. (1) (1) } al (225).. al (225).. 4 5 "1! <9 (2) (1) Total enlisted 7 16 39 7 0 .17 43 7 Q Ambulance, %-t Q Truck, K-ton, c and reconnaiss Q Truck, 2H-ton, 1 1 1 1 '3 2 2 )mmand Plate 9. T/O 6-21, April 1, 1942. Organization of the Regimental with a Field Artillery Regiment, 105-mm Howitzer, Tri tal Medical Detachment Truck-drawn. Battalion medical section. Each battalion medical section consists of a battalion surgeon, a staff sergeant, a corporal, 2 technicians grade 5, 12 privates first class or privates. The assignments and duties of the battalion surgeon and the enlisted per- sonnel are analogous to those of like personnel with an infantry battalion. A battalion aid station group which consists of a medical officer, a staff sergeant, a corporal, and 9 privates first class or privates. A battery aid group of 5 privates first class or privates who are assigned to duty as battery aid men with each battery. When necessary a litter bearer group is drawn from the aid station group. Transportation. The equipment and transportation of the medical detachment is shown in the Table of Organization 6-21 (Plate 9). The Medical Detachment of the Field Artillery Battalion, Light, Truck-drawn. The organization, equipment, and transportation of the medical detachment, field artillery battalion, light, truck-drawn (T/O 6-25) is identical with the organization of a bat- talion medical section of the regimental medical detachment of the field artillery regi- ment, 105-mm howitzer, truck-drawn. (See T/O 6-21). Medical Detachment, Field Artillery Observation Battalion. The medical detachment of the field artillery observation battalion is organized similarly to that of the 155-mm howitzer, battalion medical section. See T/O 6-75 (Plate 10). The Attached Personnel with the Engineer Units. The attached personnel with en- gineer units is distributed in accordance with the need or the mission of the engineer unit. The decision is made by the unit surgeon as approved by the unit commander, except with engineer units which are called upon to perform combat duty. The 612 MILITARY MEDICAL MANUAL attached medical personnel are located several miles from the front of the divisional area. In such situations emergency treatment and medical attention may be obtained for engineer personnel through contact with medical units in their vicinity. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 1 2 3 4 6 Unit Technician grade Total Enlisted cadre Remarks 1 The serial number symbol shown in paren- theses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification anal- ysis is found in A R 615-26. A number above 500" refers to a military oc- cupational specialist list- ed in Circulars Nos. 14 and 67, War Department, 1942. 1 1 1 1) 1 1) 2 6 7 6) ») 1) 1) 1) 1) 2) 1 (1) 1 (1) 1 Technician, grade 5] 5 5 CD 16 3 17 3 1 1 1 Q Truck, 94-ton, command and * Q Truck, cargo Plate 10. T/O 6-75, April 1, 1942. Organization of the Medical Detachment, Field Artillery Observation Battalion. Attached Medical Personnel, Engineer Combat Battalion, Infantry Division. T/O 5-15, April 1, 1942. The personnel of the medical detachment, engineer combat battalion, infantry division includes one captain, (medical officer), 2 first lieutenants (la dental officer), 1 staff sergeant, 1 corporal, 1 technician grade 4, 2 technicians grade 5, 7 privates first class and 8 privates. The transportation consists of one %-ton ambulance, one %-ton command and reconnaissance truck, and one 2 /2 -ton cargo truck. The Attached Medical Personnel with the Quartermaster Units. The organization of the detachment is dependent upon the distribution of the quartermaster unit and the mission of the unit to which the detachment belongs. The Regimental Medical Detachment with the Cavalry Regiment, Horse. (T/O 2-11, April 1, 1942). The medical detachment with the cavalry regiment is divided into a headquarters section, two squadron medical sections, and a veterinary section. (See Plate 11.) DETACHMENTS WITH UNITS OF THE CAVALRY DIVISION MEDICAL DETACHMENT CAVALRY REGIMENT 9 Officers 56 Enlisted men HEADQUARTERS SECTION 4 Officers 16 Enlisted men 1st SQUADRON SECTION I Officer 13 Enlisted men 2d SQUADRON SECTION I Officer 13 Enlisted men REGIMENTAL VETERINARY SECTION 3 Veterinary officers 14 Enlisted men HEADQUARTERS GROUP I Officer 5 Enlisted men REGIMENTAL AID STATION GROUP 3 Officers 11 Enlisted men SQUADRON AID STATION GROUP I Officer 8 Enlisted men TROOP AID GROUP 5 Enlisted men LITTER BEARER GROUP VETERINARY AID STATION GROUP I Officer 6 Enlisted men SQUADRON AID GROUP I Officer 4 Enlisted men SQUADRON AID GROUP I Officer 4 Enlisted men Plate 11. Suggested Functional Organization of the Regimental Medical Detachment with the Cavalry Regiment, Horse T/O 2-11, April 1, 1942. Headquarters section. The headquarters section consists of the regimental surgeon, the assistant regimental surgeon, two dental officers, a technical sergeant, a sergeant, four technicians grade 5 (1 clerk, 2 dental technicians and 1 medical technician), one 613 technician grade 4 (1 surgical technician), and nine privates first class or privates (2 truck drivers, 2 orderlies, 1 sanitary technician, 2 surgical technicians and 2 basics). Squadron medical section. Each squadron medical section consists of the squadron surgeon, a staff sergeant, a corporal, two technicians grade 5 (1 medical technician and 1 surgical technician), nine privates first class or privates (1 pack driver, 1 medical technician, 1 surgical technician, 5 troop aid men and 1 basic). For functional purposes the squadron section may be divided into: A squadron aid station group. A troop aid group. When necessary a litter bearer group is drawn from the aid station group. The duties of the personnel of a squadron medical section with cavalry are analogous to those of similar units serving battalions of infantry. Veterinary section. The veterinary section consists of three veterinary officers, a staff sergeant, two sergeants, two technicians grade 5 (2 veterinary technicians), nine privates first class or privates (2 truck drivers, 2 pack drivers, 4 veterinary technicians and 1 basic). For functional purposes this section may be divided into a veterinary aid station group of one officer and six enlisted men and two squadron aid groups each consisting of one officer and four enlisted men. Equipment and transportation. The equipment and transportation of the regimental medical detachment with cavalry is analogous to that of the medical detachment of an infantry regiment except in quantity. Pack animals are used to carry the equipment of the squadron sections. One %-ton ambulance, one %-ton weapon carrier truck and sixteen horses are assigned to the headquarters section. One %-ton weapon carrier truck and one % -ton truck are also assigned to the veterinary section. The transportation for the regimental medical detachment with the cavalry is as follows: 54 horses, riding. 4 horses, pack. 1 ambulance, %-ton. 1 truck, 14-ton. 2 trucks, weapon carrier, %-ton. The Medical Detachment With Division Artillery, Cavalry Division. The medical detachment with the division artillery, cavalry division, is divided into a headquarters section, 2 horse battalion medical sections, 2 horse battalion veterinary sections, and 1 truck-drawn battalion medical section. (See Plate 12.) ATTACHED MEDICAL PERSONNEL MEDICAL DETACHMENT DIVISION ARTILLERY CAVALRY DIVISION 7 Officers 68 Enlisted men HEADQUARTERS SECTION 2 Officers 6 Enlisted men HORSE BATTALION MEDICAL SECTION* (75-mm Field Howitzer, Horse- drawn ) I Officer 16 Enlisted men HORSE BATTALION MEDICAL SECTION* (75-mm Field Howitzer, Horse- drawn) I Officer 16 Enlisted men TRUCK-DRAWN BATTALION MEDICAL SECTION (105-mm Howitzer, Truck-drawn) I Officer 16 Enlisted men BATTALION VETERINARY SECTION** (75-mm Field Howitier, Horse-drawn) I Officer 7 Enlisted men * Divided into: Aid station group, litter bearer groups, and battery aid group. ** Each section to operate a battalion veterinary aid station, one for each 75-mm field howitier, horse-drawn battalion. Each section consists of I officer and 7 enlisted men. Plate 12. Suggested Functional Organization of the Medical Detachment of the Division Artillery, Cavalry Division, T/O 6-110, April 1, 1942. Headquarters section. The headquarters section consists of the regimental surgeon, one dental officer, three technicians grade 5, and three privates first class or privates. The assignments and duties of commissioned and enlisted personnel are analogous to the assignments and duties of like personnel in the headquarters section with an infantry regiment. 1 i 2 3 4 6 8 7 8 Unit Technician grade Headquarters section 2 horse battalion sections (each) 1 1 truck-drawn 1 battalion section 3 o EH Remarks Medical section 1 Veterinary | section 1 1 1 4 d 1 »1 3 •Mounted on horse. ? 1 1 1 7 ing, when basic is author- 1 1 3 (1) (D (3) •1 2 8 Veterinary (250) 1 a) .... (2) 3 bol shown in parentheses is (1) a) (3) 11 Technician, grade 51 I11 number below 500 refers to 6 14 6 14 <20 13 |29 whose qualification analy- (8) (5) (15) (*l) W (1) (D (1) a 18 Technician, medical (123) 5 a) (1) (1) (4) Nos. 14 and 67, War De- (1) (1> (3) partment, 1942. 20 Technician, surgical (225) 5 (i) (1) (1) (4) (1) (1) (3) 5 (M) (2) (*3) (6) (1) (3) (3) (10) a) (2) (D (2) (9) 6 16 7 16 68 8 17 8 17 75 1 1 1 4 8 16 a) (2) (b7) (14) 32 Q Truck, %-ton, command and recon- 1 1 3 33 Q Truck, 2M-ton, cargo... .... 1 1 3 Plate 13. T/O 6-110, April 1, 1942. Organization of the Medical Detachment, Division Artillery, Cavalry Division. 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 1 2 3 4 5 6 7 Unit | Technician grade Headquarters section | First section | Second section 1 Total detachment Remarks 1 (dD2 d 1 1 4 1 a Aid men provided as fol- lows: Reconnaissance troop (3 each) 12 Support troop (3 1 1 4 1 1 6 1 1 2 1 (1) 4 (3) (1) ( J i 20 l 24 (10) (2) (2) (1) (3) (1) (1) [ (2) l (3) (20) (5) 1 1 1 (1) 2 (1) 0) 19 (6) (2) (2) (1) (1) (1) (1) | (2) (2) (1) Headquarters troop.. 1 1 (1) 1 (1) men ride in troop transportation. d Dental. The serial number symbol shown in parentheses is an inseparable part of the spe- cialist designation. A num- ber below 500 refers to an occupational specialist whose qualification analysis is found in A R 615-26. A num- ber above 500 refers to a military occupational spe- cialist listed in Circular No. 14, War Department, 1942. Technician, grade 4| Technician, grade 5L ] d, 16 (2) 16 (2) Private, first class, j B Private J 6 5 (1) (1) 5 4 5 (2) (9) (2) 18 (2) (9) (2) 18 Basic* (521).. 23 59 27 19 19 65 2 1 1 1 1 1 2 1 1 1 5 1 Q Truck, %-ton, command and recon- 2 2 Plate 14. T/O 2-71, April 1, 1942. Organization of the Medical Detachment, Cavalry Regiment, Mechanized. ATTACHED MEDICAL PERSONNEL 615 Horse battalion medical section. Each battalion medical section consists of a battalion surgeon, a staff sergeant, a corporal, two technicians grade 5, and twelve privates first class or privates. It is divided for functional purposes into: A battalion aid station group. A litter bearer group. A battery aid group. The duties of the battalion surgeon, aid station group, litter bearer group and battery aid group are analogous to the duties performed by the battalion surgeon and similar groups of the battalions of infantry. The battalion medical section, however, must retain a higher state of mobility in order to keep up with the mounted troops. Transporta- tion facilities must be kept readily available. Horse battalion veterinary sections. Each veterinary section consists of 1 veterinary officer, 1 sergeant, 1 technician grade 5, and 5 privates first class or privates. The duties of the commissioned and enlisted personnel are analogous to those of like per- sonnel in the veterinary sections of the artillery battalion, 75-mm gun, horsedrawn. It is, however, a more mobile unit and transportation must be kept readily available. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 If. 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 i 2 3 4 5 s Unit Technician grade Medical sec- tion Veterinary section Total Remarks 1 1 1 * Mounted on horse. b 1 additional horse, riding, when basic is authorized. The serial number symbol shown in parentheses is an inseparable part of the spe- cialist designation. A num- ber below 500 refers to an oc- cupational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Department, 1942. • 1 Total commissioned 1 1 2 1 (1) 1 a. i a) i (i) 1 % (1. a) 0) a) a. (1. (3) (3) (3) * 1 (1) 1 (1) 14 (5) Technician, grade 6..1 6 Private ) (* 1) 6 (D (l) (l) (1) 6 6 (■1) (•3) (3) (2) Basic (521) (1) Total enlisted 16 7 23 17 8 25 1 1 8 7) Q Truck, Vk-ton, command and reconnais- 1 1 Plate 15. T/O 6-45, April 1, 1942. Organization of the Medical Detachment, Field Artillery Battalion, 75-mm Gun, Horse-drawn. Equipment of battalion veterinary section is as follows: Outfit Veterinary Field No. 1. 1 Chest, Medical Department, No. 80 (98070), Medical and Surgical (In- struments, appliances, drugs). 1 Chest, Medical Department, No. 81 (98080), Dressings, horseshoer’s kit, miscellaneous equipment. 1 Lantern set, 3 lanterns (99547). 1 Desk, field company or 1 desk, field, Medical Department, No. 2 complete. 1 Axe with helve. 3 Buckets G. I. nested. 1 Fly for wall tent, large, complete with poles, pins, and ropes. 1 Fork, stable, short handle. 1 Marker, green cross, with staff. 616 MILITARY MEDICAL MANUAL 1 Pickaxe with helve. 2 Picket pins, Model 1910. 50 foot rope, 1 inch, for field picket line. 1 Shovel, short handle, round point. The equipment is transported in a 2{/2-ton cargo truck of the medical section of the battalion with which the veterinary section is operating. Transportation of the medical detachment, division artillery. The transportation of the medical detachment of the artillery of the cavalry division, consists of: 14 horses, riding. 2 horses, pack. 4 ambulances, %-ton. 3 trucks, cargo, 2 /2-ton. 3 trucks, command and reconnaissance, %-ton. Regimental Medical Detachment, Cavalry Regiment, Mechanized. For organization and distribution of personnel and transportation of the medical detachment of the cavalry regiment, mechanized. See T/O 2-71, April 1, 1942 (Plate 14). The Medical Detachment, Field Artillery Battalion, 75-mm Gun, Horse-drawn. For organization, distribution of personnel, and transportation of the medical detachment, field artillery battalion, 75-mm Gun, horse-drawn, see T/O 6-45, Plate 15. The Medical Detachment, Field Artillery Battalion, 75-mm Howitzer, Horse. T/O 6-115, April 1, 1942. The organization, distribution of personnel, and transportation of this medical detachment is identical with that of the medical detachment, field artillery battalion, 75-mm gun, horse-drawn. 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 Unit Tech- ni- cian grade Headquar- ters section 4 battalion sections (each) Total Remarks Med- ical sec- tion Vet- eri- nary sec- tion Med- ical sec- tion Vet- eri- nary sec- tion 1 1 1) 5 (»i) $ (1) "(2) 6 2 25 9 11 144 7 3 28 166 5 (1) (2) (2) 3 (1) 13 (3) \i 7 (2) (3) (2) 88 (22) (34) (32) (2) Plate 16. T/O 6-150, April 1, 1942. Organization of the Medical Detachment, Division Artillery, Mountain Division. The Medical Detachment, Division Artillery, Mountain Division. The medical de tachment, division artillery, mountain division operates similarly to that of the medical detachment of the artillery of the cavalry division. For organization, distribution ol personnel, and transportation see T/O 6-150, Plate 16. ATTACHED MEDICAL PERSONNEL 617 INTERIOR ECONOMY OF THE ATTACHED MEDICAL PERSONNEL The interior economy including supply, reports, records, and pay of a medical detach- ment conforms to that of similar organizations of other services of the army and is governed by the same regulations. Messing. The regimental medical detachment messes with the headquarters com- pany of the regiment it serves. When troops are in the training area, on the march or in combat the regimental medical detachment usually messes as follows: Headquarters section with the headquarters company or battery of the regiment. Battalion or squadron medical and veterinary sections (less company, battery, or troop aid men) with the company, battery, or troop as assigned by the battalion or squadron commander. Company, battery, or troop aid men with the company, battery, or troop which they are serving. DUTIES OF COMMISSIONED PERSONNEL Regimental Surgeon (Detachment Commander). The senior medical officer present commands the detachment and is the surgeon of the regiment. He serves in both an advisory and administrative capacity. As a member of the staff of the regimental commander he advises that officer on medi- cal and sanitary matters, all advice given or recommendations made to be in accord with the policies of higher medical authority. He supervises all training of the detachment and instructs the entire personnel of the regiment in personal hygiene, field sanitation, and first aid. He provides care and treatment for the sick and wounded. He makes the sanitary inspections, supervising the sanitary procedures and precautions necessary to preserve the health of the command. He makes timely requisitions for all necessary equipment, including medical, dental, and veterinary supplies. He organizes the medical detachment and plans its work so as to insure the accom- plishment of its mission with the least possible disturbance to the arm or service which it serves. Such organization of the attached medical troops and such plans as he may make for their tactical employment are as simple as is consistent with the accomplish- ment of their mission. He keeps such records and renders such reports and returns as may be required. Assistant Regimental Surgeon. The assistant regimental surgeon is an officer of the medical corps, usually of the rank of captain or first lieutenant. In general, his duties are such as may be assigned to him from time to time by the surgeon. He acts for and in the name of the surgeon during that officer’s absence from the command. He may be detailed to supervise the preparation of reports and returns, the preparation of requisi- tions for supplies, and the issue of such supplies to sections of the medical detachment. He may also be placed in charge of the regimental dispensary and of the regimental aid station when it is established. Under the supervision of the surgeon, he may be detailed to hold sick call and conduct the training of the personnel of the headquarters section of the regimental medical detachment. Battalion or Squadron Surgeon. The senior medical officer, usually a captain, assigned to duty with any battalion or squadron of the regiment is the battalion or squadron sur- geon. In general, his duties within the battalion or squadron are analogous to the duties of the regimental surgeon within the regiment. Assistant Battalion or Squadron Surgeon. The assistant battalion or squadron surgeon is an officer of the medical corps assigned to duty with the battalion or squadron by the regimental surgeon. In general, the assistant battalion surgeon’s duties in the battalion or squadron are analogous to the duties of the assistant regimental surgeon of the regiment. During combat he treats or supervises the treatment of casualties within the battalion aid station. Because the battalion surgeon’s duties require him to leave 618 MILITARY MEDICAL MANUAL the station occasionally, it is more practical for the assistant battalion surgeon to treat the seriously wounded. Dental Officers. Dental officers of the detachment are subordinate to the senior medical officer of the detachment to which attached and are under his immediate command. In the interior organization of the detachment, dental officers are usually included in the Plate 17. Individual Equipment of a Battalion Surgeon. Plate 18. Individual Equipment of a Battalion Surgeon. headquarters of the regimental medical detachment and assigned to duty with separate battalions or squadrons of the regiment by the regimental surgeon whenever he con- siders such assignment necessary. Under the direction and supervision of the regi- mental surgeon, they are responsible for the dental care of the command. This includes the instruction of the entire personnel of the regiment in oral hygiene, the making of oral inspections to determine whether or not the command is practicing oral hygiene, the making of dental surveys to determine the amount and character of dental work to be done, and the accomplishment of this work in its order of importance to the command and to the individual. They establish and operate the dental service of ATTACHED MEDICAL PERSONNEL 619 dispensaries and during combat assist the regimental, battalion, or squadron surgeons, as the situation requires. They are usually retained within the headquarters section of the regimental medical detachment, but in the absence of a medical officer they may serve as regimental, battalion, or squadron surgeons. They are responsible for the diagnosis, care, and treatment of dental injuries received in combat. They keep dental records and render dental reports and returns as required. Veterinary Officers. Veterinary officers are included in the regimental medical detach- ment of units supplied with animals. They are subordinate to the senior medical officer of the command and are under his immediate supervision and control. In general, their duties are as follows: Full responsibility for the veterinary service of the entire command: This includes the initiation of protective measures for the prevention of communicable diseases, and the early detection, care, and treatment of such cases; the adoption of all necessary sup- pressive measures to limit the extension and duration of such diseases; the reduction of animal losses and inefficiency through the prompt discovery of the sick and wounded animals; the collection, isolation, care, and treatment of the sick and wounded animals until such time as they can be evacuated from the command or otherwise disposed of; the establishment and maintenance of a veterinary sanitary service within the com- mand for the maintenance of animals in a suitable environment as regards shelter, hand- ling, restraint, foods and feeding, grooming, work, exercise, and shoeing. The establishment and operation of veterinary aid stations, and the collecting, care, and treatment of the sick and wounded animals of the regiment at such stations. The inspection of meats, meat foods, and dairy products purchased or issued to troops. The special training of veterinary personnel, and the instruction of personnel of the entire command concerning veterinary matters. The keeping of records and the preparation and rendition of such reports and returns as are required. EMPLOYMENT OF THE ATTACHED MEDICAL PERSONNEL WITH INFANTRY The principal functions of the regimental medical detachment in garrison are: train- ing, sanitary inspections, and operation of dispensaries. Regiments ordered from the field to garrison will ordinarily be accompanied by their medical detachments. In large garrisons, personnel from the regimental medical de- tachments may be attached to the station hospital for technical training. Sanitation of Stations and Permanent Camps. The duties of the medical detachment in connection with sanitation are inspectional and advisory. Sanitary procedure in a per- manent station or camp is, in general, such as will modify and adapt the sanitary environment to the needs of the troops, rather than the temporary or expedient measures which may be used to protect the health of the command while in the field. In Garrison On the March The medical service on the march concerns itself with the care and evacuation of march casualties. Duties of Medical Officers. Prior to the march the commanding officer of the medical detachment obtains from the regimental commander his instructions as to the day’s march and communicates to his subordinates such instructions as he may deem necessary for their information and guidance. He inspects the detachment as to its preparedness for participation in the march, giving particular attention to the condition of men, trans- portation, and equipment. During the march, medical officers dispose of march casualties and conduct the march of troops under their direct command. Disposition of the Regimental Medical Detachment for the March. The medical detach- ment is disposed in the column as directed by the regimental commander. The regi- mental surgeon usually marches with that part of the staff which accompanies the regi- POINT ONE SQUAD SUPPORT ADVANCE PARTY ONE PLATOON (LESS ONE SQUAD) (I AID MAN) SUPPORT ONE COMPANY (LESS ONE PLATOON) 12 AID MEN WITH COMPANY) 1ST BATTALION (LESS ONE COMPANY) (BN SURGEON WITH STAFF OF BATTALION COM- MANDER AT HEAD OF RESERVE) AID MEN WITH RESPECTIVE COMPANIES ADVANCE GUARD BATTERY ARTILLERY RESERVE BATTERY AID MAN BATTALION SECTION 1ST BATTALION (LESS BN SURG & CO AID GROUP) + ATTACHED AMBULANCE FROM COLLECTING COMPANY 1ST BN TRAIN COLONEL AND STAFF (REGT SURG) REGIMENTAL HEADQUARTERS COMPANY 2D BATTALION (BN SURGEON WITH STAFF OF BN COMMANDER) BATTALION SECTION 2D BATTALION (LESS BN SURG & CO AID GROUPS) + ATTACHED AMBULANCE FROM COLLECTING COMPANY 2D BATTALION TRAIN MAIN BODY 3D BATTALION" BN SECTION (SAME AS 2D BATTALION) FIELD ARTILLERY BN (LESS BTRY) BN SECTION (LESS BTRY AID MEN) HEADQUARTERS SECTION OF THE REGIMENTAL MEDICAL DETACHMENT (LESS REGT SURG) REGIMENTAL TRAIN SERVICE COMPANY COLLECTING COMPANY (LESS DETACHED AMBULANCES) Plate 19. A Suggested Distribution of Medical Detachments with a Combat Team on the March. (An Interior Combat Team, Flank and Rear Protection Furnished by Other Units). ATTACHED MEDICAL PERSONNEL 621 mental commander. The assistant regimental surgeon marches with the headquarters section, the position of the latter being determined by the orders issued for the march. Dental officers march with the headquarters section when not assigned to battalion medical sections. The veterinary section of the regimental medical detachment (organi- zations having animals) marches with the regimental train. Battalion and squadron surgeons march with the battalion or squadron commander. Assistant battalion or squadron surgeons march at the rear of the battalion or squadron and at the head of their respective battalion medical sections. When there is but one medical officer with the battalion or squadron he marches at the rear of the battalion or squadron column, going forward when necessary for the purpose of making contact with and gaining information from the commanding officer. Company, battery, and troop aid men march with the companies to which assigned. The remaining personnel of the sec- tion marches at the rear of the battalion or squadron column. The trucks carrying the field medical sets of battalion medical sections while so marching are a constituent part of the battalion train; in like manner, the trucks of the headquarters section of the medical detachment are a constituent part of the train of the regimental headquarters company. When operations are imminent or march condi- tions cease, these trucks are released to the battalion or regimental surgeon (standing operating procedures). Ambulance Service. Ambulances accompanying marching troops for the collection and evacuation of march casualties are detailed from ambulance sections of the collecting company of the medical battalion. Ambulances and personnel so detailed are under the immediate control of the regimental surgeon for the duration of the march. When march conditions cease ambulances revert to their normal command status and return to their organizations. If but one ambulance is with the regiment, it follows the head- quarters section of the regimental medical detachment at the rear of the column. If additional ambulances accompany the column, they may be marched with the battalion medical sections. The ambulances which belong to the medical detachments of cavalry, field artillery, or other units are similarly disposed of during the march but remain with their organizations. March Casualties. Sick or disabled are reported to the commanding officer of their unit. The commanding officer usually directs the individual to see the medical officer at the next halt or issues a pass for the soldier to drop out of the column and await the arrival of a medical officer. The medical officer who examines the soldier returns this pass to the soldier’s company commander, showing thereon the disposition which he has made of the case. The medical officer disposes of the soldier in accordance with the conditions found after hasty examination. He may relieve the soldier of his pack and require him to con- tinue the march; he may put him in an ambulance or on any other piece of transporta- tion, for disposition at the end of the march; or he may require him to march at the tail of the column, where he can be kept under observation. In case the march order provides for march collecting posts, casualties are continued with the column until the next station is reached. If an evacuation point only is desig- nated, casualties unable to continue with the column are left by the roadside or delivered to ambulances in the rear for evacuation. All casualties separated from their organization are tagged by a medical officer. All arms and personal equipment of sick or disabled remain with them; the mount, saddle equipment, and arms of mounted soldiers are returned to their organizations. Rapidly moving mounted commands, except when provided with ambulances, rarely have transportation for the sick and disabled. March casualties unable to continue with the column may be directed to follow the command at a walk, or they may be sent back toward the main body. It may be necessary to leave them with inhabitants or under shelter, to be picked up and evacuated to the rear by troops following. In all cases it must be left to the judgment of medical officers whether or not casualties should be accompanied by personnel of the medical detachment. A record of the disposition made of sick and disabled soldiers on the march is kept by the medical officer. 622 MILITARY MEDICAL MANUAL Regimental Medical Detachment with Security Detachments. Combat units forming advance guards, rear guards, and other security detachments are normally accompanied by their attached medical troops. Plate 19 illustrates the manner in which the personnel of the regimental medical detachment may be distributed among the units of an infantry regiment marching with one battalion as an advance guard. In Camp The regimental medical detachment camps or bivouacs in accordance with march dis- positions. Battalion, squadron, and regimental dispensaries are established upon arrival in camp. Only such equipment is utilized as is necessary to permit proper functioning. Sick call is held daily in camp. Plate 20. Regimental Dispensary Established in Camp. Except when acting alone, the regimental medical detachment has no responsibilities as to evacuation of casualties from the regiment. March casualties unable to continue with the column are disposed of at night halts. Evacuation is accomplished by ambulance elements or empty supply vehicles returning to the rear. Ambulances and dispensaries exchange litters, blankets, and other medical property which accompanies the patients. In Combat (General) Tactical Employment of Medical Detachments of Infantry Units. In general, the prin- ciples herein set forth govern the tactical employment of all medical personnel attached to organizations of combat troops, although they are discussed in respect to service with infantry units. The tactics of the combat unit is the determining factor in the tactics to be employed by attached medical troops. All operations of the regimental medical detachments in the field have as their mission the rendering of support and assistance to the combat troops. They include the following: Finding, tagging, and aiding the disabled, and separating them from the able; estab- lishment of aid stations; the collection and treatment of casualties; prevention of un- necessary movement to the rear on account of sickness or injury; preservation of morale by early medical attention and removal of the wounded; examination of the dead and sanitary supervision of their disposal; and preparation of records of dead and wounded. In order to accomplish the above, the surgeon must be informed of his mission, the military siuation, the plan and time of action, zones of action, scheme of maneuver, and the terrain. This knowledge is obtained from his unit commander, through personal reconnaissance, and by the use of maps. He can thereby determine the area of ex- pected “casualty density.” Reconnaissance. Reconnaissance on the part of medical officers is necessary for the efficient execution of medical support in the field. All medical officers should endeavor to make a reconnaissance of the area occupied or to be occupied by their organizations, and to gather such information concerning the territory to the immediate front and rear of their areas as will enable them to prepare plans for the collection, treatment, and evacuation of the sick and wounded in case of a general advance or retirement. Regi- mental surgeons who find it impossible to complete such a reconnaissance because of insufficient time or of limitations imposed by the enemy should, after battalion medical officers have established their aid stations, make a reconnaissance and suggest to bat- talion commanders the desirability of any changes. The reconnaissance as made by medical officers is topographical in character and is conducted for the purpose of ob- taining the following information: ATTACHED MEDICAL PERSONNEL 623 What to look, for Why General character of country High ground Orientation. For observation points, to avoid, or to take shelter behind. For routes of evacuation to rear. For determination of the natural lines of drift of wounded. For shelter from observation and fire; for location of aid stations. Cover ] Ravines [Stream lines H.W.Co. ANTITANK PLATOON / H.W.Co. ASSAULT BATTALION^ ASSAULT// BATTALION RESERVE COMPANY ANTITANK PLATOON DEPTH UP TO 2500 YDS. HQ REGT MEDICAL DETACHMENT BN SECTION (LESS CO. AID MEN) CO AID MAN MEDICAL TRANSPORTATION INF BN COMMAND POST INF REGT COMMAND POST BN BOUNDARY BN AID STATION REGT AID STATION LEGEND RESERVE BATTALION Plate 21. Deployment of an Infantry Regiment for Attack, Showing Frontages, Depth, and Positions of the Regimental Medical Detachment. 624 MILITARY MEDICAL MANUAL Classification of Casualties. Casualties may be classified as follows: First classification Second classification Third classification Sick Communicable l Noncommunicable Gassed Wounded Dead Slight Walking Medium Transportable (Recumbent, sitting) Severe Nontransportable The approximate proportion of killed and wounded and of walking and transportable wounded, in open and in stabilized military operations, is indicated below: Type of Casualty Open warfare Percent Stabilized warfare Percent 15 20 Wounded 85 80 Able to walk to aid station (45) (40) Must be carried to aid station (40) (40) Estimation of Battle Casualties. In order that proper plans may be made for the col- lection, treatment, evacuation, and replacement of casualties, an estimate of battle casual- ties and the determination of expected areas of “casualty density” are necessary. In ad- dition to battle casualties, front line troops of a seasoned command in campaign will have, on any batde day, approximately six-tenths (0.6) of 1 per cent sick and non-battle injured. Battle casualties will average 12 to 15 per cent per day of severe fighting for an in- fantry regiment. This figure is approximate; in very severe fighting it has run as high as 35 per cent. In estimating probable battle casualties, the following facts must be kept in mind: Battle casualties are not ordinarily equally distributed along the front. The percentage of casualties in certain battalions and companies will be greater than in the regiment as a whole. Attacking troops usually have more casualties than defending troops. In the attack the greatest number of casualties will occur in units having the more difficult missions. In the defense the greatest number of casualties will occur in units holding important points. Heavy casualties usually occur at stream crossings, road crossings, road and railway junctions, and generally in locations under enemy observation. An estimate based on front-line divisions engaged will usually be more accurate than if based on a rate for a corps or an army as a whole. Orders. The field orders issued by the regimental and battalion commanders specify the time of attack, the frontages, the line of departure, the lateral boundaries, and the scheme of maneuver of the unit. In this order the initial location of the aid station is designated by the commander, usually after recommendation and conference with the surgeon. Surgeons should make sure that they receive a copy of the field order, either orally or in writing, for without this necessary information they cannot intelligently serve their units. The surgeon issues orders to his subordinates, ordinarily in the form of messages or oral instructions. The orders when so issued are usually fragmentary. Area of Operation. The area of operation of the regimental medical detachments as well as the battalion medical section is the same as that of the respective combat unit served. A diagram indicating the usual frontages and depths is shown in Plate 21. Functions of the Company Aid Group. Three men from the company aid group of the battalion medical section are attached to each lettered company, 3 to each heavy weapons company, and 1 to the antitank platoon of the battalion headquarters company. The company aid group of headquarters section is attached as follows: 3 to the cannon com- pany and 3 to the antitank company of the infantry battalion. These company aid men ATTACHED MEDICAL PERSONNEL 625 follow by bounds in rear of leading platoons; locating the wounded and administering emergency treatment (Field Manual 7-30). They direct the walking wounded to the position of the aid station and place casualties unable to walk in sheltered positions where they can be picked up by litter squads or evacuated later by ambulances. Com- pany aid men send information to the battalion surgeons by messages carried by the litter bearers or walking wounded. Plate 22. Company Aid Man. Medical equipment of the Medical Department soldier. The Medical Department soldier carries a medical kit consisting of two pouches, two cantle ring straps and a suspender. The pouches are slung from the suspender straps on the right and left sides respectively. This is the “normal” carrying position. When the gas mask is worn, which is put on after the medical kit has been adjusted in place, a change in the carrying position of the pouches is necessitated: 626 MILITARY MEDICAL MANUAL (1) All Medical Department enlisted, except litter bearers, will carry the left pouch (dressings and emergency medical tags) in front of the body fastened by snap hooks to the suspender rings as shown in Plate 22. (2) Medical Department enlisted men functioning as litter bearers will change the position of both pouches. The right pouch (medicine and instruments) is suspended in front of the body as described in the preceding subparagraph. The left pouch then is worn at the back attached to the suspender rings. This change is made due to the fact that if the pouches are carried at the sides of the body they interfere with the litter carrying straps and the actual carrying of the litter. The right pouch is carried in front of the body since the litter bearer will, in all probability, have more use for medicines and instruments. The bottom of each pouch can be extended downward to double its capacity. Emergency Medical Tag. (Plates 23 and 24). The emergency medical tag is a water- proof linen tag upon which is recorded a diagnosis of the patient’s disease or injury, the treatment given, and other essential data. A copper wire is attached to one end, per- mitting the tag to be fastened readily to the patient’s clothing, usually over the breast. Plate 23. The Emergency Medical Tag, Form No. 52b, Med. Dept. (Partially Prepared in Accordance with Wat Dept. Circular No. 182, June 1942.) Use. As a sick and wounded record the Emergency Medical Tag (W.D., M.D. Form No. 52b) is prescribed for use in a theatre of operations, and whenever troops move or take the field to engage in practice marches or maneuvers. During or after an engage- ment it will be attached to all sick, wounded, and dead. In referring to this tag the use of the abbreviation EMT is authorized. ATTACHED MEDICAL PERSONNEL 627 Purpose. For the sick and wounded the primary purpose of the emergency medical tag is to inform the medical officers under whose observation the patient successively comes, of the character of the disability and the treatment previously given at the several points of relief on the field or on the way to the rear. For the dead the purpose of the emergency medical tag is: to prevent a loss of time by other medical personnel in examining the body; to furnish as much information as is practicable regarding the details of the death. Plate 24. The Emergency Medical Tag, Form No. 52b, M.D. (Front and Back). Preparation. The emergency medical tag will be made out by the first Medical Department officer who treats the patient previous to his admission to a hospital, or by the first member of the Medical Department who finds or examines the remains (Field Manual 8-45). In accordance with War Department Circular No. 182, June 11, 1942, during combat and simulated combat (maneuvers), aid stations and collecting stations of divisional or brigade units engaged with the enemy will partially accomplish the emergency medical tag to show only name, grade, Army serial number, date, hour, diagnosis, and treat- ment given. Form No. 52b, thus partially prepared, will be signed by the person responsible, in- dicating his grade. (See Plate 23). The space for disposition together with the date and hour will be completed either at the time of partially completing the tag or if the patient’s condition requires treatment prior to evacuation to the rear, the space will be filled in at the time of departure from the medical installation. At clearing stations and other Medical Department establishments in rear of clearing stations, Form 52b will be accomplished completely. (See Plate 24). The space “STATION WHERE TAGGED” will be completed when the person at 628 the clearing station or other Medical Department installation in rear of the clearing station knows definitely the place where the patient was originally tagged. Under all conditions of service other than indicated above, Form No. 52b, when used, will be accomplished completely. The tissue paper protecting the carbon sheet will be torn out before the linen tag is written, in order, that the duplicate impression on the paper tag may be made at the same time as the original. A medium hard blac\ pencil should be used and special care exer- cised that the name of the patient or of the deceased is legibly written or printed. After the preparation of the tag is completed the carbon paper separating the original and duplicate tags will be torn out and discarded. When not in combat, the tag will be prepared with the same care as to detail as is required in the case of the register card (Form 52, M.D.). Under the “Diagnosis” will be recorded the essential facts concerning the character of disease or injury, such as fracture, the parts involved, the cause, and severity. In combat there will be many instances when the initial preparation of the tag will be faulty. The tags will be examined by medical officers along the route of evacuation, and every effort consistent with the well-being of the patients will be made to complete and correct the entries. In the case of wounds, received in action with an enemy of the United States, or as a result of an act of such enemy, the diagnosis will include a statement to that effect recorded as “Wounded in action” (WIA) and in the case of the dead found on the field, the entry “Killed in acFon” (KIA) will be made, it being understood that these are administrative rather than medical entries and that a complete diagnosis is required. It is important to remember that awards of compensation and decorations are dependent upon this record. See AR 600-45, and AR 600-95. Under “Treatment” will be noted the dressing applied and whether operation or special treatment is urgently needed. The administration of morphine or antitetanic serum will be noted in the separate spaces provided for that purpose. Under “Supplemental record,” on the back of the original, will be recorded as the case may require: The additional treatment given en route to hospital, indicating its nature and where and when it was given. The fact, time, and place of death and other essential attending circumstances, if the patient dies while en route. The hospital where the patient was admitted for definite treatment, or the disposi- tion of the body. The fact that the soldier is returned to duty from any station along the route of evacuation, prior to admission to a hospital. All entries will be signed. Abbreviations. The abbreviations listed below are authorized for use only on emergency medical tags and field medical records in the diagnosis space. No additions to or deviations from this list of abbreviations will be permitted. Tn the nonmedical entries, abbreviations authorized by the War Department may be used. MILITARY MEDICAL MANUAL CW—Contused wound. FW—Extensive wound. FUO—Fever of undetermined origin. FC—Fracture compound. FCC—Fracture compound comminuted. FS—Fracture simple. OSW-—Gunshot wound. TW—Tncised wound. KIA—Killed in action. LW—Lacerated wound. MW—Multiple wounds. NYD—Not yet diagnosed. Pen W—Penetrating wound Perf. W—Peforating wound. Pun W—Punctured wound. SV—Severe. S—Slight. WIA—Wounded in action. How attached. The original tag will be torn from the book and affixed to the clothing of the patient (or clothing of the dead, as the case may be) over the breast, or as near to it as possible, so as to be readily seen. Use in transfer of patient. An emergency medical tag will be attached to every patient transferred to a hospital from an aid station, dispensary, or establishment other than a hospital, in a theatre of operations or whenever troops move or take the field to ATTACHED MEDICAL PERSONNEL 629 engage in practice marches or maneuvers. The tag will serve the same purpose as the transfer card prescribed for use in time of peace or in the zone of the interior in time of war. Only one emergency medical tag will be attached to any patient. All necessary notes, before admission to hospital, will be made on the one tag. Use by moving commands. For commands moving, or in the field in time of peace, or for commands on a similar status in the zone of the interior in time of war, the emer- gency medical tag will be used by the senior medical officer of each command or dis- pensary in lieu of a report card for all cases terminated by death or returned to duty during the month. Any patient who is transferred from such commands to a hospital will be accompanied by an emergency medical tag. If a patient is transferred to other than an Army hospital, request will be made by the transferring officer that the hos- pital diagnosis, the complications, operations, and disposition, with dates, be entered in the supplemental record, that the tag accompany the patient if he is removed to an Army hospital, and that it be mailed to The Surgeon General, War Department, Washington, D. C., if the patient is released from the hospital to duty. Each emergency medical tag received with transferred cases by a hospital which is part of a field force, will be placed in the field medical jacket and will thereafter form a part of the patient’s field medical record. Use of the EMT for those “\illed in action.” The term “killed in action” includes those who meet sudden death as a result of battle injuries and all casualties who die before receiving treatment by a medical officer or before reaching a medical installation. Battle injuries are defined as those wounds caused by primary or secondary missiles, or by chemical agents, set in motion by the hostile act of a military enemy. Wounds or injuries from projectiles dropped by enemy airplanes at considerable distances from the operations of ground troops, and those resulting from enemy torpedo attacks on ships, are properly included among battle injuries. Whenever practicable a noncommissioned officer or a qualified private of the medical department should accompany all burial parties and prepare emergency medical tags for all the killed in action not previously tagged. Medical Department personnel attached to units of the Graves Registration Service will prepare EMTs if missing at initial interments and complete or correct such as are faulty. Contents. On each tag the army serial number, name, and rank of the deceased (the data being obtained from the identification tag attached to the body) will be written clearly and legibly. In addition to the diagnosis of killed in action (KIA), there should be entered when practicable, a brief note showing the location of any wounds, such as head, chest, abdomen, arm, forearm, hand, thigh, leg, or foot, with side involved and the character of the causative missile, such as shell, shrapnel, bullet, bayonet, saber, bomb. In case a tag is incomplete in the foregoing or any other par- ticular, Medical Department personnel on duty with the Graves Registration Service or with other burial parties will supply the missing information if it is obtainable. If identification is impossible at time of interment, notation will be made of the Graves Registration Service registration of the body in order that The Surgeon General may have a means of securing additional information at a later time. Disposition of the originals. The original emergency medical tags of the sick and wounded who are returned from aid stations to their organizations without going farther to the rear, will be removed at the aid station and retained for use by the regimental surgeon. The original emergency medical tags of the sick and wounded who are returned to their organizations direct from a station on the route of evacuation will, upon their re- porting for duty, be removed for use by the surgeons of their respective organizations. Such tags will be collected and forwarded by the senior medical officer of the establish- ment or command by whom they are removed with the next ensuing monthly report of sick and wounded. The original emergency medical tags of the sick and wounded who are admitted to a hospital which is part of a field force will be removed and placed in the jacket of the field medical record. Original emergency medical tags received with patients evacuated 630 MILITARY MEDICAL MANUAL to a hospital which maintains a register of sick and wounded will be removed, the fact of receipt and date thereof entered in the supplemental record, delivered to the registrar, and forwarded to The Surgeon General with the next report of sick and wounded. If an EMT, is the only field record received with a patient evacuated from a theatre of operations to a hospital for definite treatment in the zone of the interior, it will be forwarded to The Surgeon General within twenty-four hours. The original emergency medical tags attached to the bodies of sick and wounded who died while in transit, or of the hilled in action, will remain attached to the bodies until Plate 25. Two-Bearer Litter Squad Carrying Wounded. interment takes place. See AR 30-1805, 30-1810, 30-1815. If interment is under super- vision of the Graves Registration Service, the EMT will be removed by Medical De- partment personnel and forwarded to The Surgeon General with the next report of sick and wounded. If interment is not under the immediate supervision of the Graves Registration Service but is made by burial parties from the command, the tags will be removed by Medical Department personnel if present, otherwise by responsible persons and transmitted to the surgeons of the commands of which the dead were members. The EMT attached to the body of enemy or allied dead will be forwarded to The Surgeon General through such channel as may be prescribed. After the tag is detached from the patient the wire will be removed from the tag. Disposition of carbon copies. The carbon copies of the emergency medical tags will be assembled and utilized by the senior medical officer of each unit to prepare for the organization commander such a daily list of casualties as may be required in preparing or checking his reports. At the end of each month all the carbon copies, having served the purpose indicated, will be collected and forwarded with the monthly report of sick and wounded to the chief surgeon for transmittal to the surgeon general, (see Chapter VIII). Litter Bearer Group. This group is charged with the prompt removal of all seriously ck and wounded from the fighting line and their evacuation by litter to the site of the ud station. Litter bearers direct and assist the walking wounded to the aid station. When necessary, a litter bearer squad searches for, treats and cares for the sick and wounded. The litter bearer group assists the aid station group of its battalion medical section in moving and establishing the aid station. When the action commences, the litter bearers move forward from the aid station and make contact with the company aid men. They operate along the axis of advance of the companies in the assault echelon of the battalion, evacuating the wounded. They take advantage of the ground and cover, utilizing available covered routes, such as stream beds or ravines, from the location of assault companies to the aid station. These routes are known as “natural lines of drift.” The litter bearers serve as messengers between the battalion surgeon at the aid station and the company aid men and vice versa. ATTACHED MEDICAL PERSONNEL 631 Defilade Defilade Road to Collecting Station Lines of drift Water Overhead cover (No undergrowth! Aid Station Area Plate 26. A Desirable Aid Station Site. Hand litter-carriage is fatiguing work, and casaulties among litter bearers are quite numerous. Because of hostile fire, and the laborious task, “evacuation lag” may begin at this point, causing the first interruption in the patient’s journey to the fixed hospital. The twelve bearers can handle only three casualties on each trip. It may be necessary to supplement the litter bearers by requesting a detail of prisoners of war, or even riflemen to assist in carrying wounded from the field. Combat troops will be detailed on evacuation duty only as a last resort and only when such employment does not interfere with their combat duty. Battalion Aid Stations. Battalion aid stations are operated by aid station groups. The principles governing the establishment and operation of battalion aid stations are: Battalion aid stations are established in combat when there is no steady progress or when progress is very slow. 632 MILITARY MEDICAL MANUAL Only such part of the aid station is established as immediate circumstances require or for which imperative need can be foreseen. Personnel operating aid stations must keep in constant, contact with the combat units they serve. The aid station group prepares casualties for further evacuation. The aid station is not a proper place for the initiation of elaborate treatment of surgical cases. The treatment given should be such as will not retard the flow of casualties through the aid station. Medical property evacuated with patients must be replaced by exchange with the next medical unit to the rear. The main functions are: sorting of the wounded; rendering of emergency treat- ment or supplementing treatment already given; tagging; and keeping a record of the sick and wounded. Selection of aid station sites. The ideal site for an aid station is a sheltered locauon at the center rear of the unit served, between 300 to 800 yards (there is no prescribed dis- tance) from the front line, with covered routes of movement front and rear, and a supply of water. In the selection of the actual aid station sites, the following features should be kept in mind: Desirable Undesirable Shelter from enemy fire and observation. Proximity to natural lines of drift of wounded. Ease of contact with combat troops. Ease of communication with the rear. Economy in collecting and litter bearing work. Ease of advancement of station to front or rear. Proximity to water. Protection from the elements. Use of lights at night (yet invisibility from enemy on ground or in air). Enemy observation and fire. Close proximity to bridges, cross roads, ammuni- tion dumps, ration distributing points, artillery positions, and permanent landmarks. To select the proper site for an aid station, the battalion surgeon must make an esti- mate of the situation which includes: the disposition, strength, and mission of the troops to be served by the battalion aid station; whatever is known of the enemy and his capabilities; nature of the terrain involved. (See Chapter VII). The tactical employment of the combat units served is the determining factor in the selection of the aid station site; therefrom, the battalion surgeon can determine the local- ities where the bulk of the wounded (“areas of casualty density”) will probably be found. Consequently, he will attempt to place his aid station behind these localities. The site is finally decided upon by the battalion commander, upon recommendation of the unit surgeon. This is essential to avoid any disagreement or conflict with other installations of the battalion or units attached or in support thereof. Interior arrangement of the aid station. The space in which the aid station is estab- lished should be allotted to the various activities of the station in such a way as to per- mit their functioning in the most efficient manner. At the entrance to the aid station site is located a receiving space or area; at the opposite end, a forwarding space. In the receiving space is the record clerk who keeps a blotter of casualties. Ample space should be assigned for dressing cases. A space should be provided where hot drinks may be prepared for the wounded. A suitable layout for an aid station in a tent or area is shown in Plate 27. It must be remembered that this is purely diagrammatical and in no way indicates a definite arrangement, since in combat consideration must be given for separation of operating personnel in order to avoid excessive casualties by a shell or bomb exploding within the station area. Grouping of the personnel and the equip- ment should be prohibited except as necessary for operation. Functioning of the Aid Station. The aid station is the beginning of the route of evacua- tion. To it the battalion medical section litter bearers bring the wounded they have col- lected from the combat companies. At this station the wounded are dressed, tagged, sorted, and returned to their companies or made ready for further evacuation to the rear. ATTACHED MEDICAL PERSONNEL 633 Sorting is an important function. Malingerers and those with slight wounds are re- turned to their companies. Men disabled for combat but able to walk are directed to the collecting station evacuating the aid station. This is best accomplished by having them follow litter bearers from the collecting company. Seriously wounded men are turned over to litter bearers from the collecting company to be carried to the collecting station. Only emergency treatment is given at the aid station. Hemorrhage is arrested, bandages readjusted, antitetanic serum administered, and emergency medical tags attached and verified. For example, patients arriving at the aid station, who have received emergency treatment from a member of the company aid group or of the litter bearer group, have their dressing inspected and receive further treatment indicated. Wounded able to walk will arrive at the aid station without having contacted on their way to the rear either the company aid men or the litter bearers. Some of these casualties will have applied the dressing from their own first aid packet. These casualties will be attended as neces- sary for further evacuation. Surgical operations are rarely attempted except for those cases where immediate operation is imperative to save life or to insure future recovery. SURPLUS SUPPLIES AXES LANTERN UNITS UTTERS CHEST NO.Is WALKING WOUNDED RED CROSS MARKER PICKS ROPE SHOV ELS ENTRANCE, EY it DRESSING table KED CROSS marker. I Flag Geneva Convent/on) LYSTER. BAG, STAND. INST SOLUTIONS. HYPO INJECTIONS Blanket units COCOA UNITS (antititamus). SPLINT UNITS BUCKETS Plate 27. Conventional Floor Plan of an Aid Station. (As established in a building or tent). Records are kept of all cases passing through the aid station. The total casualties on the blotter are frequently noted and the battalion commander and regimental surgeon kept informed as to the losses. The station blotter is simply a note book showing the designation of the individual, the nature of his wound or wounds, and the disposition made of the case, such as: duty, collecting station, or died. ' The regimental medical detachment is not responsible for evacuation to the rear but does cooperate in maintaining contact with the collecting company through the contact agent who has been sent forward from the collecting company for that purpose. The Regimental Aid Station. The regimental aid station is established by the head- quarters section of the regimental medical detachment to render medical service for all personnel in and about the regimental command post. This station is established only as required in any given situation. It is not normally a link in the evacuation of wounded from battalion aid stations. When establishment is not indicated, all personnel 634 MILITARY MEDICAL MANUAL Plate 28. An Aid Station in Operation (Litter Wounded Department). Plate 29. Another View of the Aid Station (Walking Wounded Department). ATTACHED MEDICAL PERSONNEL 635 and equipment are held in regimental reserve. Partial or complete establishment of the regimental aid station may be indicated to care for the situation while the battalions of the regiment accompanied by their respective battalion medical sections are moving for- ward to their positions in line. This permits the battalion medical section to keep mobile, conserve the strength of its personnel and maintain contact with the infantry battalion it serves. Communication Available for the Regimental Medical Detachment In batde, it is often very difficult to locate and maintain communication with other elements in the chain of evacuation. Responsibility for communication, or contact, is normally from rear to front. Within the regimental medical detachment, contact is made as follows: Between regimental and battalion surgeons, by personal contact or by runner from the headquarters section of the regimental medical detachment. Between battalion surgeon and battalion commander, by personal contact or by a messenger from the battalion medical section stationed at the battalion com- mand post. Between aid station and forward companies, by litter bearers, by messages from com- pany aid men, or by walking wounded. Between aid stations and collecting companies of the medical battalion, ordinarily by contact agent from the collecting company and litter bearers from the collecting company. While the collecting company has the responsibility of making and maintaining contact with the aid stations, the battalion surgeon takes all necessary precautions to insure that such contact is made and main- tained. Reinforcement and Replacement of Personnel. By authority of the regimental com- mander, the regimental surgeon may transfer individuals from one battalion medical section to another in order to meet existing conditions. He may request reinforcements for his detachment when he foresees the need. All surgeons are authorized to call upon the next medical unit in rear for replacement of personnel, and that unit furnishes such personnel as can be spared. This procedure then extends to the next medical unit in the rear. Supplies and Equipment. In combat, commanding officers, both of unit detachments, and of battalion sections thereof, will procure all supplies, except medical, through the channels provided for other elements of the unit. They will procure medical supplies by: (a) Informal request sent to the medical unit in direct support, ordinarily a collecting company of the medical battalion. The supplies will be delivered by litter bearers, or ambulance may be used in some situations, such as during hours of darkness. (b) Informal request sent to the nearest medical distributing point. (c) The same manner as set forth when not in combat (see below). (d) Any combination of the methods outlined above. In other than combat, the commanding officer of the detachment is responsible for its supply. He submits to the unit supply officer the requirements of all articles of equip- ment authorized in Tables of Basic Allowances. Plans for the Employment. In attack situations, conditions usually will permit the making of complete plans for participation by the regimental medical detachment. The regimental commander’s plan of action should be carefully studied, coordination with the combat units provided for, and detailed plans covering all phases of the medical detach- ment’s participation in the action carefully formulated. Employment of the Headquarters Section of the Medical Detachment The head- quarters section of the medical detachment should be held in a position in readiness near the regimental command post. In certain situations it should retain its full mobility and be prepared to supply and reinforce the battalion medical sections serving the battalions of the regiment. Supplies should be made available for the care of such casualties as may occur in the vicinity of regimental command post. In certain other situations the In Attack 636 MILITARY MEDICAL MANUAL regimental aid station is established early in order that care and treatment may be given the wounded during the initial stages of the advance and before the establishment of battalion aid stations has been effected. In that capacity it assists in keeping the battalion medical sections mobile, allowing them to follow their respective battalions in the attack. Establishment of the Battalion Aid Station in Attack. The battalion medical sections follow their respective battalions into position. Aid stations are fully or partially estab- lished in the most advantageous positions to serve their respective battalions. If a strong and well maintained resistance is expected, aid stations should be located on or slightly to the rear of the line of departure. When the enemy is weak, and when little resistance is expected, the aid station group may follow the attacking troops forward from the line of departure some distance before establishing an aid station. Such action tends to diminish the work of the litter bearers during the early stages of the action and may make early movement and reestablishment of the aid station unnecessary. Premature establishment of the aid station should be avoided. Ordinarily, equipment should not be completely unpacked until wounded arrive; otherwise with the changing aspect of the battle, the aid station might, be immobilized in a place where it could not realize its full usefulness. Company Aid Men in Attack. Company aid men (3 to each rifle company) follow the companies into action. Companies often attack with 2 platoons in the assault echelon and 1 platoon in support. Company aid men attached to companies take posi- tion to the immediate rear and center of each platoon in the assault echelon and in so far as is practicable maintain this position throughout the attack. The duties of the company aid men during the attack are as follows: Maintain contact with the companies to which attached, Forward information to their respective battalion surgeon by litter bearers or by wounded able to walk. This information will include progress made by their companies, the exact location of the company on the ground, and the approxi- mate number of casualties occurring in each company. Administer emergency treatment, and mark the location of the casualty by means of the individual’s rifle or bayonet stuck in the ground, and his headdress or a piece of bandage hung from the upper end, Examine and tag the dead, and mark the location as described above. Instruct the sick and wounded able to walk of the exact location of the aid station and the proper route thereto, Place all seriously sick and wounded on the central axis of the advance of the company. Advantage should be taken of sheltered positions. The position of the seriously wounded left on the axis of advance may or may not be marked, depending on standing orders and the ability or inability of the enemy to observe such procedure. Wounded requiring movement to the axis of advance or to pro- tected positions on the terrain will be attended to as time permits. Company aid men attached to the heavy weapons company, the cannon company, and antitan\ units may be widely separated and unable to work together. For this reason they should be given more detailed instructions and taught to work independently. In general, they function in the same manner as do company aid men attached to the rifle companies of the battalion. Litter Bearer Group in Attack. As soon as action commences the litter bearer squads of the battalion medical section move forward from the vicinity of the aid station with instructions to follow along the axis of advance of the battalion, to make contact with company aid men when this can be accomplished and to clear the battle area of all wounded. As the attack progresses, litter bearer squads operate along the axis of advance of each company in the assault echelon of the battalion, evacuating the wounded to the aid station. Where distances are short the litter bearer group may use six litters (2 bearers to a litter), but when the distances are long, four bearers should be assigned to each litter. When additional litter bearers are attached to the regimental medical detachment, the ATTACHED MEDICAL PERSONNEL 637 regimental surgeon may hold the additional bearers as a reserve. Squads can be sent forward as needed. One or more squads may be attached to each battalion medical section or all may be assigned to one battalion medical section when their need is anticipated. Employment of the Regimental Medical Detachment During the Progress of the Attack. As the attack progresses, the battalion medical sections move forward in order to main- tain contact with the battalions they serve and to reduce the length of the litter-carry. The aid station may move in two parts by “leap-frogging,” or it may, if clear of patients, follow its battalion intact. During rapid movement, the wounded, after having been given emergency treatment, may be left at the site where treated. The collecting com- pany of the medical battalion as it moves forward will then care for and evacuate these wounded. When the combat regiment attains its principal objective, combat activity often dimin- ishes and the troops proceed to the consolidation of their new positions, pending orders to resume the attack or initiate pursuit, or to take up the defensive in the positions they have reached. During this period the regimental medical detachment clears the regi- mental area, checks all medical supplies, and sends requests to headquarters regimental medical detachment for replacements. Further activity of the medical detachment depends upon the continuance of the attack or other tactical plan. If the attack is continued the employment of the regimental medical detachment conforms to the foregoing. If the combat troops take up defensive action in their new positions the medical detachment is employed as in the defense. If the troops withdraw from the newly obtained positions the medical detachment is employed as stated in the discussion on retrograde movements. The accompanying table illustrates the various dispositions of the battalion medical section serving an infantry battalion during the attack. DISPOSITION OF THE BATTALION MEDICAL SECTION IN THE ATTACK Infantry formations Medical section formations 1st Phase. Advance in route column and development. Column of threes. Company aid men with companies to which at- tached. Aid station group, litter bearer group, and trucks follow in rear of battalion. 2d Phase. Approach march (desultory shelling). Lines of small columns, Company aid men with companies to which at- usually squad columns. tached. Section, less aid group, follow the bat- talion reserve. Aid station equipment transported by truck or by hand. 3d Phase. Approach march, and deployment (heavier shelling and long range machine gun fire). Usually squad columns, Company aid men follow closely the assault com- occasionally infiltration, panies to which attached. Battalion surgeon makes and skirmish lines. local reconnaissance for aid station site. Aid sta- tion group held in position of readiness. Litter bearer group follows the axis of advance of the assault companies. 4th Phase. Advancing the attack (heavy fire of all kinds). Attack formations; usually Company aid men follow the assault companies skirmish line, occasionally to which attached. Aid station group in position infiltration. of readiness or establish station. Litter bearer group follows assault companies. 5th Phase. Assault. Attack formations. Comnany aid men temporarily held up in rear of assault companies. Aid station established. Lit- ter bearer squads follows assault companies. 638 MILITARY MEDICAL MANUAL 6th Phase. Reorganization to continue the attack. Temporary defensive formation. Company aid men join companies to which at- Security detachments. tached. Aid station prepares to move, or moves forward to obtain closer contact. Litter bearer squads clear area of wounded. 7th Phase. Pursuit. Approach march or attack Company aid men with companies to which at- formations. tached. Litter bearer squads follow the axis of advance of the battalion. Aid station group moves forward in close contact with the rear elements of the battalion. 8th Phase. Organization of the ground (in lieu of pursuit). Defensive formations. Company aid men with companies. Litter bearer squads maintain contact with company aid men and continue evacuation of sick and wounded. Aid station is established in most suitable location. Defensive situations usually afford time and opportunity for a thorough organization of the medical service within the area occupied by the regiment. In this type of action certain special features enter into the administration of the medical service, these becom- ing particularly important in a prolonged defense of a zone and of less importance as the defense becomes more temporary in character. There is usually sufficient time for a systematic reconnaissance of the entire area occupied by the regiment and for the prep- aration of medical plans of operation. Dispositions should be made in such a manner as to give efficient medical support and at the same time permit relief and rest, of medical personnel. All positions should be progressively improved from the hour of occupancy. When necessary, shelter is constructed for aid stations and overhead cover provided as a protection to stations, equipment, and personnel. Headquarters Section of the Regimental Medical Detachment in Defense. The regi- mental surgeon’s office and the regimental aid station are located in the vicinity of the regimental command post, the extent of the aid station establishment being determined by the duration of the defense, the distance of the position from the front, and whether or not the station is to constitute a link in the chain of evacuation of casualties from the regiment. Battalion Medical Section in Defense. The aid station group establishes the aid sta- tion in a rear position of the battalion center of resistance in the best obtainable loca- tion. The distance of such positions from the front is dependent upon the dispositions of the combat troops, the nature of the terrain, and the natural lines of drift for casualties from the front. The litter bearer group of each battalion medical section makes and maintains contact with company aid men with the combat companies, and evacuates by litter all casualties unable to walk to the aid station. The company aid men remain with the companies to which they are attached, and when the situation permits they establish company aid posts within the company area. Such aid posts will contain little equipment other than a few dressings and possibly a litter. These posts constitute points where the company casualties may be given emer- gency treatment through the combined efforts of the company aid men. During the defense, it is desirable that one of the companv aid men from each company report in person at least once daily to the aid station maintained by his battalion medical section for the purpose of giving information and obtaining instructions. Contact with Battalion Commander. The battalion surgeon should maintain close con- tact with the battalion commander. Large patrols may be sent out, and raids at night may be made into the enemv’s position for the purpose of obtaining prisoners and infor- mation. The surgeon should have full information concerning such activities to enable him to cooperate in the best possible manner and to provide care and evacuation for the In Defense ATTACHED MEDICAL PERSONNEL 639 casualties which may result. A defense often terminates in some other type of action, therefore medical officers must inform themselves concerning the general military situa- tion and the plans of their respective commanders. A retrograde movement is any movement of a command to the rear, or away from the enemy. This includes withdrawal from action by day or night, delaying action, and retirement. See Chapter V, Part I. It is a planned action to improve the tactical position of the command. Regimental Medical Detachment in Retrograde Movements. The extent of the employ- ment of the medical detachment during a retrograde movement is influenced by the manner in which the movement is accomplished, the activities of the enemy, the strength of the covering force, the location of the covering positions to be occupied, the location of the assembly area in the rear, the rapidity of troop movement, and the effectiveness of the delaying action. Sections of the regimental medical detachment maintain contact with and continue to render medical support for the organizations which they serve. In Retrograde Movements Plate 30. Aid Station in a Dugout Shelter (Stabilized Warfare). Headquarters section of the regimental medical detachment. The headquarters section remains in close contact and continues to serve regimental headquarters personnel. If already established at the beginning of a retrograde movement, the regimental aid station may become a very important link in the chain of evacuation of casualties. If not established all station equipment should be packed and the headquarters section should be prepared to move to a new position without delay. During phases of the movement the headquarters section may be called upon to augment the work of the battalion medical sections or to establish an aid station at some point in the rear through which to evacuate casualties from the regiment. Battalion medical section. The battalion medical sections remain in contact and con- tinue to serve their respective battalions. If the covering or delaying position is occupied by a battalion it is accompanied by its respective battalion medical section. The battalion 640 MILITARY MEDICAL MANUAL aid station is partially established well to the rear of the position, providing the defense is relatively strong and the hostile pursuit slow and weak. If the reverse is the case the battalion medical section serving the battalion will be able to accomplish little more than emergency treatment of casualties and their removal to a designated collecting point, preferably near a roadway over which troops pass in proceeding to the rear. The bat- talion medical section transportation is held at or conveniendy near the site of the aid station, and every effort is made to keep it mobile. In withdrawal from action the movement of battalion medical sections or squads thereof, serving units in contact with the enemy, conform to the movement of such units. If the movement is rapid no attempt is made by the aid station group to establish a station, but selected collecting points should be designated along the battalion’s axis of withdrawal. The aid station groups of battalion sections occupy such points and provide emergency treatment for the largest possible number of casualties. As units in contact with the enemy approach these points in their withdrawal the positions are vacated and the aid station groups proceed to the designated collecting points next in the rear, taking with them the seriously wounded. Every effort is made to prevent large numbers of wounded from falling into the hands of the enemy. Abandonment of living casualties to the enemy is always destructive of morale even when it is not inhumane. In war- fare against uncivilized people it is not considered even in desperate situations; and this has often been a limiting factor in operations against barbarous tribes. In rapid retrograde movements it is frequently impossible to evacuate all casualties with the facilities at the disposal of the medical service. In such a situation one or a combina- tion of only three courses of action is possible: the speed of the movement may be re- tarded to permit evacuation with the facilities at hand; the medical service may be reinforced; or the casualties may be abandoned to the enemy together with a detach- ment of medical troops sufficient for their care. This is a command decision. It is the duty of the surgeon to present to the commander the data necessary for him to arrive at his decision, but the commander alone must decide whether or not to abandon his casualties in whole or in part. When the delaying positions are occupied by one or more companies, such companies are followed into position by the company aid men originally attached, who combine their efforts, establish collecting points for the sick and injured, and care for the casualties in the same manner as prescribed for troops in a defensive action. When the battalion medical section is divided, the battalion surgeon may order the assistant to direct and supervise the work of isolated groups of medical personnel, com- pany aid men, and Utter bearers of the section. The litter bearers will bring as many casualties to the designated collecting points as they are able to transport. Contact with collecting station. It is highly important in all retrograde movements that the collecting company charged with the evacuation of the sick and wounded from the regimental area maintain close contact with aid stations and collecting points estab- lished by the regimental medical detachments. With Troops Not in Contact with the Enemy. Troops not in contact with the enemy, or occupying selected covering positions, proceed to the designated assembly point ac- companied by their attached medical personnel. The disposition of such medical person- nel conforms to that prescribed for normal march formations. Following the Retrograde Movement. Following the retrograde movement the regi- ment may occupy a new defensive position, or the movement may simply initiate a re- tirement. If the troops occupy a defensive position or delaying position the regimental medical detachment is employed as in defense, arriving at the new positions at the same time as the unit served. If the movement initiates a retirement the employment of the medical detachment conforms to the principles as prescribed for troops on the march. EMPLOYMENT OF THE ATTACHED MEDICAL PERSONNEL WITH UNITS OTHER THAN INFANTRY ATTACHED MEDICAL PERSONNEL 641 The basic principles for the tactical employment of regimental medical detachments attached to regiments of infantry are, in so far as practicable, applied in the control of regimental medical detachments of regiments of field artillery, cavalry, and other arms. Similarly, the basic principles of interior organization, tactical employment of regimental medical detachments of infantry, cavalry, and field artillery regiments in garrison, on the march, in camp, and in combat are followed in the interior organization and tactical em- ployment of medical detachments attached to quartermaster units and combat engineer battalions of the infantry division. There are exceptions however in the armored division. See below. Artillery The Medical Detachment With Division Artillery. For tactical employment in the field, the medical detachment supporting the division artillery is divided into a head- quarters section and four battalion medical sections (one section for each battalion). See organization of the medical detachment, division artillery (T/O 6-10). In Garrison and on the March. With troops in garrison, on the march, or in permanent or semi-permanent camps, the service rendered by the medical detachment attached to the division artillery is the same as for regimental medical detachments attached to infantry regiments. Headquarters Section of the Medical Detachment. In combat the headquarters section of the medical detachment and aid station are established at or near the rear echelon of division artillery. From this position the surgeon maintains contact with artillery head- quarters and with each battalion medical section, supervising, reinforcing, and to a limited degree supplying these latter units with medical supplies and material. The aid station is established by personnel of the headquarters section and may or may not constitute a link in the chain of evacuation of casualties from the battalion aid stations. Battalion Medical Section. Battalion medical sections follow their respective artillery battalions into position, establish aid stations, and make contact with their respective bat- tery aid groups. The battalion aid station sites should conform to the same requirements as those of the infantry battalion. They should never be established near ammunition dumps or in close proximity to the designated parking places for artillery caissons and combat trains. They may be established near roadways, but not at important points such as road junctions and crossroads. A road leading to or from the immediate vicinity of the aid station is highly desirable, since this allows evacuation by ambulance. With few exceptions, as related in paragraphs below, aid stations of artillery units func- tion in the same general way as do aid stations serving infantry units. Ambulances are normally part of the medical detachment transportation and, therefore, may be used to evacuate patients from the battery positions (when practicable) and from the aid station to facilities of the medical battalion serving the division. In some instances the aid station may be so located as to be readily accessible to ambulance service of the medi- cal battalion. Litter bearer group. All sick and wounded unable to walk must be evacuated from battery positions by the litter bearers or by additional help from the aid station group or company aid group when unusual activity develops or when the litter-carry is long. The litter bearers are a part of the battalion aid station group and when not employed as litter bearers they assist in the aid station. In favorable situations the sick and wounded may be evacuated directly from battery positions by ambulance. Ambulances are normally part of the transportation of medical detachments of artillery. The battery aid group. Battery aid men are attached to each battery of artillery. They are the first to see the sick and wounded in battery positions. They give emergency treatment and care for the sick and wounded until they can be evacuated. The battery aid men eat and sleep with the personnel of the artillery batteries to which they are attached during periods of activity and return to their respective battalion medical sections only at such times as the battalion is brought together for rest or train- 642 ing. They are trained and instructed in the same manner as are company aid men attached to companies of infantry. When a battery remains in one position for a con- siderable period of time battery aid men obtain a small surplus of medical supplies with which to establish local aid posts within or nearby their respective battery positions. Each battery aid man is instructed to care for the casualties occurring in his own battery, and for the accomplishment of this work takes position in or close to the gun emplace- ment of his particular battery when the guns are being fired or when the position is being fired upon by the enemy. Casualties occurring in gun pits are immediately removed to a place of greater safety, given emergency treatment, and carried by litter bearers or directed to the battalion aid station. In all stabilized or partially stabilized situations it is desirable that battery aid men report at least once daily at the battalion aid station for the purpose of giving information and receiving instructions. The Veterinary Section (For Horse-drawn or Mounted Units). The veterinary sec- tions furnish veterinary service for all units within the combat zone having animals as part of their organization. Veterinary Aid Station. The veterinary aid station is operated by the veterinary sec- tion. In situations where two veterinary aid stations are needed, the two battalion sec- tions are separated, and each operates a battalion veterinary aid station. The functions of and the principles governing the establishment and operation of veterinary aid stations follow closely these applicable to the medical service. The veterinary section is the foremost veterinary unit in the evacuation of animals. At the veterinary aid station the veterinary section: Receives and records animal casualties. Examines, sorts, and administers emergency treatment to disabled animals. Returns to the proper organization animals able to do further duty. Prepares sick and wounded animals for further evacuation. Destroys injured animals which cannot be salvaged. Animals to be evacuated are collected by personnel from the veterinary units further to the rear, who make and maintain contact with veterinary aid stations. Principles governing the establishment and operation of the veterinary aid station: Veterinary aid stations are established in combat when required to relieve units of sick and wounded animals. Aid stations maintain contact with the combat unit they serve. The aid station is the proper place to give emergency treatment; it is not the proper place to undertake definitive treatment of any kind. Each animal evacuated should be equipped with a halter and halter-shank, and, if needed, a blanket. Usually but one veterinary aid station is established per regiment. In case a regi- ment is operating with widely separated battalions or squadrons, the sections and equipment are divided and two aid stations established. The location of the veterinary aid station. The most suitable site for the veterinary aid station is at or near the point where the majority of the animals of the unit are as- sembled. When combat is imminent the unit veterinarian reconnoiters the regimental zone of action for suitable sites for the veterinary aid station, keeping in mind the following desirable features: Shelter from enemy fire and observation. Location in the vicinity of the greatest concentration of animals. Proximity to water. Routes for evacuation by the veterinary personnel from rear veterinary units (veter- inary troops of the medical squadron or the veterinary company, separate) without interference with other transportation. Protection from the elements. As a result of the reconnaissance the unit veterinarian recommends to the unit sur- geon one or more suitable locations for the veterinary aid station; the surgeon submits this to the unit S-4 for coordination. This is done informally. The aid station is established at the approved location as soon as the regiment is in position. Only such part of the aid station is established for which the need can be foreseen. MILITARY MEDICAL MANUAL ATTACHED MEDICAL PERSONNEL 643 Functioning of the veterinary aid station. Personnel not designated as veterinary aid men work at or from the veterinary aid station. The unit veterinarian directs the work at the aid station, keeping in touch with the animal casualty situation. The junior offi- cer directs the collection of casualties, and sends forward men at opportune times to bring back animal casualties to the veterinary aid station. The noncommissioned officer remains at the aid station at all times; he receives, sorts, and records casualties and prepares the emergency veterinary tags. In the detachments with field artillery and Front (top row) and back (bottom row) of original, duplicate and triplicate copies, respectively. When the emergency veterinary tag is used in combat, those sections of the tag which would reveal the identity of the organization to which the animal belongs, the location of the organi- zation and such other information of value to the enemy will not be filled in. This would apply when the tag is initiated at such veterinary installations as aid stations, and clearing stations which may come in contact with the enemy. Plate 31. The Emergency Veterinary Tag, Form 115b, M. D. cavalry, veterinary aid men may be attached to battalions or squadrons during combat. In mounted cavalry action it may be advantageous to attach one to each troop. These veter- inary aid men follow their units into battle, give emergency treatment, tag sick and wounded animals, and place them in sheltered positions where they can be located by the veterinary aid station personnel. Classification of Sick and Wounded Animals. Proper classification is a most important 644 MILITARY MEDICAL MANUAL feature of evacuation. Its object is to eliminate the nonsalvageable and to prevent salvage- able animals from going farther to the rear than is necessary to secure definite treatment. Disabled animals are classified as follows: Salvageable. Those animals amenable to treatment within a reasonable time as follows: Minor cases which can be returned for duty immediately after treatment. Moderate cases which promise recovery within three to five days without hampering the mobility of the command. Severe cases able to walk or undergo transportation, including cases of communicable disease, which might menace the health of other animals. This is the class of animals prepared for evacuation. Nonsalvageable. Those animals requiring immediate destruction on account of: Incurable sickness or injury. Inability to walk, no transportation being obtainable. Communicable disease of such a nature that treatment is impracticable. Cavalry The Medical Detachment with Cavalry. For tactical employment in the field the medical detachment supporting a regiment of cavalry is divided into a headquarters section, 3 squadron medical sections, and a regimental veterinary section. In garrison or on the march. With troops in garrison, on the march, or in permanent or semi-permanent camps the service rendered by the regimental medical detachment attached to regiments of cavalry is in principle the same as in the case of regimental medical detachments attached to regiments of infantry. The Headquarters Section of the Regimental Medical Detachment. In combat the headquarters section of the regimental medical detachment usually accompanies the regimental reserve, from which position the regimental surgeon will supervise, rein- force, and to a limited degree supply the squadron medical sections serving the squad- rons of the regiment. The medical truck remains with the regimental train until such time as it is ordered forward for the purpose of establishing a regimental aid station. The regimental surgeon should maintain close contact with the regimental commander and with each squadron medical section of the detachment. The Squadron Medical Section. Squadron medical sections follow closely the squadrons to which attached. The squadron surgeon maintains close contact with each troop of the squadron. When the squadron deploys for action, the squadron medical section, and such personnel as may be attached, take up a position with or near the squadron reserve. Squadron aid station. With cavalry organizations in combat, aid stations cannot often be established with any degree of assurance that they will long continue to function for the relief of the units which they are designed to serve. In certain special situations aid stations may be definitely established, but in many other situations fully established aid stations do not function properly and tend only to decrease the mobility of the medical unit and to increase the difficulty in maintenance of contact with the troops. The deci- sion as to whether aid stations should or should not be established to cover any given situation must rest with the regimental and squadron surgeons, who are influenced in making such decisions by the relative dispersion of troops, their principal mission, the character of the action anticipated, and the character of the terrain over which the troops will operate. Aid stations should never be fully established during periods of continued and rapid movement of troops, nor when the dispersion of troops is such that any given aid station will not serve more than one troop, situations which are not unusual in the service of the cavalry. When cavalry is employed as a covering force, acting as a screen for the advance of troops, conducting distant reconnaissance, or employed in connecting separate armies or parts of armies in their advance, no attempts should be made to establish aid stations except at halts for the night and at such other times as minor contacts with the enemy may produce a grouping of casualties and a temporary cessation of movement. During combat, when the cavalry regiment or squadron thereof is operating on the ATTACHED MEDICAL PERSONNEL 645 enemy’s flank, exploiting a break in the enemy’s line, filling gaps in the line, or participat- ing in the main battle, aid stations should be established partially or fully. When cavalry is employed as a covering force they may be established partially, but a high degree of mobility should be maintained. Troop aid group. When the squadron medical section is able to utilize troop aid men, they function with each troop of cavalry in the same manner as do company and battery aid men attached to companies of infantry and batteries of field artillery. Two men are usually attached to each troop. Casualties occurring in the troop are first attended by troop aid men, by whom they are examined, dressed, and directed to the position of the aid station group of the squadron medical section. Litter bearers may be designated in situations when cavalry may be dismounted temporarily and fight on foot. Casualties unable to walk are removed to the position of the aid station group by the use of their own mounts, the travois, the field ambulance of the regimental medical de- tachment, or by requisitioned, wheeled transportation. Casualties unable to endure trans- portation are left with medical material and with or without medical attendants in the care of civilian inhabitants. Medical Service in Dismounted Action. In many situations, such as delaying actions, the holding of strategic points, or when cavalry units go to the assistance of hard-pressed infantry, cavalry may be dismounted temporarily to fight on foot. This is known as dis- mounted action of cavalry, and throughout its duration the medical service of the organ- ization is conducted in the same general manner as for like organizations of infantry. Troop aid men should accompany their troops into action. Squadron medical sections may or may not establish aid stations, depending upon the type, probable extent, and probable duration of the action. If aid stations are not established, collecting points for the sick and wounded are designated along the axis of movement of each troop or upon the previously designated line of withdrawal of such units. Medical Service in a Detached Troop. When a single troop of cavalry is detached from its parent organization the troop aid men remain with it for the purpose of conducting the medical service of the troop. If the troop is to be detached for more than a few days, and is accompanied by a medical officer, a medical and surgical chest or box of medicines and dressings will be carried on one of the trucks accompanying the troop. Veterinary Sections with Cavalry. The same principles of organization and oper- ation are applicable for the veterinary sections of cavalry as are used for those of horse- drawn artillery. Their equipment is carried on two packhorses, and they can establish one regimental veterinary aid station or two squadron veterinary aid stations. One aid station is usually set up in the rear of the pivot of maneuver, while the other squadron veterinary section follows the maneuvering force in readiness to set up the station when the situation indicates. More often, the detailed squadron is accompanied by one officer, one sergeant, and three privates who are kept available for that purpose. A detached troop may be accompanied by a private first class from the veterinary section. Usually, the unit personnel is kept together near the squadrons supported and assigned as the situations arise which require their services. They may be located with the combat trains when these trains are in close proximity to their units. ARMORED UNITS Attached Medical Personnel with the Armored Division. General. The big difference between employment of the Armored Division and the Tnfantry Division lies in their differences in speed and radius of action. The Armored Division consists fundamentally of five elements: Command, Reconnaissance, Striking, Supporting, and Service. The Command element of the division consists of the division commander and his staff; in action they may move swiftly in tanks or other vehicles. The Reconnaissance element consists of reconnaissance vehicles and light tanks which seek information or serve as a delaying force pending the arrival of the striking force of the division. The Striding element includes the armored regiments which are the main attack force of the armored division. It also includes Armored Field Artillery equipped with 105-mm howitzers 646 MILITARY MEDICAL MANUAL on highly mobile self-propelled mounts. Due to its high degree of mobility the artillery can be placed in action quickly and as quickly displace to new positions thus rendering close fire support for the tank regiments. The support element is the Armored Infantry Regiment which is so organized that a battalion may be attached to each tank regiment for the purpose of forming combat commands (combat teams). The infantry is trans- ported prior to contact with the enemy on half-track personnel carriers, however, they routinely dismount and fight on foot, the half-track carriers being concealed in a nearby defiladed area. When once committed, tanks do not halt until they reach the rallying point where control is regained, new objectives and new rallying points are designated and tanks may be rearmed and regassed. Medical support must be provided for all units of the division. The attached medical personnel is a part of each element and must render emergency treatment and provide for early collection of the casualties. To understand this medical support it is necessary that the reader be familiar with T/O 17, “The Armored Division” and the tactics of armored units. 1 2 3 4 6 6 7 1 Unit Tech- nician grade Head- quar- ters section 3 bat- talion sections (each) Total detach- ment En- listed cadre Remarks 2 3 4 1 1 (3 1)2 1 5 1 3 »With inserts for litters: for use as front line ambu- 5 (3 I) 3 2 9 lances. d Dental. 6 1 1 1 Staff sergeant (673) Sergeant, including 1 3 3 The serial num- H 0 10 11 12 13 14 2 1 5 5 ber symbol shown (i) (3) (1) (3) in parentheses is an (1) (1) (1) inseparable part of (1) (1) the specialist des- 1 i 4 4 ignation. A num- Technician grade 4 Technician grade 5 Private, first class. Private. Chauffeur (345 11 16 2 15 21 1 l ber below 500 refers to an occupational specialist whose qualification anal- ysis is found in AR 15 16 17 18 19 20 21 22 23 24 25 26 27 (2) (1) (2) (1) (5) (1) (8) 615-26. A number (2) (8) (24) a military occupa- (1) (1) (1) (1) tional specialist listed in Circulars 5 0) (1) (3) (1) (2) Nos. 14 and 67, (1) (2) (1) 4 a) 1942. (0 (3) (4) (9) 28 15 19 72 15 29 18 21 81 15 30 0 Car, half-track, M3, without 2 2 8 31 32 1 1 4 1 Plate 32. T/O 7-21, March 1, 1942. Medical Detachment, Armored Infantry Regiment. Armored Division. The medical service of the attached personnel of the Armored Division must be adapted to the field and combat conditions and requirements of the element it is sup- porting. First echelon medical service consists largely of emergency treatment, the collection of casualties along the main axis of advance, and the initiation of medical records. First aid training of the combat personnel of the armored units must attain a high degree of perfection since often casualties will be incurred. Since mobility and high fire power characterize mechanized action both during combat and for security, combat is ordinarily of short duration and is followed by rapid movement. The routine employment of the Armored Division carries it deep into enemy territory and often units of the division are completely surrounded by hostile troops. Attached medical personnel (medical detachments) therefore must render emergency treatment and initiate evacuation under trying conditions, surrounded by enemy. Casualties must be carried within the vehicles, in many instances, and treated as soon as they can be removed, at rallying points after objectives are taken. Aid sta- tions are rarely established but are kept mobile in order to advance rapidly to successive rallying points. Responsibility for evacuation by medical detachments with armored AIT ACHED MEDICAL PERSONNEL 647 units lies both from the front and to the rear, hence the provision of lightly armored half-track cars with litter inserts. The organization of the various medical detachments is given in Plates 32 through 38, note the small number of or absence of litter bearers. The litter bearers provided the medical detachments attached to tank regiments will be employed chiefly to remove casualties from tanks at rallying points and for short litter carry within the rallying point area to the mobile aid station for treatment and evacuation. 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 1 2 3 4 5 6 7 Unit Tech- nician grade FTead- q unrters section 3 bat- talion sec- tions (each) Total detach- ment En- listed cadre Remarks 1 (d 1)2 2 1 (d 1)5 2 » With inserts for litters: for use as front lino ambu- lances. <* Dental. 1 Total commissioned Technical sergeant (673) StafT sergeant (673) Sergeant, including Motor (337) (t 1)5 1 ('1 1)8 1 1 2 (1) (1) i 1 4 2 (1) (i) 3 f 2 J 18 1 15 1 15 (6) (1) (10) (12) (1) (1) (1) (3) k (4) (8) 1 4 2 (1) (1) 3 1 1 i 12 (1) (3) (4) (1) (1) (2) Technician, grade 4 | Technician, grade 5 linr,,ldint. Private, first class [in<;ludmg Private I ChautTeur (345) Clerk, general (405) Driver, half-track (735) 5 14 (3) (1) (1) Mechanic automobile (014) Technician, dental (067) Technician, medical (123) Technician, medical (123) Technician, sanitary (196) Technician, surgical (225).. .* Technician, surgical (225) Technician, surgical (225) Total enlisted Aggregate 0 Car, half-track M3, without arm- 5 5 5 4 5 (1) (1) (1) (1) (2) (1) (2) a) (ij 18 14 to 12 23 15 68 12 1 2 1 3 1 10 5 1 Q Truck. W-ton Q Truck, 2H-ton, cargo Plate 33. T/017-11, March 1, 1942. Organization of the Medical Detachment Armored Regiment, Armored Division. 1 2 3 4 5 1 Unit Tech- nician grade Medi- cal de- tach- ment En- listed cadre Remarks 1 ,«i>3 L- • With Inserts for litters, bu lances. 1 i 6 1 i The serial number sym- bol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification analy- 1 i 8 9 Technician, grade 4.1 Technician grade 5. includlnE s i i 10 11 12 13 u 15 16 17 18 19 20 1 6 (3) (1) (3) (2) 5 to a military occupational specialist listed in Circular No. 14, War Department, 1942. 5 (1) 5 0) (2) 3) (0) (i) 4 a) 6 21 25 5 22 29 5 23 24 25 3 1 Plate 34. T/O 17-35, March 1, 1942. Medical Detachment, Armored Reconnaissance Battalion, Armored Division. 648 MILITARY MEDICAL MANUAL The Armored Infantry Regiment. Detachments with the Armored Infantry Regi- ment operate quite similar to medical detachments with the foot infantry. The Armored Infantry Regiment uses its armored half-track personnel carriers to transport the troops to the scene of battle and thereafter fights largely on foot. Consequently, they have need for company aid men, litter bearers and an aid station group. (See T/O 7-21). 1 2 3 4 5 i a § 1 Unit Technic grade Medica detact || a « W Remarks 1 (■*1) 2 » With inserts for litters: for use as frontline am- 3 Staff sergeant (673) 1 1 Dental. 1 1 The serial number sym- 1 1 bol shown in parentheses 8 9 10 11 12 13 14 15 16 17 18 19 20 Technician grade 4 Technician grade 5 Private, first class. including 1 1 is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist 1 7 (2) whose qualification anal* o) (2) (4) ysis is found in AR 615-26. A number above 500 refers to a military occupational (1) (1) specialist listed in Circular No. 14, War Department, 5 a) 4 (2) (2) (6) a) 1942. 21 24 6 22 27 5 23 24 25 O Car, half-track ment. * M3, without arma- 2 1 Q Truck 2H-ton, cargo - 1 Plate 35. T/O 6-165, March 1, 1942. Medical Detachment, Armored Field Artillery Battalion, Armored Division. 1 2 3 4 6 1 l' nit Techni- cian grade Medical detach- ment Enlisted cadre Remarks 2 1 3 (dl)2 •J Dental. The serial number sym- bol shown in parentheses is an inseparable part of the socialist designation. A 3 5 1 1 6 1 7 1 1 8 9 10 Technician, grade 4] Technician, grade 1 * 1 an occupational specialist whose qualification analy- 11 1 4 12 (4) (1) (1) 0) (1) (1) (1) (3) to a military occupational specialist listed in Circular No. 14, War Department, 1942. 13 5 (i) 16 17 (i) 18 19 20 16 21 19 22 23 24 Q Truck, 2'-..-ton, cargo 1 Plate 36. T/O 9-65, March 1, 1942. Medical Detachment, Maintenance Battalion Armored Division. The Armored Regiments and Reconnaissance Battalion. Detachments with Armored Regiments are more specialized than others in that their tactical maneuvers are con- ducted entirely by means of the vehicles. Therefore the collection of casualties is limited to the fleeting periods of arrested movement at successive rallying points or after the engagement. Occasionally casualties may be removed from disabled vehicles which are thus prevented from keeping up with combat action. Rallying point contact with the highly mobile tank battalions is the keynote of medi- cal support for these units. Prompt removal of casualties from within tanks at rallying points must be accomplished by medical personnel in order to prevent suffering and to free individual tanks of the burden of casualties. Detachments of supporting and service elements. See Plates 35 through 38. The de- tachments with the Armored Field Artillery Battalion T/O 6-165, the Maintenance Battalion T/O 9-65, the Supply Battalion T/O 10-35 and the Armored Engineer Battalion T/O 5-215 operate similarly to the medical detachments of like units of other types of divisions with the exception that their speed of movement is much greater. Casualty estimates and types of casualties. Casualty estimates for tank regiments rarely exceed 5%. Of these, 4% are dead, leaving only 1% requiring medical care. In the armored infantry regiments the casualty rates are only slightly higher. The British Armored Forces in Libya have sustained approximately 10% casualties for all divisions employed. However, certain elements have sustained a much higher casualty rate per battle day. The types of casualties vary somewhat among the different elements of the armored division. In tank regiments fractures of the lower extremities due to the blasting effects of antitank-mines, minor wounds from metal splintering inside the tanks, fatal wounds from penetrating projectiles, and burns are the most common. There- fore, not many walking wounded from tank regiments will come to the battalion medical sections for treatment. In the armored infantry regiments all the wounds of modern warfare will be present. It is therefore imperative that first aid training of armored combat personnel be of high quality. This is especially true with reconnais- sance elements since this element moves far from immediate medical facilities and casualties must be carried within the vehicles. ATTACHED MEDICAL PERSONNEL 649 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 | 2 3 4 6 Unit Techni- cian grade Total Enlisted cadre Remarks 1 (41)2 d Dental. 3 1 1 1 1 3 5 4 <4) (1) a) a) a) (i) a) (3) 1 1 1 1 1 Technician, grade 4| Technician, grade SltacIudlng Private ) Technician, dental (067) Technician, medical (123) 5 5 a) Technician', surgical (225) 4 5 a) 16 5 19 6 1 1 1 Q Truck! 2V$-fc>n, cargo Plate 37. T/O 10-35, March 1, 1942. Medical Detachment, Supply Battalion, Armored Division. Medical equipment. Medical equipment necessarily must be the simplest with which emergency treatment can be administered and consists (in addition to the first-aid ve- hicular kits) of items essential for the control of hemorrhage, treatment of shock, and the splinting of fractures. Lifting apparatus used to remove the casualties through the turrets of the tanks consists of improvised slings. Current publications of the Military Intelligence Service of the War Department give full details of this specialized procedure. Collecting points. Collecting points are areas where casualties may be removed from tanks, either while they are in action or at a rallying point. Tanks will not stop once they enter combat unless an area offers definite concealment, cover, and defilade. Some tanks have a safety hatch designed particularly for the purpose of removing casualties readily. A collecting point will often serve as an aid station site. 650 Battalion aid stations. Aid stations are not set up by battalion medical sections in rear of the battalions when they are committed to action because the rapid movement of the armored battalions renders it impractical, especially in fire-swept zones. The battalion medical sections move along the axis of advance with the forward echelon MILITARY MEDICAL MANUAL 1 2 3 4 5 1 Unit Tech- nician grade Medical detach- ment Enlisted cadre Remarks 1 8 (4 1) 2 • With inserts for lit- ters; for use as front line 4 3 ambulances. d Dental. 1 1 6 2 2 The serial number 2 2 symbol shown In paren- 8 9 Technician, grade 41 Tectnddan, grade 5ljnc|udlng 1 1 1 theses is an inseparable part of the specialist des- ignation, A number be- 11 12 13 14 15 16 17 18 19 Private ) I 7 (7) pational specialist whose (1) qualification analysis is (2) (1) (1) found in AR 615-26. A number above 500 refers 5 o) to a military occupa- 4 (2) a) tional specialist listed in (2) (6) War Department, 1942. 20 27 7 21 30 7 22 0 Car, half-track, M3, without arma- 2 23 24 25 1 1 1 Plate 38. T/O 5-215, March 1, 1942. Medical Detachment, Armored Engineer Battalion, Armored Division. train vehicles which carry supplies needed immediately and constantly in battle, i.e. ammunition, gasoline and oil. The medical detachments and forward echelon train vehicles proceed as far forward as the situation will permit and there halt awaiting information that the battalions have succeeded in taking their objectives and have gone 1 ft 3 « unit Teahnl- Total da- 1 c tan grad* tachmant Remarks dDental. The aerial numbar symbol shown part of the specialist doslg- 6 Technician, grade » ) ( t fars to an occupational special. 1st whose qualification analysis 7 Technician, grade 5 ) ( 2 Is found In AR 615-26. A nuwber e Private, first ctass) ( 1 above 500 refers to a Military occupational specialist listed 9 Private ) ( 1 In ClreuUr No. 1», »«r 0»|*rt- •«nt, 19V2- 11 12 13 1U 15 16 17 , Plate 39. T/O 10-15, April 1, 1942. Organization of the Medical Detachment, Quarter- master Battalion, Infantry Division. into rallying areas. Thereupon the supply vehicles and medical detachments hasten to join the armored battalions at the rallying points to render service. Here the aid station personnel first remove casualties from the tanks thus freeing these vehicles for further combat action. Time is then available while the tanks continue the fight for collection and emergency treatment of casualties and to initiate as soon as practicable ATTACHED MEDICAL PERSONNEL 651 their evacuation by means of the half-track cars organically belonging to the medical detachments. Treatment consists normally of arresting hemorrhage, applying sterile dressings, chemotherapy when required, emergency splinting, administration of sedatives and morphine (in syrettes ready for injection), treatment of shock, and partially completing and attaching emergency medical tags. Regimental aid stations. In the armored regiments the regimental aid station may be a link in the evacuation from the armored battalions and is therefore in definite contrast to evacuation within the infantry regiment of the infantry division. Regimental aid stations are located near the regimental CP so as to assure convenient liaison between the regimental surgeon and the regimental commander. Defilade, cover, concealment and camouflage must be sought. The site should be on the axis of advance and near roads to intercept the drift of wounded. The terrain should be unsuited for tank operations and located where trees will afford protection for casualties. Cross roads, permanent land marks and similar targets should be avoided. The regimental aid station has armored half-track personnel carriers to evacuate wounded men from collect- ing points and battalion medical sections. Under difficult conditions, such as heavy enemy fire, half-track armored personnel carriers will evacuate casualties to the rear from the regimental and battalion aid stations toward the division medical installation. 1 1 Unit 2 3 4 Total commissioned 5 Staff sergeant (673). 6 7 Corooral *6731. 8 Technician, grade 4 0 Technician, grade 5 including 10 Private, first class-- 11 Private 12 Chauffeur (345) 13 Dental technician (067) 14 Dental technician (067) 15 Medical technician (123) 16 Medical technician (123) 17 Surgical technician (225) 18 10 Surgical technician (225) Basic (521) _ 20 Total enlisted 21 22 Q Trailer, 1-ton, 2-wheel, cargo. - 23 24 Q Truck, K-ton, weapon carrier 26 Q Truck, 2H-ton, cargo 1 2 3 4 5 1 Unit Tech- nician grade Total En- listed cadre Remarks 2 1 3 (»1)3 * Dental. The serial number symbol shown in- parentheses is an in- 4 s designation. A number below 500 refers to an occupational spe- cialist whose qualification analy- sis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Department, 1942. 6 2 7 8 f 2 9 4 10 4 11 12 (4) U> 2) (2) 13 5 14 15 5 16 17 4 (2) 18 5 a) (2) 19 Basic (521) 20 20 21 24 22 23 24 1 25 Plate 40. T/O 10-165, April 1, 1942. Organization of the Medical Detachment, Quarter- master Laundry Battalion. Medical personnel accompanying maintenance crews offer only a limited solution to the difficult problem of medical support of armored elements. Maintenance crews, especially heavy maintenance, are sufficiently far behind the scene of action that con- siderable delay in rendering medical aid would be entailed. Difficulties are presented when tanks are overturned or the various hatches jammed by enemy missiles. In such cases the crew can not abandon the tank. The maintenance crews will have to provide a means of exit, such as burning a hole through the armor by means of an acetylene torch. For this reason some medical personnel will often accompany the maintenance crews in order to administer emergency treatment at the earliest possible moment. Attached Medical Personnel with Other Units. Medical detachments with the Moun- tain, Quartermaster, Engineer, Ordnance, Special Troops, Air Force, Chemical, Signal, Coast Artillery, and other units have the same basic principles of interior organization, operation, training, and tactical management in garrison, on the march, in camp, and in combat as stated for infantry and artillery detachments. See current Tables of Organ- ization for personnel strength of officers and enlisted men and transportation. 652 Tables of Organization for several such units are as shown below. The personnel strength of other Quartermaster units for which special medical de- tachment tables are not shown are as follows: T/O 10-65, April 1, 1942. Quartermaster Service Battalion; 3 officers and 10 en- listed men. T/O 10-95, April 1, 1942. Quartermaster Remount Squadron, 7 officers and 32 enlisted men. T/O 10-115, April 1, 1942. Quartermaster Squadron, Cavalry Division (Horse); 3 officers and 14 enlisted men. T/O 10-125, November 20, 1942. Quartermaster Wagon Personnel, 6 officers and 33 enlisted men. MILITARY MEDICAL MANUAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 1 2 3 4 Unit Techni- cian grade Total Remarks 1 (d 1)2 3 1 1 3 2 2 ft ft u> (i) a) 10 13 1 1 1 4 Dental. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qual- ification analysis is found in AR 615-26. A number sbove 500 refers to a military occupational speci- alist listed in Circulars Nos. 14 and 67, War Department, 1942. Technician, grade 4 Technician, grade 5 ,inrllldin£r Private, first class . mcludlng Private Dental technician (067) Medical technician (123) Medical technician (123) Surgical technician (225) Surgical technician (225) 5 6 4 6 Q Trailer, 1-ton, 2-wheel, cargo Plate 41. T/O 10-175, April 1, 1942. Organization of the Medical Detachment, Quarter- master Sterilization Battalion. 1 2 3 4 5 6 1 Unit Tech- nician grade Head- quarters section 2 bat- talion sections (each) Total detach- ment Remarks 2 3 (d 1)2 4 6 The serial num- 6 j her s> mbol shun u in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occu- pational specialist whose qualification analysis is found 7 8 j 9 10 11 Technician, grade 5] 1 4 12 Private (2) (3) (1) (1) } <» m a) 1 16 (14) . (5) (1) (1) I (2) 1 (3) (1) ( (1) 1 (2) (3) 16 5 (2) refers to a military occupational spe- cialist listed in (1) } (1) * 5 (1) and 67, War De- partment, 1942. 22 (3) 23 15 12 39 24 45 26 Q Truck, command and re- 1 27 1 1 3 Plate 42. T/O 5-21, April 1, 1942. Organization of the Medical Detachment, Engineer General Service Regiment. ATTACHED MEDICAL PERSONNEL 653 T/O 10-145, April 1, 1942. Quartermaster Bakery Battalion; 2 officers and 9 en- listed men. T/O 10-297, January 21, 1942. Quartermaster Graves Registration Company; 13 enlisted men (obtains information for identification of dead). 1 2 3 4 1 Unit Tech- nician grade Total detach- ment Remarks 2 3 (<*1)2 4 The serial number symbol shown in parentheses is an inseparable part of the spe- cialist designation. A num- 5 4 6 7 8 occupational specialist whose qualification analysisis found in AR 615-26. A number abovo 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Department, 1942. 9 10 11 12 13 Technician, grade 4| Technician, grade 5l,n(,lnHlr)„ 2 Private.- j 10 (2) (10) (1) (!) 14 15 16 17 18 4 19 20 (2) 21 25 22 29 23 24 25 Plate 43. T/O 5-35, April 1, 1942. Organization of the Medical Detachment, Engineer Battalion, Separate. 1 2 3 4 1 Unit Tech- nician grade Total Remarks 2 3 u) (i) a) 12 14 IS 11 16 14 1 18 Plate 44. T/O 5-55, April 1, 1942. Organization of the Medical Detachment, Engineer Topographic Battalion, Army. 654 MILITARY MEDICAL MANUAL 1 2 3 4 1 Unit Tech- nician grade Total Remarks 2 1 3 (J 1)2 The serial number symbol shown in parentheses is an inseparable 4 3 5 6 occupational specialist whose quali- fication analysis is found in AR 7 8 Technician, grade 5] 1 * 9 10 Private ) 1 & (4) U) U) (1) to a miliatry occupational specialist listed in Circulars Nos. 14 and 67, War Department, 1942. 13 14 5 15 12 16 15 17 18 Q Truck, X-ton, command and reconnais- 1 19 Plate 45. T/O 5-65, April 1, 1942. Organization of the Medical Detachment, Engineer Water Supply Battalion. 1 2 3 4 1 Unit Tech- nician grade Total Remarks 2 3 d 1 d Dental. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number below 600 refers to an occupational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupa- tional specialist listed in Circulars Nos. 14 and 67, War Department, 1942. 4 2 S Staff sergeant (673) 1 6 7 8 Technician, grade 6] 1 < 9 10 Private ) l 4 (3) (4) 0) 0) (1) n 12 13 14 5 15 12 16 14 17 Q Ambulance, cross country... 1 18 Q Truck, command and rc- 19 Plate 46. T/O 5-95, April 1, 1942. Organization of the Medical Detachment, Engineer Camouflage Battalion, Army. 1 2 3 4 1 Unit Tech- nician grade Total detach- ment Remarks 2 1 3 d 1 The serial number symbol shown in parentheses is an inseparable part of the specialist designation. 4 2 6 1 6 1 occupational specialist whose quali- fication analysis is found in AR 7 8 Technician, grade 6] 1 * 9 10 Private ) ‘ fa (4) O) to a military occupational special- 11 67, War Department, 1942. 12 6 13 10 14 12 16 1 16 Q Truck, %-ion, command' and reconnais- 1 17 Plate 47. T/O 5-115, April 1, 1942. Organization of the Medical Detachment, Engineer Squadron. ATTACHED MEDICAL RERSONNEL 655 1 2 3 5 5 6 1 Unit Tech- nician grade Head- quar- ters sec- tion 2 bat- talion sections (each) Total (head- quar- ters sec- tion and 2 bat- talion sec- tions) Remarks 2 1 1 3 d 1 4 (>*1)2 d Dental. The serial number sym- bol shown in parentheses 5 6 the specialist designation. 7 1 2 1 fers to an occupational specialist whose qualifi- cation analysis is found in AR 615-26. A num- ber above 500 refers to a military occupational specialist listed in Cir- 1 10 11 12 13 Technician, grade 4 Technician, grade 5 Private, first class. . Private Chauffeur (344) Chauffeur (344) 9 13 i 5 13 10 (1) (5) (3) 0) a> a) a) 15 (2) (1) (5) U) 0) (1) 16 )55) War Department, 1942. (11) (2) (2) (3) (1) (1) (2) (4) 18 5 19 5 20 (i) o> a) 21 4 23 (i» (i) 24 Basic (521) (2) 25 11 15 41 28 •15 16 47 27 1 1 28 Q Truck, command and recon- 1 2 29 1 1 3 Plate 48. T/O 5-171, April 1, 1942. Organization of the Medical Detachment, Engineer Combat Regiment. 1 2 3 4 1 Unit Tech- nician grade Total Remarks 1 3 <-* 1)2 d Dental. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number- below 500 refers to an occupational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Depart- ment, 1942. 3 1 1 7 8 Technician, grade 41 Technician, grade 5l,n„,nHIt,„ ( 1 10 11 Private — ] 1 4 (5) (1) 13 14 15 6 O) (1) (1) 4 16 11 -■# I 17 14 18 19 1 Q Truck, command and recon- i 20 1 Plate 49. T/O 5-185, April 1, 1942. Organization of the Medical Detachment, Engineer Topographic Battalion, GHQ. 656 MILITARY MEDICAL MANUAL 1 2 3 4 1 Unit Tech- nician grade Total detach- ment Remarks 2 Captain 3 First lieutenant d 1 dental. ▼ 1 veterinary. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qual- ification analysis is found in AR 615-26. A number above 500 re- fers to a military occupational specialist listed in Circular No. 14, War Department, 1942. 4 Total commissioned 6 Staff sergeant (673) 6 7 8 Technician, grade 51 Private, first class. _ >including 1 ? 9 10 Private ) 1 7 (8) (1) (1) (1) 11 3 Technician, medical (123) 14 16 16 (3) (1) 17 18 19 19 23 20 0 21 Q 22 Q naissance. Plate 50. T/O 5-235, April 1, 1942. Organization of the Medical Detachment, Engineer Mountain Battalion. 1 2 3 4 1 Unit Tech- nician grade Total Remarks 2 1 ►3 a 77 i 5 O ►3 2 *r ? o 3 o 3 2 i § 3 Technician, dental (067). Technician, medical (123) Technician, medical (123) Technician, sanitary (196) Technician, surgical (225) Technician, surgical (225) Technician, surgical (225) Basic (521) Total enlisted Aggregate Q Ambulance . o s* 7? o section ieaaer, assistant Technician, grade 4) Technician, grade 51, Private, £hst class[incIudln* Private 1 Battery aid man (123) Chauffeur (345) Staff sergeant, including Section leader (673) Corporal, Including..... Technical sergeant, including Medical (673)... Total commissioned Captain £ 3 a EL - i • • Cm**' i ©*0» <*; j j Technician grade I I l s 81 »I • 1 I I IIU-l * -1- Headquarters section IK i a s s-S- ill- £ 1st battalion (gun) sec- tion Battalion sections - jj s || s j gs; i igi i : 3 b 3-3,- ill- £ 2d battalion (automatic weapons) section o» jj c || c j sssi 1 ssi i 3 ° ill- £ 3d battalion (searchlight) section ©> 51 58 3~ 1 1 1 sSSSSSSSSSSi-^-S^S-1 MOtM Total (headquarters section and 1st, 2d, and 3d battalion sections) - j ; i II • II ® 1: : Si cci Si : : i '"E"'Mi 3-S-i i || i ; • ; Enlisted cadre * bol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification analy* sis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War De- partment, 1942. H «• gos *S« IP i B % 9 B » I * Plate 54. T/O 4-11, April 1, 1942. Organization of the Medical Detachment, Coast Artillery Regiment, Antiaircraft, Mobile. l 2 3 4 5 6 7 1 Unit Spe- cial- ists’ ratings (class) Head- quar- ters sec- tion 1 bat- talion sec- tion Total (head- quar- ters section and 3 battal- ion sec- tions) En- listed cadre Remarks 2 3 <■*1)2 <11 • i (<* 1)5 <* 1 4 lieutenant. b May be 5 Total commissioned allot- 6 7 1 4 Dental. 8 a) (3) 0) 9 Summary of spe- 10 Technician, surgical (225) (1) (1) li 12 Section leader, assistant (C52) _ (1) 8 (3) / 13 (1) } 4 Class Num- ber 13 14 15 Private, 14 Battery aid man (521) (4) \ iiO (12) (4) (4) (1) (1) 1) (2) (1) 4th 16 5th (4) (1) (1) (1) (1) (2) (1) 15 17 Chauffeur (245) 6th (1) 6th 18 Clerk (056) 19 Total. 22 20 21 5th (1) mini 22 ber symbol shown in parentheses is an inseparable part of the specialist designation. A 23 5th (1) (3) (1) (1) (1) 24 (1) (1) (1) u> (4) (4) 25 6th (I) U) 26 27 16 10 46 tional specialist 28 20 11 53 29 b 3 3 iu section l, AR 615-26. A number 30 2 31 32 a military occupa- tional . specialist listed in section II, A R 615-26. Plate 55. T/O 4-31, November 1, 1940. Organization of the Medical Detachment, Coast Artillery Regiment, 155-mm Gun. ATTACHED MEDICAL PERSONNEL 659 1 2 3 4 5 8 7 1 Unit Tech- nician grade Head- quar- ters section 3 bat- talion sections (each) Total Enlist- ed cadre Remarks 2 1 3 (-11)2 ■"1 *1 (d 1)5 <* 1 _ * May be first 5 Dental. Tbeserialnumber symbol shown in parentheses is an inseparable part of the specialist desig- nation. A number 6 7 1 (1) s (1) (3) 9 10 (1) r T (1) 11 Technician, grade 4 | 12 13 14 15 Technician, grade 5- t, 12 1 fi 2 an occupational Private J «) (1) 1 if / °pJ } 3 specialist whose qualification anal- ysis is found in AR 616-26. A number above 500 refers to a military oc- cupational special- ist listed in Circu- 6 } W 17 18 Clerk (055).. (1) 2) (1) 19 5 0) 0) 0) <1) 20 5 21 (1) (3) 22 U) (1) (1) Department, 1942. 23 4 24 5 (!) 25 (1) 3) (4) (1) 26 (1) (1) 27 13 10 43 28 17 11 so 29 3 30 31 32 Plate 56. T/O 4-41, April 1, 1942. Organization of the Medical Detachment, Coast Artillery Regiment, Railway Artillery. 1 2 3 4 5 6 7 1 Unit Tech- nical grade Head- quar- ters seo- tion 3 bat- talion sec- tions (each) Total En- listed cadre Remarks 2 Major.. 3 Captain (■•1)2 <11 (d 1)5 4 1 4 First lieutenant • May be first lieu- tenant. b May be allotted 5 Total commissioned 4 1 7 6 Technical sergeant 1 — * — to battalion medical sections. d Dental. The serial number symbol shown in parentheses is an inseparable part of the specialist desig- 7 8 Section leader (673) (1) (3) (1) 9 Corporal, including 10 Section leader, assistant (673)... a) (3) f 1 (1) 11 Technician, grade 4| 12 13 14 15 Technician, grade 51,_ .. „ 13 J 4 1 Private J Battery aid man (123) (4) 1 13 1 16 (12) (5) 1) (2) (1) (3) (1) (1) (1) 3) (4) } 3 nation. A number below 500 refers to an occupational special- ist whose qualifica- tion analysis is found in AR 615-26. A number above 500 refers to a military occupational special- ist listed in Circular No. 14, W ar Departs inent, 1942. 16 Chauffeur (345) (5) (1) (2) (1) 17 Clerk (055) 18 Technician, dental (067) 5 (1) 19 Technician, medical (123) 5 20 Technician, medical (123) (1) (1) 0) 21 Technician, sanitary (196) (1) 1)3 10 4 17 * May be Medical Corps. Mess (824) (i) a) (i) (i) (3) (i) (i) The serial number symbol shown in pa- rentheses is an in- separable part of the specialist designa- tion. A number below 500 refers to an occupational spe- cialist whose qualifi- cation analysis is found in AR 615-26. (1) (2) (6) (1) 12 (1) (1) 13 (1) (3) (1) f 10 ) 26 (1) (1) 3 5 15 (1) 16 17 Technician, grade 4| Technician grade 5lincluding ■<9 19 Private J u) (3) (3) 2) (1) (3) 1 67 1 74 (1) 3) (3) (2) (7) (21) (1) (1) (3) (3) (3) (6) (12) (6) (3) (6) (18) (27) (27) (17) } 3 A number above 500 refers to a military occupational special- ist listed in Circulars Nos. 14 and 67, War Department, 1942. 21 Cook (060) 4 iii 22 Cook (060) 23 24 (2) («) 25 26 4 O) 27 5 (1) (1) (i) 29 (3) (1) (2) (4) (2) (1) (2) (5) (9) (9) (5) (i) (1) (2) (1) (1) (2) 32 33 34 35 36 37 38 39 (2) 40 25 53 184 17 41 27 58 201 17 42 Q Trailer, 1-ton, 2-wheel, water 43 Q Truck, K-ton, command and 44 1 45 ? 46 Changes No. 1 Washington, December 28, 1942. T/0 8-28, April 1, 1942, is changed as follows: Line Column 3 4 fi 7 2 (»1)2 2 8 o Dental officers assigned to S (» 1 0 2) 3 2 9 each clearing platoon a3 the 4 5 4 17 company commander desires. 41 30 57 201 Plate 5. T/O 8-28, April 1, 1942 and Change No. 1. Organization of the Clearing Company, Medical Regiment 674 MILITARY MEDICAL MANUAL In temporary camps and march bivouacs it may furnish temporary hospitalization for the care of the sick. Its operation is based on the principle that casualties shall be evacuated from the combat area to the rear as safely, rapidly, and continuously as human agencies will permit. Being essentially a mobile unit operating with combat forces, it has neither the personnel nor equipment necessary to provide definitive or prolonged treatment for serious cases. Its functions may include treatment of special cases—surgical, medical, or gassed. Command. The clearing platoon is an integral part of the medical battalion. Its technical or tactical employment rests, therefore, with the battalion commander. Close cooperation with collecting companies and with units evacuating the clearing station is essential if efficient operation is to be obtained. Platoon headquarters. Platoon headquarters consists of such commissioned and enlisted personnel as is required for the command, administration, and supply of the platoon as a whole. Technical personnel. Technical personnel of each clearing platoon consists of 4 medical officers (2 captains and 2 lieutenants), 1 staff sergeant, 2 sergeants, 1 corporal, 2 technicians grade 4, 7 technicians grade 5, and 40 privates first class or privates. A sergeant is section leader, and there is a technician in charge of each of the follow- ing departments: admission, surgical, shock and bath. The enlisted men are technically trained personnel for service throughout the clearing station (see Plate 5) and include: clerks, pharmacist, dental, medical, surgical and sanitary technicians; and attendants. All the enlisted men are valuable technical assistants to the medical and dental officers Transportation of the Clearing Company. The transportation of the clearing company consists of: 7 trailer, %-1-ton, 2 wheel, cargo 3 trailer, 1-ton, 2 wheel, water tank, (250-gallon) 4 truck, 54 -ton, 4x4 8 truck, 2 54-ton, cargo, 6x6 3 truck, 2 54 -ton, 6x6, cargo with winch The transportation personnel of company headquarters consists of 1 staff sergeant (motor), and 1 technician grade 4, 2 technicians grade 5. This personnel is charged with maintenance of the motor transportation for the clearing company. The technicians are automobile mechanics. The equipment for a clearing company is prescribed by Tables of Allowances and by the Equipment List. It is equipped to operate 3 clearing stations. To insure mobility, many articles deemed necessary for fixed hospitals are of necessity eliminated. Although designed for the care and treatment of all classes of casualties, particular provisions are made for the needs of emergency surgical cases. All equipment is packed in standard containers and consists, basically, of multiples of standard Medical Department field equipment, plus miscellaneous supplies. The equipment for the clearing station must be loaded on the transportation in a manner that will permit a rapid establishment of the station, particularly of those departments that function in all tactical situations. In so far as practicable, the com- plete equipment and supplies for each department of the basic unit should be carried on the same truck. Functional or operating organization. The functional or operating organization of the clearing platoon is discussed later in Chapter III under Employment of the Clearing Company. THE MEDICAL SQUADRON FOR CAVALRY DIVISIONS Organization. The medical squadron is an organic part of the cavalry division. (See Plate 6.) It consists of: Squadron headquarters. Headquarters detachment. Collecting troop. Clearing troop. Veterinary troop. THE MEDICAL REGIMENT, SQUADRON AND BATTALION 675 Personnel. The personnel of the Division Surgeon’s office is included in Division Headquarters. There are within the medical squadron 24 officers and 336 enlisted men, a total strength of 360. According to rank and grade, they are as follows: 15 medical officers: 1 lieutenant colonel (commanding officer of the medical squad- ron), 1 major, 2 captains, 11 lieutenants. 2 dental officers: first lieutenants. 2 medical administrative corps officers: 1 captain, 1 lieutenant. 1 X 2 3 4 5 6 7 8 9 Unit 1 Squadron headquarters 1 (T/0 8-86)* Headquarters detach- ment (T/O 8-86) 1 Collecting troop (T/O 8-87) I Clearing troop (T/O 8-88) 1 Veterinary troop (T/O 8-89) | Total squadron [ Enlisted cadre Remarks 2 0) (1) 4 Captain (1) P>1«1)2 1 i ><1 5 s Lieutenant ill (b-1)2 6 (d2)6 •'3 17 * Personnel shown in 6 Total commissioned (4) 6 7 7 4 24 column 2 is included in 1 9 3 10 4 7 2 7 13 4 lO^ 12 15 9 46 16 16 9 56 30 22 117 (3) (8) (6) (27) b Medical Administra- IS Total enlisted 42 137 93 64 336 50 tive_Corps. • Veterinary Corps. (4) (4) 23 (12) (12) 24 Q Semitrailer, 6-ton, combination ani- part of the sp'ecialist 4 26 Q Trailer, 1-ton, 2-wheel, water tank occupational specialist 6 2 2 28 2 1 1 2 6 29 Q Truck, H-too, command and recon- 500 refers to a military 2 3 3 1 9 30 2 1 3 6 4 3 32 2 1 3 6 33 Q Truck, 4- to 5-ton, tractor 4 4 .... T/O 8-85, April 1, 1942, is changed as fo]lows: Line Column 2 3 7 9 4 — bJ (clb2>3 4 a Personnel shown in column 2 5 (2) 18 is included in column 3. Personnel in column 2 in- cludes: 1 lieutenant colonel, MC commanding officer. 1 major, MC. 1 first lieutenant, MAC. 1 first lieutenant, chaplain. Plate 6. T/O 8-25, April 1, 1942, and Change No. 1. Organization of the Medical Squadron, Cavalry Division. 4 veterinary officers: 1 captain (commanding officer of the veterinary troop), and 3 first lieutenants. 1 chaplain: a first lieutenant. 336 enlisted men: 1 master sergeant (squadron sergeant major), 4 first sergeants, 3 technical sergeants, 13 staff sergeants, 27 sergeants, 17 corporals, 19 techni- cians grade 4, 46 technicians grade 5, 89 privates first class and 117 privates. 676 Transportation. The motor transport equipment contained in the Tables of Basic Allowances which is tabulated below takes precedence over that shown in the Tables of Organization 8-85, 8-86, 8-87, 8-88 and 8-89: MILITARY MEDICAL MANUAL Hq Dct Coll Tr ClrTr Vet Tr Total Sqdn Ambulance, %-ton, 4x4 24 24 Semi-trailer, 6-ton, combination, ani- mal and cargo carrier 4 4 Trailer, 2 wheel, 2 horse van 2 2 Trailer, %-1-ton, 2 wheel, cargo . 2 1 2 5 Trailer, 1-ton, 2 wheel, water tank, (250-gallon) 1 1 3 5 Truck, 14-ton, 4x4 1 3 3 2 9 Truck, % -ton, 4x4, command . . . . 1 1 1 1 4 Truck, %-ton, 4x4, weapons carrier 1 1 2 Truck, 214-ton, cargo, 6x6 3 1 4 1 9 Truck, 2 54-ton, 6x6, cargo with winch 1 1 1 1 4 Truck, 4-5-ton, 4x4, tractor 4 4 Squadron Headquarters. Squadron headquarters is an agency of command and in- cludes the commander, the executive officer, the adjutant and personnel officer, a medical administrative corps officer, the chaplain, and certain enlisted personnel who are mem- bers of the headquarters detachment. The squadron commander. The commanding officer of the medical squadron is di- reedy responsible to the division commander for the efficient administration, discipline, training, and operation of the medical squadron in all situations. His duties are analogous to those of the commanding officer of the medical battalion of an infantry division. The executive officer. The executive officer of the medical squadron is the principal assistant and advisor of the squadron commander. He carries on the routine adminis- tration of the medical squadron, and his duties as a whole are identical to those of the executive officer of the medical battalion, of an infantry division. The Headquarters Detachment, Medical Squadron Organization. The headquarters detachment consists of 6 officers and 42 enlisted men. (See Plate 7.) It is divided into five sections: Squadron headquarters. Personnel section. Squadron headquarters detachment. Detachment headquarters. General and medical supply section. Motor maintenance section. Functions. The headquarters detachment has the following basic functions: The supply of the medical squadron. The medical supply of the entire division. The assignment of personnel for the operation of squadron headquarters. Personnel. For strength of personnel and its distribution see Plate 7. It is employed by the detachment commander in such a manner as to best execute the functions re- quired of the detachment, due consideration being given to the training and duty re- quirements of the squadron headquarters detachment. Detachment commander. The commanding officer of the headquarters detachment is responsible for its organization, training, supply, discipline, and operation. He is the squadron supply officer and as such is a staff officer of the squadron com- mander. He is division medical supply officer and as such is an assistant to the division surgeon. In this combined capacity of detachment commander and general and medical supply officer, he directs and coordinates the activities of his enlisted personnel and the de- THE MEDICAL REGIMENT, SQUADRON AND BATTALION 677 tachment equipment and transportation in such a manner as to best execute the func- tions of the company. Personnel section. The personnel section consists of the personnel technical sergeant, 3 sergeants (clerks, general), 1 technician grade 5 (clerk, general). They handle personnel records and correspondence pertaining thereto. Squadron headquarters detachment. The squadron headquarters detachment consists of 11 enlisted men. Certain of these enlisted men operate the squadron headquarters, handling squadron administrative matters, correspondence, mail, orders pertaining to field operations, and the message center. Detachment headquarters. Detachment headquarters consists of 1 officer and 11 en- listed men. The personnel handles administrative matters pertaining to the head- quarters detachment. General and medical supply section. The general and medical supply section consists of 1 officer and 9 enlisted men. They handle all general (unit) and medical supplies and transportation pertaining to these supplies. They receive, check, transport, sort, and issue all supplies. Motor Maintenance Section. The motor maintenance section consists of 5 enlisted men; 1 motor sergeant (technical sergeant), 2 technicians grade 4, 2 technicians grade 5. The technicians are automobile mechanics (014). See Plate 7. Transportation. The transportation of the headquarters detachment consists of: 2 trailers, %-1-ton, 2 wheel, cargo 1 trailer, 1-ton, 2 wheel, water tank (250-gallon) 1 truck, 14 -ton, 4x4 1 truck, %-ton, 4x4, command 1 truck, %-ton, 4x4, weapons carrier 3 trucks, 214-ton, cargo, 6x6 1 truck, 214-ton, 6x6, cargo with winch Organization. The collecting troop of the medical squadron consists of 7 officers and 137 enlisted men. (See Plate 8.) It is divided for functional purposes into: Troop headquarters. 2 collecting platoons, identical in organization, equipment, and transportation. Functions. The collecting troop is capable of establishing and operating 2 collecting stations. It evacuates the squadron aid stations and collects casualties in rear of the squadron aid stations. It provides temporary care and treatment for casualties at the collecting stations. The collecting troop also evacuates the collecting stations, transport- ing the casualties to the clearing station by means of its ambulance section. Its functions, therefore, are analogous to the functions of the collecting company of the medical bat- talion of the infantry division. However, the cavalry division being a highly mobile unit, care and treatment of patients must be more temporary, and the collecting troop must be ready to make frequent and rapid moves. Personnel. The personnel strength of the collecting troop and its distribution are shown in Plate 8. It includes 1 captain, 6 first lieutenants, 1 first sergeant, 4 staff ser- geants, 7 sergeants, 7 corporals, 4 technicians grade 4, 12 technicians grade 5, 46 privates first class, and 56 privates. Troop Headquarters. The headquarters of the collecting troop is a tactical and an administrative unit. It consists of 1 medical officer (a captain, troop commander) and 19 enlisted men. Its functions are analogous to those of the headquarters of the collect- ing company of the medical battalion of the infantry division. Troop commander. The troop commander is responsible for the administration and operation of the collecting troop. He is responsible for the evacuation of the squadron aid stations, providing a place of temporary treatment at collecting stations, and evacuat- ing collected casualties to the clearing station by means of motor ambulances. Collecting platoon. There are 2 collecting platoons in the collecting troop. Each col- lecting platoon consists of: Collecting Troop, Medical Squadron 678 A collecting station section. A bearer section. An ambulance section. MILITARY MEDICAL MANUAL Each collecting platoon is capable of operating a collecting station and furnishing transportation for the evacuation of casualties from the squadron aid stations to the clearing station. Each platoon has 3 officers and 59 enlisted men. « 2 3 4 5 6 7 8 9 10 11 1 Unit | Technician grade | Squadron headquarters | Personnel section I Squadron headquarters detachment I Detachment headquar- ters 1 Oeneral and medical 1 supply section 1 Motor maintenance 1 section Total detachment Enlisted cadre Remarks 2 3 4 b 1 • Chaplain. b Medical Adminis- trative Corps. ® Squadron adjutant and personnel officer. d 1 qualified in pay roll procedure; 1 quali- fied in morning report procedure; l qualified in service record pro- cedure. The serial number symbol shown in pa- rentheses is an insepa- rable part of the spe- cialist designation. A 5 bol 4 b 1 1 6 Total commissioned 1 7 ===== = = 8 (1) (1) (1) 9 1 10 i 11 Motor (813).... (D (0 (i) (i) 2 (1) (1) (1) 12 (1) 13 (1) 1 14 Staff sergeant, including 1 15 (i) (1) (1) (1) (1) 1G 0) 17 Sergeant, including 3 18 19 (i) (1) (1) fers to an occupational specialist whose quali- fication analysis is found in AR 615-26. A number above 500 re- fers to a military occu- pat ional special ist 1 isted 20 Motor (813) (1) (1) 21 Corporal, including Clerk, general (4 1 22 05) (i) (1) (1) H (1) 23 Duty (566) (1) 8 24 25 26 27 Technician, grade 4. Technician, grade 5. Private, first class 1 8 6 1 1 It in Circulars Nos. 14 and 67, War Department, 1942. 28 Busier (8031 (1) 29 Chaplain’s assistant (534) 5 (1) (2) (1) (31) (16) (1) (1) 15 a) (1) 2 2 16 17 18 19 20 Technician, grade 4| 5 deluding 14 to 18 24- 52 Private J (i) Department, 1942. 21 (I) a) 22 Cook (060) 4 (D u) (2) (i) (i) 23 Cook (060) 24 25 (1) 26 (3) (2) (12) (14) (8) 27 (8) 28 4 (1) 29 5 (1) 30 (2) 31 (12) (12) (24) (1) /(3) 1(5) {8 1(2) (3) 1(7) (10) 32 (1) 1 33 (2) (2) (4) 34 — 35 5 (1) (1) (2) 36 — 37 4 1 (i) (i) 38 5 -- (4) (2) (6) 39 1 40 (5) (5) 41 19 13 42 21 144 24 15 43 12 12 44 1 45 Q Trailer, 1-ton, 2-wheel, water tank 1 46 47 Q Truck, K-ton, command and recon- 1 1 1 48 1 49 1 i 50 Plate 8. T/O 8-87, April 1, 1942. Organization of the Collecting Troop, Medical Squadron. Equipment, Supplies, and Transportation of the Collecting Troop. The equipment for a collecting troop is authorized by Tables of Basic Allowances and prescribed by the Equipment List. It consists of drugs, surgical instruments, simple sterilizing ap- paratus, blankets, litters, tentage, and such other supplies necessary for temporary treat- ment of casualties. General and medical supplies are received through the general and medical supply section of the headquarters detachment of the medical squadron. The transportation of the collecting troop consists of: 24 ambulances, %-ton, 4x4 1 trailer, %-1-ton, 2 wheel, cargo 1 trailer, 1-ton, 2 wheel, water tank (250-gallon) 680 MILITARY MEDICAL MANUAL 3 trucks, *4 -ton, 4x4 1 truck, %-ton, 4x4, command 1 truck, 2 54-ton, cargo, 6x6 1 truck, 2 54-ton, 6x6, cargo with winch Clearing Troop, Medical Squadron Organization. The clearing troop of the medical squadron consists of 7 officers and 93 enlisted men. (See Plate 9.) It is divided for functional purposes into: Troop headquarters. 2 clearing platoons, identical in organization, equipment and transportation. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 1 2 3 4 5 6 7 Unit Technician grade Troop headquar- ters 2 clearing pla- toons (each) Total Enlisted cadre Remarks 1 1 6 4 Dental. The serial num- ber symbol shown in parentheses is an inseparable part ot the specialist desig- nation. A number below 500 refers to an occupational specialist whose qualification analy- sis is found in Alt 615-26. A number above 500 refers to a military occupa- tional specialist listed in Circulars Nos. 14 and 67, War Department, 1942. (“1)3 Total commissioned 1 3 7 1 1 (1) 1 3 (1) (2) 8 (1) (6) (1) 7 1 22 t 30 (1) (2) (2) (2) (3) (4) (13) (1) (2) (4) (2) (2) {IS \ (5) (10) (8) 1 3 (1) (2) 2 (1) 1 (i) 3 2 (1) (3) (1) 1 (1) 1 3 (3) (i) 16 (1) (i) 3 2 Technician! grade 4 Technician grade 5 .including 29 Clerk, admission (055) (1) 4 5 (2) (21 (3) 5 (2) (4) (5) (2) 5 (2) (1) (1) (5) (4) (5) (4) 4 (1) 5 i 4 5 (1) (1) 21 22* 36 39 93 100 1 3 1 12 12 i i i i i i i Q Trailer! 1-ton, 2-wheel, water tank (250-gallon). 1 Q Truck, %-ton, command and reconnaissance . .... 1 1 3 1 3 7 3 Plate 9. T/O 8-88, April 1, 1942. Organization of the Clearing Troop, Medical Squadron. Functions. The clearing troop is so organized that each of its platoons can establish and operate a small clearing station. In general, its functions are analogous to those of a clearing company of the medical battalion of the infantry division. Personnel. The personnel strength of the clearing troop and its distribution are shown in Plate 9. It consists of 1 captain, 6 first lieutenants (2 of whom are dental officers), 1 first sergeant, 3 staff sergeants, 8 sergeants, 7 corporals, 7 technicians grade 4, 15 technicians grade 5, 22 privates first class and 30 privates. Troop Headquarters. The headquarters of the clearing troop is a tactical and an administrative unit. It consists of 1 officer and 21 enlisted men. The captain, a medical officer, is the troop commander. Functions. The functions of the clearing troop are analogous to those of the clearing company of the medical battalion. Troop commander. The troop commander of the clearing troop is responsible for its THE MEDICAL REGIMENT, SQUADRON AND BATTALION 681 administration and operation in accordance with the orders and policies of the medical squadron commander. He is responsible for the establishment of a clearing station or stations as the situation demands. Clearing platoon. There arc 2 clearing platoons in the clearing troop. Each clearing platoon may be divided into: A technical section. A transportation section. Each clearing platoon is capable of establishing and operating a small clearing station. Emergency treatment and such treatment as is necessary to prepare casualties for further evacuation are provided. The duties of the commissioned and enlisted personnel are analogous to those of like personnel of the clearing platoon of the clearing company of the medical regiment. The platoon consists of 3 officers (3 first lieutenants, 1 of whom is a dental officer) and 36 enlisted men: 1 staff sergeant (platoon sergeant), 3 sergeants (section leaders), 3 corporals (assistant section leaders) 12 technicians grade 4 and technicians grade 5, and 17 privates first class or privates. The technicians grades 4 and 5, the privates first class and privates are clerks, mechanics, chauffeurs, pharmacists, medical technicians, surgical technicians, and attendants. (See Plate 9.) Equipment, Supplies, and Transportation of the Clearing Troop. The equipment for a clearing troop is authorized by Tables of Basic Allowances and prescribed by the Equipment List. It consists of such equipment as is necessary for the operation of two small clearing stations. It is even more mobile than the clearing platoon of the medical regiment, yet equipment is provided for emergency surgical cases. The equip- ment is packed in standard containers and is similar to that of the clearing platoon of the medical regiment. Supplies, both general and medical, are obtained through the headquarters detach- ment of the medical squadron. The transportation of the clearing troop consists of: 2 trailers, %-1-ton, 2 wheel, cargo 3 trailers, 1-ton, 2 wheel, water tank (250-gallon) 3 trucks, 14 -ton, 4x4 1 truck, %-ton, 4x4, command 1 truck, %-ton, 4x4, weapons carrier 4 trucks, 2 J4-ton, cargo, 6x6 1 truck, 2 *4-ton, 6x6, cargo with winch The Veterinary Troop, Medical Squadron Organization. The veterinary troop of the medical squadron consists of 4 officers and 64 enlisted men. (See Plate 10.) It is divided for functional purposes into: Troop headquarters. First platoon (collecting). Second platoon (collecting). Third platoon (clearing). Functions. The veterinary troop provides the evacuation and temporary treatment facilities for animals as does the collecting and clearing troops for men. Personnel. The personnel strength of the veterinary troop of the medical squadron and its distribution are shown in Plate 10. It consists of 1 captain (commanding officer), 3 first lieutenants, 1 first sergeant, 4 staff sergeants, 7 sergeants, 1 corporal, 4 techni- cians grade 4, 9 technicians grade 5, 16 privates first class, and 22 privates. Troop Headquarters. The headquarters of the veterinary troop is a tactical and an administrative unit. It consists of 1 veterinary officer and 14 enlisted men. A captain commands the veterinary troop. He is responsible for the administration and operation of the troop in accordance with the orders and policies of the medical squadron commander. 1st and 2d platoons (collecting). The 1st and 2d platoons are identical in organiza- tion, transportation, and equipment. They are the collecting platoons and evacuate the veterinary aid stations by means of lead lines. Each platoon consists of 1 veter- inary officer and 21 enlisted men. Id platoon (clearing). In combat the 3d platoon establishes the veterinary clearing 682 MILITARY MEDICAL MANUAL station which provides temporary care and treatment for the animals until they can be evacuated farther to the rear. The location of the clearing station depends upon the type of operation employed by the cavalry division. The clearing platoon con- sists of 1 veterinary officer and 8 enlisted men. (See Plate 10.) Transportation. The transportation of the veterinary troop of a medical squadron consists of: 16 animals, (4 draft, 12 riding) 2 trailers, 2-wheel, 2-horse, van 1 i 2 3 4 5 6 7 8 Unit 1 Technician grade 1 Troop head- quarters 2 collecting platoons (each) 1 Clearing pla- toon *3 o 1 IB X P w Remarks •1 — — — •Mounted on 4 Total commissioned 1 1 1 4 horse. (1) (1) (1) (1) (3) Motor (813) (1) (1) (i) (CD2) (i) Supply (821) (1) m 0) (1) m (1) 15 Technician, grade 4| 4 2 A R 615-26. A num- 16 Technician, grade 5lil,„|11(1itl<, 9 6 9 2 her above 500 refers 17 to a military occu- 18 Private ) (1) -2 1) pational specialist (1) 1) (1) (1) n (1) a) i) 1942. 23 Chauffeur "(245) 5 (2) 4) (3) (2) 7) Cl) Cl) 3) (i) 1) (1) Cl) n (6) (12) (1) m (1) 5 (1) i) (Cl) 2) 5) 4 a) 1) 33 Technician, surgical, veterinary (226) 5 (1) 2) (1) (ij 35 Basic (521) J — (Cl) 3) (6) = = (2) (4) (2) (5) 41 Q Semitrailer, 6-ton, combination animal and 2 4 2 ' 1 1 1 1 2 1 4 48 Q Truck, 4- to 5-ton, tractor 2 4 Plate 10. T/O 8-89, April 1, 1942. Organization of the Veterinary Troop, Medical Squadron. 4 trucks, 4- to 5-ton, tractor, 4x4 2 trucks, 14-ton, 4x4 1 truck, %-ton, 4x4, command 1 truck, 214-ton, cargo, 6x6 4 semi trailers, 6-ton, combination animal and cargo carrier 1 truck, 2 *4 -ton, 6x6, cargo with winch THE MEDICAL BATTALION, INFANTRY DIVISION, TRIANGULAR Introduction. The medical battalion is a divisional medical unit developed to furnish medical support for the infantry division. Its medical service is comparable to that of the medical regiment, with a consolidation of the battalions into a headquarters de- tachment and medical companies, furnishing the necessary evacuation and medical care for casualties for the division. Because of the high mobility of the division, the THE MEDICAL REGIMENT, SQUADRON AND BATTALION 683 installations of the medical battalion must be of a more temporary nature and possess increased readiness and ability to maintain contact with the units of the division. Functions. The functions of the medical battalion are identical to those of the medical regiment. For this reason the battalion is organized as a miniature medical regiment to maintain the best operative coordination of all the existing facilities and to give flexibility to expansion of the medical service when necessary. (See Plate 11.) MEDICAL BATTALION 34 Officers 470 Enlisted men ATCHD. CHAP I Officer BATTALION HEADQUARTERS (3 | Officers HQ 4 HEADQUARTERS DETACHMENT 7 Officers 44 Enlisted men COMPANY A (COLLECTING) 5 Officers 102 Enlisted men COMPANY B (COLLECTING) 5 Officers 102 Enlisted men COMPANY C (COLLECTING) 5 Officers 102 Enlisted men COMPANY D (CLEARING) 12 Officers 120 Enlisted men COMPANY HEADQUARTERS 2 Officers 22 Enlisted men CLEARING PLATOON 5 Officers 99 Enlisted men CLEARING PLATOON 5 Officers 49 Enlisted men COMPANY HEADQUARTERS I Officer 17 Enlisted men STATION PLATOON 3 Officers 14 Enlisted men COLLECTING PLATOON I Officers 71 Enlisted men DETACHMENT HEADQUARTERS I Officer 16 Enlisted men BATTALION HEADQUARTERS SECTION 3 Officers 8 Enlisted men GENERAL ANO MEDI- CAL SUP- PLY SEC- TION 1 Officer 8 Enlisted MOTOR MAIN- TENANCE SECTION I Officer B Enlisted men BEARER SECTION 42 Enlisted men AMBULANCE SECTION (12 ambulances) I Officer 29 Enlisted men PERSONNEL SECTION I Officer 4 Enlisted men Plate 11. Suggested Functional Organization of the Medical Battalion, Infantry Division. Personnel. There are within the medical battalion 34 officers and 470 enlisted men, a total strength of 504. One chaplain (first lieutenant) is attached. (See Plates 11 and 12). According to rank and grade they are as follows: 24 medical officers: 1 lieutenant colonel (commanding officer of the medical bat- talion), 1 major (executive and plans and training officer), 11 captains, and 11 first lieutenants. 8 medical administrative corps officers: 2 captains, 1 first lieutenant, and 5 second lieutenants (2 may be replaced by qualified warrant officers when available). 2 dental officers: 1 captain, and 1 first lieutenant. 470 enlisted men: 1 master sergeant, 5 first sergeants, 3 technical sergeants, 13 staff sergeants, 29 sergeants, 16 corporals, 15 technicians grade 4, 37 technicians grade 5, 157 privates first class, and 194 privates. 684 MILITARY MEDICAL MANUAL Transportation. The motor transport equipment contained in the Tables of Basic Allowances which is tabulated below takes precedence over that shown in the Tables of Organization 8-15, 8-16, 8-17, and 8-18: Hq & Hq Det Coll Co (ea) Clr Co Total Bn Ambulance %-ton, 4x4 12 36 Trailer, %-1-ton, 2 wheel, cargo 3 2 5 14 Trailer, 1-ton, 2 wheel, water tank (250-gallon) 1 1 3 7 Truck, 14 -ton, 4x4 2 1 4 9 Truck, %-ton, 4x4, command 1 1 4 Truck, %-ton, 4x4, weapon carrier 3 3 Truck, 114-ton, 4x4, cargo 1 3 Truck, 114-ton, 4x4, cargo with winch 1 3 Truck, 214-ton, cargo, 6x6 4 1 6 13 Truck, 214-ton, 6x6, cargo with winch 1 2 3 Battalion Headquarters. Battalion headquarters is an agency of command and con- sists of the commanding officer, the executive and plans and training officer (combined 1 2 3 4 5 6 7 8 9 10 1 Unit ! Battalion headquarters (T/O ‘ 8-16)• 1 Headquarters and headquar- | ters detachment (T/O 8-16) ! 3 collecting companies (each) (T/O 8-17) | Clearing company (T/O 8-18) j Total battalion j Attached chaplain Aggregate | Enlisted cadre Remarks 2 Lieutenant colonel _. (»1) (1) M 1 l 1 1 3 Major 1 4 Captain (cl) « 2 2 (di)6 (<*!)« 14 14 5 First lieutenant.. . e 1 2 13 1 14 quarters personnel 6 Second lieutenant c e2 « 1 0 5 included in column 3. 7 Total commissioned (3) 7 5 12 34 1 35 8 Master sergeant 1 1 1 l 9 First sergeant 1 1 1 5 5 5 ® Medical Adminis- trative Corps. 10 Technical sergeant 3 3 3 2 11 Staff sergeant 1 3 3 13 13 13 12 Sergeant 5 6 6 29 20 21 e Qualified war- 13 Corporal. 1 4 3 16 16 6 14 Technician, grade 4 4 1 8 15 15 9 available, may be used to replace these 15 Technician, grade 5 7 5 15 37 37 14 1 , 16 Private, first class.. .. 9 37 37 157 157 17 Private, including ... 12 45 47 194 194 } 1 adjutant, personnel; 18 Basic. (4) 44 (8) 102 i c •SIS 1 (39) 470 (39) 470 19 Total enlisted — 72 supply, general. 20 (3) 51 107 132 504 1 505 72 21 Q Ambulance, Ji-ton 12 36 36 22 Q Trailer, 1-ton, 2-wheel, cargo 3 2 5 14 14 23 Q Trailer, 1-ton, 2-wheel, water tank (250-gal.) 1 1 3 7 7 24 Q Truck, 4-ton 2 1 1 4 9 9 25 Q Truck, 24-ton, command and re- connaissance i 4 4 26 Q Truck, 4-ton, weapon carrier 3 4 15 15 27 Q Truck, 2,4-ton, cargo... 4 6 10 10 28 Q Truck, 24-ton, cargo, with winch.. 1 2 5 5 29 Q Truck, 24-ton, wrecker, with winch.. .. 1 1 1 Plato 12- T/O 8-15, April 1,1942. Organization of the Medical Battalion, Infantry Division- THE MEDICAL REGIMENT, SQUADRON AND BATTALION 685 duty) and the adjutant, (a medical administrative corps officer). The enlisted men who are employed in the battalion headquarters are members of the headquarters and head- quarters detachment. A captain of the headquarters detachment is the supply officer for the unit and the medical supply officer of the division. 1 1 2 3 4 6 6 7 8 e 10 Unit | Technician grade 1 Battalion headquar- ters section j Personnel section | Detachment head- quarters section | General and medical ! supply section | Motor maintenance section | Total detachment | Enlisted cadre Remarks 2 “1 1 3 b 1 1 4 °1 ° 1 2 5 o 1 1 6 cdl cdl 2 — and plans and train- 7 3 1 1 1 1 7 = = = c Medical Admin- 8 l 1 1 9 (1) (1) 0) 30 1 1 l 11 1 1 1 3 2 12 Motor (813) 1 (1) 0) (1) 13 (i) (1) (1) 14 Supply (821) ' _ (1) (1) 15 1 1 1 lfi (1) (1) (1) 17 1 2 1 1 5 9 IS (1) (1) 19 Motor (813) (1) (1) (2) 0) 20 Supply (821) (1) (1) (2) (1) 1 2t 1 1 22 (1) (1) (1) 23 Technician, grade 4J ( 4 3 low 500 refers to an 24 Technician, grade 5llTlplnH!n„ 6 3 11 6 6 1 occupational special- 25 Private, first class, r & q 1 i ist whose qualifica- 26 Private.. J 112 ( 1 tion analysis is found 27 (1) (1) in AR 615-26. A 2S 5 (1) (1) 29 5 (1) (1) 30 (4) (3) (1) (8) 31 4 (1) (1) (1) 32 5 (1) (1) (1) 33 (1) 0) (1) 34 (1) (1) 35 (1) O) 36 Cook (060) ' 4 (1) 0) (1) 37 Cook (060) - 5 (1) (1) 38 (2) (2) 39 4 (2) (2) (ij 40 Mechanic, automobile (014).. 5 (1) (2) (3) 41 (3) (3) 42 (1) (1) (1) (1) (4) 43 44 Total enlisted 8 11 4 5 16 17 8 9 8 9 44 51 13 13 45 3 3 46 Q Trailer, 1-ton, 2-wheel, water tank (250-gal.) I 1 47 1 1 2 48 Q Truck’ %-ton, command and recon- 1 1 4!) 1 1 1 3 50 1 3 1 5 51 (1) (3) (4) 52 Wrecker, with winch . (i) (1) Plate 13. T/O 8-16, April 1, 1942. Organization of the Headquarters and Headquarters Detachment, Medical Battalion, Infantry Division. Battalion Commander. The commanding officer of the medical battalion is a lieu- tenant colonel. His duties arc analogous to those of the commanding officer of the medical regiment. The executive and plans and training officer and the adjutant have duties analogous to those of like officers of the medical regiment. 686 MILITARY MEDICAL MANUAL Headquarters and Headquarters Detachment, Medical Battalion Organization. The headquarters detachment is organized for functional purposes (see Plate 13) into: Battalion headquarters section. Personnel section. Detachment headquarters section. General and medical supply section. Motor maintenance section. Functions. The headquarters and the headquarters detachment has the same functions as that of the regimental headquarters and the headquarters and service company of the medical regiment. This headquarters and headquarters detachment has as its normal functions the operation of activities necessary for the administration and maintenance of the battalion through such services as supply, mess, and clerical duty. The detach- ment operates the division medical distributing point. Personnel. The distribution of the personnel of the headquarters detachment is shown in Plate 13. Exclusive of the battalion headquarters section it consists of: 1 captain, MAC, (commanding officer), 1 first lieutenant, MAC, in charge of the general and medical supply section and 2 second lieutenants, MAC, one in charge of the personnel section and the other in charge of the motor maintenance section; and 41 enlisted men. (See Plate 13). Battalion Headquarters Section. See Plates 12 and 13. For organization see preced- ing paragraph. Its functions are similar to those of the regimental headquarters sec- tion of the headquarters and service company of the medical regiment. Detachment Headquarters Section. The functions of detachment headquarters section are similar to the company headquarters of the headquarters and service company of the medical regiment. It consists of 1 officer and 16 enlisted men. Personnel Section. The personnel section consists of 1 officer and 4 enlisted men. They are assisted by the company personnel clerks and handle all personnel records and the correspondence pertaining thereto for the medical battalion. General and Medical Supply Section. The general and medical supply section con- sists of 1 second lieutenant, MAC (may be qualified warrant officer), and 8 enlisted men. The functions of this section are similar to that of the general and medical supply section of the headquarters and service company of the medical regiment. Motor Maintenance Section. The motor maintenance section consists of 1 first lieu- tenant, MAC, and 8 enlisted men. Its function is similar to that of the motor main- tenance section of the headquarters and service company of the medical regiment. The Collecting Company, Medical Battalion Organization. There are three collecting companies in the medical battalion identical in organization, transportation, and equipment. Each is organized for functional purposes (see Plate 14), into: Company headquarters. A station platoon. A collecting platoon (consisting of a litter bearer section and an ambulance section). Functions. The collecting company of the medical battalion has the same functions as the collecting company of a medical regiment. The collecting company is responsible for the collection of all casualties from aid stations of the division, the temporary treatment of these casualties, and their evacuation to the clearing station. The collect- ing company provides medical support for one infantry regiment. When standing operative procedures arc in effect, one collecting company usually accompanies the regimental combat team. Personnel The distribution of the personnel of the collecting company of the medical battalion is shown in Plate 14. The personnel consists of 2 captains, 2 first lieu- tenants, 1 second lieutenant, MAC, 1 first sergeant, 3 staff sergeants, 6 sergeants, 4 corporals, 1 technicians grade 4, 5 technicians grade 5, 37 privates first class and 45 privates, a total strength of 5 officers and 101 enlisted men. THE MEDICAL REGIMENT, SQUADRON AND BATTALION 687 The transportation of the collecting company consists of: 12 ambulances, %-ton, 4x4 2 trailers, %-1-ton, 2 wheel, cargo 1 trailer, 1-ton, 2 wheel, water tank (250-gallon) 1 truck, J4-ton, 4x4 1 2 3 4 5 6 7 8 9 il l a a Collect- ing platoon 1 Unit § J3 a ■3 © E S o O Station platoo Litter bearer section Amtulance section Total compan Enlistod cadre Remarks 2 Captain i 1 2 3 First lieutenant.— 2 2 J Insert number of 4 Second lieutenant »1 1 5 i 3 1 5 — battalion. » Medical Adminis- 8 First sergeant (585) i 1 1 trative Corps. The serial number Staff sergeant, including - i 1 1 3 3 symbol shown in pa- 8 Mess (824)... . . ..I. CD (1) (2) (0 rentheses is an insep- 9 Platoon leader (651) (1) (l) (2) arable part 0/ the 10 Sergeant, including 3 1 1 1 6 5 specialist des’gnation. A number below £00 11 Liaison agent (503) (1) (1) (1) 12 Motor (813)—— (1) (1) refers to an oocupa- 13 Section leader (652) (1) (1) 0) (3) (3) tional specialist whose qualification analysis is found in AR 615-26. A 14 Supply (821) O) 1 (1) (1). 15 Corporal, including., 1 1 l 4 1 Assistant section leader (652) ( 1 (1) (1) (3) number above 500 re- 17 Clerk, company (405)——- (1) 11 (1) (1) fers to a military occu- 18 20 21 Technician, grade 4) including 11 40 26 1 5 37 45 (1) pational specialist listed in Circular No. 14, War Department, 1942. riiviiltjj first clcibS_. I Private _J Bugler (803) (1) 0) (2) (1) (1) —- 23 Chauffeur (345). 5 O) 24 Chauffeur (345) (2) (12) (16) (1) 25 Cook (060) 4 (1) 26 Cook (060) 5 " (1) (1) °7 Cook’s helper (521) (2) (2) 28 Litter bearer (657) (36) Q C* w 2 Captain 1 1 ((•'1)6 tcue 3 First lieutenant 1 6 Drives vehicle 4 Total commissioned 2 5 12 5 First sergeant (585) 1 1 J Dental. The serial num- ber symbol shown in parentheses is an inseparable part of the specialist des- 6 Staff sergeant, including i 7 Mess (821) a) (1) (1) 8 Platoon leader (651) .. a) 9 Sergeant, including 2 6 (1) (4) 0) 10 Motor (813) a) (1) 11 Section leader (652) (2) 12 Supply (821),. (1) 1 (1) ber below 500 re- 13 Corporal, including... 14 Clerk, admission (055) (1) (2) 0) f “ (1) (1) 3 4 tional specialist whose qualification analysis is found in A R 615-26. A nura- 15 Clerk, company (405) 0) 17 16 17 Technician, grade 4) Technician, grade 5l:„ . 45 19 ber above 500 re- fers to a military occupational spe- Private 1 l 47 0) (2) 20 Bueler (803) (1) 21 Chauffeur (345) 5 0) (3) 22 Chauffeur (345) . (3) (3) (3) (3) (* 1) (2) cular No. it. War Department, 1942. 23 Cook (060) 4 (3) (3) (2) O) (2) (2) (2) (4) (8) (4) (2) (4) (10) (18) (18) 0) 0) 24 Cook (060) 5 25 Cook’s helper (521) 26 Mechanic, automobile (014) 4 27 Orderly (695)... 28 Pharmacist (149) 4 (1) O) (2) (4) (2) (1) (2) (5) (9) (9) (5) (n (i) 0) 29 Technician, dental (067) 5 30 Technician, medical (123)... . 5 31 Technician, medical (123) 32 Technician, sanitary (196) ... 33 Technician, surgical (225) 4 p) 0) 34 Technician, surgical (225) 5 35 Technician, surgical (225) 36 Ward attendant, medical (303)...... . 37 Ward attendant, surgical (303) 38 Basic (521) 1_. (1) 39 Total enlisted 22 49 40 Aggregate 24 41 Q Trailer, 1-ton, 2-wheel, cargo 1 2 42 Q Trailer, 1-ton, 2-wheel, water tank (250- gal.) 1 2 1 43 Q Truck, X-ton 44 Q Truck, 2>£ ton, cargo 2 2 6 2 45 Q Truck, cargo, with winch 1 Plate 15. T/O 8-18, April 1, 1942. Organization of the Clearing Company, Medical Battalion, Infantry Division. Organization. The armored medical battalion (T/O 8-75) is composed of the battalion headquarters and headquarters company, and three armored medical com- panies identical in organization, equipment and transportation. See Plates 16 and 17. Headquarters and Headquarters Company. The headquarters and headquarters com- pany of the Armored Medical Battalion consists of the battalion headquarters and the headquarters company. The battalion headquarters is further subdivided into a head- quarters section and a personnel section. The headquarters company is further sub- THE ARMORED MEDICAL BATTALION Hq See 6 Sig Cen @> Platt* 16. Functional Organization of the Armored Force to Show Relationship of Attached Medical Personnel and Armored Medical Battalion. Co Hq Comm. Plat Tk. Comd. Ren Plat Hq & Hq Co 3 Maint Co Hq & Hq Co 2 Truck Co A. F. School Tn Hq Hq Co GHQ RES Tank Units Arm'd Division Trains Hq & Hq Co Maint. Supply Bn Medical Bn Arm'd Div Tank Destroyer Battalion Engr Bn T/O March I. 1942 Arm’d Div Arm'd Signal Co UJ O cc o u. Q cc o 2 O' < Attached Aviation 3 Arm'd F.A. Bns Arm'd Div Arm'd Div Arm'd Inf Regt Additional Units from GHQ as situation demands Arm’d Div Two Arm'd Regts Arm'd Div Arm'd Div Officers W.O. E.M. Total Division 690 69 13,431 Attached Medical 50 364 Attached Chaplains 14 Aggregate 754 69 13,795 Arm'd Div Arm'd Ren Bn Attached Medical ARM'D CORPS Serv Co Sig Bn Attached Chaplains Hq Co Hq Co Corps Hq Div Hq TANKS Light Medium THE MEDICAL REGIMENT, SQUADRON AND BATTALION 691 divided into a company headquarters, a battalion supply section, a division medical supply section, a battalion maintenance section, and a transportation platoon. Battalion headquarters. The battalion headquarters consists of 9 officers (the battalion commander, his staff, the personnel officer), 2 warrant officers and 20 enlisted men. Battalion headquarters is divided into a headquarters section and a personnel section. 1 1 2 3 4 5 6 Unit Battalion headquar- ters and headquar- ters com- pany (T/O 8-76) 3 medical companies (T/O 8-77) (each) Total battal- ion Enlisted cadre Remarks 2 3 5 7 8 Total commissioned 10 11 43 10 First sergeant 1 1 4 4 11 Technical sergeant 3 1 6 5 12 Staff sergeant 2 10 32 26 13 Sergeant 12 4 24 15 14 Corporal 1 6 19 10 15 7 3 16 8 16 Technieian, grade 5 20 11 53 4 39 20 Total enlisted 90 122 456 75 21 Aggregate - 103 133 502 75 22 O Car, half-track, M3, without arma- 18 29 Q Truck, %-ton, carry-all, with 12-volt 4 4 16 45 32 (1) (3) 33 (2) (6) (4) (1) (i) (5) h) a) (4) 37 Maintenance wrecker, with (3) a) (6) 38 (2) (2) 39 (2) (6) 40 (1) 0) 41 (2) (6) 42 (1) (1) 43 (1) (1) 44 4 4 16 Changes No. 1 j WAR DEPARTMENT, Washington, December 28, 1942 T/O 8-76, March 1, 1942, is changed aa follows: Lice Column 2 3 4 6 4 t 7 21 (■>1)4 (4 2)4 3 6 13 22 4 Dental oflloers as- signed to each medi- cal company at ths discretion of the bat- talion commander. 13 10 43 106 132 602 Plate 17. T/O 8-75, March 1, 1942, and Change No. 1. Organization of the Armored Medical Battalion. There are 8 officers, 1 warrant officer, and 12 enlisted men in the headquarters section. The personnel section consists of 1 officer (second lieutenant, MAC) and 1 technical sergeant (sergeant major), 3 sergeants (morning report 368, payroll 368, and service record 368), 3 technicians grade 5, and 1 private first class or private. Headquarters Company. The headquarters company consists of 4 officers, 1 warrant 1 2 3 4 5 6 7 8 9 to 11 12 13 14 15 16 17 IS 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 30 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 65 56 67 68 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 7ft 77 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 17 Unit •8 | a % Battalion headquarters Headquarters company Aggregate Enlisted cadre Remarks | Headquarters section Personnel section Company head- quarters a s >* •a a 3 « Division medical supply section Battalion maintenance • Transportation platoon Total company Command section Maintenance sec- tion * l Administrative, supply, and mess section b Platoon headquar- ters 1 Fuel and lubri- cants section Ration section Lieutenant colonel 4 1 .f 1 fgh 2 1 1 3 2 3 * 1st echelon mainte- nance of company vehicles. b Additional mess per- sonnel for battalion head- quarters mess. « Contains 2 “crews,” each with 2H-ton truck available for reinforcing companies of the bat- talion as required. d Battalion comman- der. • Executive officer or second in command. 1 Operations officer or S-3, or operations non- commissioned officer. * Medical Administra- tive Corps. b Adjutant or S-I. officer or J Chief of platoon, sec- tion, crew, etc. k Supply officer. ■Specially selected quartermaster officer. “ Maintenance officer. “ Mounted in H-ton truck. ° Assistant operations officer, signal communi- cation. p Assistant adjutant, clerical. « Assistant supply offi- cer. r Mounted on motor- cycle. • Driven by crew mem- ber or passenger. The serial number symbol shown in paren- theses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification anal- ysis is found in A R 615-26. A number above 500 refers to a military occupa- tional specialist listed in Circular No. 14, War Department, 1942. Major Captain . 1 1 1 2 > 1 Second lieutenant. « 1 ik 1 i»»l Total commissioned 5 1 1 1 1 1 4 10 Warrant officer. rr p 1 • i 1 3 Master sergeant, including 1 1 1 <“ 1) — == — 2 (1) 3 (1) (1) (1) 1 3 (1) (2) 2 s 12 (1) (1) 0) 0) (2) (5) 1 (1) 1 20 1 S (1) (1) (1) (3) (5) (5) (14) 1) (4) (1) (1) (1) (1) 0) (2) (3) (1) (1) 3) W (3) (1) (3) (1) (8) r 0) 0) (1) 1 2 (1) (1) 2 (0 (1) 9 (1) (1) (1) (1) (1) (4) 1 (1) 5 1 Maintenance (337) Sergeant major (502) (' 1) Supply (825) 01) (1) 1 2 First sergeant (585) . ... 1 1 (1) 1 1 Sergeant major, personnel (816). Supply (821). (i) (i) (2) 2 0) (1) 8 Staff sergeant, including 1 01) 1 Maintenance (337) (1) 1 Sergeant, including Communication (542) i (l) 3 1 2 2 1 1 Crew chief (337) a) (1) Morning report (368) a) (i) Pay roll (368) Section leader (652) (i) a) (2) Service records (368) (i) Supply (821) (1) 1 (1) 11 (i) (2) (i) (5) (1) 84 Corporal, including Clerk (405) Technician, grade 4] Technician, grade 5L_ .. „ Private, first class |lnc udlng Private Agent messenger (716) 5 10 (' 1) (• 1) (1) 4 2 6 4 8 11 9 4 Agent messenger (716) Bugler (803) Cargo handler (590) (2) (1) (2) a) “{ (1) (3) Chauffeur (345) (3) } (i) Chauffeur, truck (345) . Chauffeur, 2H-ton truck (345) Chauffeur, 10-ton wrecker (245) Clerk (405) 6 5 5 a) (i) (2) (i) (2) (1) (9) (i) (1) (i) (2) Clerk (055) a) a) (i) Clerk, mail (056)... . 5 5 Clerk, officers record section (405).... Clerk, stock (324) (1) (1) 1) (2) (3) Cook (060) 4 6 8j (3) m «) Cook (060) Cook’s helper (521) Draftsman (076) 4 4 4 5 (1) (i) Electrician, automobile (012).. Mechanic (014) (1) (2) (3) (1) (3) 4) (3) (1) (1) (1) (6) a) (i) (3) Mechanic (014) Orderly (695) (3) Painter (143). 5 (1) Radio tender (776) (2) (i) Welder (256) 4 (1) Basic (521) (2) (2) (2) Total enlisted Aggregate Q Truck, 10-ton, wrecker 12 8 2 6 15 6 12 14 10 5 70 90 24 18 10 3 6 15 8 12 15 1 1 10 5 75 1 103 1 1 2 1 3 4 1 15 (1) (5) (1) (3) 2) (1) (1) (1) 4 24 Q Car, light. 5-passenger sedan 1 2 Q Motorcycle, solo Q Trailer, water, 250-gal 1 1 1 3 1 1 14 (1) s (3) (2) Q Truck, \\-ton 1 1 Q Truck, ‘4-ton carry-all with 12- volt ignition (•1)3 1 Q Truck, including Equipment 1 1 (?) 1 (? 2 5 1 Fuel. lubricants (3) Kitcnen . Maintenance wrecker, with winch (i) (2) Medical supply. (2) Personnel a) Supply a) at (1) 0) 1 8 Radio set 3 Changes No. 1 WAR DEPARTMENT, Washington, December 28, . 1942. T/O 8-76; March L, 1942, is changed as follows: Line Column 3 IS 17 4 ('«k2«l)3 4 5 (*'1*2)3 4 7 8 13 00 21 106 Plate 18. T/O 8-76, March 1, 1942, and Change No. 1. Organization of Headquarters and Headquarters Company, Armored Medical Raftaiioirc THE MEDICAL REGIMENT, SQUADRON AND BATTALION 693 officer, and 70 enlisted men: 1 captain, 1 first lieutenant, 2 second lieutenants, 1 warrant officer, 2 master sergeants (1 maintenance sergeant, mounted in }4-ton truck, and 1 supply sergeant, chief of division medical supply section), 1 first sergeant, 2 technical sergeants (supply), 2 staff sergeants (1 maintenance and 1 mess), 8 sergeants (1 main- tenance crew chief, 2 section leaders, 5 supply), i corporal (clerk), 6 technicians grade 4(1 cook, 1 automobile electrician, 3 automobile mechanics, and 1 welder), 15 technicians grade 5 (4 254-ton truck drivers, 1 10-ton wrecker truck driver, 4 automobile mechanics, 3 clerks, 2 cooks, and 1 painter), and 33 privates first class or privates (3 cargo handlers, 14 2 J4-ton truck drivers, 2 chauffeurs, 1 stock clerk, 3 cooks’ helpers, 3 orderlies, 1 radio tender, and 6 basics). The headquarters company performs the same functions as the headquarters and service company of the medical regiment. Company headquarters. The company headquarters consists of the command section, the maintenance section and the administrative, supply, and mess section. The command section consists of 1 officer (a captain) and 2 enlisted men (a chauffeur and a radio tender). The maintenance section consists of 1 staff sergeant (maintenance chief of section) 1 technician grade 4 (mechanic) 1 technician grade 5 (mechanic), and 3 private first class or privates, (one 2 54-ton truck driver, and two basics). The admin- istrative supply and mess section consists of 1 first sergeant, 1 staff sergeant (mess), 1 sergeant (supply), 1 corporal (clerk), 1 technician grade 4 (cook), 2 technicians grade 5 (cooks), 8 privates first class or privates (2 chauffeurs 2J4-ton truck drivers, 3 cooks’ helpers and 3 orderlies). The transportation for the company headquarters consists of one water tank trailer (250-gallon), one 54-ton truck and one %-ton carry-all truck, with 12-volt ignition and radio set, three 2 54-ton trucks (1 for equipment, 1 for kitchen, 1 maintenance wrecker with winch). Battalion supply section. The battalion supply section consists of 1 second lieutenant (supply officer, chief of section), 1 warrant officer (assistant supply officer), 1 technical sergeant, 1 sergeant (supply), 1 technician grade 5 (clerk), and 3 privates first class or privates one 254-ton truck driver, and 2 basics). Division medical supply section. The division medical supply section consists of 12 enlisted men: 1 master sergeant (supply sergeant, chief of section), 1 technical sergeant (supply), 2 sergeants (supply), 2 technicians grade 5 (clerks), and 6 privates first class or privates (2 cargo handlers, 1 chauffeur, 2 2 54-ton truck drivers, and 1 stock clerk). The transportation for the division medical supply section consists of one 3/4-ton com- mand truck, two 2 54-ton cargo trucks. Battalion maintenance section. The battalion maintenance section contains two “crews” each with a 2 54-ton truck available for reinforcement of the battalion as re- quired. The battalion maintenance section consists of 1 second lieutenant who is an especially selected quartermaster officer (maintenance officer, mounted in a 1/4-ton truck), 1 master sergeant (maintenance, mounted in 1/4-ton truck), 2 sergeants (la crew chief and the other a supply sergeant), 3 technicians grade 4 (1 automoble electrician, 2 mechanics, and 1 welder), 5 technicians grade 5 (1 10-ton wrecker truck driver, 3 mechanics, and 1 painter), and 2 privates first class or privates (two 254-ton truck chauf- feurs). The transportation of the battalion maintenance section consists of one 10-ton wrecker truck, one 54-ton truck (driven by crew member), and two 254-ton maintenance wrecker trucks, with winch. Transportation platoon. The transportation platoon consists of 1 first lieutenant, MAC, 2 sergeants (section leaders) and 2 technicians grade 5 (254-ton truck drivers), and 11 privates first class or privates (1 cargo handler, 8 2 54-ton truck chauffeurs and 2 basics). Transportation consists of one 54-ton truck and six 254-ton trucks. The transportation platoon is subdivided into a platoon headquarters (1 officer, first lieu- tenant, MAC), a fuel and lubricant section (1 sergeant (section leader), and 9 254-ton truck chauffeurs), and a ration section (1 sergeant (section leader), 1 chauffeur (254- ton truck), 1 private first class or private (cargo handler) and 2 basics). Medical Company. There are 3 medical companies identical in organization, equip- ment, and transportation in the armored medical battalion. See Plate 19. The armored medical company consists of a company headquarters, a litter platoon, an ambulance 694 MILITARY MEDICAL MANUAL platoon and a treatment platoon. Each armored medical company performs functions similar to that of a collecting company of the medical battalion for the area which it serves. There is provided a collecting, an ambulance (evacuation), and a treatment service. 1 2 3 4 fi 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 i 2 3 4 6 6 7 8 9 10 11 12 18 Unit Tech- nician grade Company headquarters Litter pla- toon Ambu- lance pla- toon Treatment platoon Total com- pany En- listed cadre Remarks Com- mand section Adminis- trative, supply, and mess section Main- te- nance section Pla- toon head- quar- ter^ Oper- ating section Casu- alty treat- ment section Captain 1 2 (<•1)3 3 7 1 » Maintenance officer. b Company adminis- trative officer. ® Medical Administra- tive Corps. d Dental. • Driven by crew mem- ber or passenger. The serial number symbol shown in paren- theses is an inseparable part of the specialist des- ignation. A number be- low 500 refers to an occu- pational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupation- al specialist listed in Cir- cular No. 14, War De- partment, 1942. (Mi i 1 <• D Total commissioned 2 1 1 1 5 1 11 First sergeant (585) — - = “ — --1" — r i 0) 10 (1) (1) (?) (4) 4 0) (1) (2) 6 (1) , 8 { 11 1 39 1 47 (32) / (2) l (8) 0) (2) (3) 0) (24) (1) (1) (1) (1) 3) (5) (1) (2) (4) (8) 1 1 0) 8 ft 1 (2) 2 Technical sergeant, including 1 0) 3 Surgical (225) 1 1 (1) 1 1 1 2 Maintenance (337) Mess (824) a) Platoon sergeant (651) (D «) (i) a) 0) (3) 1 3 (1) Clerk (055). «) 8 3 «) (2) Supply (821) (2) 1 (1) 2 2 1 Clerk (405) (2) (2) 0) 10 Technician, grade 41 Technician, grade 5ll_-l„/»i__ Private, first class fincludlnS Private 3 (1) 8 8 O) (1) 30 (2) (1) 29 (27) 1 (1) 14 i l Chauffeur, 2>3-ton truck (345) Chauffeur, 2M-ton truck (345) Cook (060)... 5 4 5 } (2) (1) (2) (3) (4) (2) a) Cook (060) ... Cook’s helper (521) Driver, half-track (735) 6 <« (24) Litter bearer (657) 4 !8 Radio tender (776)... (1) 6 5 8 (1) (2) (4) (2) (4) (i) 4 5 Basic (521) (2) (2) (2) (2) Total enlisted 3 14 7 33 32 2 18 13 122 17 46 Aggregate... 6 14 7 34 33 3 23 14 133 ~TT 47 48 49 80 51 52 53 54 55 56 57 58 59 60 O Car, half-track M3, without anna- 1 1 12 2 5 4 10 (1) (2) il>> 8 (2) 4 12 1 1 c i) 1 1 1 1 . 2 1 Q Truck, M-ton, carry-all, with 12-volt 1 1 Q Truck, 2H*ton, including 2 1 4 (1) (2) 2 O) a) Maintenance wrecker, with winch. (i) «) (i) (l) (1) 1 1 1 1 Changes No. 1 l WAR DEPARTMENT, Washington, December 28, 1942. T/0 8-77, March 1, 1942, is changed as follows: Line Column e 11 3 2 6 & 4 10 46 22 132 Plate 19. T/O 8-77, March 1, 1942, and Change No. 1. Armored Medical Company. Company headquarters. Company headquarters consists of a command section; an administrative, supply, and mess section; and a maintenance section. The command section consists of 1 captain (company commander), 1 first lieutenant, MAC (maintenance officer and company administrative officer), 1 communications ser- THE MEDICAL REGIMENT, SQUADRON AND BATTALION 695 geant, and 2 privates first class or privates (1 chauffeur and 1 radio tender). The trans- portation and equipment of the command section consists of one 3/4-ton carry-all truck with 12-volt ignition. The administrative, supply, and mess section consists of 14 enlisted men: 1 first sergeant, 1 staff sergeant (mess sergeant), 3 sergeants (1 clerk and 2 supply sergeants), 1 corporal (clerk), 1 technician grade 4 (cook), 3 technicians grade 5 (2 cooks, 1 254-ton truck driver), and 4 privates first class or privates (1 254-ton truck chauffeur, and 3 cooks’ helpers). The transportation consists of two 2 54-ton trucks for the kitchen and section equip- ment and one 54 -ton truck. The maintenance section consists of 7 enlisted men: 1 staff sergeant (maintenance), 1 technician grade 4 (mechanic), 1 technician grade 5 (254-ton truck chauffeur) and 4 privates first class or privates (a chauffeur, a mechanic, and 2 basics). This section per- forms first and second echelon motor maintenance for the vehicles of the company. The maintenance section transportation consists of one 1/4-ton truck and a 2%-ton truck, a maintenance wrecker with winch. The litter platoon. The litter platoon consists of 1 officer (first lieutenant, MAC) and 33 enlisted men: 1 staff sergeant (platoon sergeant), 2 corporals (section leader as- sistants) 1 technician grade 5 (half-track driver), and 29 privates first class or privates (2 chauffeurs, 1 254-ton truck driver, 24 litter bearers and 2 basics). Transportation of the litter platoon consists of 1 half-track M3 car without armament, one 1/4-ton truck, one 3/4-ton carry-all truck with 12-volt ignition, one 2 54 -ton truck (personnel with litter inserts and a radio set). The ambulance platoon. The ambulance platoon provides the ambulance service for evacuation of casualties. It is commanded by a second lieutenant, MAC. The en- listed personnel consists of 1 staff sergeant (platoon sergeant), 2 corporals (section leader assistants), 29 privates first class or privates (27 chauffeurs and 2 basics). Trans- portation of the ambulance platoon consists of 12 cross-country ambulances, two 54-ton trucks, one %-ton carry-all with 12-volt ignition and radio set. Treatment platoon. The treatment platoon is organized into a platoon headquarters and operating section and a casualty treatment section. The total strength is 6 officers and 33 enlisted men. The platoon headquarters consists of 1 first lieutenant (medical officer) 1 staff sergeant (platoon sergeant), and 1 private first class or private (chauffeur), a total strength of 1 officer and 2 enlisted men. Transportation of platoon headquarters consists of one 3/4-ton carry-all truck with 12-volt ignition and radio set. The operating section consists of 2 captains (medical officers), 2 first lieutenants (medical officers), 1 technical sergeant (surgical), 3 staff sergeants (surgical), 1 tech- nician grade 4 (surgical technician), 4 technicians grade 5 (1 dental technician, 1 medical technician, and 2 surgical technicians), and 9 privates first class or privates (4 chauffeurs, 1 medical technician, and 4 surgical technicians), a total strength of 5 officers and 18 enlisted men. Transportation consists of 1 trailer, (250-gallon water tank), and four 2 54-ton trucks (la truck with bus or panel body, 1 a truck with an operating room body, and 2 cargo trucks). The casualty treatment section consists of 1 first lieutenant (medical officer), 2 staff sergeants (la section leader, the other a surgical technician), 1 corporal, 2 technicians grade 5 (medical technician), and 8 privates first class or privates (2 254-ton truck chauffeurs, 4 medical technicians, and 2 basics), a total strength of 1 officer and 13 enlisted men. Transportation of the casualty treatment section consists of one 250- gallon water tank trailer, two 54-ton trucks (1 with operating room body and the other equipped with litter inserts.) MEDICAL BATTALION MOUNTAIN DIVISION Organization. The Mountain Medical Battalion (T/O 8-135) furnishes medical support for the mountain division in a manner similar to that which a medical squadron furnishes for the cavalry division. It is organized into a battalion head- 696 MILITARY MEDICAL MANUAL quarters, a headquarters detachment, three collecting companies identical in organi- zation, equipment, and transportation, a clearing company, and a veterinary com- pany. The personnel consists of 47 officers and 543 enlisted men, an aggregate strength of 590. 3 oo o» ot *> co to *-* Q Trailer, 2-wheel, 2-horse van Q Trailer, 1-ton, 2-wheel, wrater tank (250-gallon) Q Truck, M-ton Q Truck, command and reconnaissance... Q Truck, %-ton, weapon carrier.. Q Truck, 2K-ton, cargo Q Truck, cargo, with winch Q Truck, 4-5-ton, tractor Staff sergeant Sergeant Corporal Technician, grade 4 Technician, grade 5 Private, first class Private, including Basic Total enlisted Aggregate Q Ambulance, %-ton First sergeant Captain Lieutenant Total commissioned Lieutenant colonel Unit - 3 s SS3S Battalion headquarters (T/O 8-136) » to ; J S3 w rf*.*—GCOtO>—CbtOtO’-**-* CO Headquarters detachment (T/O 8-136) CO ~j j ; i i j j is; as a - Cn 4.- 3 collecting companies (T/O 8-137) (each) CO fO-'ift' 1 »£> 1 3 7 137 |129 m2o5o*4^0» © Clearing company (T/O 8-138) ©» 45" 3 1 4 1 4 3 5 15 10 2 16 33 47 (13) - • 0=4. Veterinary company (T/O 8-139) Oi wmoo Stcoo> *J» wSS i 2 “ ft s- Total battalion (battalion headquar- ters, headquarters detachment, 3 col- lecting companies, 1 clearing com- pany, and 1 veterinary company) : : ; ; : \ ; \ j | ; 58 58 Enlisted cadre - a Personnel shown in column 2 is in- cluded in column 3. Personnel in column 2 includes— 1 lieutenant colo- nel, Medical Corps, com- manding offi- ccr. 1 major, Medical Corps, execu- tive officer. 1 captain, Medi- cal Corps, planning and training officer. 1 captain, chap- lain. 1 lieutenant. Medical Ad- ministrative Corps, adju- tant. 1 lieutenant. Medical Ad- ministrative Corps, person- nel officer. b May be Medical Administrative Corps. c Chaplain. d Dental. Remarks • Changes] No. 1 j WAR DEPARTMENT, Washington, December 28, 1942. T/0 8-135, April 1, 1942, is changed ns follows: Column Line r— ■ ■ ■— fi 7 4 (*1) 6 12 6 <<2) 9 33 Plate 20. T/O 8-135, April 1, 1942, and Change No. 1. Organization of the Medical Battalion, Mountain Division. Headquarters Detachment. The headquarters detachment performs similar functions to those of the headquarters detachment of the medical squadron. There are 9 officers and 43 enlisted men in the headquarters detachment. It is organized into a battalion headquarters and a headquarters detachment. Battalion Headquarters. The battalion headquarters consists of a personnel section and an administrative section. The personnel section consists of 1 lieutenant, MAC (a qualified warrant officer may replace this officer), 1 technical sergeant (personnel), 3 sergeants (record clerks; 1 qualified in pay roll procedure, 1 qualified in service record procedure, and 1 quali- fied in morning report procedure), and 1 private first class or private (general clerk). The administrative section consists of 1 lieutenant colonel (battalion commander), 1 THE MEDICAL REGIMENT, SQUADRON AND BATTALION 697 major (executive officer), 2 captains (1 a chaplain, 1 the plans and training officer), 1 lieutenant MC or MAC (adjutant), 1 master sergeant (sergeant major), 3 technicians grade 5 (1 chaplain’s assistant, 1 light truck driver, and 1 a stenographer), and 7 privates first class or privates (4 light truck drivers, 2 orderlies, and 1 basic), a total strength of 5 officers and 11 enlisted men. (See T/O 8-136.) 1 2 3 4 5 6 7 8 9 10 Battalion head- quarters Headquar- ters detach- ment 1 Unit | Technician grade | Personnel section Administrative sec- tion | Headquarters 1 General and medical supply section | Motor maintenance section Total Enlisted cadre Remarks 2 » 1 3 4 (*>1)2 * Battalion com- mander. 5 odl 6 0 May be Medical Administrative Corps. d Warrant officer may replace officer. • 1 qualified in pay roll procedure; 1 quali- fied in service record procedure; 1 qualified 7 8 a) (1) (1) 9 10 1 i 11 (1) p) a) 12 (i) (1) 13 14 (1) (i) (1) 6 (3) (1) (2) (1) cedure. The serial number symbol shown in pa- rentheses is an insepa- rable part of the spe- cialist designation. A number below 500 re- fers to an occupational specialist whose quali- fication analysis is 15 (i) 16 Sergeant, including Clerk, record (4 Motor (813) 3 17 35) • (3) 18 (1) 19 SuddIv (825) (2) 20 Corpora], including Clerk, company Technician, grade 4 Technician, grade 5 Private, first class. Private 1 (1) 2 21 (1) (1) 2 9 22 23 24 25 26 10 8 tant (534) 5 a) 8 11 (1) (3) 0) a) — found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Depart- ment, 1942. 27 0) (2) (1) 28 29 p> 0) (2) a) 30 Cook (060) 31 (2) (2) (8) (1) (3) 2) (1) (4) 32 p) (4) (1) (3) 33 (1) 34 4 a) (2) a) 35 5 (1) 36 (2) (1) (1) 37 Stenographer (213) 5 38 (1) (1) (1) 39 11 11 11 43 40 16 12 12 52 41 Q Trailer, 1-ton, 2-wheel, water tank (250-gallon) 42 43 Q Truck, command and re- connaissance 1 44 45 6 1 46 Plate 21. T/O 8-136, April 1, 1942. Organization of Headquarters Detachment, Medical Battalion, Mountain Division. Headquarters Detachment. The headquarters detachment is organized into a head- quarters, a general and medical supply section and a motor maintenance section. These sections perform similar functions to those of like sections in the headquarters detachment of the Medical Squadron. The personnel consists of 3 officers and 27 enlisted men. The headquarters consists of 1 captain, MC or MAC (detachment commander and division medical supply officer), 1 first sergeant, a staff sergeant (mess and supply), a sergeant (motor), a corporal (company clerk), 2 technicians grade 5 (1 cook, and 1 automobile mechanic), and 6 privates first class or privates (1 cook, 2 cooks’ helpers, 1 driver light truck, 1 mechanic automobile and 1 basic), a total strength of 1 officer and 11 enlisted men. The general and medical supply section consists of 1 lieutenant (may be MAC)7 a technical sergeant (supply) 2 sergeants (supply), 2 technicians grade 5 (1 stock clerk, 698 MILITARY MEDICAL MANUAL 1 light truck driver), and 6 privates first class or privates (2 general clerks, 3 light truck drivers, and 1 basic), a total strength of 1 officer and 11 enlisted men. The motor maintenance section consists of 1 lieutenant (may be MAC), a staff sergeant (motor), 1 technician grade 4 (automobile mechanic), 2 technicians grade 5 (automobile mechanics), and 1 private first class or private (basic), a total strength of 1 officer and 5 enlisted men. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 l 2 3 4 5 6 7 8 (Toil Tech- nician grade Com- pany head- quar- ters Sta- tion pla- toon Col- lect- ing pla- toon Total com- pany En- listed cadre Remarks 1 1 4 The serial number symbol shown in parentheses is an in- separable part of the specialist designa- tion. A number be- low 500 refers to an occupational special- ist whose qualifica- tion analysis is found in AR 615-26. A number above 500 refers to a military occupational special- ist listed in Circulars Nos. 14 and 67, War Department, 1942. 2 2 1 2 2 5 1 1 (1) 1 3 (1) (2) 7 (1) (1) (4) (1) 5 (4) (1) 2 13 20 27 U) 0 (1) (1) (11) (1) (7) (15) (1) (3) (5) (2) (1) (2) (3) (7) 1 1 1 a) 2 (1) 2 3 (1) (1) 2 (1) (2) (2) (1) Supply (821) 0) 1 2 (2) 2 (2) 1 (1) 7 (1) (1) (1) (1) (1) 1 1 } 2 Technician, grade 41 Technician,grade 51 includ jng 18 37 Private... 4 5 (11) (I) 5 (7) (15) 0) 5 8 8 (2) (3) (2) 8 ill 4 5 (1) (4) Total enlisted... 13 23 42 78 8 Aggregate 14 25 44~ 83 8 5 » Remarks ! ,3 >> 1 1 § | a | 1 1 s & e o O CQ 3 & s 'a o H o H a W 1 1 4 3 (41)3 (41)3 10 2 4 4 14 d Dental. The serial number symbol shown in paren- theses is an inseparable part of the specialist designation. A number 1 1 6 2 1 1 5 1 (i) (i) a) a) (3) (i) Motor (813) 9 (1) 1 (1) 1 10 1 4 1 occupational specialist whose qualification analysis is found in 11 (1) a) (8) (1) (1) 7 CD 13 1 i 2 (1) (i) (3) above 500 refers to a military occupational specialist listed in Cir- culars Nos. 14 and 67, War Department, 1942. a) (1) (3) (10 J19 140 151 (1) (3) (3) (2) / (3) 1(9) (19) (1) (1) (3) 05) (3) (3) (3) (9) (3) (3) (6) (9) (9) (i) 6 (1) 34 17 18 19 20 Technician, grade 4] Technician, grade 5( 18 29 1! Private J a) (3) (3) (2) 23 Cook (060) 5 25 (4) (4) 26 )5 (1) (1) (0 (3) (1) (5) (6) (5) (1) (1) (1) (3) (1) (1) (2) (3) (3) (3) (5) (1) (1) (1) (3) (1) (1) (2) (3) (3) (3) (i) (1) (2) (3) (2) (1) (2) (3) 40 41 (3) (12) A 42 23 32 6 38 137 18 43 25 36 6 42 151 18 44 5 5 15 45 46 47 Q Trailer, 1-ton, 2-wheel, water tank (250-gallon). Q Truck, %-ton, command and recon- naissance. ... 1 1 1 1 1 1 1 4 4 1 ... 48 3 3 9 49 Q Truck, 2Wton, cargo, with winch 1 1 3 Changes No. 1 WAR DEPARTMENT, Washington, December 28, 1942. T/O 8-138, April 1, 1942, is changed as follows: Column 3 4 6 7 0 2 0» 1)2 1 1 5 "•Dental officers assigned 3 (<•2)3 2 ' 2 9 to each platoon as the coin- 4 5 3 3 14 pany commander desires. 43 2S 35 41 151 Plate 23. T/O 8-138, April 1, 1942, and Change No. 1. Organization of the Clearing Company, Mountain Medical Battalion. THE MEDICAL REGIMENT, SQUADRON AND BATTALION 701 The transportation of the station section consists of one 1-ton 2-wheel trailer (250 gallon water tank), one %-ton command truck, three 254-ton cargo trucks and one 254-ton cargo truck with winch. 1 2 3 4 5 6 7 8 1 Unit Technician grade Company head- quarters 3 collecting and treatment pla- toons (each) Evacuation pla- toon (motor) '3 o Enlisted cadre Remarks 2 Captain .. * 1 3 1 2 1 8 a Mounted. b Qualified in sick and wounded record procedure. 4 2 2 1 9 5 First sergeant (585) _ 1 1 1 6 1 1 1 5 2 7 (i) (i) (4) 15 (1) (1) 1 derly for each 2-horse 8 (1) 3 (1) 4 9 2 10 (81) (1) (1) (9) (1) (3) 10 symbol shown in pa- 11 (1) (3) 12 ((*1)2) separable part of the specialist designation. 13 (1) 14 (1) 2 (1) 1 15 1 3 refers to an occupa- tional specialist whose qualification analysis is found in AR 615-26. A num- 16 ((*1)2) (3) (9) (1) j !« 17 (1) 18 (1) ”3" 18 19 Technician, grade 4| Technician grade 5 including ... _ 22 14 20 21 22 Private, first class | 6 Private j 5 (1) l 47 (3) (1) (3) (2) (2) (3) (1) (1) (8) (2) (1) (18) (1) (2) (4) (3) (3) (3) (15) (3) (6) (13) J1 her above 500 refers to a military occupa- tional specialist list- 23 5 (1) 24 (1) 14 and 67, War De- partment, 1942. 25 Cook (060) 4 (2) (2) (3) 26 Cook (060) 5 27 28 5 (1) 29 5 (1) (2) 30 Driver, light truck (345) (6) (2) 31 32 5 (1) (i) 33 (* 6) 34 5 (1) (2) (*1) 35 36 (*3) 37 (“ 1) (1) (1) (5) (1) (2) (3) 38 39 40 Technician, medical, veterinary (250) 5 .... (i) (i) (i) 41 42 Technician, surgical veterinary, (226) 5 .... 43 (2) (2) 44 23 28 22 129 9 45 25 30 23 138 9 46 3 14 45 47 (6) (7) (1) (18) (24) (3) 3 48 (3) 49 50 3 51 Q Trailer, 1-ton, 2-wheel, water tank (250- 1 1 52 1 3 4 53 Q Truck, %-ton, command and reconnais- 1 1 54 1 3 4 55 3 3 Plate 24. T/O 8-139, April 1, 1942. Organization of the Veterinary Company, Medical Battalion, Mountain Division. The ambulance section (motor) consists of 1 corporal (section leader), and 5 privates first class or privates (light truck drivers), a total of 6 enlisted men. Each ambulance motor section has five %-ton ambulances. Veterinary Company. There is one veterinary company in the Mountain Medical Battalion. It is organized into a company headquarters, 3 collecting and treatment 702 MILITARY MEDICAL MANUAL platoons identical in organization, equipment, and transportation, and an evacuation platoon (motor). The personnel consists of 9 officers and 129 enlisted men. (See T/O 8-139.) The functions and operation of the veterinary company are similar to those of the veterinary troop of the Medical Squadron. The transportation consists of eighteen draft horses, twenty-four riding horses, three pack mules, three 2-wheel, 2 horse van trailers, one 1-ton 2-wheel 250 gallon water tank trailer, four %-ton trucks, one %-ton command truck, four 214-ton cargo trucks with winch and three 4- to 5-ton tractor trucks. Company headquarters. The company headquarters personnel consists of a captain (company commander, mounted), a lieutenant, 1 first sergeant, 1 staff sergeant (mess), 2 sergeants (a barn boss and a supply sergeant), 1 corporal (company clerk), 2 techni- cians grade 4 (cooks), 6 technicians grade 5 (1 record clerk, 2 cooks, 1 light truck driver, 1 automobile mechanic, and 1 horseshoer), and 10 privates first class or privates (3 cooks’ helpers, 2 light truck drivers, 2 orderlies, 1 veterinary ambulance orderly and 2 basics), a total strength of 2 officers and 23 enlisted men. The functions of this headquarters are similar to those of the headquarters of the veterinary troop of the Medical Squadron. The transportation of company headquarters consists of 3 riding horses, one 1-ton, 2-wheel 250 gallon, water tank trailer, one %-ton truck, one %-ton command truck, and one 2%-ton cargo truck with winch. Collecting and treatment platoon. There are three collecting and treatment pla- toons in each veterinary company of the Mountain Medical Battalion. The functions of the collecting and treatment platoon are similar to those of the collecting platoon of the veterinary troop, Medical Squadron. The personnel of each platoon consists of 2 lieutenants, 1 staff sergeant (platoon), 3 sergeants (2 section leaders and 1 veterinary sergeant), 2 corporals (2 assistant section leaders), 3 technicians grade 5 (1 admission clerk, 1 veterinary medical technician, and 1 veterinary surgical technician), and 19 pri- vates first class or privates (1 record clerk, 6 lead line riders mounted, 1 supply packer, mounted, 1 stable man, 5 veterinary medical technicians, 2 veterinary surgical tech- nicians and 3 basics), a total strength of 2 officers and 28 enlisted men. The transportation of the collecting and treatment platoon consists of 6 draft horses, 7 riding horses, and 1 pack mule. Evacuation platoon (motor). The evacuation platoon (motor) consists of 1 first lieutenant (veterinary officer), 1 staff sergeant (platoon sergeant), 4 sergeants (1 motor sergeant, 3 section leaders), 3 corporals (assistant section leaders), 1 technician grade 5 (heavy truck driver), and 13 privates first class or privates (2 heavy truck drivers, 6 light truck drivers, 3 veterinary ambulance orderlies, and 2 basics), a total strength of one officer and 22 enlisted men. The function of the evacuation platoon (motor) is to evacuate all casualties by motor whenever possible and as designated by higher authority. The transportation of the motor evacuation platoon consists of three 2-wheel, 2 horse van trailers, three %-ton trucks, three 214-ton cargo trucks with winch, and three 4- to 5-ton tractor trucks. One ambulance orderly is provided for each 2-horse ambulance trailer. CHAPTER III MEDICAL SERVICE OF THE DIVISION Introduction. In order to understand the medical service of the division one must acquire a knowledge of the organization of its division medical personnel. This personnel consists of the officers and men of the Medical detachments Medical battalion (squadron) Medical section of division headquarters. Medical detachments are the attached medical units. They are an integral part of their respective regiments, battalions, and similar organizations. The organization and em- ployment of these units is described in Chapter I. The medical battalion, as an integral part of the division, operates the division medical service. This function is performed by units whose names are explanatory of their organization and type of division: i.e. Medical battalion infantry division Medical battalion, armored . . armored division Medical battalion, motorized motorized division Medical company, airborne airborne division Medical battalion, mountain mountain division Medical squadron cavalry division Medical battalion, engineer amphibian brigade engineer amphibian brigade. The organization of these units is described in Chapter II. It is the object of this chapter to discuss the coordination and relationship between attached medical units and the division medical service, and to enumerate the organiza- tion and discuss the function of the medical section of division headquarters. The medical service of the infantry division is described in detail. Brief discussions of the operation of medical service in the armored, motorized, airborne, mountain, and cavalry divisions are included. The medical battalion, engineer amphibian brigade is included in this chapter as its function is similar to that of a division medical unit. For additional information on division medical service see FM 8-10, Medical Service of Field Units. Responsibility. The commanding officer of a unit (army, corps, division, brigade regiment, battalion, etc.) is responsible for all that his unit does or fails to do. Com- manding officers of units are therefore responsible for the medical service within their organization. The surgeon is in turn responsible for property advising the unit commanders on all matters pertaining to the medical service. Principles of Evacuation. The following principles are applicable to all types of divisions, including animal evacuation (which is executed by veterinary personnel operating under supervision of the medical corps): Medical service is continuous. The demands of the military situation are paramount. The fighting forces are to be relieved of the presence of sick and wounded as rapidly and thoroughly as possible. Disposition of medical units is aimed at administering the most good to the greatest number. Medical personnel and medical units accompany the organization to which they be- long at all times. When necessary, in rapid advances, casualties are left to be picked up by medical units from the rear. Casualties in the combat zone are collected at medical installations along the general axis of advance of the units to which they pertain. Sorting of the fit from the unfit takes place at each medical installation in the chain of evacuation. Evacuees who can be treated successfully in a limited period of time within a command are not evacuated unless it is necessary to relieve the medical unit of their care to free it for movement, or to make room for new casualties. 704 MILITARY MEDICAL MANUAL LEGEND Infantry (Bn orRegt) Field Artillery Unit Attached Medical Units in Operation Attached Medical unit in Reserve Division Medical . Installations > f, units 4 (Med Bn) Plate 1. Medical Support of Infantry Division in Combat. (Schematic) MEDICAL SERVICE OF THE DIVISION 705 Medical units must possess and retain tactical mobility to permit them to move to positions on the battlefield in support of combat elements. Medical establishments are set up for operation only as required by the situation, or as foreseen to meet con- tingencies of the immediate future. Those not set up are held in reserve at a point where they are readily available. In general, the size of medical units in the chain of evacuation increases, and the necessity and ability to move them decreases, the farther from the front lines medical installations are located. Mobility of medical installations in the combat zone is dependent upon prompt and continuous evacuation by higher medical echelons. THE INFANTRY DIVISION Medical Section of Division Headquarters (Plate 3) Tables of organization authorize a medical section as an organic part of division head- quarters. The medical section of division headquarters is a separate entity from all other medical units of the division. It is organized to assist the division surgeon in the execution of his duties. DIVISION COMMANDER ASST DIV COMDR ARTY ADVISOR GENERAL STAFF CHIEF OF STAFF G-l G-2 G-3 G-4 SPEC IAL STAFF S E CTSON A R T I L L E R V C H E M I C A L E N & I N E E R 5 ! 6 N A L A D J & E N E R. A L I N S P £ C T O R Q. u A n. T s. a M A S T £ XL O R D N A N C E J U D G £ A D V F I N A N C E C H A P L A I N M £. D ! C A L A N T I T A N K Plate 2. The Place of the Medical Section in Division Headquarters. The medical section, including the division surgeon, operates as a section of the division special staff. (See Plate 2) The senior medical officer of the division is a member of the division commander’s special staff. He is called the Division Surgeon. The division surgeon is a technical advisor to the division commander and his staff relative to: All matters pertaining to the health and sanitation of the command or of occupied territory. Food inspection for the division. Technical supervision of the procurement and purification of water supply where emergency measures are necessary. 706 MILITARY MEDICAL MANUAL Care and disposition of the sick and injured. Medical (dental, veterinary) supply for the division. Training of all troops in sanitation, first aid, and hygiene. Training of all Medical Department troops. Reports and records pertaining to the Medical Department. Personnel are provided in the medical section of division headquarters to assist the division surgeon in the performance of his gigantic task of supervising the medical activities of the division. MEDICAL SECTION Headquarters Infantry Division., DIVISION SURGEON LIEUT COL.MED CORPS MEDICAL ADVISOR. TO DIVISION COMMANDER^ MEDICAL INSPECTOR MAJOR.MEDICAL CORPS SPECIAL ASSISTANT TO DIVISION SURGEON DENTAL SURGEON MAJOR, DENTAL CORPS TECHNICAL ADVISOR TO DIVISION SURGEON VETERINARY OFFICER MAJOR VET CORPS DIVI SION POOD INSPECTOR. OFFICE EXECUTIVE IST LIEUT MED ADM C PREPARATION OP REPORTS -RECORDS y CORRESPONDENCE WARRANT OFFICER REPORTS y RECORDS MASTER SERGEANT CHIEF CLERK SERGEANT MEAT y DAIRY TECH -4™ GRADE STENOGRAPHER. RECORD CLERIC 1 -TECH A™ GRADE 2 TLC.w GRADF. Plate 3. Medical Section of Division Headquarters. Medical inspector. This officer makes periodic inspections of the divisional area, ren- dering reports to the division surgeon; Inspects all medical department activities within the jurisdiction of the division, including operation of the medical service in subordinate units; Supervises storage and distribution of medical supply; Supervises sanitary details of the division. He prepares statistical charts, reports, and records relative to the health of the division. The functions of venereal disease control officer are performed by the division medical inspector. Division dental surgeon. This officer is an assistant to the division surgeon. He is responsible for the proper conduct of the dental service of the division. His duties are advisory, administrative, supervisory, coordinative, and professional. Veterinarian. This officer, assisted by a qualified sergeant, inspects the food of the division and prepares veterinary reports. When animal units are attached to the division he supervises the operation of the veterinary service. Office executive. The first lieutenant, medical administrative corps, is called the “office executive.” He supervises the preparation of reports, correspondence, and records pertaining to the medical section of division headquarters. The other personnel of the medical section include a warrant officer, a master MEDICAL SERVICE OF THE DIVISION 707 sergeant (chief clerk), and a sergeant (meat and dairy). A stenographer and 3 record clerks included in this organization are used as general assistants. In combat the medical section, less the division surgeon, is at the rear echelon (See Plate 1. Rr Ech). The surgeon maintains close contact with the commanding general and the staff at the division command post. When duty requires his presence elsewhere, the surgeon leaves a capable assistant from the medical section to represent him at the command post. The surgeon divides his time between the division command post, the medical bat- talion, and the medical detachments. He maintains contact by telephone with the medical section at the rear echelon when personal visits there cannot be made. The division surgeon has no direct command over the medical battalion or the medical detachments. He is a staff officer. Within limits prescribed by the commanding general, the surgeon may exercise technical supervision over the operation of the medical bat- talion and the medical detachments of various units of the division, although the operation of these detachments is the responsibility of their respective commanders. Following consultation with the medical battalion commander, the division surgeon makes recommendation to G-4 relative to the tactical employment of the medical battalion and its component parts. The approval of these recommendations forms the basis of the medical plan, which in turn is executed by the various medical units. It is essential that the surgeon be thoroughly conversant with the various staff sections from which he secures information or supplies. The General Staff Section Chief of Staff: The surgeon will consult the chief of staff on matters not specifically allotted to a member of the general or the special staff sections. Matters in which there is doubt as to which staff section has jurisdiction are coordinated by the chief of staff. G-l: Sanitation; measures for the control of communicable diseases of men and animals. Medical problems associated with prisoners of war, refugees, and inhabitants of occupied territory. Personnel matters, and replacements for medical units. Reports of human casualties. Employment of prisoners of war to reinforce the medical service. G-2: Nature and characteristics of weapons, missiles, gases, and other casualty-pro- ducing agents employed by the enemy. The character of the organization and operation of the medical service of the enemy, especially as it relates to new methods which may deserve study and trial. Communicable diseases in enemy forces. Supply of maps. G-3: Current information of the tactical situation; future plans. Mobilization and training of medical units; training of all personnel in hygiene and first aid. Signal communications in medical installations. G-4: Tactical disposition of medical units. Supply matters, both general and medical. Movements of medical units. Evacuation by higher echelons. Reinforcement of the medical service by a higher echelon. Hospitalization. Shelter for medical troops and installations. Coordination of nonmilitary welfare and relief agencies in medical installations. Traffic restrictions affecting medical vehicles. Reports of animal casualties. Animal replacements for medical units. All other matters which have not been specifically allotted to another general staff section, or wherein there is doubt as to which section has jurisdiction. Engineer: Water supplies; sewage systems. 708 MILITARY MEDICAL MANUAL Road construction and maintenance in and around medical installations. Construction, repair, and maintenance of roads and structures used by the medical service. Preparation of signs. Camouflage. Maps. Quartermaster: Disposition of the dead at medical installations; the sanitary aspect of the disposition of all dead. Bathing, delousing, and laundry facilities for all troops. Clothing for gassed cases, and other patients returning to duty. General supply of medical units. Procurement of land and existing shelter for medical troops and installations. Procurement and operation of utilities allocated to the Quartermaster Corps. (See FM 100-10). Transportation, land and water; motor and animal transport of medical units. Chemical warfare officer: Gas defense of medical troops and installations; gas masks for patients. Types of gas used, and methods of identification. Toxicology and pathology of new gases. Adjutant General: All official correspondence through command channels. Personnel matters. Postal service for medical units and installations. Signal officer: Signal communications for medical installations. Judge Advocate: Questions of military and civil law. Administration of justice in medical units. Headquarters commandant: Physical arrangement for the division surgeon’s office. Provost Marshal: Custody of sick and injured prisoners of war. Disposition of strag- glers and malingerers in medical installations. Introduction. The medical battalion is charged with evacuation of all casualties from infantry battalion and regimental aid stations. If for any reason, casualties cannot be gathered at aid stations, the collecting companies of the medical battalion may re- move casualties directly from the field. The medical battalion always accompanies the division. Artillery casualties are generally evacuated from artillery aid stations directly to the division clearing station in artillery ambulances, which are included in the trans- portation allotted division artillery. Plans for Employment. See medical plan, (Chapter VII). EMPLOYMENT OF THE MEDICAL BATTALION, INFANTRY DIVISION Battalion Headquarters Headquarters of the medical battalion together with personnel from the headquarters detachment establish the battalion command post. This should be located in vicinity of the clearing station—the focal point of division medical support. Here messages be- tween the battalion commander and the collecting companies are received and dispatched by ambulance or other motor means. The headquarters detachment is also located in vicinity of the clearing station (See Plate 1). The close association of these units enables the medical battalion commander to maintain intimate contact and good control over his battalion. A telephone line generally connects the command post of the medical battalion with the division command post. SOP and the Medical Battalion A modern division designates routine procedures be handled by “SOP”—standing operating procedure. This system eliminates voluminous written orders and speeds all movements provided all personnel are well trained in its execution. In addition to many routine details, SOP designates the composition of division fighting units known as combat teams. The usual composition of a combat team is a regiment of infantry, a battalion of light artillery, a detachment of signal troops, a platoon of engineers and a collecting company. There are three combat teams in an infantry division. Th« troops MEDICAL SERVICE OF THE DIVISION 709 not included in combat teams arc designated division troops. Therefore, the medical battalion, less its three collecting companies, is considered a part of division troops. A collecting company normally accompanies the same combat team under all condi- tions. The combat team trains as a unit initially, thereby training its various officers and units to operate as one team. In operation, if a combat team is in reserve, its collecting company remains in reserve. Occasionally an entire collecting company will not imme- diately accompany a combat team to position for battle. Some collecting company per- sonnel with ambulances and other transportation may remain behind with the medical battalion until such time as they are required in the operation of their company. This action shortens the length of the combat team march column, rendering it less vulnerable to air attack. Such parts as remain behind constitute a company reserve. Unless other- wise directed, this reserve is temporarily under command of the medical battalion com- mander until called for by the collecting company commander. It may be feasable for the battalion commander to use these ambulances for short missions—evacuating units on call—until such time as these vehicles are required by the collecting company. Normally only one of the two platoons of the clearing company is initially established at station. The other platoon generally remains as a reserve in vicinity of the clearing station. It may relieve or reinforce the clearing station in operation, or it may be dis- patched forward or rearward to establish a clearing station for the care of casualties occurring from major fluctuations of the front line. In other words, platoons of the clearing company must be prepared to reinforce each other, or leap frog each other, according to the number of casualties requiring treatment, and the progress of the combat troops. Battalion headquarters and personnel of headquarters detachment establish the batta- lion command post in vicinity of the clearing station. The headquarters detachment normally sets up its installations in vicinity of the clearing station and the battalion com- mand post. By centralizing the battalion headquarters and the headquarters detachment in vicinity of the clearing station—the focal point of all division medical evacuation— contact is readily maintained with collecting companies by means of ambulance-borne messages. By dispersing the transportation equipment, and personnel of these installa- tions there is little likelihood of them being involved simultaneously in air bombardments. In Attack. In attack, elements of the medical battalion are so disposed as to give greatest support to the main effort of the division—the zone of greatest expected casualty density. The medical battalion (division medical service) must be operated and dis- posed of in a manner that permits it to remain mobile that it may advance as necessary to give medical support to the division. All medical installations are established close to the front line in anticipation of forward movement of the combat troops. Attack by Envelopment. Collecting companies establish collecting stations in the zone of operation of their own combat teams. If the front of the combat team making the secondary (holding) attack is very broad, and the litter carry long, it may occasionally be advisable for the collecting company with that combat team to split its personnel and equipment, thus establishing a collecting post in addition to the collecting station. Both units are then evacuated by the ambulances of that collecting company, utilizing an ambulance control point. (See Plate 13, Figure 3) Each collecting company accompanies its own combat team. In the enveloping force (main effort) the collecting company remains mobile, establishing station only when the number of casualties and the disposition of the supported units warrant such action. Casualties may be treated during rapid forward movement by opening medical chests in the rear end of trucks for treatment of patients at the roadside. Evacuation by ambulance may be accomplished without establishment of a shuttle. The collecting company with the combat team in reserve remains in reserve but should be prepared to move when its combat team moves. The clearing company establishes stations along the main axis of advance of the division. Occasionally on an encirclement a clearing platoon maly be attached to the reinforced combat team making the encirclement. Battalion headquarters apd the headquarters detachment accompany the main clear 710 MILITARY MEDICAL MANUAL ing station. They establish the battalion command post, the battalion supply and maintenance installations in vicinity of the clearing station. In attac\ by penetration. Concentration of enemy fire will fall on the troops massed for the penetration. The attack will progress slowly until the enemy position has been ruptured. Casualties will be heavy initially. Upon rupture of the hostile position the intensity of enemy fire will be less, litter bearer evacuation will be safer; and medical installations may be moved close to the injured, and vehicular transportation of the wounded will become practicable. However, before displacing any medical installations forward, the possibility of success of enemy counterattacks must be considered. In pursuit. Functioning medical installations continue to treat casualties in positions already occupied at the time the decision for pursuit is announced. Medical personnel are attached to the pursuing force and function as described for units of the medical battalion in attac\. (See above). In Defense. The medical problem is to locate medical installations in order to furnish medical support to the troops initially committed, yet have sufficient flexibility to permit medical support for extensions of the flanks or for counterattacks. In order to meet these contingencies, a reserve may be held out in each medical unit, or portions of each medical unit may be maintained mobile. The difficulties in evacuation are principally those due to the wide extension of the front and interference caused by enemy fire. Op- portunity must be taken during lulls in the combat or in darkness, to push ambulance evacuation up to the aid stations. Generally all medical installations are established farther to the rear in the defense to avoid being involved in minor fluctuations of the line. The collecting companies with combat teams in reserve also remain in reserve. They are committed with their combat teams and establish stations when the number of casualties intercepted warrant such action. The clearing company initially establishes station with one platoon, the other platoon being held in reserve to relieve the first one, or to expand the station. With secure flanks. This is generally a passive (stable) defense. Movements of com- bat elements are generally restricted to the interior of the defended position. Such a position is strongly held and reserves are generally small. The mass of medical support is centrally located in the area of greatest expected casualty density and is not required to displace frequently. With open flanks. This type of defense assumes an active mobile defense. Recon- naissance should be made for suitable locations of medical installations to support the plans of the combat troops to occupy previously prepared flank positions, or for counterattack of the enemy. To support of such operations must have medical officers necessitates a thorough knowledge of the plans of the combat troops. Employment of the Collecting Company There are three collecting companies in a medical battalion. Collecting companies are the forward echelon of the division medical service. They are the connecting links in the chain of evacuation between infantry aid stations and the division clearing station. Their mission in combat is threefold: (1) Remove evacuees from infantry aid stations to collecting stations. (2) Prepare evacuees at the collecting station for further evacuation. (3) Transport evacuees by ambulance from collecting stations to the division clearing station. SOP and the Collecting Company. Speed through decentralization is the key to success under SOP. However, SOP requires a thorough understanding by, and training of all personnel involved in such operations. Officers of collecting companies must be familiar with the standing operation procedure of their division. A division SOP will assign a collecting company to the same combat team for movement and medical support. This SOP will specify the location of the collecting company in the march column. Such a position is generally well to the rear of the column, behind all combat units. In some divisions only part of the collecting company may initially accompany the column, the other parts of the company remain- ing with the medical battalion until required by the collecting company. MEDICAL SERVICE OF TOE DIVISION 711 Ambulances may be detailed to infantry battalions for the collection of march casualties. These vehicles return to collecting company control when march conditions cease. Prior to their departure from the collecting company bivouac area a rendezvous point must be designated for their assembly after the march. During marches the collecting company is under control of the combat team com- mander. He may approve the initial location of the collecting station in some situations. The medical battalion commander must be kept informed of the location of the collecting company at all times. This may be done by motor messenger—most fre- quently by ambulances en route to the clearing station. Medical troops must be intimately associated with the combat troops. A collecting company must train with its combat team. To have a collecting company remain in camp during the tactical training of these combat troops and then expect these medical soldiers to render efficient medical support during maneuvers and combat is an over- sight that might easily be made by a commander. Medical troops will enhance the morale of the fighting man for he knows that his medical support will be given by officers and men who can withstand the same hardships and dangers as he, having trained with him from the organization of the combat team. Interest in training naturally lies with the fighting troops, but the medical game should always be played. In combat unattended wounded troops will lower morale and impede the progress of battle. In Camp. In garrison, camp, or bivouac, collecting companies may be called upon to furnish ambulance service for regimental and battalion dispensaries. In addition to routine training, the collecting companies may furnish the personnel for the interior guard of the medical battalion. Personnel trained in sanitation may be used to assist the division medical inspector in instruction on methods of insect control, and of garbage and waste disposal. However, these men are to be used for instruction, supervision, and inspection only and do not actually engage in the execution of the wor\. On the March. Collecting companies furnish personnel, transportation, and equip- ment for collection of march casualties. The method of collection of march casualties is dependent upon the type of march made. Casualties are collected by ambulances and are usually evacuated directly to the clearing station. Motor marches. When infantry troops are transported by truck, an ambulance may be detailed to follow in rear of each battalion, accompanying the attached medical troops. Casualties occurring are treated by the battalion medical section and are trans- ported by ambulance. Combined foot and motor marches. Ambulances are not attached to the medical de- tachments, but march collecting points may be designated prior to marches. March collecting points are merely points along the route of march, easily identified on a map and on the ground, where casualties may be assembled. These points are not manned by collecting company personnel, but are visited by collecting company ambulances, which traverse lateral roads when possible to lessen interference with the marching troops. Foot marches. March collecting posts are generally designated for care of casualties of foot marches. A march collecting post is a station along a route of march where attached medical personnel may transfer to the division medical service (collecting com- panies) such casualties as are unable to march. Each post is operated by one or more men of a collecting company, and is equipped with litters, blankets, and medical supplies. A supply of water is desirable. These posts are located adjacent to the route of march and are evacuated by ambulancees utilizing parallel routes, when available. When all units have passed the march collecting posts, and all casualties are evacuated the personnel manning them are gathered by ambulance and returned to the collecting company. Security Detachments. One or more ambulances with a few litter bearers may be de- tailed by one collecting company to accompany the cavalry reconnaissance troop of the division. These vehicles generally march with the radio equipped service elements of the troop. They may be dispatched to collect casualties by means of radio messages within the radio net of the troop. 712 MILITARY MEDICAL MANUAL When a large body of troops, such as a battalion, is sent out as an advance guard or a flank, or a rear guard, one or more ambulances may be detailed to accompany the medical section of such a unit. These ambulances will return to control of the collecting company upon cessation of the movement, or upon relief of the guard. Evacuation of Artillery Casualties. Collecting rarely establish contact with the aid stations of division artillery because medicaf detachments of division artillery are organically equipped with ambulances. Artillery casualties are normally evacuated directly from the artillery aid stations by their own ambulances. Casualties among artillery personnel are normally less than in infantry units, and the attached medical personnel of artillery are generally able to prepare and evacuate their casualties directly to the clearing station. When artillery casualties occur beyond the capabilities of their own transportation, collecting companies may be called upon to furnish ambulances to assist in their evacuation. Functions of the Collecting Company. The functions of the collecting company in combat are fourfold: (1) Contact. To establish and maintain contact with the medical detachments of combat troops—the regimental medical detachment of the infantry rifle regiment. (2) Treat. Establish and operate a collecting station, administering the treatment necessary to return minor casualties to their units, or to prepare more seriously injured casualties for further evacuation to the rear. (3) Evacuate. To relieve the medical detachments of casualties, moving these casu- alties to the clearing station or returning them to duty. (4) Transportation. Transport casualties to the clearing station. Plate 4. A 3/4-ton Weapon Carrier with Trailer (Collecting Company Transportation). Preparation for Combat. The preparation of the collecting company for its arduous service functions during combat is important. Essential features of this preparation are that vacancies in the company should be filled by requisitions for filler replacements. Company transportation, equipment, and individual clothing and equipment should be inspected, repaired, and checked by the company officers. Missing and unserviceable items should be replaced. All company property should be repaired and placed in the best condition possible. Missing expendible items of chests should be replaced. Addi- tional medical supplies and expendible items should be drawn from headquarters de- MEDICAL SERVICE OF THE DIVISION 713 tachment in anticipation of combat requirements. Rations and gasoline will be drawn at the time, place, and in quantities specified by division SOP. All unit identification must be removed from organization equipment and distinctive insignia must be removed. All papers relative to unit designations must be disposed of, and check made on vehicles to be sure no identifying papers are found in glove com- partments or unit identifying numbers painted on surface. Medical department chests, quartermaster issue buckets, kitchen mess washing cans, gasoline containers, and other galvanized equipment must be darkened in order to avoid reflections of sunlight or night flares. This may be satisfactorily done by applying to the clean galvanized surface (for no longer than five minutes) a mixture of 5% copper sulfate in household vinegar. The mixture must be carefully washed off at the end of 5 minutes. The appearance should be a dull dark grey. Should the first coat be too light the process may be repeated. Care should be exercised to prevent the mixture from corroding the entire thickness of the galvanized coating. This coating is much more satisfactory than paint which chips and blisters. Orders. The company commander receives his orders either from the medical battalion commander or the combat team commander depending upon whether the company is operating as part of the battalion or as attached to a combat team. Orders are either oral or in the form of written messages. Most generally they are oral-dictated or fragmentary. SOP is not mentioned in orders unless to make a variation of it. Orders given by the company commander are oral, unless a written message is utilized to transmit an order to a detachment of the company some distance away. Plans. Routine plans for operation of the company should be written as company SOP. Such details as loading schedules for transportation of equipment, the designa- tion of where personnel are to be transported in the company vehicles, and location of vehicles in the column should be set forth in this document. With SOP as a working basis, the company commander may make plans for general employment of his company, knowing details of the execution will be carried out without mention. In anticipation of forward or rearward displacement of his unit, the company commander must have several plans for location of his installations based upon map studies and ground reconnaissances. Each plan must include location of the collecting station, the basic relay post, the ambulance shuttle, and probable litter routes for the evacuation of the aid stations. Recommendation for the location of a collecting station should be submitted to a combat commander for approval to avoid conflict with other units operating in the area. Sites which are suitable for the station (see subsequent paragraph) are fre- quently required for artillery positions, engineer dumps, or for reserve troops. In case of conflict, combat troops have priority. Therefore, medical officers should be prepared to recommend alternate areas for the location of these medical installations. Before making a recommendation for the location of a station, the officer responsi- ble should make at least a map study. Ground reconnaissance is much to be preferred, but time may not permit it. Situations may arise where either the division surgeon, the medical battalion commander, or the collecting company commander will have to recommend the location of the collecting station. The division surgeon is the staff representative of the medical service. He usually would make the recommendations to G-4 for the location of all division medical installa- tions. However, he should consult the medical battalion commander before such action is taken. Under some situations the battalion commander might deal directly with G-4. In a meeting engagement (development from a march) or in a tactical situation where a combat team is making a wide envelopment or encirclement, speed of action is essential in locating a collecting station. In such situations the company commander will generally initiate action by recommending the location of his collecting station to the combat team commander, informing his medical battalion commander of the approved site of this installation. In some rapidly moving situations, the company commander may have to establish station and then request approval of its location. Location of a Collecting Station. Since a collecting company must evacuate aid 714 MILITARY MEDICAL MANUAL stations of the infantry, the most important factor in determining the location for a collecting station is the position of these several aid stations. This entails a knowledge of infantry battalion boundaries and a map study or reconnaissance of a narrow belt of terrain some 500 yards to the rear and paralleling the line of departure or main line of resistance, in order to determine the probable location of aid stations. In a prepared attack or prepared defensive position this information may frequently be obtained in advance. In a meeting engagement, such advance information of combat elements may not be available, but usually fairly accurate deductions may be made. In such situations it may be advisable to move the collecting company initially to a concealed position and hold it in readiness to advance to position after the tactical situation has developed and aid stations have been located. Desirable sites: A position intercepting the natural lines of drift of the wounded is desirable. Wounded men who are able to walk make their way to the rear seeking treatment. Some follow the only route they know, which is the one over which their organization advanced, even though it is exposed to hostile fire. Others instinctively avoid enemy observation and fire, particularly machine gun fire, by following ravines, stream beds, and other defiladed byways. These routes are known as the natural lines of drift of wounded, and must be considered in the location of all medical installations near the front. A location with sufficient defilade from elevations of terrain, for protection from direct small-arms fire and from flat-trajectory artillery fire, is required for protection of personnel and equipment. A distance beyond the effective range of hostile artillery fire renders a collecting station useless. Cellars, brick, concrete or stone buildings may be utilized. In stabilized situations dugouts may be constructed. Positions in woods or beneath cover not under direct enemy observation should be sought. Concealment is essential. The location medical installations afford the enemy a reliable index to other troop dispositions of the division. Do not underestimate the intelligence of your enemy. Camouflage your unit. A medical soldier or a medical truck looks like any other military unit from a distance. Don’t reveal your medical unit’s location by careless camouflage discipline. Reduce to a minimum the distance of the litter carry. The average carry should not be more than 1500 yards. Increase of this distance reduces the efficiency of casualty collecting. Do not locate so far forward as to become involved in minor fluctuations of the line. Locate near the center of the zone of action or the sector of the combat team. This will equalize the distances from the several aid stations, and is extremely desirable unless there be urgent reasons to the contrary. Probable areas of casualty density must be considered. The site selected must be accessible to ambulances. However, blocked or destroyed roads, or intensity of enemy fire may prevent ambulances from reaching the station for varying periods. In extreme situations ambulances may be able to evacuate the collect- ing station only at night. Considerable accumulations of wounded may occur. The site must be sufficiently large to permit parking and movement of motor vehicles and the dispersion of personnel and evacuees. Firm ground is essential. A site adjoining a supply of water is desirable but not essential, for among the col- lecting company equipment is a 250 gallon water trailer. One must consider that the location of a collecting station will depend upon the ter- rain, the road net, the enemy capabilities and the nature of the operation (attack, de- fense, etc.). No fixed rules can be laid down, but certain guides may be followed. A collecting station should rarely be nearer than 1200 yards from the front line, nor should it be farther than 3500 yards from that line. It should be near the center of the zone of action in a lateral direction, other things being equal. Undesirable sites: A location which permits enemy observation and fire should be avoided. Positions so close to the firing line that they permit the station to become involved in minor fluctuations of the infantry combat positions must be avoided. Close proximity to bridges, fords, important crossroads, ammunition distributing points, artil- MEDICAL SERVICE OF THE DIVISION 715 lery and heavy weapons positions must be avoided to prevent destruction of the station by enemy fire directed at those targets. Average location: Bearing in mind exceptions to the foregoing guides, an average location for the location of a collecting station may be described as a concealed and protected position about one mile from the front line, not adjoining any possible enemy targets, equidistance from the lateral boundaries of its zone of action, and on or near a road leading to the rear. (See Plate 1.) Movement of the Company to the Collecting Station Site. Under many situations the company commander will be forward completing his reconnaissance for the location of the collecting station when the company moves forward with the combat team march column. Prior to his leaving the company bivouac area the company commander will know what time the combat team march column will leave the bivouac area and what route the column will follow. After completion of his reconnaissance the company commander may return and guide the collecting company forward to the site he has chosen for the station, but frequently he will send a guide back to meet and direct the company into the site he has chosen. He can utilize additional time in studying the terrain, planning for sites for establishing departments of the station, parking and camouflaging of transportation, and obtaining contact with the infantry aid stations. The company will move forward by motor in open column, or by infiltration, depend- ing upon the division SOP and the decision of the division commander. Frequently occupation of positions will be made under cover of darkness exercising complete black- out precautions. Close supervision by officers and noncommissioned officers is required to maintain camouflage discipline. At night troops must avoid revealing positions by unauthorized display of lights, or by leaving foot or vehicular tracks during the night which will reveal positions when viewed from the air by day. Establishment of the Collecting Station. Unit training and company SOP should permit the establishment of the station within a very few minutes. The collecting station personnel should be dispersed to limit the number of casualties occurring from a single shell or bomb burst and may be organized into the following main departments: Receiving and property exchange Litter wounded Walking wounded Forwarding and property exchange (where a numerical record of patients is kept on a blotter) The company command post and message center are preferably located near the re- ceiving department. The kitchen generally continues to operate inside the 21/2-ton truck. It prepares hot drinks for the patients and mess for the personnel. It may move to the basic relay post occasionally to mess the ambulance and motor maintenance personnel who are gathered there. A place removed from line of vision of the station must be set aside for a morgue. Gas casualties must be treated in a place removed downwind from the collecting station. Certain station personnel must be designated to treat these casualties. Receiving department and property exchange. Patients arrive at the receiving depart- ment as two main groups; Litter wounded and walking wounded. These casualties may occur in approximately equal numbers. These two general groups are separated for treatment. A medical officer of the station platoon may work at the receiving depart- ment. He quickly examines each evacuee either by inspection or by reading the emer- gency medical tag. He makes a diagnosis and may render urgent emergency treatment. He directs walking wounded to their treatment section, and determines priority of treat- ment of litter wounded by directing station personnel to carry them to the litter wounded department. A noncommissioned officer, usually the Staff Sergeant (Platoon Leader), supervises the litters, blankets, and splints at the receiving department. He checks all litter squads to be sure that they are executing a correct property exchange. In the absence of an officer he will establish priority of treatment and directs walking wounded to their treatment section. Persistent gas casualties must be shunted to the gas treatment section and prohibited from entering the station proper. Litter wounded department. Patients should be prepared for evacuation by these per- 716 MILITARY MEDICAL MANUAL sonnel. However, all treatment at a collecting station is based upon the most good to the greatest number. A large percentage of patients will arrive in good condition having been adequately treated at aid stations. They will require little additional treatment before evacuation. (However, patients may arrive who have received inade- quate treatment because of having been missed by aid station personnel, because of rapidity of action.) Patients may arrive at a collecting station without having received adequate treatment but a patient should never leave a collecting station without having received a secure splint, an adequate -dressing, or other necessary emergency treatment. Plate 5. Receiving: Department of a Collecting Station. (Patient on a Wheeled Litter). Plate 6. Litter Wounded Department of a Collecting Station. MEDICAL SERVICE OF THE DIVISION 717 All patients are examined, checked, dressed or redressed as necessary. Only simple emergency operative procedures are executed at a collecting station. Tourniquets found on patients are removed and hemorrhage controlled by a more permanent hemostasis. The personnel of this department may be a medical officer, a noncommissioned officer, technicians, and privates necessary to assist in the preparation and administration of hypodermics, assist in the operation of shock litters, and assist in general. A sub- section of the litter wounded department may be necessary for the treatment of surgical shock. Patients in shock may be treated in groups by elevation of the foot of their litters on medical chests or lantern crates. By means of blankets and canteens (dis- carded by causualties) filled with hot water, heat may be applied. Lighted lanterns placed beneath the elevated litters have been used in the administration of heat. Plasma may be administered if available. Plate 7. Shock Treatment in a Collecting Station. Three blankets may be made to provide four layers under and over the patient in the following manner. Place the first blanket on the litter lengthwise so that its long edge corresponds to one pole of the litter, and fold it once back upon itself until the folded edge falls atop the opposite pole. Place the second blanket lengthwise upon the litter so that its long edge is atop the folded edge of the first blanket. Fold the second blanket back upon itself once until its fold is above the litter edge of the first blanket. Place the patient upon the litter atop the doubled folds of the first two blankets. The third blanket folded lengthwise once is placed over the patient. The free edges of the two lower blankets are then brought atop the third blanket giving 4 layers of blanket beneath and 4 layers of blanket atop the patient. Walking wounded department. Triage, or separation of walking wounded from malingerers and those suffering minor injuries is most important. Medical officers op- erating such departments must quickly separate those who need treatment from those seeking excuses to avoid remaining in the combat area. Slightly wounded not requiring further evacuation should be given necessary dressings and medication and returned to their organizations. Malingerers may be instructed to return to their organizations, or if particularly troublesome may be turned over to military police for return to their organizations. Some divisions have the military police call at collecting station sites on routine scheduled hours. Other units will collect stragglers and malingerers at points 718 MILITARY MEDICAL MANUAL along a “straggler line” generally in rear of collecting stations. Walking wounded requiring treatment prior to evacuation are given required treatment by personnel in this department which generally consists of one medical officer, a noncommissioned officer, and one or two technicians or privates. Forwarding department and property exchange. A noncommissioned officer operates the forwarding department. He has sufficient enlisted personnel assisting him to load the ambulances and keep an informal blotter record of casualties handled by the collect- Plate 8. Walking Wounded Department of a Collecting Station. ing station. The man operating this department must supervise a correct exchange of blankets, splints, and litters between the ambulances and the collecting station. He will supervise the loading of walking wounded and litter wounded, giving priorities to cases as determined by station personnel. He must instruct ambulance chauffeurs or orderlies relative to place of delivery of written messages and requisitions for medical supplies carried by them on their trip to the rear. He must also check with ambulance personnel for any supplies they may have brought with them on their forward run. Patients with communicable disease, and those who are casualties from persistent gas must be segregated and evacuated by separate ambulances. It is essential that the noncommissioned officer at the forwarding department super- vise the exchange of property between the company ambulances and the station. He checks the ambulance orderlies and chauffeurs in their transfer of litters, blankets, and splints to the station in exchange for those loaded into the ambulance with evacuees. The record kept at the forwarding department is merely numerical. No form is specified in regulations for this record. It may be merely a pencil tabulation in a notebook. It should be sufficiently complete to inform higher authority at any time of the number of casualties evacuated. The detail required in such reports will be designated by the division commander. However, the personnel of a collecting com- pany is not of sufficient number, nor is it organized to keep voluminous and detailed records. Adding the burden of administrative detail will retard the speed of evacua- tion without adding to information that might well be secured from the clearing station or medical detachments with combat troops. , The command post and message center. The command post and message center are considered together inasmuch as the former is served by the latter. They should be MEDICAL SERVICE OF THE DIVISION 719 located out of the way of patients being moved through the station. The command post may be placed in the station site where it will be camouflaged, yet convenient. The message center is best placed near the receiving department, where the man operating the message center can ask each litter bearer squad or walking wounded man whether he is carrying a message for the station. Men should be instructed to ask this of each group or individual, for frequently in the stress of battle men forget they are carrying messages in addition to their other duties. The message center receives and transmits written messages and papers pertaining to medical units in the chain of evacuation; occasionally official documents pertaining to other units. Messages sent from the collecting station should be sent to the message center in duplicate. The message center will make a record of the time forwarded on a “message center log,” an informal paper which aids in determining whether all messages forwarded nave been received. Plate 9. Forwarding Department of a Collecting Station. The original copy of the processed message is forwarded to its destination together with a message receipt. The duplicate of the processed messages is held in a live file— a large envelope—until such time as the message receipt is returned. Upon return of the signed message receipt the number recording the message outstanding is checked off and the duplicate message is placed in a dead file—another envelope. The message center records are usually closed at hour 2400, and the message center log and dead messages of each 24 hour period are forwarded to the medical battalion adjutant for inclusion in the historic records of the battalion. Kitchen. With the modern quartermaster gasoline fired stove units a mobile supply of hot drinks may be kept for patients at all times. In most situations it is advisable to keep the kitchen loaded and operating inside the body of its truck, for loading or unloading of stove units in operation is extremely hazardous, and would have to be done frequently in rapidly moving tactical situations. In situations where ambulance evacuation is extremely slow, nourishment may be administered at a col- lecting station. With personnel of the company scattered from battalion aid stations to the clearing station, the ingenuity of the company commander, the mess officer, and the mess sergeant must be exercised to the maximum to feed the company. Food may have to be distributed in food containers, but in actual combat, “C” ration or other concentrated rations may be distributed to the troops. 720 MILITARY MEDICAL MANUAL Morgue. This is merely a place designated where those who die at the station are placed until they can be taken over by quartermaster or unit burial details. It should be placed out of sight of evacuees passing through the station. Gas treatment section. Should gas be used by the enemy in the zone of action of the combat team, treatment must be begun by collecting company personnel until reinforce- ments arrive to take over this work. A limited amount of gas casualty treatment equip- ment is available in collecting companies, and personnel to administer treatment must be improvised from personnel within the company, as none is authorized for this section. When operating, this section must be set up downwind from the station, and separate ambulances must transport all evacuees suffering from persistent chemical agents. Gas treatment battalions, (G.H.Q.) are attached to combat areas where gas is used extensively. They are organized and trained for this type of work. (See T/O 8-125.) Such a battalion is composed primarily of three gas clearing companies. A platoon of one of these companies may establish an installation in vicinity of the collecting station. Decontamination of persistent agent casualties must be performed rapidly to avoid extensive injury. Personnel caring for this type of casualties must wear special pro- tective clothing and gauntlets in addition to their gas masks. In absence of ambulance reinforcements certain ambulances must be designated to transport all gas casualties, and these vehicles must be decontaminated upon completion of this service. They should be driven with windshield and rear doors tied open to insure adequate ventila- tion when hauling persistent agent gas casualties. Plate 10. Contact Agent Describing Location of an Aid Station to Collecting Company Commander. The Liaison Section. The responsibility for contact (liaison) with units supported is a responsibility of the collecting company commander. There is authorized for a collecting company a sergeant who is designated liaison agent sergeant. He is generally employed to keep track of the contact agents. Other members of the liaison section must be improvised from personnel within the company. Any personnel may be used, but judgment should be exercised so as to not remove any personnel from key positions in the company. Men chosen as contact (liaison) agents should be intelligent and resourceful, trained in the use of maps and compass, and they must be able to move across terrain using it to advantage in order to avoid becoming casualties. There are two major means for original employment of contact (liaison) agents. MEDICAL SERVICE OF THE DIVISION 721 They may be transported with the company to the collecting station site from where they are dispatched forward to find the aid stations. Upon finding the aid station to which dispatched, an agent will return to the collecting station, report his findings, and guide the litter bearers forward. The other method is to inform the agents of the contemplated location of the collecting station and detail the agents to the attached medical sections prior to leaving the combat team assembly area. In this method the agents will return to the collecting station which may be easier to find because of its larger size. They will then act in a manner similar to the first method by telling the company commander the location of their aid station, and guiding forward litter bearers to evacuate it. Upon return to the aid stations the contact agents remain with the battalion surgeon keeping the collecting company commander informed of the situation. They transmit pertinent information to the rear by written messages transported by litter squads. Messages of special importance are usually sent in duplicate by two different squads, the duplicate copy being clearly marked “duplicate.” Occasionally ambulances may be used as a means during operation of advance ambulance shuttles. Rough sketches completely labeled may be clearer than detailed written information. Walking wounded may be used as a delivering agency when no other means are available, but they cannot be considered entirely reliable. The Collecting Platoon. This unit is composed of a litter bearer section and an ambulance section. Current tables of organization authorize a medical administrative corps officer (or warrant officer) as platoon leader and place him in the ambulance section for operation. Plate 11. Litter Relay Post. Transfer of Evacuee From Hand Carry to a Wheeled Litter. The Litter Bearer Section. Litter bearers are used to transport patients between bat- talion aid stations and the collecting station when motor vehicles cannot be used for this evacuation. The assembling of litter cases at the collecting station is a slow pro- cedure. An additional duty of this section is to clear the field of wounded when the tactical situation has been such that attached medical units have neglected clearing the field in order to keep up with their attached units. A squad of four litter bearers ordinarily accomplishes quicker evacuation than two man squads because the labor involved is exhausting. Two bearer squads may be 722 MILITARY MEDICAL MANUAL efficient for short litter carries when they are not required to make many trips. As- suming that the average distance between the collecting station and an aid station is 1200 yards a litter bearer squad will require one hour per round trip. However, the time actually required is dependent on many factors such as inclement weather, mud, rough ground, density of undergrowth, time of day or night, intensity and type of enemy action, and the fatigue of the litter bearers. Some means within the company are available to assist in reducing the time of litter collection. Wheeled litter might be used where roads or smooth terrain permits, and litter relay posts may be utilized to shorten the haul and permit frequent rests of bearer squads. (See Plate 11). An advance ambulance shuttle operating between the collecting station and advance ambulance loading post, or even to a battalion aid station at night or during lulls in enemy activity, will greatly speed evacuation. Displacement of the station forward will of course aid in speeding either type of evacuation. When authorized by the commander, prisoners of war may be used to supplement company personnel. The litter bearer section leader, a sergeant, is in charge of the litter bearers. He has a corporal to assist him. He details squads to accompany liaison agents forward to battalion aid stations, organizes litter relay posts as directed, and supervises work of his section. He maintains close contact with litter bearer squad leaders and keeps the company commander constantly informed of the condition and operation of his bearer section. The Ambulance Section. The most important function of the ambulance section in combat is to transport casualties from the collecting station to the clearing station. When opportunities are afforded it also evacuates battalion and regimental aid stations directly. It also may be used to transport messages during employment of its am- bulances and may also transport medical personnel and supplies in addition to casual- ties. It also transports the litter bearer section of the company, and furnishes the transportation necessary for the collection or march casualties. The collecting station is generally established at a point accessible to ambulances. Local conditions may prevent the approach of ambulances to the station over a period of several hours, and on account of enemy activity it may be impracticable to reach collecting stations except at night. It is desirable to conserve the strength of the litter bearer section by hauling them to the collecting station site. When this is done vehicles may move forward and rearward by infiltration to avoid aerial observation and attracting enemy artillery or aircraft bombardment. Drivers must be trained to avoid making obvious and un- necessary tracks that might be picked up on enemy airphotos. The ambulance shuttle. Generally one empty ambulance is camouflaged and placed at the collecting station forwarding department, which is known as an ambulance load- ing post (ALP). It moves to the rear when fully loaded with evacuees. One or more groups of two ambulances each are placed behind the collecting station at distances of 150 to 600 yards between groups. These grouping of 2 vehicles are known as an am- bulance relay post (ARP). The remainder of the vehicles are gathered in a defiladed position with overhead cover, or are camouflaged. They should be well dispersed to prevent more than one being destroyed by a single shell or bomb. The place where these vehicles are parked is known as the basic relay post (BRP). (See Plate 13). Basic relay posts are generally 600 yards to 2 miles behind the collecting station. The shuttle may be established either by dropping vehicles off at the points designated as relay posts on the trip forward to the collecting station, or it may be established when the vehicles have discharged their loads of litter bearers and are headed back to the basic relay post. The latter method is advantageous in that it gives the ambulance drivers an opportunity to see the location of the collecting station. However, it requires each driver dropped at a relay post to turn his vehicle about on the road in order to be headed toward the collecting station. As an ambulance loaded with evacuees leaves the collecting station (ALP) it moves directly to the clearing station. As it passes relay post(s) on the way to the rear its passage is the signal that another vehicle is needed forward. Upon noting the approach MEDICAL SERVICE OF THE DIVISION 723 of the rearward bound ambulance each vehicle in the shutde moves forward one place, occupying the position previously occupied by the vehicle in front of it, until the place at the collecting station site (ALP) is reached. At the ALP patients are loaded, property is exchanged, and as soon as the ambulance is loaded it again moves to the clearing station on another round trip. The reservoir for ambulances is at the basic relay post (BRP) to which all vehicles having completed a trip to the clearing station return. At the basic relay post the Plate 12a. Ambulance 3/4-Ton 4x4. Used For All Infantry and Motorized Divisions and in Corps and Army Medical Units. Plate 12b. Inside View of 3/4-Ton 4x4 Ambulance, Heater is Obscured by Ambulance Orderly’s Seat. 724 MILITARY MEDICAL MANUAL ambulances are serviced, the personnel are rested, and usually the motor maintenance personnel operate in their maintenance capacity. Personnel may be messed at the BRP by moving the kitchen to them from the collecting station, or they may be fed in relays by moving forward to the kitchen at the collecting station site. Advantages of the shuttle system. This system places ambulances at the collecting sta- tion at the rate at which they are loaded and dispatched. It permits a steady flow of patients through the collecting station to the clearing station. It avoids the unnecessary massing of transport in the forward areas. It minimizes the danger of damage to ambulances by the enemy. It permits the commanding officer to control his company, enables him to extend its activity without advancing the ambulance station, and affords a reserve which is easily manipulated. It facilitates administration and maintenance during combat by withdrawing these activities farther from the front. It permits the use of ambulances as necessary to operate the shuttle without employ- ment of the entire section. The remaining ambulances may then be used for specific calls or in convoy for particular situations. Forwarding medical supplies. The ambulance section is used as an agency during com- bat to forward medical supplies required for current replacement by the collecting company and aid stations in its zone of action. Drivers deliver messages (informal re- quests) asking for supplies to the clearing station message center. The request is then delivered to the Headquarters Detachment which furnishes the supplies. These sup- plies when assembled are forwarded on the next returning ambulance which, on reach- ing the ambulance station, transfers them to the first ambulance moving forward from that station. This is repeated at each subsequent relay post until the supplies reach the collecting station. It is occasionally possible to deliver medical supplies direct to aid stations. Ambulances normally are not diverted from their prescribed routes for the delivery of supplies. This method of forwarding medical supplies is only used when the Headquarters Detachment cannot transport the supplies in its own vehicles. Transmission of messages. It is the responsibility of noncommissioned officers and drivers to see that all messages entrusted to them are delivered with no unnecessary delays. Messages must be transferred from the driver first receiving them to the first driver moving out from the ambulance station or relay posts. The man in charge of an ambulance control point examines all messages carried by ambulances arriving at his post from the rear. If necessary, he holds the message until an ambulance passes his post going to the point addressed. Ambulances are not diverted from their prescribed routes for the transmission of messages. Advance ambulance shuttle operation. At night and frequently during lulls in enemy activity ambulances may be used forward of the collecting station to speed evacuation of casualties. For installation of advance ambulance shuttles vehicles are brought from the basic relay post (BRP) to avoid interference with the ambulance shuttle already operating in a satisfactory manner. Two ambulances may be operated between an aid station and the collecting station. Drivers and orderlies of these vehicles must be shown the location of the aid station to be evacuated and given forward landmarks, to prevent their movement into the area of enemy occupation. Patients are loaded into these ambulances by litter bearers of the collecting company, property is exchanged with the aid station, and patients are trans- ported to the receiving department of the collecting station. To speed evacuation the following procedure has been found very successful. The driver who has just brought these patients to the rear dismounts, and his place is taken by a driver who has brought an empty ambulance forward. The patients are then driven to the clearing station by a different driver—one who has been operating in the ambulance (rear) shuttle. (This system compares with the passengers riding in the same pullman car who are taken across the United States by different engineers who transfer at various railroad terminals.) This driver transfer scheme permits the utilization of drivers DRIVERS Patienbs Checked FIGURE 2. OPERATION OF AN ADVANCED AMB ULANCE SHUTTLE TO A BATTALION . . AID STATION. NOTE DRIVER EXCHANGE WHICH KEEPS EXPERIENCED DRIVERS ALONG ROUTE TO AID STATION. THIS BREAK REPRESENTS A DISTANCE 2™4.MILES FIGURE !. AMBULANCE SHUTTLE ESTABLISHED FIGURE 3. USE OF AMBULANCE CONTROL POINT MANNED BY ONE ENLISTED MAN Plate 13. Operation of Ambulance Shuttles. 726 MILITARY MEDICAL MANUAL familiar with the roads and terrain forward of the collecting station and speeds evacua- tion by preventing unnecessary transportation of patients between different ambulances, A quick check at the collecting station should be made by a medical officer during the interim of exchange of drivers to observe whether any evacuees have died on the trip between the aid station and the collecting station. Should an evacuee in an ambu- lance moving rearward from the aid station to the clearing station be found in such condition as to render continuation of his journey beyond the collection station a poor risk, he should be removed from the ambulance at the collecting station, and given appropriate treatment. Empty space created by removal of evacuees at the receiving department should be filled with evacuees at the forwarding department, and ambulances should be dispatched to the rear only when full payloads of patients are available, unless lack of additional evacuees prolongs a reasonable delay in time of dispatch. Disposition of empty ambulances. Upon completion of the trip to the clearing station the ambulances are returned to the basic relay post. The operation of vehicles at the basic relay post, and in the relay, is similar to that of taxicabs at a large railroad sta- tion or in front of a theatre at the end of a performance. The most recent arrivals take their place at the rear of the vehicular line and move out for a haul when their turn comes. Those ambulances most recently completing trips have the longest rest period before beginning the next run. Control of ambulances at the clearing station. At the clearing station ambulances of other collecting companies, from the engineer combat battalion, and from artillery battalions will also be arriving with casualties. Much confusion may occur and in times of action property exchange may go amiss in the turmoil. Bearing these conditions in mind, during such times of duress it is sometimes desirable for a noncommissioned officer representative of the collecting company (Ambulance section) to remain back at the clearing company to check on the arrival of his collecting company ambulances and to check the property exchange between the clearing station and his company ambulances. He can also supervise dispatching of messages and medical supplies to his company, and assure delivery of messages received. Special Operations of a Collecting Company. (1) Retrograde movements. In retro- grade movements the immediate problem confronting the collecting company com- mander is to evacuate the greatest possible number of casualties in the shortest possible time. This is accomplished by advancing ambulances to aid stations, or when this is impracticable, to advance ambulance loading posts forward of the collecting station site where patients are brought by litter bearers. Another means to supplement evacua- tion is to utilize trucks when available. Many more patients may be hauled in trucks than in ambulances, i.e.: 21/2-ton truck can haul 18 litter cases; 1 l/2-ton truck can haul 12 litter cases, and a %-ton weapon carrier may haul 5 litter cases when wooden cross- pieces are laid between the side seats. Patients may be hauled to the clearing station or to an entrucking point where they are transferred to army ambulances, trucks, or to other available transportation for movement to an evacuation hospital. (2) Night withdrawals. To reduce litter carry at dark, vehicles are advanced as far ahead of the collecting station as the situation permits. Ambulances are usually de- tailed to infantry units for the movement, and after the withdrawal has begun casualties are handled as in any march. (3) Delaying action. The collecting company commander assigns sufficient ambu- lances to support the covering force. Ambulances should be used to the fullest extent practicable in front of the collecting station. The support of the withdrawal elements will conform in general to methods described above. (4) Retirement. Ambulance service is provided for the covering force or rear guard as in withdrawals. March collection is provided for the main bodies as for a march. Medical vehicles generally march between the main body and the rear guard. Evacua- tion is accomplished by parallel roads and during halts when practicable. Relief of a Collecting Company at Station. When a collecting company at station is to be relieved, the commanding officer of the relieving collecting company will bring his key personnel forward and, accompanied by the commander of the company in MEDICAL SERVICE OF THE DIVISION 727 Figure 1. A 2y2 ton cargo truck loaded with 18 litter patients. Figure 2. A IV* ton cargo truck loaded with 12 litter patients. Figure 3. A % ton weapon carrier, showing how 4 litters may be carried. (It 2x4 lumber is placed across the seats a fifth litter may be carried. Plate 14. Utilization of Trucks for Emergency Evacuation of Patients. (See Chapter VII, Part III) 728 MILITARY MEDICAL MANUAL operation, will make a reconnaissance of the area of operation. He will note the location of the collecting station, aid stations supported, litter routes, ambulance relay posts, and basic relay post. Local orders and maps are transferred. The relief is effected at the time and by routes prescribed in orders. Casualties in process of evacuation at the time of relief should be transferred to the relieving organization at the time of the relief. Introduction. Clearing is the process of disposing of the casualties of a division or comparable unit. It consists of sorting all casualties of the unit, returning to duty such as are immediately fit for full duty, and transferring all others, except the dead, to a medical unit of a higher echelon. It is not to be confused with hospitalization. A clearing unit is necessary to complete the service rendered by other units of the medical service of the division. Collecting stations are located too near the front to permit their being equipped for the thorough treatment of shock or for the preparation of patients for extended evacuation. Nor can there be operated at collecting stations the clerical force necessary in the preparation of reports and returns required by the com- mander, or individual records of patients. A clearing unit is primarily a combat organization. Its principal function in combat is to operate one or more clearing stations at which casualties are received, sorted, given temporary care and emergency treatment. It also completes individual records of patients. A clearing unit is primarily a combat organization. Its principal functions is to operate in combat one or more clearing stations at which casualties are received, sorted, given temporary care and emergency treatment, and when indicated, prepared for further evacuation and transfer at the clearing station to a medical unit of a higher echelon, usually an ambulance unit of the army medical service. A clearing station is an installation established by a clearing unit for the purpose of discharging the functions of clearing or triage (sifting). Accordingly, casualties received are sorted and classified as follows: (1) Those who require prolonged care and are fit for immediate evacuation. (2) Those requiring prolonged care but needing immediate treatment before evacuation is possible. (3) Those who are probably returnable to duty within a few hours—the number depending upon the necessity of keeping the clearing station free for movement. In an infantry division the clearing station is the rearmost installation of the division medical service. It is essential that all casualties from the infantry division pass through the clearing station to insure that no casualties are evacuated from the division area who should be returned to their organizations for duty. There are no ambulances in a clearing company. Inasmuch as no vehicles are available to move patients, the number of patients at the clearing station is held to a minimum in order to keep the clearing station free to move on short notice. The functions of a clearing station are similar to those of a collecting station. The principal difference between the two installations is that because of more elaborate equipment and a more favorable location, the clearing station is able to undertake slightly more elaborate treatment and measures essential to further evacuation of casualties than are impracticable or impossible in a collecting station. Unlike the commanders of other subordinate elements of the division medical service, the duties and responsibilities of the clearing unit commanders are restricted largely to the establishment and operation of the clearing station. Equipment of a Clearing Company. A clearing company of an infantry division is equipped to care for 230 litter patients and at least as many embulatory patients simultaneously. Such a company has two platoons, and each platoon—the basic unit— can care for 115 litter and as many or more ambulatory patients at the same time. Al- though designed for the care and treatment of all classes of casualties, particular pro- visions have been made for the needs of emergency surgical cases. Although major surgery in combat will be cared for primarily by mobile surgical Employment of the Clearing Company MEDICAL SERVICE OF THE DIVISION 729 hospitals or motorized evacuation hospitals, provisions are made in the clearing company for needs in the treatment of emergency surgical cases when these more elaborately organized units are not available for immediate support. Instrument sets, including thoracic, craniotomy, laparatomy, and orthopedic instruments, are rolled in canvas containers and packed in standard medical chests. A number of chemical heating pads are carried as substitutes for other forms of heat in the treatment of shock, although a limited number of hot water bottles are available. There are also 2 auxiliary gasoline powered electric lighting plants, with surgical lamps, electric light bulbs, and sufficient wire to install electric lighting in buildings or tents, should commercial current not be available. All equipment and articles of medical supply are packed in standard containers and consist basically of multiples of standard medical department field equipment, specialized equipment, and miscellaneous supplies. In each platoon there are 15 canvas folding cots and 100 litters. This gives an aggre- gate of 30 cots and 200 litters in the company. There is sufficient metal mess equip- ment in the company to feed simultaneously about 100 evacuees. Since most walking wounded and many litter wounded will have their own mess equipment with them, mess equipment for these personnel will be no problem. The transportation of a clearing company, medical battalion (T/O 8-18) is extremely limited. With such a small number of vehicles and trailers, the problem of transporting the clearing company equipment and personnel will probably be solved by one of the following methods, or by a combination thereof: (1) Equipment transported on trucks and trailers, and personnel walk. (2) Equipment transported on trucks and the personnel scattered throughout the remainder of the battalion, especially in ambulances of the collecting companies, for movements of the medical battalion as a whole. (3) Shuttling one entire platoon including equipment and personnel, with the com- bined transportation of the entire company. This method is especially useful when one platoon is functioning at station, and the other platoon is being displaced or “leap frog- ging” the operating unit. Employment of the Clearing Company. The clearing company is an integral part of the medical battalion. Its technical and tactical employment rests, therefore, with the medical battalion commander. The clearing company renders no medical service while marching. When large bodies of troops of the division are marching it is necessary to provide temporary professional care for the sick and injured. This is usually accomplished in march camps by the establishment of one of the clearing platoons at station. On the March. A clearing company (platoon) is at station when it is established and ready for operation. When command marches, and other professional care is not avail- able, a clearing platoon remains at station for the reception of march casualties until the platoon accompanying the division troops has established station at the new bivouac. In retrograde movements, clearing stations should be evacuated before the command marches, and subsequently employed according to the tactical situation. When the company is split, that is, when it operates the two platoons independently, there is suffi- cient personnel and equipment in company headquarters to permit the operation of two messes, and each platoon may mess independently of the other. In Combat. When combat is imminent, one or both of the platoons of the clearing company are established at station within the division zone of action. If one platoon only is established, then the other is initially held as a reserve. The number of casualties received, and the rapidity of the advance of the combat troops will determine the subse- quent use of the reserve. In mobile warfare it may be necessary to move clearing stations daily or oftener. However, clearing stations are not moved as frequently as the collect- ing stations of the division. The Station. Regardless whether the company is operating as a whole or as two platoons, the equipment of the company is grouped for operation into an admission department, a walking wounded, a litter wounded, and a forwarding (evacuation) de- 730 MILITARY MEDICAL MANUAL partment. There is also a shock section, a waiting section, and of course the usual sanitary installations and a kitchen. In the plan of operation for such a company it is essential that an orderly plan for admitting, sorting, treating, recording, and evacuating patients be envolved. Pro- visions must be made for expanding the unit, with utilization of both platoons of the company, or for the cooperative action with other clearing companies, such as those sent as reinforcements from army medical regiments or Cl HQ gas treatment battalions. Plat Hq Clr Sta Off Supply Receiving Awaiting Treatment Awaiting Treatment Dispensary Laboratory Dental Shock Treatment Litter Patients Walking Patients Evacuation Ambulance turn around Basic unit Reserve tents established as necessary Markers—dis- tances in paces LEGEND Evacuation Road to Hospital Plate 15. A Ground Plan for Clearing: Station, Infantry Division. It is essential that systematic methods which have speed and precision be developed in order that unloading and loading of equipment from and on trucks and trailers be accomplished without delay, that pack and unpacking of equipment and supplies be done with dispatch, that officers and men know how to install the various units of equipment, and that personnel be trained in the erection and striking of the large ward tents. Such training should be initiated and carried out by means of a company SOP. This procedure will eliminate many oral orders and detailed instructions. It will be extremely helpful when operating under duress. MEDICAL SERVICE OF THE DIVISION 731 The apportionment of personnel shown in T/O 8-18 is based on the duties which must be performed in order that the unit may perform its combat service functions. Flexi- bility within the organization is necessary and demands the shifting of personnel from one duty to another as circumstances require. It is a function of the company com- mander to train personnel by temporary interchange in departments so that emergencies can be met successful without undue embarrassment. Location of a Clearing Station. Obviously a clearing station cannot be set up at a place without consultation and authorization. Inasmuch as the clearing station is a division medical installation, it comes under the jurisdiction of the General Staff Officer, G-4. Through an exchange of opinions between the division surgeon and the medical battalion commander, recommendations for the location of the clearing station area are made to G-4. Should G-4 approve the area for location of the clearing station, the location will be announced in the Division Order. After learning of the approved location for his clearing station the company com- mander definitely locates the site of the station by an actual reconnaissance of the ground. Premature establishment 01 the station, or selection of an undesirable site are to be avoided, as the station is relatively immobile. The tactical situation and all of the following factors should therefore be considered before a clearing station is established. Necessary A location on or near a serviceable road on the route of evacuation between col- lecting stations at the front and evacuation hospitals in the rear. A space large enough for the complete station. Desirable A location 4 to 7 miles from the battle front outside the range of hostile light artillery. Safety from observed long range artillery fire. Buildings that can be used. Central location within the division sector or zone of action. Water supply. Soil well drained, level, firm, and free from rocks or large stones. Undesirable Location in immediate proximity to crossroads, main roads (liable to interdiction), dumps, and artillery positions. Heavily wooded areas. Soil that is rocky, swampy, or that contains an excess of sand or clay. Ground plan. The clearing station establishment is divided into the following areas, all of which must be concealed: (1) Clearing station proper. The area must be large enough to establish the equip- ment normally necessary to care for the varied types of cases that arrive at the station. Additional area for expansion or establishment of entire station. Concealment is paramount. The Geneva convention rules of warfare are observed by our troops, but newspaper accounts of action against certain enemies reveal that these rules are not always respected and little or no protection of our medical installations can be expected. Medical installations indicate to the enemy very useful tactical information relative to the strength of our forces. (2) Transportation area. The transportation area may be some little distance from the station proper, in order to obtain adequate concealment. Dispersion also is em- ployed to minimize the losses of vehicles from a single shell or bomb. (3) Personnel bivouac area. Here again concealment, dispersion, and protection are absolutely necessary. (4) Kitchen area. This area should be located convenient to the basic unit and also to the personnel bivouac area, but above all must be concealed. (5) Sanitary installations. No fixed rule can be set for the location of these in- stallations, however, again concealment is to be stressed, and secondly convenience to the patients and troops, observing necessary principles of sanitation. Variations in ground plans. Variations in the establishment of a station are the rule. 732 MILITARY MEDICAL MANUAL Gone is the day when a clearing station may be set up with tentage alined like a circus on location, either for ease of care of patients or for military precision and show. The entire installation must be fitted to the ground available in the best possible manner to obtain cover, concealment, defilade, protection from mechanized and armored threat, and still function in an efficient manner. Existing buildings. Existing buildings often provide all of the requirements admirably. Small towns and villages offer excellent, concealment, buildings offer shelter, plumbing facilities may be present, and public buildings such as schools, municipal halls, and county courthouses with large rooms and large doorways will be utilized to the fullest possible extent. Operation of a Clearing Station. The basic unit, whether set up without shelter, in existing buildings, or under canvas, usually consists of the following departments: (1) Headquarters (platoon or company) for unit and patients. (2) Admission and sorting. Establishment of priority of treatment, filling out clear- ing station tag (M.D. Form 53) and sending admission section to unit office. Directing movement of wounded to proper section for treatment. Sorting (triage) is essential in order to prevent too many unnecessary evacuations from the division area. Once a man has left the division area it requires several days for him again to rejoin his organiza- tion, regardless of speed of his recovery; hence by preventing unnecessary evacuation from the division, the medical units assist in maintaining fighting strength. (3) Walking wounded. (4) Litter wounded. (5) Shock treatment. (6) Dispensary, and laboratory. (7) Dental section. (8) Supply section. (9) Kitchen for messing of both patients and company personnel. (10) Forwarding department—completion of emergency medical tags, removal and completion of disposition tag (M.D. Form 53) and property exchange with vehicles evacuating the station to the rear. (x) When gas casualties arrive and no other unit is adjoining the clearing station is available to treat them, personnel of the clearing station must initiate treatment utilizing the gas casualty treatment sets. When handling casualties suffering from persistent chemical agents, protective clothing and gauntlets must be used by medical personnel in addition to their gas masks. Records. A record is made of every patient admitted and every patient disposed of, whether returned to their organizations, evacuated to the rear (usually by army ambu- lances) or who dies in the station. Consolidation of the admission and evacuation records gives an accurate indication of the number of men out of action, and this may be the best and the most accurate picture the division commander can obtain, relative to the actual casualties sustained by his division. Accurate records are essential. For simplicity, a medical department form, Clearing Station Tag M.D. Form 53 is used in the clearing station. Its purpose is to facilitate the handling of records connected with the admission and disposition at clearing stations. An individual tag (M.D. Form No. 53) is initiated for each patient admitted. This tag is composed of two sections. Both sections are initiated in the receiving department of a clearing station. To speed the preparation of these tags an imprinting machine is used. This machine prints information directly from the identification tags worn about the necks of all military personnel. The machine is adjustable as to selec- tion of lines to be printed. Only the two uppermost of the five embossed lines of the identification tag are required for reproduction on the clearing station tag. When used in a clearing station, the imprinting machine is adjusted to print the upper two lines only. The man designated to initiate the M.D. Form 53 at the receiving department places the casualty’s identification tags in the imprinting machine and prints the casualty’s name as serial number in the appropriate spaces of Section B and Section A of the form. If obtainable, the grade and organization are printed in the spaces provided for this information, and the abbreviation for the diagnosis is placed in the designated spaces MEDICAL SERVICE OF THE DIVISION 733 This information is placed on both section A and section B. In addition, the month, day, year, and time are placed on section A—admission. Section A, upon completion, is torn form section B at the perforation marks and is sent to the clearing station office. Section B is attached to a button of the patient’s clothing and remains with him till he reaches the disposition clerk. INSTRUCTIONS: THIS TAG IS FOR USE IN CLEARING STATIONS. On admission enter all information ON "BOTH” SECTIONS EXCEPT UNDER "REMARKS" AND "DISPOSITION". TRAUMA- TISM DIAGNOSIS WILL BE ENTERED BY USE OF ABBREVIATIONS AUTHORIZED IN PAR. 50, FM 8-45. In CASE OF ILLNESS OR GASSING, "SK” OR "GAS” WILL SUFFICE. Injuries should indicate part of body INVOLVED AS: HEAD, BACK, CHEST, ABDO- MEN, Upper Extremity, etc., e. g., (1) GSW - G - Pen - Chest. (2) MW - 3 - Head, Chest, Upfer Extr. (3) FCC - Lower Extr. SECTION "A" WILL EE DETACHED AT ONCE AND SENT TO OFFICE. SECTION “B" WILL BE ATTACHED TO PATIENT'S CLOTHING WHILE IN THE CLEAR- ING STATION. AT TIME OF DISPOSITION, COMPLETE THIS SECTION, E. G„ DISPOSITION: (1) Died, or (2) Duty, or (3) Surg. Hosp. 6. AND SEND SECTION TO OFFICE. Destroy both sections when office record is completed. Form 53 MEDICAL DEPARTMENT. U. S. A, (Authorized May 21, 1942) Plate 16. M.D. Form No. 53. As admission sections are received in the office they are arranged systematically to await arrival of the disposition sections. The record clerk using plain paper prepares a check list in duplicate similar to the form shown in Plate 16. On the rear of the tag are instructions to destroy both sections of the tag when office record is completed. This instruction is not obligatory if in the surgeon’s opinion the completed sections have further value, as, for example, in forwarding all “disposition” sections daily with check list to the division surgeon. However, since the check list con- tains all of the information shown on form M.D. 53, it is duplication of effort to have both sets of information forwarded. Section II, W.D. Cir. 182, dated June 11, 1942, has reference to entries on M.D. Form 52b (EMT), the result of which will be that all casualties received by a clearing station in combat will have incomplete FM Tags. The missing information should be entered at the clearing station, if obtainable. It is desirable to place this information on tags at the receiving departments, for many 734 MILITARY MEDICAL MANUAL Plate 17. Printing1 Evacuee’s Name and Army Serial Number on M.D. Form No. 53 by Means of Imprinting: Machine. (Tetanus Toxoid Date and Blood Type Also Shown). CHECK LIST OF SICK AND WOUNDED 0001 Nov. 3, 1042 Period covered 2400 Nov. 3, 1942 St at 1 o n Co D, (Cl r)_10_ lied Bn Name A.S.No. Grade & organi- zation Diag- nosis Adm. date &. hour Dispo- sition Date iic hour Oively, Roy E. GQ65S20 Pvt 1 cl C-SW, Pen 2 Nov 42 Evac 3 Nov 42 Co M 39 Chest 2300 Mo 9 0530 Inf Welton, Samuel 0-32167 Capt 40 Pneu- 3 Nov 42 Evac 3 Nov 42 S • FA monia 0110 No 9 0530 Lobar Zellar, William 30123456 Gorp Co EW Abdom- 3 Nov 42 Died 3 Nov 42 T. B 39 Inf en 0600 0630 Weiss, Jack 33072201 Pvt Co FS 5 Met- 3 Nov 42 Returned 3 Nov 42 (None) A 10 QM acarpal, 0635 to duty 0730 Bn Left Plate 18. Check List of Sick and Wounded (Clearing Station) MEDICAL SERVICE OF THE DIVISION 735 patients may lose consciousness before the forwarding department is reached. Because of activity at the receiving department this information may not be completed. All EM Tags should be checked at the forwarding department and information completed if obtainable. Section B accompanies the patient through the clearing station. A space “remarks” is provided for use in the station. When the evacuee arrives at the forwarding department the disposition section is completed, giving the place of disposition, the month, days, year, and the time; and section B is then sent to the station office where the information is used by the station clerk to complete the chec\ list of sic\ and wounded. No other records are required of clearing stations. Contact. The only normal direct contacts of a clearing station are with the ambu- lances of collecting companies to the front, and with the ambulance units of higher echelons in the rear. In each case the responsibility for contact rests with the ambu- lance units whose disposition and movements must conform to those of the clearing station. Evacuation of a Clearing Station. The arrangements for evacuation of a clearing station are the responsibility of the division commander, but this is usually arranged for by the division surgeon through G-4, or directly by the division surgeon himself. When the division is operating as part of an army, arrangements of evacuation of clearing stations are made through army G-4 (or directly with the army surgeon). When the division is operating as part of a smaller unit, the G-4 of the unit head- quarters (or directly with the surgeon of the unit) is contacted for evacuation of the clearing stations. Supplementary Units. Frequently during heavy engagements a surgical hospital (Army) may be moved to the vicinity of the clearing station to take over cases requir- ing surgical treatment. A surgical hospital is equipped with mobile operating rooms and necessary auxiliary equipment to perform major surgical operations. The surgical hospital is equipped with a limited number of ambulances and may evacuate cases requiring urgent surgical treatment from the clearing station to its own installation. Patients evacuated for treatment by a surgical hospital are considered removed from the division, as are those evacuated by higher echelon ambulances to evacuation hospitals. Closing Station. Usually warning orders precede actual orders to close station, and the station may be gradually dismantled and loaded until the minimum amount of equipment is employed in service to care for the few casualties within the station. At the receipt of the order to move, (assuming that all patients are being evacuated), the entire station equipment and personnel are loaded on vehicles and moved to the new location for employment as ordered by higher authority. If a few patients re- main within the station they may either be moved forward on truck to the new station site, or personnel must remain back with them until they are evacuated, after which the personnel who remained with them will rejoin their unit. Employment of the Headquarters Detachment Introduction. The headquarters detachment is an organic part of the medical battalion. It is the service unit of the medical battalion, and although called head- quarters detachment it functions as a company. It has its own company commander, first sergeant, mess sergeant, supply sergeant, motor sergeant, and clerk. It submits a morning report, and operates its own mess. Headquarters detachment has a number of important functions among which are: Furnishes personnel to assist officers of the medical battalion headquarters. Provides personnel to operate the personnel section of the battalion. Procures and issues all classes of supplies to all units of the medical battalion. Executes second echelon maintenance for motor vehicles of the medical battalion. Procures and issues medical supplies for all units of the infantry division, in addition to the medical battalion. Battalion Headquarters Section. Officers of battalion headquarters, and men from the headquarters detachment comprise the battalion headquarters section. The officers consist of: 736 Commanding officer Lieutenant colonel, Medical Corps. Executive and plans and training officer Major, Medical Corps. Adjutant Captain, Medical Administrative Corps. Supply officer Captain, Medical Administrative Corps, who also functions as division medical supply officer, and is commanding officer of Headquarters Detachment of the Medical Battalion. The men include a master sergeant (battalion sergeant major) who manages the ad- ministrative details of battalion headquarters and supervises the sergeant (message center chief), the clerk-typist, and orderlies. This section assists the battalion commander in the organization, training, and tactical employment of the medical battalion. In maneu- vers and in combat they will establish the command post of the medical battalion. Since the clearing station is the focal point of the division medical service the battalion com- mand post should be established in vicinity of the clearing station. Occasionally the divi- sion signal officer will establish a single telephone line to the battalion command post which will assist in maintaining contact with the division command post, and especially with the division surgeon. Personnel Section. A 2d Lieutenant, Medical Administrative Corps (or qualified warrant officer), technical sergeant, and 3 clerks comprise this section. Together with the clerks of headquarters detachment, and companies A, B, C, & D, this section pre- pares all records, reports, payrolls, and cares for most correspondence. It maintains all personnel records pertaining to officers and men of the battalion, and generally is custodian of the service records and qualification cards for the men of the battalion. In garrison or in camp this section generally operates as part of the medical battal.ion. However, in maneuvers and in combat this section will operate, mess, and bivouac with Rear Echelon of Division Headquarters (See Plate 1). Detachment Headquarters Section. For all practical purposes headquarters detach- ment is a company. The battalion supply officer (Division medical supply officer), a captain, Medical Administrative Corps, is its commander. The men of this section perform the administration, motor maintenance, supply, and mess for the headquarters detachment, and also operate the mess for the medical battalion headquarters. Obviously this section cannot be located far from battalion headquarters. Motor Maintenance Section. Motor vehicles of the medical battalion requiring repair or adjustments beyond the capabilities of the chauffeurs of company mechanics are transferred to this section. This section also makes inspections to check on the pre- ventive maintenance executed by company maintenance sections. A second lieutenant, medical administrative corps, a technical sergeant, a sergeant, 4 mechanics, and 2 privates compose this section. In combat the focal point for medical battalion vehicles, especially ambulances, is at the clearing station, so this unit should be located ip vicinity of the clearing station. General and Medical Supply Sections. The captain, Medical Administrative Corps, who commands the headquarters detachment, is involved in 3 echelons of supply. He is interested in the supply of his detachment; he is supply officer of the medical bat- talion; and he is medical supply officer for the division. To assist him he has a 1st lieutenant, medical administrative corps, (or qualified warrant officer) and the following men: A technical sergeant who is battalion supply sergeant, who is not concerned with supply of the headquarters detachment any more than he is with the supply of companies A, B, C, or D. His concern with medical supply of the division, and general supply of the battalion, including equipment, uniforms, rations, gasoline, and similar necessities. He has a sergeant, a clerk, and chauffeurs to assist him. MILITARY MEDICAL MANUAL General Supply of the Battalion. Rations and gasoline (Class I and Class III). On maneuvers and in combat rations and gasoline are generally distributed to units of the division daily. The details of this daily distribution is enumerated in the division SOP (standing operating procedure). There are three ways these classes of supplies may be issued to units of the division: (1) Railhead distribution. Vehicles of the medical battalion headquarters detach- ment are driven to the division railhead (or truckhead) and will draw rations and MEDICAL SERVICE OF THE DIVISION 737 gasoline allotted to the medical battalion. These vehicles will return with their loads to the headquarters detachment bivouac area for breakdown of the ration. (2) Dump distribution. The same transportation must move to the Class I and Class III dumps established by the quartermaster battalion of the division. This method is used when the quartermaster trucks must unload their reserve of rations and gasoline in order to be of some other service. (3) Unit distribution. The quartermaster trucks will distribute battalion rations and gasoline to the bivouac area of the headquarters detachment. (This method is not used frequendy). The headquarters detachment in turn must “break down” the rations and gasoline, in other words divide it into lots the size of which are in proportion to the company to which it is to be given. There are two general ways in which these “broken down lots” may be turned over to the companies: (1) The transportation of the company may return to the bivouac area of the battalion headquarters detachment and pick up the rations and gasoline—distributing point distribution. Very frequently this may be the only sure way for a company to insure getting its daily quota of supplies. It is easier for a company to find the cen- trally located headquarters detachment than it is for the latter to find camouflaged collecting stations in the thick of battle. (2) The headquarters detachment may load these items onto its own trucks and led forward by company guides these trucks will transport supplies forward to the company kitchens and motor vehicles. The time of distribution of supplies at the railhead, truckhead, or dump is pub- lished in division SOP, or SOP as modified in the division administrative order. This latter document will also specify the type of ration to be distributed, i.e.: A, B, C, D, K, etc. The time for distribution of supplies by the medical battalion must be decided by the battalion commander, usually upon recommendations of the battalion supply officer. Because of air activity, most movements of supply vehicles will be at night and under blackout conditions. Such precautions will greatly impede the breakdown of rations and gasoline by the general supply section of headquarters detachment. General and Medical Supplies in Garrison or Camp. This subject is one requiring detailed explanation. It is covered in Chapter X. Briefly it consists of the headquarters detachment consolidating company requisitions, forwarding the approved consolidated requisitions, drawing the supplies in bulk and redistributing them in accordance with original company requisitions. A similar method is employed for medical supplies. Medical Supply in Combat. Since speed in combat is essential, a requisition in the field may consist of a pencil notation of what is wanted by a unit. In garrison and in training units must follow the usual channels of securing medical supplies. In combat medical supplies for an infantry division are secured in the following manner: Headquarters detachment reserve—approximately 3 days of medical supplies for a division are carried. (Based upon experience tables World War I.) Medical supply dumps—generally established in vicinity of evacuation hospitals. Medical supply depots—occasionally forward far enough to be within reach of headquarters detachment transportation. Daily train—(railhead)—provided a requisition has been submitted well in ad- vance, and time lag for requisition and distribution channels is considered. Medical service of a division is the responsibility of the division commander. He relies upon his division surgeon to keep him informed as to the medical service. Medical supply is extremely important to efficient function of this service. It is highly im- probable that requisitions, however urgent, would be dispatched without consultation of the division surgeon. Although not following the usual chain of command, it is likely that the division medical supply officer would deal directly with the division surgeon in manners pertaining to medical supply, keeping his battalion commander informed constantly of his actions. No prescribed methods of procedure are pre- scribed, but with all probability, many details of such action may be formulated during 738 MILITARY MEDICAL MANUAL the initial training periods of an infantry division, and a SOP written to the satisfaction of all parties concerned. Distribution of medical supplies. In combat medical supplies are requisitioned in a manner designed to expedite both requisition and delivery. The systems involved should be simple and flexible. Each medical unit, from attached medical units up through the headquarters detachment of the medical battalion carries a small reserve. The reserves of the attached medical units will naturally be first depleted in action. Attached medical units may requisition directly on the division medical supply officer by informal memorandum (a slip of paper bearing organization designation and a list of articles wanted), and may call for them in one of their own vehicles. There is little likelihood of such units having supplies delivered to them by headquarters detach- ment in combat. Another very satisfactory method of securing supplies is for detach- ments to call upon the collecting company evacuating them. Supplies may be requested by written message and delivered by litter bearers on their trip forward to evacuate the aid stations. Likewise collecting companies may send a messenger back by motor vehicle or in an ambulance to obtain medical supplies. These supplies may then be delivered by a detachment truck with the messenger as a guide, or more probably by returning ambulance. However, when supplies are returned by ambulance it should be remembered that ambulances are operating as part of a shuttle, and chauffeurs are trained to return to the basic relay post upon completing a trip to the clearing station. The officer or noncommissioned officer in charge of the basic relay post should routinely check each vehicle reporting to the basic relay post for any supplies or messages that are brought forward. When such items are found in vehicles it is a simple matter to dispatch these articles forward in another vehicle, or to avoid delay at relay posts forward simply transport them forward in a small vehicle (14-ton truck) generally loaned to the ambulance section for checking operation of the shuttle. MEDICAL SERVICE WITH ARMORED FORCE (FM 8-5) Employment of Armored Units. For the tactics and technique of the employment of units of the Armored Force see FM 17-10. Characteristics of employment of medical units with armored force. Because of the high mobility of Armored Force units the establishment of medical installations is difficult and limited. Higher units must evacuate wounded at once as the units below the armored corps will have no hospital facilities. The combat zone of armored units is deep. Fighting will often be extremely con- fused and the establishment of definite front lines not only difficult, but unusual. The movement and establishment of installations of unarmored units frequently will be impracticable. Division Surgeon Division Medical Inspector Division Veterinary Surgeon Division Dental Surgeon Division Medical Supply Office Executive Plate 19. Organization of Division Surgeon’s Office, Armored Division. The number and type of casualties will vary in different components of the Armored Force. A standard evacuation system cannot be applied to each unit. Tank casualties will probably be less than infantry casualties as such troops are pro- tected from small arms fire and shell fragments. Tank casualties will be due to blast- ing effect of mines,, resulting in fractures of the lower extremities; minor wounds caused by bullet splash and fragmentation inside the tank; and fatal wounds caused MEDICAL SERVICE OF THE DIVISION 739 by projectiles of larger caliber penetrating the tank. Severe burns may also be received from vehicles set on fire. It is estimated that total casualties among tank personnel will normally be about 5 per cent and that 4 per cent will be fatal. Casualties in particular actions may run extremely high. In combat in Africa, casualties in certain units have run as high as 30 per cent in one battle day. Armored infantry are vulnerable to air attack, even when mounted in armored per- sonnel carriers. When dismounted they will be as vulnerable as any other dismounted troops. They will usually suffer higher casualties than troops in tanks. Owing to the demand for close support, casualties in artillery troops will be higher proportionately than in artillery supporting other arms. Casualties in reconnaissance troops may be high. There can be no set plan for evacuation of such casualties and they must be carried with the unit until other troops close on the reconnaissance units. The mortality rate among abdominal and brain cases will be definitely affected by the rate of evacuation to medical installations affording definitive surgical treatment. Forward elements should have sulfathiazole and sulfaguanidine. Medical personnel must be well trained in evacuation of wounded from tanks. They must be taught how to open and get into tanks. They must at times depend upon maintenance personnel to open the doors of the tanks for them. Support of Armored Force Medical Units. Medical units of higher organizations must be prepared to evacuate the wounded from armored divisions and GHQ reserve tank units. The medical regiment attached to the armored corps assists in evacuation from division collecting points. Armored divisions and GHQ reserve tank units attached to army corps depend upon the medical regiment of that corps for assistance. When an armored division is sent on an independent mission its medical battalion should be appropriately reinforced. Division Surgeon. The division surgeon is a member of the division commander’s special staff, is the technical advisor on all matters relating to sanitation and medical service, and is responsible for the technical training of all medical personnel of the division. His duties are administrative. He has no command functions. Any orders given by him are in the name of the division commander. Plate 17 shows the organ- ization of the division surgeon’s office. The division surgeon’s office will usually be established at the rear echelon of the division command post. However, the division surgeon will make visits to the forward echelon as necessary. He must maintain liaison at all times with medical elements of the forward echelon of division headquarters and with supporting medical units. In order to make plans for employment of the medical battalion and to provide for adequate medical support from higher units, it is essential that the division surgeon be given timely warning of the division commander’s plans. THE ARMORED MEDICAL BATTALION, ARMORED DIVISION The armored medical battalion is a flexible, highly mobile unit capable of accom- panying combat elements of the armored division. It is composed of a battalion head- quarters and headquarters company and three medical companies. It is commanded by a lieutenant colonel. Employment. The medical battalion is organized so that it may function as a unit or elements may be attached to tactical groupings of the division. On the march, one medical company will usually be attached to each combat command and the other com- pany to the trains, but will be available to the battalion commander on call. Medical companies march at the rear of the columns. Medical personnel and ambulances may be attached to advance, flank, and rear guards and to reconnaissance detachments. Headquarters and Headquarters Company. The headquarters and headquarters com- pany is organized as shown in Plate 18. This company is organized for administration, supply, and maintenance of the medical battalion. It also furnishes medical supplies for the unit medical detachments. 740 MILITARY MEDICAL MANUAL Medical Company (Armored). There are three medical companies (armored) in the medical battalion. They are so constituted as to be self-contained, are as mobile as any other element of the force they accompany into action, and assure prompt medical care and evacuation of forward units. Each company has a company headquarters consisting of command, maintenance, administration and supply, and mess sections, Headquarters and Headquarters Company Medical Battalion Battalion Headquarters Battalion Supply Section Division Medical Supply Section Transportation Platoon Battalion Maintenance Section Company Headquarters Command Section Communication, reconnaissance, liaison, section Personnel Section Platoon Headquarters Fuel and Lubricants Section Ration Section Command Section Maintenance Section Administration and Supply Section Mess Section Plate 20. Organization of Headquarters and Headquarters Company, Medical Battalion (Armored). Medical Company (Armored) Company Headquarters Litter Platoon Ambulance Platoon Treatment Platoon Command Section Maintenance Section Administration and Supply Section Mess Section Platoon Headquarters Operating Section Gas Casualty Section .Plate 21. Organization of Medical Company (Armored). a litter platoon, an ambulance platoon, and a treatment platoon. The commanding officer of this company has his command post in a Vz -ton carry-all. This vehicle has an SCR-528 radio set which can be set on the division net, medical battalion net, or the net of the unit to which attached. His maintenance section has mechanics and a 214- ton truck, wrecker, and is capable of first and second echelon maintenance. The ad- ministration and supply section maintains pertinent records of sick and wounded and MEDICAL SERVICE OF THE DIVISION 741 is concerned with property exchange and medical supply. The mess section is adequate to furnish food for the company personnel and wounded. Litter Platoon. Personnel and transportation. This platoon is commanded by a lieutenant, Medical Administrative Corps; he is assisted in his duties by noncommis- sioned officers. The privates in the platoon act for the most part as litter bearers. The transportation includes a number of trucks, one of which is equipped with a radio (see appropriate T/O and T/BA for details). Operation. The fluid nature of armored operations makes it impracticable to establish battalion and regimental aid stations in the orthodox manner. This is particularly true of the armored regiments. It is contemplated that litter bearers will be employed in the evacuation of battalion and regimental mobile collecting points established by their re- spective attached medical personnel as they follow up the units they service. With the armored half-track, capable of carrying four litter cases, they are capable of operating in areas otherwise denied them. The 14-ton truck permits approach to isolated cases by utilizing terrain features and can evacuate two to four litter cases (when equipped with hood brackets). The 2}4-ton truck may, under certain conditions, be utilized in the evacuation of casualties, as they carry 18 litter cases. Evacuation by the platoon will normally be to the mobile collecting station established by the operating section of the treatment platoon. By means of its radio, this platoon maintains contact with all elements of the striking force it is serving. The most difficult problems will be presented in the treatment and removal of wounded from a disabled tank. Special arrangements and train- ing for the removal of wounded from the tank turret and escape port must be provided. Ambulance Platoon. This platoon is commanded by a lieutenant, Medical Adminis- trative Corps. He is assisted in his duties by noncommissioned officers. The privates in the platoon act for the most part as ambulance drivers and ambulance orderlies. The transportation consists of a few small trucks, one of which is equipped with a radio. It functions as a platoon or as two self-contained sections. This platoon is used to evacuate forward areas if the situation permits, and will usually evacuate to the mobile collecting station established by the treatment platoon. With a view to main- taining the full complement of ambulances in the forward divisional areas and ex- pediting evacuation, a shuttle system with the corps medical regiment ambulances must be established. At a predetermined point in the evacuation chain, arrived at by agreement with the corps surgeon, a designated corps ambulance is made available to the contacting division ambulance driver. The corps ambulance driver completes the evacuation of division evacuees to the mobile hospital station, while the division chauffeur takes the corps ambulance into the forward divisional area. The advantage of this transfer of ambulances lies in the fact that the division ambulance driver is familiar with the tactical situation and knows the location of the units he is servicing. With this system the delivery of medical supplies from the corps to the division is expedited and property transfer is facilitated. Hazards of air strafing or indirect harassing or interdiction artillery fire are lessened as there is in the evacuation system no delay otherwise occasioned by transfer of patients from one ambulance to another. This system has the added advantage of reducing the handling of seriously wounded men to the minimum. Radio contact with all elements of the division is available to this platoon. Treatment Platoon. The treatment platoon consists of a platoon headquarters, an operating section, and a gas casualty treatment section. The platoon headquarters has 1 first lieutenant, Medical Corps, 1 platoon sergeant, and 1 private (chauffeur). It is transported on a l/z-ton (carry-all) and maintains contact with other elements by radio. The operating section of this platoon has as its personnel 4 first lieutenants, Medical Corps, 1 first lieutenant, Dental Corps, and 18 enlisted men. Its equipment and per- sonnel are carried on two 2 Vz -ton 6x6 trucks. It has in addition a special operating room body mounted on a 2%-ton truck chassis, with necessary surgical equipment, and a bus or panel type body likewise built on a 2 *4-ton 6x6 truck chassis. This section establishes in combat what was formerly called the collecting station. It is the nucleus of the medical battalion in that all activities of the battalion radiate from its center 742 MILITARY MEDICAL MANUAL in both directions. Its mobility and the maneuverability furnished by the 2 l/z -ton 6x6 truck chassis permit employment well forward. It will be established along axis of evacuation of the force it supports and will usually operate in the rear of artillery. It can readily meet conditions imposed by a shifting of the evacuation axis. It has facilities for rendering adequate emergency surgical care, including blood transfusions, at a time when such procedures are most effective. When the combat mission of the division results in disruption of lines of communication, this section can continue to function. It is conceivable that under certain conditions wounded will be convoyed to the rear. Evacuation of advanced elements will be to the collecting and treatment station established by this section. Here wounds will be redressed, splints applied or adjusted, morphine and tetanus toxoid administered, emergency surgical measures em- ployed, and the patient reacted from shock and prepared for evacuation to the rear. No predetermined operative procedure can be elaborated that will satisfactorily meet all tactical situations that may confront the armored division. Intimate control, in- tensive personal supervision, and marked initiative are the essentials for efficient fun- tioning of all elements of the medical battalion. The gas casualty treatment section is equipped to treat gas casualties in the forward area if and when the enemy resorts to the use of gas. When not employed for this purpose, it augments the operating section. It is equipped with an operating room body on a 2 Zz -ton, 6x6 truck chassis and has a bathing pavilion and clothing ex- change section. It usually accompanies the operating section into action, but may function independently. It is so constructed that it may serve the same purpose as the mobile surgical truck. Plate 22. Surgical Truck (Operating Room) with Armored Medical Company Treatment Platoon. In the establishment of the collecting and treatment station, concealment and camou- flage must be employed. Direction signs must be placed along the line of drift, well forward to indicate its position. Since this station is usually established at night, careful reconnaissance by the medical company commander and an officer of the platoon is essential. Guides must be posted and all security measures observed. MEDICAL SERVICE OF THE DIVISION 743 Evacuation of these stations by air may not be practical. Air evacuation assumes control of the air by friendly forces and suitable landing fields. For these reasons air evacuation may often be limited to areas adjacent to evacuation hospitals. Medical Supply, Communication, and Liaison Armored Units. Supply in action. The battalion distribution point for medical supplies is usually established near the forward command post of the division. However, in combat, the supply officer estab- lishes dumps in the forward area. These dumps may be on the ground, but preferably are in %-ton trucks. One dump must be in the vicinity of the collecting station where supplies of the regiment and battalion detachments may be replenished, and one dump is established in assembly areas immediately prior to attack. Considerable amounts of medical supplies must be kept well forward on wheels during combat with the supply section of the medical company. The division medical supplies are kept in trucks near the rear echelon of division headquarters where the division is committed. Division medical supplies are replenished by the corps. Dumps should always be so dispersed that enemy fire will not destroy all of them. In all field units of the medical service of the armored division there is automatic exchange of nonexpendable items of equipment. In combat, expendable medical supplies are obtained by informal requisi- tion from the next higher medical unit. Unit delivery will be made by Y\-ton pick-up truck, %-ton truck, or ambulance. Under certain conditions, delivery of medical sup- plies to isolated units may have to be made by parachute. For this purpose, a dressings unit, splint unit, and blanket unit should be packed in a reinforced canvas bag the size of a mail bag, weighing not to exceed 60 pounds, as all three units could be delivered by one parachute. Class 1 items will be handled in the manner usually employed for other battalions of the armored division. The transportation platoon draws class I supplies at the division ration dump and gas distributing point and breaks them down for delivery to the individual medical companies. A complete refill of gasoline must be main- tained in the combat train of each combat command. Communication and liaison. The responsibility for the establishment and main- SCR-510 510 510 510 510 510 510 Litter Platoon Ambulance Platoon Treatment Platoon Platoon Platoon Platoon Platoon Platoon Platoon SCR-528 528 C.O. Co. B C.O. Co. A C.O. Co. C SCR-510. SCR-508 SCR-510 Bn. C.O. Bn. Comm. O. C.O. Hq. Co. SCR-510 SCR-510 Siq. Cen. SCR-506 Plate 23. Radio Net, Medical Battalion, Armored Division. To Div. Administrative Net Div. Trains Command Net (Listen Only} (Notes: A medical company attached to another unit will change to that unit’s Irequency. When one company is with the trains, the battalion commanding officer will usually have to transmit messages to it through division command channels. All radio vehicles are Hi-ton carryalls. Dotted lines indicate “physical contact.’’) 744 MILITARY MEDICAL MANUAL tenance of liaison is a command responsibility of the battalion commander. He dis- charges this function through the command, reconnaissance, and liaison section of battalion headquarters. In this section he has two agent messengers on motorcycles and an SCR-508 (12-volt) radio. All elements of the medical battalion are equipped with radios. Commanding officers of the medical companies of this battalion are charged with maintaining liaison with the medical detachments of regiments and battalions. They accomplish this mission through contact agents and by radio. Mes- sages may be sent by litter bearers, ambulance drivers, and by walking wounded under certain circumstances. During radio silent periods when the division is going into assembly areas, contact agents in %-ton trucks must be used. In combat, the use of special panels to indicate the location of collecting points requiring evacuation to the division G-3 air section of the bomber control unit may be necessary. This information would then be relayed to forward echelon of division headquarters. The employment of this system will be particularly applicable to the reconnaissance battalion and to other elements of the armored division that may have lost contact with other units with which it is operating. 1 1 2 3 4 5 6 7 8 9 Unit 1 Battalion headquar- ters (T/O 8-66) * Headquarters andhead- quarters detachment (T/O 8-66) 1 3 collecting companies (each) (T/O 8-67) | Clearing company (T/O 8-68) [ Total Battalion [ Attached chaplain Enlisted cadre Remarks 2 (*1) 1 1 3 (1) 1 4 (1) ('1)2 2 5 13 5 First lieutenant (-1) « 2 2 (42)7 15 1 6 «.2 5 — — — — — quarters. Personnel 7 Total commissioned (4) 8 5 12 35 1 shown in column 2 is . = ===== r- == ===== == included in column 3. 8 1 1 1 9 1 1 1 5 5 10 3 3 2 11 2 3 3 14 14 12 7 6 6 31 23 13 1 4 3 16 6 14 4 2 8 18 7 15 10 8 18 52 13 16 9 35 39 153 17 15 42 50 191 18 (5) (6) do (34) 19 20 Total enlisted — 53 61 101 106 128 140 484 519 1 71 71 21 = 12 36 22 Q Trailer, 1-ton, 2-wheel, water tank i i 3 7 23 3 1 6 24 1 1 25 1 1 3 7 26 1 1 1 5 27 9 3 14 32 28 1 2 5 29 Q Truck, 2M-ton, wrecker, with winch _. i i Changes No. 2 WAR DEPARTMENT, Washington, December 28, 1942. T/0 8-65, April 1, 1942, is changed as follows Column Line S 0 4 (d 1) 6 14 5 (o 1) a 14 Plate *4. T/O 8-65, April 1, 1942, and Changes 1 and 2. Medical Battalion, Motorized MEDICAL SERVICE OF THE DIVISION 745 Introduction. A motorized division is a highly mobile infantry unit having great fire power. It is organized along the general lines of an infantry division. It generally is combined with two armored divisions and other troops into an armored corps. The Medical Battalion Motorized. The division medical service of the motorized division is furnished by the Medical Battalion, Motorized (T/O 8-65). A motorized medical battalion is similar in organization to the medical battalion of an infantry division. It differs from a medical battalion in that it has many more motor vehicles. There are more men in a motorized medical battalion because of the larger number of motor vehicles. MEDICAL SUPPORT OF THE MOTORIZED DIVISION 1 2 3 4 5 6 7 8 9 10 1 Unit Technician grade j Battalion headquar- 1 ters section a o 1 1 g £ I Detachment head- quarters section | Qeneral and medical supply section | Motor maintenance section Total detachment Enlisted cadre Remarks 2 Lieutenant colonel * 1 t Insert number of battalion. • Battalion oom- mander. b Medical Adminis- trative Corps. c Qualified warrant officer, when available, may be used to replace these officers. d T qualified in pay record procedure. 1 qualified in morn- ing report procedure. The serial number symbol shown in pa- rentheses is an insepa- rable part of the spe- cialist designation. A number below 500 re- fers to an occupational specialist whose quali- fication analysis is found in AR 615-28. A number above 500 refers to a military 3 1 4 1 »1 5 bl bl 6 b.l b cl 7 4 1 1 8 8 Master sergeant, including 1 9 a) (1) (1) 10 1 11 1 1 12 a) (1) (1) (1) (1) (1) 13 (i) 14 Supply (821) 0) 15 1 16 Mess (824) (1) (1) (1) (1) (1) 17 (1) 18 19 (■*3) (3) (2) (2) (3) 20 Motor (813) (1) (1) 1 a) 21 (i) (1) 22 23 (1) 10 (1) 4 10 (1) 1 24 25 26 27 28 Technician, grade 41 Technician, grade 5l,„. a 10 7 Private J (1) 15 (1) Cl) occupational specialist listed in Circulars Nos. 14 and 67, War De- partment, 1942. 29 Chaplain’s assistant (534) 5 to 30 a) 31 0) (1) 32 (1) a) (1) a) (2) (2) (2) (10) (3) (3) (3) (1) (5) 53 61 33 5 (i) 34 Cook (060)... 4 (1) W (2) (1) 35 Cook (060) 5 36 Cook's helper (521) 37 5 (2) (4) 38 (3) (2) (1) (3) (2) 39 Mechanic, automobile (014) 4 40 Mechanic, automobile (014) 5 (1) 41 (3) (1) O) 42 Stenographer (213) 5 43 (1) (2) (1) 44 12 12 45 16 14 10 46 Q' Trailer, 1-ton, 2-wheel, water tank 47 2 48 1 49 1 50 51 1 2 52 (1) a) (5) (7) (1) (1) (1) 53 (1) 54 (i) 55 (1) Plate 25. T/O 8-66, April 1, 1942, and Change 1. Headquarters and Headquarters De- tachment, Medical Battalion. The operations of all units of a motorized medical battalion are similar to those of the medical battalion of the infantry division described in the beginning of this chapter. Motorized divisions operate as infantry divisions when the personnel have dismounted from their vehicles. Medical support of such units consists of medical service furnished in camp or bivouac, medical support of marches, and after the combat zone is reached 746 MILITARY MEDICAL MANUAL 1 2 3 4 5 6 7 1 Unit Tech- nician grade Com- pany head- quar- ters 2 clear- ing pla- toons (each) Total com- pany En- listed cadre Remarks 2 Captain 1 2 5 3 First lieutenant- 1 (d 1)3 7 R Drives vehicle in 4 Total commissioned 2 5 12 duties. 5 First sergeant (585) 1 1 I 6 Staff sergeant, including. 1 1 3 3 Mess (824). . . (1) (1) (2) 6 a) (2) 4 symbol shown in pa- rentheses is an insepa- rable part of the spe- cialist designation. A 8 Platoon leader (651) (1) 2 9 Sergeant, including '2 10 Motor (813) 0) (1) (4) (1) 3 (1) (2) 0) 2 11 Section leader (652) (2) 12 Supply (S21) (1) 1 fers to an occupational specialist whose quali- fication analysis is 13 Corporal, including i 14 Clerk, admission (055). 0) (2) (1) I .1 (1) (1) 3 4 15 Clerk, company (405) 0) 17 16 17 18 Technician, grade 4j Technician, grade 5l- , 49 A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War De- partment, 1942. 1 39 19 Private . . 1 1 50 20 Bugler (803) O) (3) (3) (2) (1) (3) (3) (2) (4) (15) O) (D (2) (2) (2) (4) (8) (4) (2) (41 (10) (18) (18) (11) 21 Cook (060) 4 (1) (1) 22 Cook (060) 5 23 Cook’s helper (521). 24 Driver, light truck (345) 5 (2) (6) 25 Driver, light truck (345).. (3) (1) Cl) 26 Mechanic, automobile (014) 4 27 Mechanic, automobile (014) 5 28 Pharmacist (149) 4 (1) 0) 29 Orderly (695) (2) 30 Technician, dental (067) 5 (1) (2) (4) (2) (1) (2) (5) (9) (9) (5) (1) (1) 31 Technician, medical (123) 5 32 Technician, medical (123) 33 Technician, sanitary (196) 34 Technician, surgical (225) 4 0) (1) 35 Technician, surgical (225). 5 36 Technician, surgical (225) 37 Ward attendant, medical (303).. 38 Ward attendant, surgical (303).. 39 Basic (521). . .. (1) 40 Total enlisted 22 53 128 17 41 Aggregate 24 58 140 17 42 Q Trailer, I-ton, 2-wheel, water tank (250-gallon) 1 1 3 43 Q Truck, %-ton, command 1 1 3 44 Q Truck, 94-ton, weapon carrier 1 1 45 Q Truck, cargo 2 6 14 46 Q Truck, cargo, with winch 2 Changes No. 2 WAR DEPARTMENT, Washington, December 28, 1942. T/0 8-68, April 1, 1942, Is changed as follows: Line Column 3 4 5 7 1 1 4* CO lO («* 1) 2 (d 1) 2 2 2 6 6 d Dental officers assigned to each clearing platoon as the company commander desires. 4 4 12 2(1 57 140 Plate 26, T/O 8-68, April 1, 1942, and Changes 1 and 2. Clearing Company, Medical Battalion, Motorized, MEDICAL SERVICE OF THE DIVISION 747 and troops arc dismounted, the medical support in combat is identical to that of an infantry division. The Division Surgeon. The medical section of division headquarters in a motorized division is identical in organization to that of an infantry division. The division surgeon is separate from the medical battalion commander. He functions as a staff officer and his duties are identical to those of the division surgeon of an infantry division. Introduction. Airborne divisions are a new addition to our fighting forces. They are smaller than corresponding units of the ground troops. The airborne division is trans- ported to a combat area by airplanes and gliders. After disembarking from planes and gliders an airborne division will fight as an infantry division. Airborne divisions probably will be employed to hold areas initially captured by paratroops pending the arrival of armored divisions, motorized divisions or other reinforcements. Areas orig- inally captured by paratroops and held by airborne troops generally radiate from air fields and portions or terrain permitting landing of cargo planes and gliders. Airborne divisions will be deficient in heavy transportation and heavy equipment. The equipment transported by cargo planes generally must be light. Vehicles of the 14 -ton, 4x4 truck, and similar types will be carried in cargo planes. Such limitation on transporta- tion will influence operations and the medical support of operations. Medical Support. The division medical service of an airborne division is furnished by an Airborne Medical Company. This unit differs from the usual division medical unit in size and organization. Because of the smaller size of an airborne division the division medical unit has been correspondingly reduced. An airborne medical company is composed of a company headquarters, a division medical supply section, and three identical platoons. Since transportation is limited, attempts to utilize commandeered vehicles, or other means of supplementary transportation must be improvised, to aid in the transportation of casualties. Evacuees are gathered near the fields utilized to land supporting cargo planes. Medical personnel with airborne divisions must be prepared to give treatment and temporary care pending arrival of transport planes. Temporary loss of air superi- ority may keep vulnerable cargo planes from arriving in the combat area for brief periods of time. Additional clearing support will be transported by air, but it will be delayed unless air superiority is maintained. Troops and troop supplies are normally transported by the troop carrier wing of the air support command of an army air force. All cargo ships are equipped with litter racks, and they may be loaded with casualties before departing from the combat area on their trip to the home base. Medical personnel operating with airborne divisions must be acquainted with air operations and methods of air transportation. Speed dur- ing such operations is essential, and split second timing is paramount to success of airborne operations. Because of limitation of transportation, cargo space is at a premium. Extreme care must be exercised by medical personnel to utilize available cargo space for equipment and supplies that are essential and useful. Casualties evacuated from areas occupied by airborne divisions are transported by air and are returned to hospitals in vicinity of base fields. At these hospitals definitive treatment and elaborate surgical procedures may be initiated. Medical Support of Airborne Divisions Introduction. Mountain divisions are organized, trained and equipped to operate in extreme cold and at high altitudes. Vehicular transportation is limited, and pack transportation is included in most organizations. The large number of animals in a mountain division requires a large veterinary organization for veterinary service. Oper- ations of such organizations require specialized training in extreme cold at high altitudes. Training is conducted in mountainous districts as in the Rocky Mountains of United States. Mountain divisions are offensive as well as defensive organizations. Division artillery consisting of 4 battalions of pack howitzers allows considerable artillery support to operations entailing the use of the division. MEDICAL SUPPORT OF MOUNTAIN DIVISIONS 748 MILITARY MEDICAL MANUAL Medical Support. The division medical service of a mountain division is furnished by the Mountain Medical Battalion, (T/O 8-135). This unit is organized along the lines of a medical battalion, but is modified to operate in support of a mountain division. It has a veterinary company. The collecting companies have no ambulances. The clearing company has three clearing platoons each consisting of a station section and a motor ambulance section. MEDICAL BATTALION Mountain Division Battalion Headquarters HEAD- QUARTERS DETACH- MENT 9—officers 43—men Trucks Trailers COLLECTING COMPANY 5—officers 78—men 3—horses 22—pack mules 1—escort wagon COLLECTING COMPANY COLLECTING COMPANY CLEARING COMPANY 14— Officers 137—Men 15— Ambs (m) Trucks Trailers VETERI- NARY COMPANY 9—O's 129—Men Animal* Trucks Trailers Plate 27. The Medical Battalion, Mountain Battalion. 1 2 3 4 5 6 7 1 Unit Battalion headquar- ters » | Headquarters and headquarters de- tachment (T/O 8- 1 196) 3 medical companies (each) (T/O 8-197) Total battalion | Enlisted cadre i Remarks i 2 (b 1) 1 1 3 (1) 1 1 4 CD (• D C 2 2 8 ft « 2 C 1)5 C 1 17 G (• 1)°2 5 * Battalion head- quarters personnel shown in column 2 in- 7 (4) 8 8 32 8 1 1 i *> Battalion com- mander. « Medical Adminis- trative Corps. d Dental. • Qualified warrant officer, when available, may be used to replace this motor officer (clas- sification: technician specialist, motor trans- port) . 9 1 1 4 4 10 3 3 3 11 2 3 11 11 12 4 7 25 15 13 1 4 13 7 14 4 4 18 11 15 9 9 36 14 16 9 43 138 17 18 63 176 18 (7) (10) (37) 19 Total enlisted 60 124 422 66 20 68 132 454 66 21 Q Trailer, 1-ton, 2-wheel, water tank (250-gal.) 1 2 7 22 3 10 33 23 Q Truck, command and recon- 1 1 24 Q Truck, 94-ton, weapon carrier 2 1 5 25 5 3 14 26 Q Truck, cargo, with winch Q Truck, 2H ton, wrecker, with winch 1 3 27 1 1 Plate 28. T/O 8-195, July 23, 1942. Medical Battalion, Engineer Amphibian Brigade. No prescribed rules may be laid down for operation of the division medical service of the mountain division. Every operation will be different. Troops and animals must be trained to become accustomed to operate at high altitudes where it is cold. Medical troops must be trained in mountain climbing, and for the transportation of casualties MEDICAL SERVICE OF THE DIVISION 749 over mountain trails on pack animals, and up and down formations of terrain not adaptable to trails or trail building.. The principles of operation of the medical battalion of the infantry division, and the medical squadron of the cavalry division should form the basis of knowledge for plans and operation of medical units with mountain divisions. MEDICAL SUPPORT OF THE ENGINEER AMPHIBIAN BRIGADE Introduction. The Engineer Amphibian Brigade is a unit smaller than a division, yet it is of sufficient size to warrant inclusion of a medical battalion within its organ 1 2 8 4 6 6 7 8 e 10 1 Unit | Technician grade 1 Battalion headquarterssec- tion | Personnel section j Detachment headquarters section j General and medical sup- ply section | Motor maintenance section | Total detachment Enlisted cadre Remarks 2 *1 1 3 M 1 4 «1 41 2 6 41 41 2 6 Second lieutenant .. 4 1. 4 *i 2 k E xecuti ve and plans 7 Total commissioned 4 1 1 1 1 8 — and training. e Assistant plans and 8 1 1 1 g (1) (1) (1) 10 1 1 1 n 1 1 i 8 3 12 Motor (813) (i) (1) 13 (1) 1 (1 ) 14 (1) (1) U ) 15 1 1 2 2 16 (1) (1) (i) 17 (1) (1) a) 18 2 1 1 4 3 19 Motor (813) (1) (i) (2) (?) 20 8upply (82i) (1) (1) (2) hi qualified in morning 21 1 1 1 JQ (1) (1) (i) 23 Technician, grade 4] l 4 2 k Driven by auto- 24 Technician grade 5 , j d, 10 3 11 8 6 » 2 mobile mechanic. 25 Private, hrst-class | 6 The serial number 26 Private. j [16 symbol shown in pa- 27 (1) (1) 28 Checker, receiving and shipping rable part of t he special- (186) (1) (1) 29 4 ('1) (1 ) (i) 30 6 ('l) hi 31 ('1) (1) (?) 32 5 (1) 1 33 Cook (060) 4 (1) 1) (1) 84 6 (*2) it) hi 35 (*2) (0 36 6 (ij (2) 37 «) (1) (2) (2) (9*) 38 4 (2) (?1 39 5 (1) u5 (2) 1942. 40 (3) (3) 41 5 (1) 42 Basic ~(52'l)_--I.--.- CD (2) (3) a) (7) 43 Total enlisted 11 4 16 11 R "bo- "IT 44 TT "IT T2~~ 9 "bT TT 45 Q Trailer, 1-ton, 2-wheel, water tank (250-gal.) 1 1 46 Q Truck, W-ton . _ 2 1 8 47 Q Truck, command and recon- 1 1 48 1 1 2 49 2 8 1 6 60 (1) (3) (4') 61 (1) 1 62 Wrecker, with winch (hi) a) — Plate 29. T/O 8-196, July 23. 1942. Headquarters and Headquarters Detachment, Medical Battalion, Engineer Amphibian Brigade. 750 MILITARY MEDICAL MANUAL ization. This brigade has a headquarters, a headquarters company, a boat regiment and a shore regiment. There is also a maintenance company, a signal company, and an ordnance platoon. The supply of the unit is furnished by a quartermaster battalion, and medical support is given the brigade by the Engineer Amphibian Brigade Medical Battalion. Each regiment has its own attached medical units. 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 10 17 18 19 20 21 22 23 24 25 20 27 28 29 30 31 32 33 34 35 30 37 38 39 40 41 42 43 44 45 40 47 48 49 50 1 2 3 4 5 6 7 8 9 Remarks Unit | Technician grade 1 Company headquar- ters Collect- ing platoon | Clearing platoon j Total company | Enlisted cadre 1 Litter bearer I section I Motor sec- tion 1 1 0*14) 3 2 6 1 :::: * Medical Adminis- trative Corps. b Drives truck, 34- ton, in addition to other duties. d Dental. The serial number symbol shown in pa- rentheses is an insep- arable part of the specialist designation. A number below 500 refers to an occupa- tional specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military oc- cupational specialist listed in Circular No. 14, War Department, 1942. 1 Vi 1 1 1 6 8 1 3 (1) (2) 7 IS IS 4 IS (1) Ji s 1 (2) (1) (13) (30) (1) (2) (6) IS IS (1) IS! II! (10) 1 3 (1) (3) 4 1 2 is 3 4 "(i) (i) (ij (ij (i) "(ij (i) 1 1 (1) .... 1 1 Platoon (651) .... 1 1 6 *3 1 6 18 *1 h 2 41 3 9 21 1 8 2 5 4 17 — 6 i 1 2 12 27 60 — 1 r 1 a) (i) 3 (1) 3 1 1 1 2 2 (i) (1) (2) 4 (2) 2 2 2 0 i) (D 2 (i) (i) 4 (2) (2) 10 17 (2) 4 2 1 pitalization units (ca- pacity 200 beds each) or one hospitalization unit (less a ward sec- tion) can be established (i) tk i) (1-) (1) (6) (2) a) a) Motor (813)--- (1) (1) a) (3) (1) (2) 13 (-1) */ Plate 9. Conventional Arrangement of Evacuation Hospital. LEGEND conventional or a similar arrangement, the unit commander or his representative, usually the detachment commander, designates the exact location of the left front corner of the No. 1 (receiving) tent. Markers designating this and similar points for all tents to be erected are then placed from left to right and front and rear. For the establishment of the installation under canvas, a space of 200 yards square is required. If utilizing existing shelter, the requirements are estimated at 80,000 square feet. A standard order of priority within a unit for the erection of tentage facilities training, MEDICAL SERVICE WITHIN THE CORPS AND ARMY 785 permits coordination of loading and unloading (train or trucks), and insures early estab- lishment of vital departments with an minimum time lag between arrival and the time the installation is ready for actual operation. A conventional hospital plan and a priority list having been adopted, deviations there- from are kept at an absolute minimum. The following order for the erection of tentage, also applicable to the establishment of departments in existing shelter, is suggested only as a guide (tent numbers refer to Plate No. 9): Receiving wards (department), tents Nos. 1 and 2. Preoperative wards, tents Nos. 8 and 9. Shock wards, tents Nos. 15 and 16. Bath department, tent No. 3. X-ray and sterilizing departments, tent No. 10. Dressing and dental departments, tent No. 4. Operating rooms, tents Nos. 11 and 12. Pharmacy and laboratory, tent No. 5. Headquarters and registrar’s office, tent No. 6. Messes (including kitchens), tents Nos. 7, 14, and 21. Basic wards medical surgical, tents Nos. 13, 17 to 20, inclusive, and 22 to 27 inclusive. Latrines and screens in designated areas. Quarters for personnel. Remaining administrative offices, supply, and storage facilities. Remaining wards. Other sanitary installations. With proper coordination of personnel canvas for several departments can be erected simultaneously. However, the completion of the basic unit or such part of it as the commander prescribes, together with the more important sanitary installations, takes precedence over the remaining priorities. Distribution of Personnel. Based upon the markers, tentage and department equip- ment are appropriately distributed throughout the area, following which the detachment commander assembles all available men, organizes squads consisting of nine men, one a noncommissioned officer, and assigns to each squad the erection of particular tent(s). Squads of men from a particular section or service such as the mess section or service may be directed to erect the canvas of that department, and immediately to continue with the installation of the operating equipment of that department. Following the erection of the canvas of the basic unit a part or all of the bearer group is utilized as indicated to complete the project. Each section and service commander or chief is charged with the installation of such equipment as pertains to his particular department(s). He inspects his equipment for serviceability, requesting emergency repairs as indicated, and draws any additional supplies required. When his department is prepared to operate he immediately notifies the unit commander or his designated representative. Operation. Headquarters is located conventionally in tent No. 6 and is part of the basic unit. The unit (hospital) commander’s office may be in the headquarters tent or if desired may be located in a small tent adjacent to headquarters: Coordinates the functions of all departments, assigning wards to services, and re- distributing if necessary the personnel among departments to meet most equably the de- mands of the situation. Makes such reports of admissions and dispositions as may be required by higher authority (normally a daily report is submitted to the army surgeon, stating the number of cases admitted and the number suitable for evacuation). Maintains liaison with the army surgeon or his representative regarding evacuation by hospital train or other unit, medical supplies, equipment for expansion, support by other medical elements, and future movements of the installation. Receiving Department. Every incoming patient is brought for preliminary examina- tion, sorting and admission. Although conventionally located in tents Nos. 1 and 2, at times the influx will demand expansion into adjacent departments such as the dressing 786 MILITARY MEDICAL MANUAL tent and the preoperative wards. Every patient is examined by an officer. Duong stress periods only one of the two regularly assigned officers can be on duty in the department. Augmentation may be accomplished by temporary transfer of one or more officers from other departments, as from the dental service, to the receiving department. The chiefs of the medical and surgical services may help with examining and sorting. Every effort is made to determine the exact nature of the condition of each patient so that transfer between services after admission will not be necessary. If the influx is too great, secondary sorting may be accomplished in the dressing tent or in the preoperative wards. An improvised office is established in tent No. 1 with the clerical personnel of the section (one staff sergeant, one sergeant, two general clerks, and one typist) organized to perform the following functions (see also FM 8-45): The field medical record (M.D. Form No. 52c and d) is initiated for each case unless previously initiated as in a surgical hospital, and such notations entered thereon as directed by the examining officer. At the same time, an index card (M.D. Form No. 52a) is made and forwarded to the registrar’s office. M.D. Form 53 may be sub- stituted for 52a. The EMT is removed from the patient, placed in the field medical jacket, and the jacket attached to the patient. An officer receives and checks the patient’s valuables, placing the receipt therefor in the field medical jacket. The valuables for each patient are sealed in a separate en- velope, the latter clearly marked with the patient’s name, organization, and serial num- ber, and locked in a field safe or suitable substitute. Clothing and equipment are removed, listed and stored, or turned over to the supply department for disposition in accordance with existing policies. Each patient is issued hospital clothing and assigned to ward and service. From the receiving department walking patients are directed and litter cases are carried by section personnel to one of the following destinations: Dressing tent, bath tent, preoperative ward, X-ray ward, medical or surgical evacua- tion wards, shock ward. Assignment of patients to particular wards within a service may be made in accordance with directives from the chiefs of the services. For example, the chief of the surgical service may designate particular wards for particular type wounds as orthopedic, chest, head, or abdominal cases; or for ambulatory and litter cases. Exchange of such items of medical supply as splints, blankets, etc., accompanying in- coming patients is accomplished by representatives of the supply department operating adjacent to the receiving department. Located conventionally in tent No. 6, the office of the registrar is convenient to the unit headquarters and the receiving department. The personnel of this department receives the index cards from the receiving department. Together with information furnished by the wards and from the evacuation officer, the office prepares the report of sick and wounded as required from all hospitals in the theatre of operations. For further information regarding reports and returns see FM 8-45. During operations the surgical service includes the dressing department, the bath tent, the sterilizing and operating departments, and the shock, preoperative, and other surgical wards. The personnel are distributed by the chief of the service to meet existing needs. Dressing department tents located near the receiving department, receive for dressing and further sorting all ambulant surgical cases except those sent directly to the pre- operative wards because of the obvious gravity of their wounds. The officer in charge examines each patient carefully to determine the extent of the injury, administers prophylactic sera as indicated, dresses wounds, performs such minor surgery as may be indicated, and sends the patients to the proper wards. Those found with serious wounds are sent to the X-ray, the preoperative ward, or the operating room, as indicated. The personnel varies with the situation and the distribution as made by the chief of the surgical service. Normally, one nurse and a surgical technician assist the officers in charge. MEDICAL SERVICE WITHIN THE CORPS AND ARMY 787 Equipment should include chairs or benches, two litters on racks for use as operating tables, bedside tables, basins, pails, water heater, and irrigators. Instruments and dress- ings are obtained from the sterilizing department as needed. Bath Tent. The bath tent is an adjunct of the preoperative wards and is under the supervision of the surgical service. Normally, only surgical cases are sent there and then as a part of the preparation for operative procedures. The personnel consists of enlisted technicians supervised by male nurses. Cases are sent to the bath tent as ad- mitted and clothing is removed and returned to the receiving department, and after bathing hospital clothing is furnished and the patients sent to the preoperative wards. Equipment includes portable bath apparatus, water bags with attached hose and nozzles, litters on racks, rubber sheeting, blankets, soap, razors, water heater, and solutions for washing wounds. Bathing facilities for appropriate gas cases are arranged in a separate department. Preoperative Wards. Patients are received in the preoperative wards from the re- ceiving office direct or through the dressing or bath tent. Each patient is again examined, particular care being taken to determine blood vessel or nerve injury, condition as to shock, the presence of tourniquets, uncontrolled hemorrhage, and the necessity for immediate surgical procedure or for supportive treatment prior to operation. Sound judgment and proper care and treatment in this department are vital for the success- ful operation of the surgical service. Close supervision by the chief of the service is indicated. The equipment includes facilities for bathing, shaving, administration of sera, in- travenous infusions, hypodermoclyses, enemata, transfusions, dressings, and allied functions. The personnel should be carefully selected and changed only when absolutely necessary. From the preoperative wards, patients are routed to: Evacuation wards for fractures and other traumatisms not complicated by open wounds and other cases operated on in clearing stations prior to admission who are in condition for immediate evacuation; Special wards for head, chest, abdominal, and shock cases, not yet ready for operation or evacuation; X-ray department; Operating rooms (tents), with the following priority; cases with active hemorrhage, those with tourniquet in place, and those with open unsplinted fractures. Shock Wards. The shock wards are located adjacent to other surgical departments and receive patients from the receiving department, the preoperative wards, and from the operating room. Equipment is limited to that necessary to combat shock. Personnel comprises the special shock teams (see T/O 8-580). After response to treatment pre- operative cases are sent to the operating room or to the preoperative wards; post- operative cases to surgical wards as indicated. Sterilizing Room (Tent). This department sterilizes instruments, dressings, and operative packs for the entire service. Prepared package dressings are utilized to the fullest extent; otherwise, sheets, towels dressings, etc., are prepared for all types of cases. Likewise, instruments are sterilized in lots as indicated for particular procedures such as debridement, intestinal surgery, brain operations, etc. A nurse is in charge of the enlisted personnel. Liaison with the other surgical departments to correlate their needs is essential. The operating rooms, identical in equipment, are located adjacent to the other surgical departments (see Plate No. 10). A conventional arrangement of the interior of an operating room or tent allows the simultaneous functioning of six specialist teams. Operating tables are litters on racks, and shelving along one side holds dressings, instruments, and scrubbing solutions. Tables between each two teams provide space for opening operative packs. One surgical nurse serves two operating teams, other nurses serve as operative assistants. One-way traffic is advised, patients are brought in at one end and removed through the opposite end. Personnel for the operating rooms are drawn from the surgical teams as indicated. All personnel should be relieved every 8 hours during periods of stress. 788 Patients are brought in by litter bearers and are placed on the vacant operating tables without being removed from their litters. Final preoperative preparation is accomplished and the anesthetic begun while the preceding case is being completed. An appropriate team performs the indicated procedure, one of the operators dictates a short resume of the procedure, and completes the report by adding the word DETAIN or EVACU- ATE. Cases to be evacuated are of two classes, those suitable for immediate evacuation and those requiring from 12 to 24 hours observation prior to evacuation. In determining whether patients should be detained or evacuated the operator is guided by the con- dition of the patient, the available space in the hospital, and the policy of the com- mander under the existing situation. Clerical personnel enter on the field medical records and clinical cards, preferably with ink or typewriter, such pertinent data as the name of the operator, the anesthetic, operative time, type operative procedure, the time intervening between incurrence and operation, and such observations as removal of foreign bodies. Records of patients dying in the operating room are completed and sent to the evacuation officer. Bed assignments are made by a noncommissioned officer who keeps a list of available beds. Litter bearers are on call at all times. Patients in shock are sent to the shock wards, detained cases to the basic wards, those tempo- rarily detained to the secondary wards. Patients to be evacuated are sent to the evacua- tion wards as soon as they have recovered from the anesthetic. MILITARY MEDICAL MANUAL Plate 10. Conventional Arrangement of Operating Tent, Evacuation Hospital. Operating time for each case may be estimated as l/2 hour. Thus one team working 8 hours can operate 16 cases. One team handling minor cases only can care for ap- proximately 50 cases per 8-hour shift. On this basis plans for augmentation of the surgical teams can be made in advance of the actual need. The X-ray department is adjacent to the preoperative wards and the operating rooms. Part of the room (tent) is converted into a dark room for fluoroscopic examinations. Most cases are fluoroscoped, X-rays being taken only for those wounds requiring an accurate location of foreign bodies such as head and neck cases. Cases are handled with- out being removed from the litter whenever possible. The officer or X-ray technician handling the case locates foreign bodies, dictating the findings to a clerk or typist. These remarks are transcribed on the clinical card and supplemented by sketches when such appear advantageous. A brief entry is made also on the field medical record. Occasionally, the operating surgeon is called to verify the condition before removal to the operating room. After X-ray examination the patient is returned to the preoperative ward or sent to the operating room as indicated. Those found negative for pathology and their condition otherwise permitting may be sent directly to the evacuation wards. The dental department is located in the tent with the dressing room, and its per- sonnel furnish emergency dental treatment to patients and duty personnel, handle minor maxillo-facial wounds (of insufficient severity to warrant handling by the plastic- maxillo-facial team), and in emergency augment the personnel of such other depart- ments as the receiving and dressing departments. The Laboratory and Pharmacy. Services are grouped together and one officer super- vises the operation of both departments. The laboratory confines its procedures, if possible, to blood counts, uninalysis, blood typing, etc. More complicated procedures MEDICAL SERVICE WITHIN THE CORPS AND ARMY 789 arc referred to supporting laboratory installations. The pharmacy functions in its ap- propriate capacity, limited by the supplies available. Wards are apportioned to the services by the commander according to existing needs. Each service furnishes the ward personnel for its assigned wards. Nurses are appor- tioned to the chiefs of services and assigned by them in the most advantageous manner. Privates (basic or technicians) are assigned to wards and noncommissioned officers to groups of wards. In addition to such special wards as preoperative and shock, there are 11 basic wards. These are distributed as indicated in the preceding paragraph. In addition to those within the basic unit, there are 17 other wards which may be utilized for secondary treatment or evacuation wards as the situation indicates. Such local reports may be instituted as periodic reports to the receiving department or to the chief of service as to available beds, reports to the registrar of admissions, available beds, patients suitable for evacuation, together with their classification (status, disease or injury, litter or ambulant, etc.) When a call for evacuation is received by the ward officer, he verifies the suitability of patients for evacuation; marks them for identification; sends their clinical cards to the evacuation officer; and just prior to their evacuation, adjusts splints and dressings, checks clothing and blankets for suitability, and makes sure that the field medical record is properly attached to each patient. The morgue is located inconspicuously under canvas and is large enough to accommo- date four litters on racks, and should contain galvanized-iron cans, pails, rubber sheets, and sponges. One or two enlisted men are assigned to duty at the morgue. The re- sponsibility for the morgue rests with the chief of the laboratory service. The evacuation officer, upon being notified of a death within the installation, obtains the field medical record and the clinical card (no prescribed form) of the deceased, closes them, and sends them to the registrar. The registrar, in his capacity of com- manding officer of patients, with the ward (or department) officer, secures the per- sonal belongings and the valuables of the deceased, inventories them, and transmits them to the unit supply officer. The body, properly tagged for identification, is re- moved to the morgue and prepared for burial. Final disposition of the remains is a function of the unit supply officer or a representative of the Graves Registration Service if one is attached to the unit. The registrar is responsible that report of death is for- warded to higher authority in accordance with existing regulations. (See TM 8-260.) Evacuation Department. Patients may be admitted directly to the evacuation wards when their condition warrants their evacuation. Other patients are moved by the evacuation department directly from medical or surgical wards to the transport of the evacuating unit. Upon receipt of information that a certain unit is to evacuate patients at a certain time, the evacuation officer notifies all wards that may have patients suitable for evacua- tion. Ward officers immediately furnish the evacuation officer with a list of such patients and shortly before loading time he dispatches bearers to the wards indicated for the movement of evacuees to the loading platform. As they are placed there, the evacuation officer or his representative rechecks all patients for suitability of clothing, checks the attached field medical records for presence and completeness, prepares a list of patients who have valuables deposited in the hospital (from receipts in field medical records) and obtains same from the receiving officer, and at the proper time turns such valuables over to the officer in charge of the unit receiving the patients. After checking the field medical records, clerks stamp them EVACUATED and add the designation of the evacuating unit and the date, and enter on a tally sheet a check for each patient being loaded. This tally sheet (two copies) becomes, when signed by both, a list for the officer of the evacuating unit and a receipt for the evacuation officer of the hospital. Patients being evacuated by hospital train or truck convoy are loaded by the personnel of the evacuation department of the hospital. If the patients are being evacuated by airplane ambulances, the loading thereon is performed by the personnel of the medical battalion, airplane ambulance. 790 MILITARY MEDICAL MANUAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Administrative services Professional services 1 Unit Technician grade Headquarters Hospital headquarters section Detachment headquar- ters section Hospital supply and utilities section j Hospital mess section Transportation and maintenance section 1 Registrar and com- manding officer, de- 1 tachment of patients ! Receiving and evacua- tion | Operating section » Ward section Pharmacy, laboratory, and X-ray section Total | Enlisted cadre Remarks 2 1 1 3 1 1 1 3 • O perating section includes: 2 surgical teams, each in- cluding 1 general surgeon, 1 assistant general surgeon, 1 anaesthetist, 3 nurses, 2 4 Dental. 25 28 27 “Medical (673) “ . . (2) (2) (4) (1) (2) (1) • Medical Administrative 1 10 11 3 Corps. 28 20 (1) 0) (10) (1) ' General laboratory special- ist. Medical (67*3) (10) 62 (2) 30 31 32 Technician, grade 31 Technician, grade 4 7 38 4 15 20 3 8 21 11 8 25 41 4 9 6 * Chaplain. h Qualified In sick and wounded report procedure. 11 chief nurse, 1 assistant 33 Private, first class| 47 MEDICAL SERVICE WITHIN THE CORPS AND ARMY 791 <54 t 06 chief nurse. 86 (4) (4) i Following may be substi- 5 (1) l) tuted: 20 surgical technicians pnpW (ana) (k 1) (1) (225), grade 3; and 20 medical 5 (1) (1) technicians, (123), grade 4. 5 (1) (1) (Substitution may bo made 4 (1) (1) (1) (3) (D when directed by the War 5 (1) (1) (2) (1) Department.) 42 (2) (l) (2) (5) k Also drives truck. 43 (1) (!) 1 Officers’ and nurses’ mess. 5 (1) (1) (1) (3) The serial number symbol (l) (1) (1) (3) shown in parentheses is an Cnnk (DfiO) | 4 ((1 1)3) (4) 7) (2) inseparable part of the special- P,nnk (OftO) 5 ((> 1)3) (4) (7) (3) 1st designation. See AR 615- ((i 3)6) (5) (ll) 26. 49 Driver, light truck C345) 5 \ (3) (18) f (5) - . 50 J l (16) (4) (4) 4 (1) 1 (1) C3 5 (k 1) (1) (k 2) (2) (20) (20) 50 3 (1) (D (1) 57 4 (1) (1) 59 4 (1) (1) 59 4 (i) (1) 0) 5 (i) (1) 4 (3) (3) (1) 5 (5) (5) (2) ft 3 (10) (10) 3 (1) (1) (1) 4 (1) (1) p>6 5 (D (1 67 (1) (1) (2) (2) 3 (6) (6) (2) 70 4 (4) (2) (6) (2) 5 (4) (8) (12) 79 (12) (12) 73 4 (1) (1) (1) 74 5 (1) (1) 75 (1) (1) 76 Basic (521) '. ... ... (20) (20) 77 Total enlisted 9 40 6 17 21 4 9 24 75 12 217 34 78 Aggregate 6 9 41 7 13 22 0 13 56 104 14 296 34 70 0 Trailer, 1-ton, 2-wheel, cargo. 18 18 80 0 Trailer, water-tank (250-gallon) 2 2 81 0 Truck, ... 1. 1 1 2 82 0 Truck, %-ton, command 1 1 83 0 Truck, %-ton, weapons carrier.. 1 1 84 0 Truck, 2V£-ton, cargo 2 16 18 85 0 Truck, 2>£-ton, cargo, w/winch 2 2 86 0 Truck, water tank (700-gallon). ... ... 1 . --- 1 Plate 11. T/O 8-581, January 8, 1943. Evacuation Hospital, Semimobile. 792 MILITARY MEDICAL MANUAL 1 2 | 3 4 0 6 7 8 9 10 11 12 13 14 15 Clinical section 1 Unit j Technician grade Headquarters j Medical service » Surgical service b Eye, ear, nose, and , throat service « 1 .... ... Orthopedic service d X-ray service d Laboratory service*1 Dental service * Convalescent sectioi i Detention section « Total Enlisted cadre Remarks 2 Colonel ... 1 1 3 Lieutenant colonel h 1 1 »Includes 1 major, M. C., chief of medical service (internist); 1 captain, M. C., assistant chief (internist). b Includes 1 major, M. C., chief of surgical service (general operator); 1 captain, M. C., 4 i 1 1 1 3 5 i 4 1 1 i 1 1 1 i 1 i 13 6 1 l 3 1 6 7 k 1 6 7 8 8 2 3 2 1 1 1 4 7 2 31 assistant chief (general operator); 1 lieutenant, M. C., anesthetist and assistant surgeon. 9 Master sergeant, including 1 1 c Includes 1 captain, M. C., chief of service (otorhinolaryngologist); 1 lieutenant, M. C., assistant chief (opthalmologist). d Includes 1 captain, M. C., chief of service. e Includes 1 captain, D. C., chief of dental service (prosthetist); 2 lieutenants, D. O. (general clinical dentistry); 1 lieutenant, D. C. (oral surgeon). 1 Physical rehabilitation section (6 convales- cent companies), includes 1 captain, M. C., chief of section; 6 second lieutenants, M. A. 0., commanding companies. s Personnel for control and treatment of venereals, includes 1 captain, M. C., chief of section (urologist); 1 lieutenant, M. C. (urol- ogist). t Medical inspector and executive officer. 1 Commanding officer, detachment of pa- tients. 10 Sergeant major (502),” (1) 1 0) 11 1 1 12 Technical sereeant, including _ 3 2 5 3 13 Clerk, chief (052) O) (1) (1) 14 Mess (824) _ (1) 15 (1) 0) (1) 16 m! .... (1) (1) 0) 3 17 Technician, laboratory (409). Staff sergeant, including 0) (1) IS i 6 1 8 19 (i) 0) 20 (6) (1) 2 (7) (3) 21 2 2 12 18 9 22 (1) (1) 23 Medical (673) 1 (2) (6) (6) (1) (9) (2) 24 0) (7) (6) 25 0) 2 (1) (1) 26 12 1 15 27 (1) (1) 28 Medical (673) (12) (1) (13) MEDICAL SERVICE WITHIN THE CORPS AND ARMY 793 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 4'.! 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 Supply, medical (825) (1) 47 (?) (2) (1) (2' I , o) [ 1 24 i 10 j 2 Medical Administrative Corps; 1 Quarter- master Corps; 1 chaplain. k Medical Administrative Corps. Distribution of personnel indicated hereon is advisory. Considerable variation therefrom is left to the discretion of the commanding officer of the hospital. The serial number symbol shown in paren- theses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circular No. 14, War De- partment, 1942. T/O 8-590, April 1, 1942, is changed as follows: Technician, grade 3] Technician, grade 4 Technician, grade 5 [-including... 31 49 17 ... 1 8 13 Private, first class.. Private J Baker (017).. 5 ■ 31 ; 1 13 > .... ! (2); (1) : CO Baker (017) Bugler (803) (1) (2) (1) (1) J (1) \ (16) (1) (1) (1) (1) (1) (9) (17) (18) (18) (1) (1) (1) (1) (1) (3) (2) (2) (2) (5) (1) 0) (2) (3) (6) (1) (1) (17) 5 5 (1) (1) Chaplain’s assistant (534)... (1) (1) } (ID (1) (1) (1) (1) (1) (1) (3) (4) Cl) (1) (1) (1) (1) * (6) 5 Clerk, general (055). Clerk, stock (324) 5 Clerk’ stock (324) Clerk-typist (405) 5 (1) Clerk-typist (405) 7 (1) (2) (2) (2) Cook (060'' 4 5 02) (12) (12) (5) (5) Mechanic, automobile (014) _ 5 4 Repairman, utility (121) Stenographer (213) Technician, dental (067) 4 5 5 4 5 (1) (3) (2) (1) (1) (2) Technician, dental (067) Line Column 3 Technician) laboratory (858). Technician, medical (123)... Technician, medical (123)... Technician, medical (123)... (i) 0) (1) ""(1) (0 (1) (1) (1) (1) (3) 4 oil Technician, sanitary (196)... Technician, surgical (225).. Technician, surgical (225)... Technician, surgical (225)... 5 3 4 5 (1) Changes! No. 2 | T/O 8-590, April 1, 1942, is changed as follows: (1) (2) (3) (3) U) (1) (3) (3) Technician) X-ray (204) 4 5 Technician) X-ray (264) Basic (521) (5) (7) (2) Total enlisted 57 — 35 79 21 192 38 Aggregate . Line Column 65 43 86 23 223 38 Q Ambulance, %-ton 3 13 4 1 2 1 A 4 1 2 7 4 Q Car, 5-passenger, light sedan. 76 3 2 9 t Q Truck, %~ton, weapon car- rier 6 6 [A. G. 320.2 (6-16-42).] Plate 12. 170 8-590, April 1, 1942, and Changes 1 and 2. Convalescent Hospital. 794 MILITARY MEDICAL MANUAL Property exchange with the evacuating officer is handled by representatives of the supply officer. Disposition of Patients. Patients fit for full field duty are discharged from the hospital, marked duty, and are taken over at the "hospital by representatives of the nearest re- placement depot. Patients requiring no further treatment but who will be fit for full field duty within a reasonable length of time are transferred to a convalescent hospital. Patients requiring definitive treatment that can not be rendered in an evacuation hospital, or who will require lengthy hospitalization, or who, when hospitalization is completed, will be unable to perform military duty, are transferred to a general hospital within the communications zone. Movement of Installation. When a functioning hospital is directed to close and move, all patients are segregated in the evacuation wards. As soon as a tent is cleared of'patients, the equipment is packed and the tent struck. The detachment commander is in charge of the packing although each section or service commander supervises the packing of the equipment of his particular department. Dismantling normally proceeds in the following sequence: Basic unit (less messes and the headquarters). Secondary wards. Evacuation wards. Headquarters and other administrative offices. Quarters for personnel. Messes. Sanitary installations. Properly trained, the unit should be able to estaolish the installation in from 4 to 6 hours and dismantle and move in from 8 to 10 hours after being cleared. Movement of the unit with equipment requires approximately two-thirds of a type A train, or 184 truck-tons in addition to its integral transport. Administration. Unit headquarters submits morning reports and other personnel reports and returns to army headquarters through the army surgeon or as directed. To obtain the proper amount of rations, a similar report of patients hospitalized is also rendered. Class l supplies are automatic. They are drawn daily by the unit supply officer at a designated distributing point in the army service area. The unit supply officer in turn issues them to the mess officer. Medical Supplies are obtained from the army medical depot in one of the following ways: by requisition through the army surgeon, by drawing upon established credits, by informal memorandum which also must be approved by the army surgeon. Delivery of medical supplies is accomplished by sending unit transport directly to the depot, by shipment from the communication zone to the nearest railhead or to the siding adjacent the installation, or in emergencies by the transport of the depot. Other Supplies are obtained by requisition through the army surgeon on the nearest depot of the branch concerned. First Echelon Motor Maintenance is performed by the transportation group of the supply and utilities section. Second and third echelon motor maintenance are by ap- propriate designated ordnance units of the army service area. When not at station, personnel of the medical service operate a dispensary for the care and treatment of the sic\ and injured personnel of the unit. When at station, sick and injured personnel are reported to the receiving department. EVACUATION HOSPITAL, SEMIMOBILE The evacuation hospital, semimobile is an organic element of the Army. It is designed to perform the functions of either the evacuation hospital (T/O 8-580) or the surgical hospital (T/O 8-570) and may replace either or both in the Army medical service. MEDICAL SERVICE WITHIN THE CORPS AND ARMY 795 CONVALESCENT HOSPITAL The convalescent hospital, an independent unit, is an organic element of the army and is under such control of the army surgeon as the army commander designates. A type army contains one such unit. As in the case of the surgical and evacuation hospital this unit is commanded by the senior officer of the Medical Corps assigned thereto and present for duty. Organization. See T/O 8-590. The general organization is designed to permit expansion to meet unusual requirements. Functions. The convalescent hospital renders care and treatment to cases whose nature does not warrant definitive treatment in an evacuation hospital and whose duration and prognosis do not warrant transfer to a general hospital. Such cases include: Convalescent cases from evacuation hospitals who will be fit for full field duty within a reasonable length of time. Venereals, by transfer or direct admission. Headquarters Headquarters section Clinical section Convalescent section Dentention section Medical service Surgical service Eye, ear nose, throat service Orthopedic service X-ray service Laboratory service Dental service Plate 13. Functional Organization of Convalescent Hospital. Cases other than venereal, by direct admission from army (corps and division) clearing stations and from dispensaries operated by medical personnel attached to various units operating in the vicinity of the hospital such as the replacement depot. Headquarters. The hospital headquarters consists of the hospital commander and the enlisted assistants necessary for the operation of headquarters and the administrative functions incident to the operation of the hospital. The number of such assistants make it advisable to form a headquarters section. See Plate 12, Organization of con- valescent hospital. Headquarters section. A suggested functional organization of a headquarters section consists of: Detachment headquarters: 1 First sergeant 1 Staff sergeant (clerk, general) 1 Sergeant (clerk, admission) 1 Technician, grade 5 (clerk, typist) 1 Private first class, or private (bugler) Hospital headquarters group: 1 Master sergeant, sergeant major 1 Technical sergeant (clerk, chief) 1 Technician, grade 5 (clerk, general) 1 Technician, grade 5 (chaplain’s assistant) 1 Private first class, or private (clerk, general) 1 Private first class, or private (stenographer) 796 MILITARY MEDICAL MANUAL Unit Supply and Utilities group: 1 Technical sergeant (supply, medical) 1 Corporal, (supply, medical) 1 Technician, grade 4 (pharmacist) 2 Technician, grade 5 (carpenter) 1 Technician, grade 5 (clerk, stock) 1 Private first class, or private (clerk, stock) 1 Private first class, or private (clerk, typist) 1 Private first class, or private (repairman, utility) 2 Private first class, or private (basic) Unit transportation group: 1 Sergeant (motor) 1 Corporal (dispatcher) 1 Technician, grade 5 (mechanic, automobile) 11 Technician, grade 5, private first class, or private (chauffeur) 1 Private first class, or private (chauffeur) 1 Private first class, or private (basic) Headquarters mess group: 1 Technical sergeant (mess) 3 Technician, grade 4 (cook) 4 Technician, grade 5 (cook) 2 Technician, grade 5 (baker) 1 Technician, grade 5 (technician, sanitary) 4 Privates first class, or private (cook’s helper) 2 Privates first class, or private (baker) 2 Privates first class, or private (basic) Location. The unit being inactive, the headquarters is conveniently located in the bivouac or camp area; the unit being at station, the headquarters is located within and near the front of the installation. Commander. The hospital commander is directly responsible to the army commander or the surgeon, as prescribed, for the administration, discipline, training, and opera- tions of his unit in all situations. While at station, he maintains close liaison with the army surgeon and his assistants, the commanders of active evacuation hospitals within the army area, and with the commander of the replacement depot to which cases are sent upon complete recovery. Executive officer. The executive officer, an officer of the Medical Corps, is also the medical inspector. His duties are similar to the executive officer’s duty of an evacuation hospital. Supply officer. An attached officer of the Quartermaster Corps functions as the unit (hospital) supply officer. In addition to his supply duties, he also may be charged with utilities, transportation, the duties of fire marshal, and may command the head- quarters section. Adjutant. An officer of the Medical Administrative Corps is the adjutant and in addition may be charged with the duties of unit personnel and assistant fire marshal. Chaplain. See TM 16-205. Clinical Section: Medical. Two officers of the Medical Corps, both internists, serve as chief and assistant chief. There is 1 sergeant (medical), 1 private first class, or private (clerk, typist), 1 technician, grade 4, 1 technician, grade 5; and 2 privates first class or private (techni- cians, medical). Surgical. Three officers of the Medical Corps serve as surgeon and chief of service, assistant surgeon and assistant chief, and anesthetist. The enlisted personnel include 1 technician, grade 3; 2 technicians, grade 4; (all technicians, surgical), and 2 privates first class, or private (clerk, typist). MEDICAL SERVICE WITHIN THE CORPS AND ARMY 797 Eye, ear, nose, and throat. Two officers of the Medical Corps serve as chief of service and otorhinolaryngologist, and the assistant chief and ophthalmologist respec- tively. The enlisted personnel includes 2 privates first class, or privates, (technicians, surgical), and 1 private first class, or private (clerk, typist). Orthopedic. One officer of the Medical Corps, the chief of service. Enlisted as- sistants include 3 technicians, grade 5 and 1 private first class, or private (all technicians, surgical), and 1 private first class, or private (clerk, typist). X-ray. One officer of the Medical Corps, 1 technician, grade 4 and 1 technician, grade 5 (technicians, X-ray), and 1 private first class, or private (clerk, typist). Laboratory. One officer of the Medical Corps, 1 technical sergeant (pharmacist), 1 technical sergeant (technician, laboratory), and 2 technicians, grade 5 (technicians, laboratory). Dental. Four officers of the Dental Corps including the chief of the dental service a captain (prosthetist), 2 lieutenants (general clinical dentistry), and 1 lieutenant (oral surgeon). Enlisted assistants include 1 technician, grade 4 and 3 technicians, grade 5 (all technicians, dental), and 1 private first class, or private (clerk, typist). Additional. One sergeant and 3 privates first class, or privates (basic) form a utility squad and act as replacements and reinforcements for the various services. Functions. The clinical section operates: Receiving office for the hospital. Dispensary for the treatment of convalescent patients and duty personnel. Clinics and departments wherein the special functions of the various services are accomplished such as operating room, X-ray clinic, pharmacy, etc. Ward for the care and treatment of sick and injured duty personnel and of hospital patients whose condition is such as precludes assignment to the convalescent or deten- tion sections. Other functions as may be assigned by the hospital commander. Convalescent Section. This section is provided to furnish care, treatment, and physical rehabilitation to convalescent patients. It is capable of caring for approximately 1800 patients. The section is commanded by a captain of the Medical Corps, who is chief of section, and includes six second lieutenants of the Medical Administrative Corps. The enlisted personnel includes six staff sergeants (section chief), twelve ser- geants (six medical and six mess), twelve corporals (medical), six technicians, privates first class, or privates (chauffeurs); twelve technicians, grade 4 (cook); twelve techni- cians, grade 5 (cook); twelve privates first class, or privates (cook’s helper); and seven privates first class, or privates (basic) The section personnel provides cadres for six companies each consisting of one second lieutenant of the Medical Administrative Corps, one staff sergeant (section chief) one sergeant (mess), two corporals (medical), one technician, private first class, or private (chauffeur), four technicians, privates first class or privates (cook) and two privates first class, or privates (cook’s helper). Detention Section. The personnel of the detention section includes those for control and treatment of venereals. The two officers of the Medical Corps are both urologists. A captain is chief of the section and he is assisted by a first lieutenant. The enlisted personnel includes one staff sergeant (section chief), two sergeants (one medical and one mess), one corporal (medical), two technicians, grade 4 (cook), two technicians, grade 5 (cook), two privates first class, or privates (cook’s helper), one private first class or private (clerk, typist), one technician, grade 4 (technician medical), one technician, grade 5 (medical), three privates first class or privates (technician, medical), three privates first class, or privates (technician, surgical); and two privates first class, or privates (basic). The cadre divides itself functionally into two groups, an administrative and a treat- ment. The former contains the personnel for forming a varying number of companies. The technical specialists form the treatment group but may be utilized also for admin- istrative purposes. The officers function in both groups. Functions. The care, treatment, administration, and control of all venereals admitted to the hospital. 798 MILITARY MEDICAL MANUAL Enlisted Personnel. The qualifications of the enlisted personnel of the convalescent hospital are analogous to those required for similar personnel of the evacuation hospital. Training. Training in this unit parallels that of the evacuation hospital. Installation. The unit establishes one convalescent hospital. Capacity. The hospital has a normal capacity of 3000 patients and can be expanded to accommodate 5000 for a period not to exceed 1 week. Location, (see FM 8-15). Usually located centrally but well to the rear of the army area in a place that is convenient to evacuation hospitals and army replacement units. It may be located in rear of the army rear boundary, although remaining under army control. Physical arrangement. If to be installed in existing shelter, approximately 120,000 square feet of floor space is required. If under canvas, a space approximately 540 by 300 yards is required. In either case, ground or floor space should be such as to permit ex- pansion. There is no conventional arrangement for a convalescent hospital. Hospital head- quarters and the receiving department are placed conveniently for transport elements arriving with patients. The clinical section is installed adjacent to the receiving depart- ment with messing facilities for bed patients in the same general vicinity. For detention and convalescent sections containing only ambulant patients considerable leeway in loca- tion is allowable. The detention section is so placed as to facilitate the segregation of its patients from those of other sections. The establishing of the installation is analogous to that of the evacuation hospital. The commander makes such decisions as to the location of sections and the extent of the initial establishment, while the exact location of departments and the priorities within the section are the prerogatives of the section commanders subject to the approval of the hospital commander. No portion of the hospital is ever established until the need for it is definitely foreseen. The condition of the patients arriving at the convalescent hospital is never such as demands extensive and elaborate hospital facilities requiring any con- siderable time for operation. Operation. The receiving department is the responsibility of the clinical section and usually is operated by the medical service. The headquarters section furnishes clerical assistance and the property exchange is operated by the supply group of the same section. Clothing, valuables, and equipment are handled as in other army hospitals. All patients brought to the receiving department are carefully examined by a medical officer, medical records checked or initiated, index cards initiated and sent to the registrar (adjutant), and assignment is made to ward or section or both. In the case of patients admitted to the convalescent section, only the section assignment is necessary, the section chief being charged with assignment to company, tent, etc., within the section. At a specified time each day, or in emergencies at any time, the personnel of the re- ceiving department examine cases referred to them by other sections of the hospital, either because of relapse or the presence of some intercurrent complication. Such cases are re- turned to their section with recommendations for treatment, or transferred to the clinical section for definitive treatment, or transferred to an evacuation hospital. While at station, the hospital headquarters becomes the administrative center of the installation. It contains the office of the commander and his staff, the offices of the medical inspector, the registrar, unit personnel officer, commander of the detachment of patients, and the commander of the medical detachment. From it emanate all reports and returns relating to patients and duty personnel. Headquarters maintains liaison with all medical units which are sources of patients, with the army surgeon and his assistants, and with army replacement units. The commander and his staff correlate the functions of the various departments of the hospital, transfer personnel, both officer and enlisted, between sections to meet unusual situations as they arise, and conduct anticipatory planning relative to possible movements and expansion. Patients are direct admissions from the receiving department and trans- fers from the other sections. Treatment is rendered. By the treatment of patients from the other sections in the MEDICAL SERVICE WITHIN THE CORPS AND ARMY 799 various clinics (eye, ear, nose, and throat, X-ray, dental, etc.) and by the operation of wards for the treatment ot such cases as are indicated. With the exception of the genito-urinary clinic operated by the personnel ot the detention section, it operates all uie protessional services ot the hospital. Short duration cases from units operating in the immediate vicinity of the hospital upon complete recovery are returned to duty. Other cases as indicated are transferred to the section within the hospital trom whence they came, transferred to an evacuation hos- pital, or sent to designated replacement depot(s). Type of patients are patients other than venereal who have not fully recovered from the etiects ot injury or disease and who will be able to perform full military duty upon complete recovery, but who no longer require any further treatment. Operation. All patients admitted to the convalescent section are assigned to a com- pany commanded by a medical othcer. Such assignment may be made without regard to me condition trom which the patient is recuperating, or in some situations various companies may be designated to receive certain types of cases such as an orthopedic com- pany, a respiratory disease company, etc., depending upon the condition from which the patients are convalescing. Each company commander is responsible for the medical records of the patients as- signed to his company, tor thoroughly familiarizing himself with each case, and with the renabiiitation ot ail cases under his control. At least once each day, he makes a thorough physical inspection ot each man in his company and arranges tor a graduated scale of exercises, assigns hours tor bed rest, and by any other means at his command endeavors to bring about complete recovery in the shortest possible period of time. If at his daily inspection he discovers signs or symptoms indicating relapse or the presence of a complicating or an intercurrent condition, he immediately refers such cases to the clinical section tor consultation. Decision as to the disposition of such cases rests with the latter section (see above). From the convalescent section, cases are either returned to duty (to replacement depot or to a command operating in the vicinity of the hospital) or transferred to another section of the hospital. Detention section. The detention section renders care and treatment of venereal cases only. Patients are received by direct admission or by transfer from the installations of other medical units within the army. Treatment is definitive and supportive. Normally, control of patients is facilitated by the organization of companies as in the convalescent section. Patients recovering without permanent disability are returned to duty. Partients whose condition renders them unfit for further military service are transferred to an evacuation hospital for transfer to rearward installations. Supply department. The supply group of the headquarters section procures and dis- tributes supplies of all classes to the various sections and departments of the hospital. Procedure in disposition of cases. All patients being returned to duty are reported to the receiving department, hospital headquarters and the registrar’s office having been previously notified, where their clothing, equipment, and valuables, if any, are returned to them. They are turned over at the hospital to representatives of an army replace- ment depot, or in indicated cases are sent to their organization (units operating in the vicinity). Cases requiring transfer for more elaborate treatment than can be rendered in the convalescent hospital and cases having conditions rendering their retention in the service undesirable are transferred to an evacuation hospital, usually by means of the ambulance elements of an army medical regiment. These arrangements are made by the receiving department through the hospital headquarters. Procedure in case of death occurring within the installation is similar to that out- lined for the evacuation hospital. The registrar, the ward surgeon, the laboratory officer, and the supply officer are charged with their appropriate pertinent functions. 800 MILITARY MEDICAL MANUAL Movement of hospital. When necessary, the installation is moved by echelon. A portion of the personnel and materiel is withdrawn from service and moved to a new location, by common carrier or army truck transport, to establish the new hospital. When the new hospital is ready to receive patients, the old one suspends admissions. The movement gradually proceeds from the old to the new location as the patient population decreases in the former and increases in the latter. Administration. Personnel. All morning reports and other personnel reports and returns are submitted by the hospital headquarters to army headquarters. Supply. Supply is handled as for the supply of the evacuation hospital. Motor maintenance. First echelon, and such second echelon as is within their capabilities, is accomplished by the personnel of the transportation group of the head- quarters section. Further repair and maintenance are accomplished by designated ord- nance units in the army service area. Care of sic\ and injured. When not at station, personnel of the medical service operates a dispensary for the care and treatment of the sick and injured of the unit per- sonnel. The hospital being active, sick and injured personnel are reported to the receiv- ing department for appropriate action. Messes. The entire unit contains personnel and equipment for the operation of eleven messes, one for officers, one for enlisted duty personnel, the others for the patients of the various sections. The distribution of the latter will depend upon the number of patients within the various sections and may necessitate the transfer of mess personnel between sections. Usually, the supply officer operates the officers’ and enlisted duty messes, officers of the section being designated as mess officers of the various patients’ messes. The supply group draws the rations for all messes. MEDICAL SUPPLY DEPOT, ARMY OR COMMUNICATIONS ZONE. Organization. The medical supply depot is an organic element of the Army operat- ing directly under the army commander or the army surgeon, as prescribed. Both the medical supply unit and the installation which it establishes are termed depot. To avoid confusion, the establishing agency is designated unit or medical supply unit, and its installation depot or medical supply depot. Basically, the unit is organized to establish and operate one medical supply depot. However, it is capable when the situation demands of operating one main depot and one or two advanced depots. The organization of the two sections of the advanced depot platoon is identical. The optical repair section remains with the base platoon. A suggested functional organization of the unit is shown in Plate 14. Command. The medical supply depot is commanded by the senior officer of the Medical Corps assigned thereto and present for duty. The unit commander is an officer having had prior training and experience in the various phases of medical supply functions. He is directly responsible to the army com- mander or the army surgeon, as may be prescribed, for the administration, discipline, training, and operation of the unit in all situations. Depot Headquarters Section. The depot headquarters section includes the unit com- mander and the enlisted assistants required in the headquarters section. When the unit is not at station the headquarters is located at a convenient point in the unit camp area. When the unit is operating but one depot, the headquarters is located adjacent to the depot. If the unit is operating more than one depot, the head- quarters remains with the base depot. Staff. Executive officer. The executive is an officer of the Medical Corps with considerable experience and training in the procurement and handling of medical supplies. Adjutant. The adjutant is an officer of the Medical Administrative Corps, Sanitary Corps or Specialist Reserve. In addition to handling the routine duties of his office he may be designated unit personnel officer. Unit supply officer. The unit supply officer, an officer of the Medical Administrative Corps, is usually charged with the operation of the unit mess and may be designated MEDICAL SERVICE WITHIN THE CORPS AND ARMY 801 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 1 2 3 4 5 8 7 8 9 10 ii Unit | Technician yrade Depot head- quarters detach- ment Base pla- toon Ad- vanced depot pla- toon | Total | Enlisted cadre Remarks 8 3 C | x: | Q (3) $ c a If gi “a p c j Optical repair section | Base depot section | Section 1 | Section 2 Private—Continued. (2) 0) (2) ffl (2) 8 (14) 8 $ (2) (2) (2) (6) (80) 3 (5) (21) (ij (ij 5 "(2) 0) (1) (1) "(ij (2) (4) 4 5 (1) (1) (2) 3 3 (2) (2) Orderly (695) 0) (3) (50) (1) (3) (1) (10) (1) (15) (1) (15) 4 5 (1) (D (2) (4) (1) 8 (3) — 21 22 14 7 101 42 42 227 19 == 15 8 108 45 45 243 19 == 1 1 2 2 2 8 1 4 1 10 (8) ::: Q Trailer, 1-ton, 2-wheel, water 1 1 1 2 0) 0) 1 1 i 1 0) 1 2 (2) 2 (2) 2 (2) a) Plate 14. T O 8-661, Anri! 1, 1942, and Change 1. Medical Supply Depot, Army or Communications Zone. T/0 8-661, April 1, 1942, is changed as follows: Line Column 6 8 (b 1 • 1)2 1 2 3 4 6 6 7 8 9 10 11 Depot head- quarters detach- ment Base pla- toon Ad- vanced depot pla- toon g T3 S a 1 Unit ! Technician grade Depot headquarter sect Depot general supply e transportation sectio j Optical repair section Base depot section Section 1 Section 2 Total Enlisted cadre Remarks (tl>2 (<*1*1)2 officer, Medical t 2 8 b Veterinary 16 0 Optical special- 7 (1) (1) 0) ministrative Corps. 11 Clerk, chief (502) (i) (i) (2) (l) (1) a) ministrative Corps, Dental Corps, Sanitary Corps, or Specialist Reserve. 12 (O (1) 13 0) 14 15 (2) » (1) (2) (i) a) (3) (1) (1) (3) (1) (D ministrativeCorps, Sanitary Corps, or Specialist Re- 18 (i) (ij a) a) 19 CD a) (i) 20 Technician, optical, and section leader (365) (i) h Cutter and edg- 21 * Frame repair 22 (3) 0) (3) 0) (1) (5) (1) 23 24 (i) (i) (i) ber symbol shown in parentheses is an inseparable part of the specialist des- ignation. A num- 25 (i) (2) (1) (i) (i) 26 27 28 (2) (D (D (4) (1) (2) (1) ( 4 11 29 a) (D (D 30 (i) a) fers to an occupa- tional specialist whose qualifica- tion analysis is 31 (1) 11 32 83 34 Technician, grade 3| Technician, grade 4 6 36 2 35 36 37 Private, first class.. Private J Bugler (803) a) 67 189 (1) (9) (1) (5) (1) (3) (3) (4) (4) (4) l1 26. . A number above 500 refers to a military occupa- tional specialist 38 (i) (6) (i) u) a) 39 (i) (i) 40 a) a) (1) (D (i) 41 War Department, 1942. 42 (1) (1) (1) (i) to (i) (D (i) (i) 0) (i) (!) (1) (D 43 a) (i) (D a) (2) (2) 46 Cook (060) •This table supersedes T/ 08-235, November 1940, including Cl, June 6, 1941. 802 MILITARY MEDICAL MANUAL detachment commander. In the discharge of any or all of these functions, enlisted assistance is furnished by the headquarters section. Dental and veterinary assistants. Two officers, one each from the Dental Corps and Veterinary Corps, act as assistants to the unit commander on matters pertaining es- pecially to their respective corps. Their services are especially valuable when necessity demands the local procurement by purchase of dental and veterinary supplies. Although they are staff assistants, most of their actual duties are performed in the administrative section of the depot. Medical Supply Depot Depot Headquarters Detachment Advanced Depot Platoon Base Platoon Depot Headquarters Section Depot General Supply and Transportation Section Section I Section 2 Optical Repair Section Base Depot Section Plate 15. Functional Organization of Medical Supply Depot. The Base Platoon is commanded by an officer of the Medical Corps highly specialized in all phases of medical supply functions. After the platoon has established the depot, the platoon commander supervises all phases of its operation, exercising such command as the unit commander, who also is the depot commander, may delegate to him. He is in effect the executive officer of the depot. In addition, he is the accountable officer for the depot and maintains the depot stock record account. The optical repair section includes one officer (optical specialist), one staff sergeant (technician, optical and section leader), and six technicians or privates. This section as implied by its designation, makes such repairs and adjustments of all optical items of medical supply as can reasonably be performed in the field with the available equip- ment. One 2%-ton truck, cargo and one 1-ton cargo trailer furnish the transportation for the special equipment of the section. Enlisted Personnel. General qualifications. During active operations, the personnel of the medical supply unit will be subjected to long and arduous labor, the demands for supplies will be continuous, and any movement of the installation due to enemy air observation will be made under cover of darkness. For these reasons, the general qualifications of the enlisted personnel are the same as for other medical units in the combat zone. Vocational qualifications. The unit is one of specialists. Almost every enlisted man must possess, from training and experience received prior to or after entry into the service, a considerable knowledge of some particular specialty. Those specialists utilized in the routine administration of the unit are trained after entry into the service. How- ever, such specialists as instrument and optical repairers are selected from individuals having actual knowledge of these occupations by reason of previous employment in civil concerns manufacturing and repairing surgical instruments and optical supplies. Every individual officer and enlisted man, in the optical repair section falls into the latter category. Individual. Although the chief duties of the enlisted personnel of the unit pertain to administration and supply, nevertheless each man is trained in the basic qualifications of the Medical Department soldier. Specialist training includes training of carpenters, clerks, instrument repairers, ma- chinists, storekeepers, assistant storekeepers, stenographers, electric plant operators, mechanists, optical specialists, and record, stock and stock shipping clerks. Group. As soon as the individual and specialist training has progressed sufficiently, training in functional groups is instituted. This is applicable to the operation of unit headquarters, the mess, the depot office, the depot storeroom, the optical repair section, and the transportation personnel. Some group training is gained within the zone of the interior or the communications zone by actual apprenticeship in operating medical depots. This type of training is highly desirable whenever it can be arranged. Unit. After completion of group training, unit training is accomplished by actual participation by the entire unit in large scale field maneuvers. Due to lack of sufficient integral transportation to accomplish movement of the unit, other means of unit train- ing are not available. Installations. The installations of the unit are medical supply depots. The term medical supply depot may be further qualified as a base or an advanced depot. Ordinarily, the unit establishes and operates but one base depot but may operate in addition one or two advanced depots. Physical arrangement. In the ideal situation, the depot is established in permanent or semipermanent buildings. Canvas (tents or paulins) is utilized only when necessary. Conventionally, the depot requires two buildings (existing or constructed), one of the large warehouse type and one smaller, preferably adjacent to the former. A suggested arrangement of the depot within the larger building is, in one end, to establish the depot office (depot headquarters section); adjacent to the office and occupying the bulk of the central portion of the building, to store the supplies; the remainder of the building to be occupied by the general and optical repair sections. This building should have, on one side, a railroad siding, a dock, or a suitable approach for motor vehicles; on the other, a motor road. The second building houses the mess, the unit supply, and the transportation office. At the discretion of the unit commander, the headquarters may be established in this building or combined with the depot office. The former location is deemed preferable as it tends to delineate between purely unit and depot administration. Storage and issue. Efficiency in the handling of the medical supplies is increased by dividing the storage and issue section into two functional groups: Receiving and storage. Operates in that portion of the depot adjacent to the incoming carrier, rail, boat, or motor vehicle, receives all supplies consigned to the depot, checks all items against the packers’ lists, and stores such supplies in a manner designed to facilitate their later issue. Issue. Located on the opposite side of the building, receives requisitions, memoranda, or other authorized requests for supplies; removes from storage, packs, and segregates the orders; and loads supplies on the transport sent to the depot by the consuming units. This group, or the depot office from information submitted by this group, pre- pares invoices for the outgoing supplies, shipping tickets, or obtains informal receipts from the receiving agency. Repair department. If considered desirable, the repair department may be divided into a general, an instrument, and an optical repair group, each functioning as im- plied by the designation. MEDICAL SERVICE WITHIN THE CORPS AND ARMY 803 Establishing depot. As soon as possible after the general location of the depot has been designated, the unit commander accompanied by his staff, the commander of the base platoon, and certain key enlisted personnel proceed to the site and survey the accommodations. Decision is made as to the utilization of existing shelter and arrange- ments made with army engineers for repairs, alterations, or any necessary new construc- tion, including enlargement or installation of railway siding facilities. Usually, the in- tegral motor transport of the unit with trucks carrying portions of the organizational equipment moves forward with the commander. When the bulk of the depot supplies and unit equipment arrives by rail or truck transport, the unit commander informs appropriate officer and enlisted personnel of the location of the various departments. Each functional group (section or platoon) then proceeds with the unloading of its particular equipment and the establishment of its department with the least possible delay. All possible aid is furnished the storage and issue section in the unloading of the depot supplies. Operation. Additional depot supplies are procured from the next higher medical supply echelon, usually in the communications zone, by one of the following methods: Automatically, wherein a flow of supplies to the army depot based on the average expenditures is initiated by the depots of the higher echelon in an effort to keep the stock of the army depot at a prescribed level (usually 10 days). By formal requisition which must be approved by the higher echelon. In emergencies, by formal request which also must receive the approval of the higher echelon. By drawing against credits established in its depots by the higher echelons. Requisi- tions against credits require no individual approval. When exhausted, credits must either be renewed or other means of supply substituted. The credit system is invoked by higher echelons when there is a shortage in some particular item or items within the theatre and assures an equable distribution of the supply on hand. Army medical depots, according to the policy established by the chief surgeon, en- deavor to maintain a stoc\ calculated to supply the army units for a definite period of time. Based on the type of operations, and the many factors influencing the flow of supplies from the zone of the interior to the theatre and from the communications to the combat zone, such period may vary from 3 to 10 days. In addition, complete sets of equipment for attached medical units are stocked. Usually the army depot does not stock complete sets of organizational equipment for larger medical units. Usually, regardless of whether the unit is operating one or three installations, but one stoc\ record account is maintained (for exception see below). In situations other than combat, accomplished shipping tickets become vouchers for dropping from account- ability all items issued. Under combat conditions, such records as hand receipts may become sufficient authority for relief from accountability. Issue of medical supplies by the depot is accomplished by one of the following methods: At the depot, either direedy to subordinate supply officers who bring their own transport, or by shipment by common carrier to the railheads of divisions and corps. By arranging with the higher supply echelon and the regulating officer for a carload shipment destined for one establishment, such as an evacuation hospital, to be sent direct to a railhead adjacent to such establishment. On depot records, such shipments are handled as though they had actually passed through the depot. In emergencies, by delivering supplies on unit transport direedy to the consuming in- stallation. The repair department of the depot within limits of ability of personnel and avail- able equipment makes repairs to all items of medical supply damaged during shipment to the depot or after issue by the depot. Items belonging to the former category, as soon as the damage is discovered by the storage and issue section, are transferred informally to the appropriate repair section. Items damaged after issue are returned to the depot, usually on the transport of subordinate medical supply officers, and trans- ferred to die repair department. All items received by the repair department are dis- posed of in one of the following ways: 804 MILITARY MEDICAL MANUAL MEDICAL SERVICE WITHIN THE CORPS AND ARMY 805 Repaired and returned to the storage and issue department. Repaired and returned to the supply officer requesting such repair. Reported to the depot office as nonsalvageable and held for survey (if such formality be necessary). Returned to higher supply echelon for disposition. Movement of depot. Any displacement of the depot forward or backward in its entirety disrupts its functional capacity. Therefore, movement is accomplished as follows: A portion of the unit (see below) transported by common carrier or trucks proceeds to the new location, carrying with it a varying amount of the more critical items of supply. Upon arrival, it lays out the new depot in skeletal fashion and initiates a limited operation. The base depot section of the unit continues the operation of the old depot until a designated time and date, when it packs the remaining organization equipment and supply stock and moves to the new location. In the meantime, through arrangements with the higher supply echelon and the regulating station, all incoming shipments are routed directly to the new depot. Thus a continuous operation is permitted and the logistical problem is minimized. Advanced depot platoon. Under certain situations (see FM 8-15) a medical supply unit may operate one or two advanced depots in addition to the base depot. In general, functional groups within an advanced depot are limited to a records, a storage and issue, and a mess group. No sharp delineation is possible as all personnel perform such duties as the situation demands. There is no conventional arrangement of an advanced depot. Existing shelter at the designated site is utilized to the best advantage. Canvas is utilized when necessary and available. Ordinarily, supplies are procured informally from the main depot. Under exceptional circumstances, as when the depot is serving an independent corps, procurement may be from a designated communications zone depot (see above). The minimum amount of supplies compatible with the situation is stocked. Administration. The unit has internal administrative responsibilities comparable to those of a company. These devolve upon headquarters and the headquarters section. In addition, the unit is charged with the internal administration of the depot(s). MEDICAL LABORATORY, ARMY OR COMMUNICATIONS ZONE Organization. (See Plate 16 and T/O 8-611). The medical laboratory, a mobile unit is an organic element of the army operating under such technical supervision of the army surgeon or his representative, the army medical inspector, as is prescribed by the army commander. Functionally, the unit divides itself into a headquarters, a headquarters section, and four laboratory sections, one stationary and three mobile. The stationary section acts as the base laboratory and the mobile sections as satellites assisting the base laboratory in the study of epidemiological, sanitary, and other problems. Functions. In general, the medical laboratory is designed to provide the army medical service with facilities that are immediately available for certain types of laboratory sup- plies; supplemental laboratory examinations, and epidemiological and sanitary investiga- tions. The laboratory has specific functions as follows: Performs routine water analyses. Performs special examinations pertaining to meat, food, and dairy supplies. Investigates epidemics and epizootics. Distributes special laboratory supplies such as special reagents and solutions, culture media, and diagnostic biologicals not furnished through routine supply channels. Performs for army medical units special serological, bacteriological, pathological, and chemical examinations when the emergency demands less delay than would be entailed by referring them to the general medical laboratory. 806 MILITARY MEDICAL MANUAL Augments temporarily in emergencies the laboratory section of any army unit, or assists in the organization of a combined laboratory section functioning for several units grouped in the same locality. In performing such temporary augmentation, withdrawal is accomplished at the earliest possible time. Performs post-mortem examinations incident to special investigations, and collects and preserves such pathological speciments as are of historical or educational value to the Medical Department. Command. The unit, medical laboratory, is commanded by the senior officer of the Medical Corps assigned thereto and present for duty. The commander is an officer who has had broad training in general laboratory work and epidemiology. He is directly responsible to the army commander or the army sur- geon, as may be prescribed, for the administration, discipline, training, and operations of the unit in all situations. UNIT HEADQUARTERS Stationary laboratory section Mobile laboratory section Mobile laboratory section Mobile laboratory section Director's office Bacteriological group Pathological group Chemical group Serological group Veterinary group Plate 16. Fundamental Organization of the Medical Laboratory. Headquarters. The headquarters consists of the unit commander, his staff, and cer- tain enlisted personnel to assist in the internal administration of the unit. The latter include a technical sergeant, a mess and supply sergeant, and such specialists as a clerk, cooks, motorcyclists, chauffeurs, and a typist. The headquarters is located invariably with the basic element of the unit, the stationary laboratory. The headquarters administers and supplies the unit, operates the unit transport other than the transportation which moves the mobile laboratories, messes the entire unit ex- cept when elements are widely separated, and occasionally furnishes clerical and trans- portation aid to the laboratory elements. Staff. The unit staff consists of one officer, usually an officer of the Medical Ad- ministrative Corps, who is the adjutant and as such is charged with the usual duties of that office. In addition, he may be designated to perform other staff functions, including those of the unit supply officer. If the commander desires additional staff officers, he may so designate them from the other officers of the unit. However, the detailing of officers for administrative duties must be carefully considered in the light of the technical functions of the unit and its installa- tions. Enlisted Personnel. General qualifications. (Same as for evacuation hospital.) Vocational qualifications. The majority of the enlisted men of this unit are laboratory technicians. Individuals with previous experience as medical students or technicians in civil clinical laboratories prior to entry into the service may be utilized to advantage. Training. In addition to basic individual training, specialists shown in Tables of Organization must be trained, Those requiring qualification for this particular unit are: MEDICAL SERVICE WITHIN THE CORPS AND ARMY 807 Technicians, laboratory, noncommissioned. One master, four technical, two staff, and six sergeants trained as laboratory technicians. In addition to training in basic laboratory methods and technique, one noncommissioned officer is trained in each of the following laboratory specialties: chemistry and toxicology, bacteriology, pathology, serology, and veterinary laboratory procedures. The highly specialized technical training of these 1 2 3 4 5 1 Unit Techni- cian grade Medical labora- tory » Enlisted cadre Remarks 2 Lieutenant colonel.. b 1 3 (• 1) d 3 (”2)'5 “Includes 1 stationary labora- tory and 3 mobile laboratories. Each mobile laboratory consists of— Personnel— 1 captain, Medical Corps. 1 technical sergeant. 4 5 6 h 1 7 Total commissioned 11 8 1 1 2 laboratoi y Lcchmoxans. 1 chauffeur. Equipment— 12H-ton truck outfitted with laboratory chests as re- quired from base unit. 1 54-ton truck assigned from base unit when required. •> Commanding officer, Medical Corps, with broad training in gen- eral laboratory work and epidemi- ology. ° Veterinary. <• Includes— 1 bacteriologist, Medical Corps. 1 pathologist, Medical Corps. 1 bacteriologist and pathologist, Veterinary Corps, with spe- cial training in the laboratory examination of foods. • May be Sanitary Corps. 1 Includes— 3 captains, Medical Corps, in charge of the 3 mobile labora- tories. 1 chemist, Sanitary Corps or Medical Corps, with special training in biochemistry, water chemistry, and toxi- oology. 1 serologist, Sanitary Corps or Medical Corps. s With special training in general laboratory work and medical biology. h May be Medical Administra- tive Corps. * 1 with special training in toxi- cology, 1 with special training in bacteriology. i 1 with special training in path- ology. 1 with special training in serology. k With special training in veteri- nary laboratory procedures. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose quali- fication analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Department, 1942. 9 Technician, laboratory (411) (1) 4 (1) 4 10 11 Technician, laboratory (411) (4) 3 (4)1 1 12 Staff sergeant, including ...1 13 Chief clerk (052).. .1. (1) 02) 8 a) 14 Technician, laboratory (411) 15 1 16 Mess and supply (824) (1) 0) 0 5) (° k 1) 1 a) 17 Motor (337) 18 Technician, laboratory (411) 19 Technician, laboratory (411) 20 Corporal, including 21 Motor (337) (1) f 2 22 Technician, grade 31 23 24 Technician, grade 4 Technician, grade 5 [-including 5 1 10 1 2 25 26 27 Private, first class.. Private J Chauffeur (344) 7 l 10 (1) (1) CD 0) (2) (1) 0) (1) (3) (1) (3) 0) ((« k 1) 2) (3) (4) (°k4) (4) } « 28 5 (1) (1) (1) (1) 29 30 Cook (060)... 4 31 Cook (060). 5 32 Cook’s helper (521) 33 Driver, heavy truck (245) 5 34 Driver, light truck (345) 5 35 Driver, light truck (345) 36 Mechanic, automobile (014) 5 37 Orderly (695) 38 Stenographer (213) 4 39 Technician, laboratory (411) 3 40 Technician, laboratory (411) 4 41 Technician, laboratory (411) 5 42 Technician, laboratory (411) 43 Basic (521) 44 Total enlisted 51 11 45 Aggregate 62 11 46 Q Semitrailer, 2-wheel, laboratory.. 1 47 Q Truck, 14-ton 2 48 Q Truck, 14-ton, carry-all 1 49 Q Truck, 254-ton, cargo. 3 50 Q Truck, 4- to 5-ton, tractor 1 Plate 17. T/O 8-611. Organization of the Medical Laboratory. Army or Communications Zone. individuals is accomplished by attachment for temporary duty to the laboratory service of an army hospital authorized for such training in the zone of the interior or by attendance at appropriate resident courses offered by the Army medical and veterinary schools. Privates, first class, and privates. Certain privates first class, or privates trained as 808 MILITARY MEDICAL MANUAL general laboratory technicians and one as a veterinary laboratory technician. The basic laboratory training of these individuals includes a knowledge of the more common laboratory apparatus; the principles and practice of asepsis and sterilization; the obtain- ing of specimens such as nasal, throat, blood, urethral smears, and water samples; methods of collecting mosquitoes and other entomological specimens; the preparation and inoculation of culture media; and the technique of the more common staining methods. Following the basic technical training, various individuals are given special training to provide in effect assistants for the noncommissioned specialists. One man is trained in the general duties of a stenographer, and in laboratory termi- nology, laboratory abbreviations, and the preparation of laboratory reports. One man from the headquarters section is trained as a typist. He must be proficient in grammar, spelling, and punctuation, and after training should be capable of operating any standard typewriter and transcribing at the rate of not less than 40 words per minute after having deducted for all errors. Group. Group training is applicable to the chauffeurs, cooks, motorcyclists, and laboratory technicians. Unit. Since the unit is composed of a stationary or base section and three satellite mobile sections, all of which will function as a team in the field, much of the unit train- ing will be of a technical nature. Technical training includes the establishment and operation of the laboratories, stationary and mobile, in improvised or existing shelter and under varying conditions of weather and terrain. Utilizing available facilities (terrain and personnel), epidemiological surveys requiring the participation of the entire unit may be executed. The unit tactical training is limited to antiaircraft protection, selection of sites for installations, concealment, camouflage, and a general knowledge of the tactics of other army medical units is essential. Logistical training includes the packing and unpacking of equipment, movement by motor (day and night), and supply while operating in the field. Installations. The unit is capable of establishing and operating one stationary and three mobile laboratories, the former being the basic and the latter auxiliary elements. The unit, as a whole, moves by common carrier or by its integral transport augmented by additional trucks to the site previously designated for the location of the basic element. Stationary laboratory. The stationary laboratory, together with the unit headquarters, is located well to the rear in the army area where it will not become involved in minor movements and where it is readily available. It is established in existing buildings, preferably in a civil laboratory, such as may be available in a school, a public health agency, or a commercial organization. The internal functional organization must remain flexible as the demands upon the various laboratory specialities will fluctuate with the territorial location, the season, the character of the troops and the civil population, and various other factors. However, to promote the general efficiency of the establishment, the following organization based upon the qualifications of the personnel is suggested. Headquarters section includes personnel of the unit commander; an assistant, an officer of the Medical or Sanitary Corps; the master sergeant (sergeant major); 1 techni- cal sergeant; 1 sergeant; and 2 privates, first class, or privates; 1 stenographer, 1 laboratory technician and 2 basic. This group correlates the operations of the laboratory, assigns personnel to functional groups therein, receives and distribues incoming specimens, checks and dispatches outgoing reports, handles the laboratory supplies, records all statistical data concerning the work performed by the installation, and in emergencies furnishes technical aid to the various groups as indicated. Bacteriological group includes personnel specially trained in bacteriology; 1 officer, Medical Corps; 1 staff sergeant; 1 sergeant; and 3 privates, first class, or privates. Pathological group includes personnel specially trained in biochemistry, water chem- istry, and toxicology; 1 officer, Medical or Sanitary Corps; 1 staff sergeant; 1 sergeant; and 1 private, first class, or private. MEDICAL SERVICE WITHIN THE CORPS AND ARMY 809 Serological group includes personnel specially trained in serology; 1 officer, Medical or Sanitary Corps; 1 sergeant; and 1 private, first class, or private. Veterinary group includes personnel specially trained in veterinary bacteriology and pathology, the laboratory examination of foods, and other general veterinary laboratory procedures; 1 officer, Veterinary Corps; 1 sergeant; and 2 privates, first class, or privates. Physical arrangement. The arrangement of the various groups within the laboratory will depend upon the plumbing and lighting facilities within the buildings utilized. Operations. Within the purview of policies laid down by the army surgeon, material submitted to the stationary laboratory will come from: Laboratory sections of army medical units. Army medical inspector or his assistants. One of the mobile laboratories operating apart from the stationary laboratory. Other sources designated by the army surgeon. All requests for laboratory procedures are routed to the headquarters section where they are disposed of as follows: Classified and delivered to the appropriate functional group, or Forwarded to the office of the army surgeon for transmittal to appropriate laboratories in the communications zone. Copies of reports of the examinations completed are disposed of as follows: One copy filed in the office of the headquarters section. One copy to the unit submitting the request routinely through the message center, or in emergencies by courier or other means. The mobile laboratory unit contains three mobile laboratories, each capable of limited temporary independent technical operations. As implied by the designation, the mobile laboratory moves by means of light motor transportation and operates to solve a specific problem. It is not contemplated that the mobile units of army laboratories will ordinarily do complicated definitive laboratory work. They will carry out simple laboratory pro- cedures and will collect material for epidemiological, sanitary, or supplemental laboratory examinations. More complicated examinations such as certain types of bacteriological work and chemical analyses requiring equipment and facilities that are not easily trans- portable will ordinarily be performed in the stationary section of the army laboratory. The necessary equipment and supplies required to meet any specific situation will be furnished by the stationary section. Such equipment and supplies should be so organized that they can be rapidly assembled in standard Medical Department chests, placed in a carry-all or other light transportation, and transported where needed with the least possible delay, considering road priorities. Routinely, the mobile laboratories remain under the control of and are administered by the basic unit. However, when operating at a considerable distance from the basic element, they may be attached for rations only to other units. Upon receiving a directive from the unit commander, the officer in charge studies the mission, makes an estimate of the situation, selects and packs the required supplies, arranges for personnel as indicated, and moves out to the location specified. Upon ar- rival, he selects a suitable site for the installation and proceeds with the project. The laboratory may change its location whenever necessary, due notice of such moves being sent at once to the unit commander. Upon completion of the project, or earlier if so ordered, the laboratory returns to the headquarters of the unit without delay. During intervals between independent missions, the mobile laboratory personnel will be utilized in the stationary section at the discretion of the unit commander. The personnel of each mobile laboratory include an officer of the Medical Corps, one technical sergeant, and three privates, first class, or privates. Of the latter, two should be laboratory technicians and one chauffeur. If required for the mission, this group may be augmented by additional specialists from the stationary laboratory. Administration. The unit has internal administrative responsibilities comparable to those of a company. These devolve upon the unit commander and his headquarters. In addition, the unit is charged with the internal administration of the laboratory in- stallations which it establishes. These also evolve, upon the unit commander. 810 MILITARY MEDICAL MANUAL If elements of the unit operate separately, all administrative overhead remains at the unit headquarters (vicinity of the stationary laboratory). Concerning supplies in general, the stationary laboratory section should be equipped for independent operation and in addition maintain sufficient supplies and equipment to operate the mobile sections. A complete list of the initial supplies and equipment is contained in the basic equipment lists, laboratory, army and communications zone. Additional supplies are obtained by requisition through command channels from proper army depots. Special laboratory supplies not handled by the army medical supply depot are obtained from designated laboratories in the communications zone. According to existing policy, formal requisition may or may not be necessary in obtaining such special items. VETERINARY COMPANY, SEPARATE The organization of the company is designed to facilitate functional division. The five platoons are identical and each is capable of independent tactical and technical operation, although dependent upon the company headquarters for administration. Likewise, each platoon contains three sections which again are capable of limited in- dependent operation. COMPANY HEADQUARTERS PLATOON PLATOON PLATOON PLATOON PLATOON HEADQUARTERS SECTION SECTION SECTION Lead line group Ambulance group. Plate 18. Functional Organization of Veterinary Company, Separate. The veterinary company, separate, is either: An autonomous element of army troops under such control of the army surgeon or his representative, the army veterinarian, as the army commander prescribes. A GHQ unit operating under such direct control of the chief surgeon, GHQ as prescribed by its commander. Functions. The chief functions of the separate veterinary company are the evacuation of noneffective sick and injured animals by means of lead lines and motor transport, and their care and treatment during the movement. It evaucates cases within the com- bat zone as follows; 1 2 3 4 5 6 7 © •V c3 S) C3 A § 2* o C3 w fl c3 © 1-4 1 Unit Js *© >»"£ fl 2 a fl 0.3* a C § 0 O o O ♦d © Remarks .c © J33 E- o £ w 2 Captain _ 1 1 3 First lieutenant 1 b 1 6 a Each platoon may be divided into 3 sections. b Mounted on horse. The serial num- ber symbol shown in parentheses is an inseparable part- of the specialist desig- nation. A number below 500 refers to an occupational specialist whose qualification analy- sis is found in AR 615-26. A number 4 Total commissioned 2 1 7 5 1 1 1 6 Staff sergeant, including 4 1 9 3 7 Mess (824) (i) (i) (1) (1) (5) (1) (1) 15 (i) 8 Motor (813) 9 Platoon (651) (1) 10 Stable (710). '. c> i) (i) (i) (i) i 11 Supply (821) 12 Sergeant, including 3 13 Section leader (652) (b 3) 3 (15) 16 (1) 1 14 Corporal, including i 15 "Assistant section loader (652) (3) (15) (1) r 13 J 23 16 Clerk, companv (405) (1) 19 0) 4 2 17 18 19 20 21 Technician, grade 4| 5 including 25 Private, first class.. [ & Private j Bugler, messenger (803) a) (i) (1) (2) (2) (3) | 46 [ 62 (1) (1) 0) (2) (2) (3) f (7) \ (8) (2) (ID (1) (5) (1) (1) (1) (45) (5) (5) (15) (5) (5) (17) 1 above 500 refers to a military occupa- tional specialist listed in Circulars Nos. 14 and 67, War Department, 1942. 22 Carpenter, construction (050) 5 23 Clerk (055) 24 Cook (060). 4 (1) 25 5 26 Cook’s helper (521) 27 5 (3) 28 Driver, heavy truck (245) } 29 Driver, light truck (345) 5 (2) (1) (b 1) 30 Driver, light truck (345) (2) 31 Horseholder (521) 32 Horseshoer, clinical (094) 4 (b 1) (1) 33 Mechanic, automobile (014). 4 (1) (1) (1) (1) 34 Mechanical, automobile (014).. 5 35 Orderly (695) 36 Orderly, ambulance, veterinary (697) (9) (1) (1) (b 3) (1) 0) (3) 37 Stableman (311).. 38 Technician, medical, veterinary (250) 5 (1) 0) (1) 0) 39 Technician, medical, veterinary (250) 40 Technician, surgical, veterinary (226). 4 41 Technician, surgical, veterinary (226) 5 42 (2) 43 25 32 185 13 44 Aggregate 27 33 192 13 45 Q Animal, including... 3 14 73 (30) (43) 15 46 Horse, draft (6) (8) 3 47 Horse, riding (3) 48 Q Semitrailer, 6-ton, combination animal and cargo carrier. _. 49 Q Trailer, 1-ton, 2-whcel, water tank (250- gallon) 1 1 .50 Q Truck, >4-ton 1 1 6 51 Q Truck, command and reconnais- 1 1 52 Q Truck, eargo 1 5 53 Q Truck, cargo. 1 i 54 3 15 Changes] No. 1 J WAR DEPARTMENT, Washington, November 16, 1942. T/O 8-99, April 1, 1942, is changed as follows: Line Column 3 4 6 2 *> 1 32 0) 45 3 iY 68 47. (3) (7) (38) 52 l 1 6 53 Delete entire line Plate 19. T/Q 8-99, April 1, 1942, and Change 1. Organization of Veterinary Company, Separate. 812 MILITARY MEDICAL MANUAL In the absence of second echelon veterinary service within the division (veterinary troop), it evacuates cases from the installations of the first echelon veterinary service (stations of veterinary sections of medical detachments) directly to the veterinary evacuation hospital. Within the cavalry division, the veterinary troop furnishing second echelon veterinary service; it evacuates cases from the installations of that echelon (veterinary clearing stations and clearing posts) to the veterinary evacuation hospitals. Within the army service area, it furnishes evacuation or transfer service as follows: From the veterinary evacuation hospital to the veterinary general or veterinary con- valescent hospital, or to the railhead for further evacuation to the rear. From the veterinary convalescent hospital to the veterinary evacuation hospital or veterinary general hospital (relapsed cases). Transfers discharged patients from veterinary hospitals to remount units. Command. The company is commanded by the senior officer of the Veterinary Corps assigned thereto and present for duty. He is directly responsible to the army commander or the surgeon, as may be designated, for the administration, discipline, training, and operations of the company in all situations. Although the army surgeon cannot delegate his command responsibilities pertaining to the veterinary company, separate, he routinely delegates the supervision of the tactical and technical operations of the company to the army veterinarian, the latter keeping the surgeon fully informed at all times concerning such operations. Company Headquarters. The company headquarters under Tables of Organization consists of the company commander, a commissioned assistant of the Veterinary Corps, and the necessary enlisted assistants required in the internal administration of the unit. The latter include the first sergeant; the supply, mess, motor and stable sergeants; the company clerk; and such specialists as bugler, chauffeurs, clerks, cooks, carpenter, and automobile mechanics. The stable sergeant and one orderly (private) are mounted. The personnel of company headquarters established operate an installation designated also company headquarters. As established, the company headquarters consists of the company CP (office of the company commander and the message center), the unit mess, the unit supply distributing point, motor maintenance department, the company stables (picket lines), and any other departments necessary for the internal company house- keeping. The company commander may delegate to his commissioned assistant such functions as the operation of the mess, the unit supply, and the care and maintenance of the unit transport. The company headquarters does not lend itself to division, and functional elements of the company operating separately ordinarily are not augmented for administrative purposes by headquarters personnel. Such reports and returns concerning sick and injured animals as may be required by higher authority are initiated by functional elements (platoons) and consolidated and forwarded by the company headquarters. Platoon. Each of the five platoons consists of a platoon headquarters and three sec- tions. The platoon is designed to serve a type corps or a cavalry division; the section, an infantry division. It is an organic element of the separate veterinary company capable of independent tactical and technical operation but dependent upon company head- quarters for administration. The platoon is commanded by an officer of the Veterinary Corps, usually a lieutenant, who is directly responsible to the company commander for the operation of the platoon in all situations. The platoon performs the technical functions of the company incident to the evacua- tion of sick and injured animals and their care and treatment during movement. In the performance of these functions the platoon operates three lead lines and three veterinary ambulances. Platoon Headquarters. The platoon headquarters consists of the platoon commander, the platoon sergeant, a chauffeur, a clinical horseshoer, and a stable man. The platoon commander and the horseshoer are mounted but during operations the mount of one MEDICAL SERVICE WITHIN THE CORPS AND ARMY 813 of these individuals may be required for one of the lead lines. Inasmuch as motor transport (truck) is available, this transfer results in no impairment to the mobility of either individual. The platoon headquarters establishes the platoon CP which consists of the office of the platoon commander and the message center. The latter is omitted if the message center of the company is in the same vicinity. Ordinarily the CP is located comparatively near the veterinary evacuation hospital to which or from which the platoon is evacuating animal casualties. In the usual situation it will be forward of this installation and on the route traversed by the evacuating elements. The platoon headquarters personnel are charged with: Check of the emergency veterinary tag of each animal evacuated by the platoon, and the entry in the appropriate space of the disposition made of the case. Maintenance of a log of evacuated animals containing the following data for each case: the animal’s Preston brand number; organi- zation, if known; general nature of sickness or injury; method by which evacuated; lead line or ambulance number; and the hour, date, place, and manner of disposition. Data from this log are extracted from time to time and forwarded to company headquarters for consolidation and rendition to higher authority. Control of Operation. Through the personnel of platoon headquarters and the CP which they establish, the platoon commander is able to control the operation of the various sections and elements thereof. Each ambulance and lead line is numbered and as it passes and repasses the CP a record is kept of the time, route, and destination, thus enabling the platoon commander to know at all times the approximate location of each element of the platoon. Liaison: While primarily a section function, from time to time various individuals from platoon headquarters assist in maintaining liaison with the forward veterinary installa- tions being evacuated by the platoon. The chauffeurs may be trained and utilized in this capacity as the need arises. The section having no prescribed allotment of personnel, the following is suggested: one sergeant (section leader), one corporal (assistant), a chauffeur, three ambulance orderlies, two technicians (veterinary or veterinary surgical), and one basic private or private, first class. Four of these individuals being mounted (see above), the section falls naturally into two groups, a lead line group, the sergeant, two technicians, and the basic private; and an ambulance group, the corporal, the chauffeur, and the ambulance orderlies. Each section operates one lead line and one veterinary ambulance. For effective opera- tion, contact with the forward veterinary elements must be established early and main- tained continuously. For this mission the section leader and the assistant section leader are especially trained in the tactics and operative procedures of the units furnishing first and second echelon veterinary service, map reading, sketching, orientation by day or night, and the use of available means of communication. For the initiation of contact these individuals may precede or may be accompanied by the remainder of their group, lead line or ambulance, in the movement to the front. The senior noncommissioned officer is responsible for the transmission of duplicate emergency veterinary tag (M.D. Form No. 115b). Operation. In the usual situation with the section operating separately, the lead line group becomes the forward portion of a single chain of veterinary evacuation, the am- bulance group the rear portion. The point at which animals are transferred from lead line to ambulance becomes a veterinary ambulance loading post. The distance over which animals are moved by these two means varies with such factors as terrain, weather, enemy weapons, total distance involved, and road net. On the other hand, the two groups may operate in different sectors or a division of the task may be made on the basis of type cases to be evacuated by each. Lead Line. The veterinary leading apparatus consists of the McClellan saddle, blanket, special harness for two horses, and the lead line which is 120 feet (two 60-foot sections) of 3/4-inch manila rope equipped with heavy snaps for the attachment of the animals. Each section normally accommodates 10 animals with a maximum for the two sections 814 MILITARY MEDICAL MANUAL of 22. Horses wearing the special harness are placed in file, one in lead, the other in trail, the distance between governed by the length of line to be utilized. The line attaches to the breeching of the lead and the breast collar of the trail horse. A third horse, also equipped with special harness, may be placed in a swing position at the junction of the two sections. Operation. Normally four men, designated, a veterinary evacuation squad, operates the lead line. Numbered from 1 to 4, No. 3 rides the lead and No. 4 the trail horse while Nos. 1 (the noncommissioned officer in charge) and 2 ride free of the line and parallel to it, one on each side. Preparation for Movement. The line horses being harnessed, Nos. 3 and 4 place their animals in proper positions, attach the lead line, and mount. Nos. 1 and 2 attach the animals to be evacuated in order from front to rear, coil excess line, if any, about the pommel of the saddle of the trail horse, mount, and take position to right and left. Movement. The line moves at the command of No. 1, the lead horse maintaining a moderate tautness of the line without retarding movement. Turns. In making a right (left) turn, No. 3 executes a right (left) oblique No. 4 a left (right) oblique, Nos. 1 and 2 meanwhile grasping the line or halter of the led animals move the central portion of the line to the left (right) to avoid contact with trees, fences, or buildings which may be on the corner. Reversing Line. To reverse line the squad halts, Nos. 2, 3, and 4 dismount, and No. 2 hands the reins of his mount to No. 1. He then unsnaps the line from the breast collar of the trail horse and snaps it to the breeching after the horse has been reversed by No. 4. He repeats the process with the lead horse, then all mount and move out. The former trail horse becomes the lead horse, and vice versa. Precautions. Adjust harness to insure strain on lead horse is taken on the traces and the strain on the trail horse by the breeching. Lack of proper adjustment places strain on back straps. In operation of the line, the slower horse should be placed in the lead. Turning corners must be executed at the walk. Veterinary Ambulance. The term veterinary ambulance may be applied to any vehicle capable of transporting sick or injured animals. The two units now provided are a truck, 114-ton, 4x4 cargo and trailer, 2-wheel, 2-horse van; and a truck, tractor, 4-5 ton, as the prime mover with a semitrailer, 6-ton, animal carrier. The ambulances now provided for the veterinary company, separate, are the larger units capable of carrying patients. The veterinary troop is provided with both the units referred to above. All sharp edges and projecting surfaces of the inside of the body are padded to prevent further injury to animal casualties being transported. Slings for supporting indicated cases are highly desirable. The rear end of the truck is so constructed that it will open out as a ramp for loading and unloading. When lowered for use its slope should not be greater than 25° from the horizontal. If wooden, the ramp is equipped with cleats affixed about 6 inches apart, and if metallic, it is covered entirely with canvas to prevent slipping. Functions. In addition to transporting animal casualties to the rear, the veterinary ambulance may be utilized to move one lead line group complete with animals to the front. If an ambulance so moves a lead line group, the point at which the group is unloaded usually becomes the veterinary ambulance loading post. A veterinary ambulance is operated by an ambulance group which in the veterinary company separate consists of a corporal (in charge), a chauffeur, and three ambulance orderlies. Preparation for Loading. The corporal of the ambulance group is in charge of ambulance loading and unloading. The ambulance being at the loading post, the ambulance is turned and the ramp lowered and properly adjusted. The floor of the ambulance is checked to assure proper sanding or other method being utilized to pre- clude unnecessary slipping of the animals. The animals are then checked to determine the type case(s) and the condition of splints, bandages, or other dressing. Any adjust- ment or change of the latter is accomplished prior to loading. Plate 20. Schematic Diagram, Veterinary Service, Field Army. Veterinary Evacuation Animals Returned to Duty 816 MILITARY MEDICAL MANUAL Loading. Several methods of animal loading are described in FM 25-5. All ambulance personnel participate in the loading. Unruly animals are given an early priority. The animals are led into the vehicle by means of a ramp which is a tail-end lowered, and are placed in the truck in rows facing the front. Animals with communicable diseases are loaded in a separate ambulance if one is available. If not available the arrangement is altered, cases with conditions other than communicable being placed in the front with their heads in one direction, those with communicable diseases being placed in the rear with their heads in the opposite direction. The ambulance orderlies are responsible for the technical procedures incident to the care and treatment of the animals. The corporal and the chauffeur are responsible for the actual loading, the securing of the animals within the ambulance, and the closing of the tailgate and any other preparation of the ambulance prior to movement. During movement, the ambulance orderlies ride in a space provided in front of the patients, in the two-patient unit; in the eight-patient unit, space is provided for orderlies in front of each row of four patients. The non-commissioned officer in charge of each ambulance unit rides in the cab with the chauffeur. Unloading. The ambulance being in the most advantageous position, the ramp is lowered, the animals untied, and led off the truck in single file by the ambulance per- sonnel. Usually the personnel of the receiving unit take over the animals at the unloading point. Precautions. Extra ropes should be carried by the ambulance for use in emergencies such as the loading of unruly animals. The inside of the ambulance must be thoroughly cleansed and disinfected after the transportation of animals with communicable disease, whether diagnosed or suspected. The personnel of the company should be selected from men familiar with animals, who instinctively like animals and have no fear of them. Such individuals are found among men from farms and farming communities. Men who have been employed previously in livery stables, blacksmith shops, or teamsters are highly desirable. In addition to the basic qualifications of all non-commissioned officers those of the separate veterinary company should possess these characteristics enumerated. Training. In addition to the subjects outlined in the basic training of the Medical Department soldier and those included for the personnel of the animal-drawn ambulance battalion, the following subjects are emphasized: Emergency veterinary tag, its uses and dispositions (see TM 8-450 and AR 40-2245). Terminology commonly used in veterinary diagnoses. Animal casualties and casualty classification for purposes of transportation. Elementary veterinary anatomy and physiology. Veterinary first aid, care and treatment of sick and wounded animals during trans- portation. Animal ambulance loading and unloading. Operation of lead lines. Methods of handling unruly animals. Tactics of units employing animals, with emphasis on horse-drawn and pack artillery and horse cavalry. General operative procedure of other mobile veterinary units. In addition to the training common to all chauffeurs the chauffeurs of the veterinary ambulances are trained in the supervision of loading and unloading, care and mainte- nance of their vehicles, limitations of the veterinary ambulance as to terrain and weight capacity, and the care and treatment of animals during transportation. The corporal from company headquarters is trained in the duties of company clerk and the appropriate specialist clerk (also in company headquarters) is trained in the prepara- tion of records and returns pertaining to the animal casualties handled by the company. Since the platoon is the basic operating element, most of the unit training will be by platoon. The platoon is trained as a whole in its tactical functioning, marches, bivouacing as a unit, care and nomenclature of organizational equipment and transport, establishment and operation of ambulance loading posts and the evacuation of animal casualties (simulated), communications available to the platoon, and the operation of lead lines and motor transport by day and by night over varying types of terrain. The combined training of the company or elements thereof is conducted by the army surgeon or his representative, the army veterinarian. Such training is combined with that of such elements of the second, third, and iourth echelons oi veterinary service as may be available and feasible. The company commander is responsible for the par- ticipation of his unit or an element thereot. Installations. The company or elements thereof establish and operate the following installations: The company headquarters is the installation established in bivouac or during combat for the purposes of company control and administration. It includes the company CP, the housekeeping and maintenance facilities of the company, and the headquarters of one or more of its integral platoons. During operations (FM 8-15) it is located with a view to attaining the maximum contact with the functional elements of the company. Usually this will be in the vicinity of the veterinary evacuation hospital(s) to which the company is evacuating animal casualties. It should be forward of such installations and along the route being utilized by the bulk of the units. Having arrived at the site of the installation, the company commander designates the locations of the various elements. The company message center and the CP of platoon(s) operating with the company headquarters are placed adjacent to the route of evacuation. Otherwise, there is no conventional arrangement for the installation. Operation. The company CP is the office of the company commander and in his absence is operated by his assistant or by the first sergeant. It is the seat of all company records and the place where reports and returns concerning casualties evacuated are consolidated and prepared for forwarding to higher authority. The message center is operated by the company clerk who keeps a record of all messages coming to or going from the company, or being transmitted by the leaders of the functional groups (ambulance or lead line). The company mess is operated by the appropriate personnel and during combat is prepared to serve hot meals at all hours. The peculiar characteristics of the company necessitate the messing of the bulk of the company as the opportunity presents itself. Cooked food may frequently be prepared at company headquarters and carried by truck to platoons operating within a reasonable distance of the installation. If the distance precludes such method, the involved element(s) are attached for rations to a convenient Medical Department unit. The unit supply includes the supply officer (usually the commander’s commissioned assistant), the supply sergeant, and such other enlisted personnel as is indicated. The company supply officer is the accountable officer of the unit. He procures all the sup- plies required by the company and operates a distributing point at the company head- quarters. During combat, platoons operating separately usually will obtain necessary veterinary supplies from the veterinary (evacuation) hospital which it is serving. Under the supervision of the unit supply, each platoon operates its own property exchange for such items as halters, blankets, etc. The motor sergeant and the automobile mechanics supervise the care and mainten- nance of all the motor transport of the company, make such repairs as their facilities allow, and arrange with higher motor repair echelons for such as they are unable to perform. The stable sergeant has general supervision over the care and feeding of all the animals of the company and the maintenance of their equipment. March Collecting Posts. Although normally established and operated by second echelon veterinary service, march collecting posts may be established by elements of the company. Veterinary Ambulance Relay Posts. If the situation indicates the shuttle system of MEDICAL SERVICE WITHIN THE CORPS AND ARMY 817 ambulance evacuation, relay posts arc established as for the parallel operation of ambul- ances evacuating sick and injured personnel (see FM 8-10). Veterinary Ambulance Loading Posts. Although normally established by first or second echelon veterinary service, veterinary ambulance loading posts may be established and operated by elements of the company. The installation is placed as far forward as the roads and the military situation permit and is operated by the ambulance group. Ter- rain features are used to best advantage for the purpose of concealment and protection of the vehicle. An embankment, a mound, or the side of a hill may facilitate loading by reducing the grade of the ramp. Ambulances should be turned before loading. Employment. In the allotment of a task to platoon or section the internal organization of such elements is kept tactically intact whenever possible, one element being, assigned to one chain of veterinary vacuation. A platoon or an element thereof may be attached to a subordinate echelon when its operation by the army veterinary service is imprac- ticable or when reinforcement of the veterinary service of a subordinate echelon is indicated. Such attachment, except for rations is to be avoided whenever possible. Administration. The company is charged with the usual personnel administration of a separate unit, the company morning report, reports of casualties (company personnel), requests for replacements, and other required reports and returns being forwarded direct to army headquarters. Animals. The morning report of animals, reports of animal casualties, etc., are pre- pared by the company (headquarters) and disposed similarly to personnel reports. Casualties Evacuated. All reports and returns concerning animal casualties evacuated by the company are consolidated in company headquarters from information submitted by the platoons and forwarded to higher authority as required. Messing. The company normally operates one mess at the company headquarters, serving meals to personnel as their duties bring them in contact with the headquarters, or distributing cooked meals to elements of the company operating in the general vicinity of the headquarters. Neither plan being feasible, elements of the company are attached for rations to convenient Medical Department units. Supplies. Class I supplies are received automatically, either at the company head- quarters or at the nearest distributing point established for army troops. Supplies other than class I normally are procured by formal or informal requisition from the nearest appropriate depot. In emergencies veterinary supplies are obtained from the nearest veterinary hospital. Care of Sick and Injured. In bivouac, sick and injured personnel are reported to designated medical installations within the area; during combat, they are reported to the most available aid station. MILITARY MEDICAL MANUAL CHAPTER V THE MEDICAL SERVICE OF A FIELD FORCE Introduction. This chapter seeks to formulate the responsibilities of the Medical De- partment in a field force and to describe the organization and the operation of the agencies provided by laws, regulations, and plans for such purpose. This service must be organized and shaped in general conformity with Tables of Organization (See Chapter IV, Part I.) prescribing the ground and air forces and the specific war plan covering the enterprise for which the task force is created. Behind the tactical units lie the important activities of the Medical Department designed to provide for the definitive treatment and the ultimate care of war casualties. Being predicated upon the general mobilization plan and the specific war plan involved, the organization and operation of the Medical Department within the field force is coordinated with the general policies of The Surgeon General in providing the medical service within the zone of the interior. This involves matters of personnel incident to mobilization not only of the field force but of that part of the home population which is militarized; it includes also the general plan for medical attendance, hospitalization, and sanitation and the procurement, distribution,, and replenishment of medical, dental, and veterinary supplies. ORGANIZATION General Plan of Organization. Based upon the above plans and policies there must be worked out the organization of the Medical Department within the task force, including the organization of the office of the chief surgeon and of the surgeon of the communica- tions zone and its various sections, if there be any, and the necessary contact with the general staff and the surgeons of the armies or groups of armies in order to establish the means of controlling the activities of the Medical Department within the force. These will include, in general, all activities which have their counterpart in the medical service of the zone of the interior, such as personnel, medical attendance, sanitation, equipment and supply, but with added attention necessary in the matters of the strategical distri- bution of medical units, equipment and supplies, the utilization of specialized personnel, and the formulation of policies regarding professional treatment and the all important matters of evacuation and hospitalization. The Medical Service Functions. The Medical Department within a field force is classi- fied as one of the technical, supply, and administrative services. As such its functions are as follows: General functions. The preservation of the strength of the forces in the field, accom- plished by the care and treatment of the sick and injured men and animals of all military forces and the conversion of casualties into replacements whenever possible. Specific functions. The specific functions of the Medical Department are: The initiation of sanitary measures to insure the health of troops. The direction and supervision of all public health measures among inhabitants of occu- pied territory. The care of the sick and wounded men and animals, in camp, on the march, on the battlefield and after removal therefrom. The methodical disposition of the sick and wounded, so as to insure the retention of the effectives and to relieve the fighting force of the non-effectives. The transportation of the sick and injured. The establishment and operation of hospitals, dispensaries, and other installations necessary for the care of the sick and injured. The supply of material necessary for the prevention of disease among the troops and for the care of the sick and injured. The preparation and preservation of records of sickness and injury, for the immediate information of higher authority and to assist in the adjudication of claims with justice both to the government and to the individual. 820 MILITARY MEDICAL MANUAL Chief Surgeon’s Office, General Headquarters. The War Department, upon the recommendation of The Surgeon General, assigns a medical officer, who is acceptable to the commanding general of the Army ground Forces and to the Commander of the task force, as chief surgeon. This officer becomes a member of the “special staff” of the commanding general of the force. Under the commanding general he controls all Medical Department activities within the theatre of operations through the coordination of the general staff at general headquarters (GHQ). It is necessary that the chief surgeon maintain his office at GHQ in order that he may keep in close touch with the commander in chief and his general staff. As the GHQ is concerned with broad matters of policy and strategy, rather than with the details of administration and operation, the chief surgeon’s office is organized so as to fulfill its staff functions chiefly through direct cooperation with the divisions of the general staff at that headquarters. For this purpose, a medical officer or group of officers may be assigned to maintain immediate liaison with each division of the general staff liaison officers. While so serving, they may be actually located in the office of the chief surgeon or in the general staff offices, according to the policy announced by GHQ. Questions arising within all sections that in any way affect the Medical Department come before these officers for comment before being finally decided, and their recommendations should be in accordance with the policies of the chief surgeon. The chief surgeon must spend much of his time away from GHQ, for only in this manner can he keep himself well informed as to the status of the medical service in the theatre of operations. Therefore, it is necessary for him to have an assistant at GHQ, who is the deputy or assistant chief surgeon of the force and who acts for the chief sur- geon when he is absent. This assistant should be a medical officer of wide experience and one who is familiar with general staff work. The Medical Headquarters GHQ. The medical headquarters at GHQ consists of: Chief surgeon. The chief surgeon has general control of Medical Department activities and of policies which concern the department. Deputy or assistant chief surgeon. The deputy or assistant chief surgeon acts for the chief surgeon when he is absent. Liaison with general staff sections. Medical officers are detailed for liaison with the general staff sections as follows: . One for liaison with the personnel section (G-l) who is concerned with medical re- placements, sanitation, and sanitary inspections, including those necessary in the admin- istration of military government of occupied territory, casualty records, and general activi- ties of the Red Cross. One for liaison with the intelligence section (G-2) who is concerned with military in- telligence of value to the Medical Department. One for liaison with the operations and training section (G-3) who is concerned with movement orders of all Medical Department units and all matters of organization and training pertaining to the Medical Department. One for liaison with the supply section (G-4) who is concerned with matters dealing with evacuation, hospitalization, and medical supply for men and animals; Red Cross hospital and supply activities and Medical Department troops in general headquarters reserve. The chief veterinarian acts as supervising head of the veterinary service. Other Assistants to the Chief Surgeon. The following, while operating directly under the office of the chief surgeon, are located in the Medical Department Concentration Center or other convenient points: Chief of professional services. The chief of professional services coordinates the ac- tivities of the medical, surgical, dental, and aviation medical services, but solely in an advisory capacity. Consultants and assistants. Consultants and assistants include such other commissioned personnel as may be necessary to insure efficient operation of the medical service. The role of the medical groups assigned to regulating stations which are established and administered under the direction of G-4, GHQ, is discussed under the heading “Regulating Station,” below. THE MEDICAL SERVICE OF A FIELD FORCE 821 Units Under Immediate Control of the Chief Surgeon. The chief surgeon keeps under his immediate control (usually at the Medical Department Concentration Center) such medical units as he wishes to hold as GHQ reserves for the purpose of augmenting the medical service within a particular army. These reserve units may include evacuation- hospitals, surgical hospitals, veterinary evacuation hospitals, auxiliary surgical groups, medical gas treatment battalions, medical motor ambulance battalions, medical animal- drawn ambulance battalions, field hospitals, and medical sanitary companies. The first three mentioned are army units primarily and are discussed in Chapter IV. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 B g 1 I 1 3 .3 Remarks 1 Unit •a Headquarters 1 a S | 6 shock teams ! 6 gas teams • -1 a !i 4-. 0) 4 thoracic-su teams h 4 miscellan teams ■ 3 dental-prost teams i Total ”3 g T3 1 1 W • 1 surgical team consists of— 1 general surgeon. 1 assistant general surgeon. 1 anesthetist. 1 nurse.' 2 surgical technicians. b 1 orthopedic team consists of— 2 Colonel 3 Lieutenant colonel 1 nurse. 2 surgical technicians. 01 shock team consists of— 1 general surgeon. 1 nurse. 2 surgical technicians. 4 ("4)8 d3 48 50 32 5 6 First lieutenant 24 4 4 7 6 12 ' 132 8 24 6 12 — • 1 gas team consists of— 1 officer, specially trained 70 9 First sergeant (585) - 10 Staff sergeant, including , , casualties. 2 nurses. 11 Mess (824) (1) to 0) 12 Sergeant, including... 13 Section leader (652) (2) «) 1) (2) (') * 1 maxillo-facial team consist of— 1 plastic surgeon. 14 Supply (821) 15 10 Corporal, including 17 Clerk-typist (405) (1) 44 (1) ( 52 J 79 0) 1 1 1 nurse-anesthetist. 1 nurse. 1 dental technician. 18 19 20 21 Technician, grade 4) Technician, grade 5 48 12 12 12 Private.. ...... 1 17 l 21 1 surgical technician. « 1 neuro-surgical team consists of— Chauffeur (344) (3) (3) (1) (1) (1) (4) 5) 9) (1) (3) 3) 0) U (1) 23 Chauffeur (345) 24 Clerk, general (055) 1 assistant operating sur- 25 Clerk-typist (405) 20 1 anesthetist. 1 nurse. 2 surgical technicians. h 1 thoracic-surgical team con- sists of— 1 thoracic surgeon. 1 assistant surgeon. 1 anesthetist (intra-trachial anesthesia). 1 nurse. 2 surgical technicians. * Specialists not otherwise pro- vided for and as directed. 1 1 dental prosthetic team con- sists of— 1 prosthetist. 3 dental technicians, one of whom drivos dental labo- ratory. k Medical Administrative Corps. 1 Principal chief nurse and assistant chief nurse. 27 Cook (060) a> a) 28 Cook (060) 29 Cook’s helper (521) (9) ,(« (10) (1) (3) (10) (10) (6) (44) (52) (5) 30 Mechanic, automobile (014) 5 31 Orderly (695)... 32 4 (1) 33 Technician, dental (067) . . (3) (6) 34 (4) 35 Technician, medical (123)... . . (6) (6) (4) 30 Technician, medical (123) 37 Technician, surgical (225) 4 (24) (6) (6) (6) (4) (4) (4) W 38 39 Technician, surgical (225) 5 (5) (24) (6) (4) (4) 40 51 48 12 12 12 176 a 41 56 144 24 30 24 24 24 16 12 378 42 Q Car, 5-passcnger, light sedan 3 43 41 45 The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose quali- fication analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circular No. 14, War Department, 1942. Plate 1. T/O 8-571, July 13, 1942. Organization of the Auxiliary Surgical Group. The Medical Department Concentration Center (T/O 8-600-1) is also a GHQ re- serve unit, although its local administration may be supervised by the surgeon of the communications zone. This unit provides the administrative overhead for the units in GHQ reserve and for Medical Department replacements. A center of this character permits units to be prepared for service, overhauled, and refitted under coordinated con- trol at one place, instead of being scattered by single units throughout the theatre of operations. This concentration of units also facilitates the solution of supply and re- placement problems. The Auxiliary Surgical Group (T/O 8-571) is a GHQ reserve unit. These groups are authorized at the rate of one per army in the field. The teams constituting them are em- ployed at hospitals either in the combat zone or communications zone, wherever their 822 MILITARY MEDICAL MANUAL 1 2 3 4 6 6 7 Tech- nician grade Head- quar- ters Center head- En- listed cadre Bemarks UBJt quar- ters sec- tion Total 1 surgical hospital. These units are taken from the allowances of the 33 Q 1 1 Army from which with- 34 Q Q 1 1 35 1 1 pitals. . These units are taken from the allow- ances of the Army from which withdrawn. 1 auxiliary surgical group. The operation and maintenance of this center require addi- tional personnel from other arms and services for the following ac- tivities: supply, utili- ties, laundry, postal service, finance, and military police. The serial number symbol shown in pa- rentheses is an insep- arable part of the spe- cialist designation. A number below 500 re- fers to an occupational specialist whose quali- fication analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Depart- ment, 1942. Plate 2. T/O 8-600-1, April 1, 1942. Headquarters, Medical Department Concentration Center. i 2 3 4 5 6 7 Unit Tech- nician grade Head- quar- ters » Center head- quar- Total En- listed cadre Remarks ters sec- tion b • Includes— 1 colonel, MC, commanding offi- cer. 1 lieutenant colo- nel, MC, execu- tive officer and medical i n - spector. 1 major, VC, meat and dairy in- 2 3 1 1 4 6 *1 6 4 1 7 4 8 1 captain, MAC, adjutant. 9 (1) 1 (1) (1) 10 11 12 (1) (1) (1) 13 14 Meat and dairy hygienist (120) («1) <* 1) ( 3 CD mander and as- sistant adjutant. ® Veterinary. d Medical Adminis- trative Corps. This unit provides 15 Technician, grade 41 ?ewLCifin’,?iole 5 including.... 16 17 18 1 2 18 19 (1) (1) 0) (1) (3) (1) 0) (1) m (3) (1) (2) (i) (i) CD (1) (3) (1) (1) 0) (2) (3) (2> administration in. the theater of operations of medical and veterinary units held during con- 21 23 24 25 Cook (060) 5 26 for the purpose cf over- hauling and rehabili- tation, or as GHQ 27 28 29 4 30 Normally the follow- ing Medical Depart- ment units are as- 31 22 22 32 4 23 27 sembled at this center as QHQ reserve: THE MEDICAL SERVICE OF A FIELD FORCE 823 1 1 2 8 4 5 6 7 8 Unit Battalion headquarters (T/O 8-]26)« Headquarters and headquarters detachment (T/O 8-126) 3 clearing companies (each) (T/O 8-127) Total battalion Attached chaplain Enlisted cadre Remarks ? (b 1) 1 1 ? (1) l 1 4 Captain - (1) ('1)2 6 17 Personnel shown f) (• 1) • 2 (»ldl) 23 1 in column 2 in- 7 cludedin column 3. 6 "«2 2 b Battalion com- mander. 7 (4) 8 12 44 1 • Medical Admin- istrative Corps. 1 1 1 d Dental Corps. 1 1 4 4 «Qualified war- 10 3 3 3 rant officers, when 11 2 3 11 2 available, may be 1° 4 8 28 4 1? 1 3 10 4 these officers; 1 4 10 34 18 qualified in motor 8 15 53 12 maintenance, 1 10 9 42 135 qualified in per- 17 13 65 178 sonnel admlnlstra- 18 (5) (14) (47) tion. 137 457 48 20 Aggregate 64 149 601 1 48 21 2 6 22 Q Trailer, 1-ton, 2-wheel, water tank 1 6 16 ?8 2 2 8 24 Q Truck, 5-1-ton, command and recon- 1 3 2.5 3 1 6 26 4 11 37 27 Q Truck, 2H-ton, wrecker, with winch. 1 1 Changes No. 1 WAR DEPARTMENT, Washington, January 26, 1943. T/O 8-125, August 11, 1942, is changed as follows: Lino Column 2 3 4 8 2 1 3 l (Delete al! other remarks.) 4 l 1 5 6 l 1 7 6 2 7 4 4 12 20 4 50 149 Plate 3. T O 8 125, \ugust 11, 1942, and Change 1, Medical Gas Treatment Battalion. 824 MILITARY MEDICAL MANUAL 1 2 3 4 5 6 7 1 Unit Tech- nician grade Com- pany head- quar- ters 3 clear- ing pla- toons (each)» Total com- pany b En- listed cadre Remarks 2 1 1 3 1 3 4 Captain 2 6 » Normal bed capac- ity of 1 platoon when acting independently is 100. 5 o 1 (d 1)2 7 6 Total commissioned 2 5 17 7 6 18 ity of company is 380. o Medical Adminis- trative Corps, d Dental. 8 1 1 1 9 3 1 6 4 10 (1) 0) 0) (1) 0) 0) (1) 0) 2 « Nurses normally will accompany the unit when assigned on a functional basis. 11 Motor (813) 12 (1) (3) (1) 6 13 Supply (821) (1) 14 2 While on a training basis they are not assigned. The serial number 15 (2) 1 (6) 4 . (2) 2 16 Corporal, including 1 17 "Clerk, admission (055) (1) (3) 0) 1 65 l 86 (1) (4) (7) (4) (10) (12) (11) (2) (2) (4) (27) (36) (3) (3) (6) * 02) (6) (3) (6) (15) (20) (1) (1) 4 9 18 Clerk, company (405) (1) 14 symbol shown in pa- rentheses is an insepa- rable part of the spe- cialist designation. A number below 500 re- fers to an occupational specialist whose quali- fication analysis is found in AR 615-26. 19 20 21 22 23 Technician, grade 4] Technician grade 5 60 Private, first class.. I H Private J (1) (1) (1) (1) (1) } 2 24 Cook (060) 4 (1) (2) (1) (3) (4) (3) (3) (3) 25 Cook (060) 5 26 27 Driver, heavy truck (345) 5 (3) A number above 500 28 Driver, heavy truck (345) refers to a military occupational specialist 29 Driver j light truck (345) (2) (2) (2) (1) 30 4 31 Mechanic, automobile (014) 5 14, War Department, 1942. 32 Orderly (695) _ _ i _ O) (9) (12) (1) 0) (2) (4) (2) (1) (2) (5) (6) 33 Orderly, hospital, medical (303).. 34 Orderly, hospital! surgical (303).. 35 Pharmacist (149)1 (1) (1) (1) 36 5 37 5 38 Technician, medical (123) 39 (1) 0) 0) 40 4 41 5 42 Technician! surgical (225) 43 (2) 44 Total enlisted 19 64 211 24 45 21 75 246 24 46 Q Ambulance, 54-ton 2 6 47 Q Trailer, l-tori, 2-wheel, water tank (250-gallon) 1 1 4 48 Q Truck, %-ton, command and reconnaissance 1 1 4 , 49 1 1 50 1 6 1 19 51 Q Truck! 2t4-ton, cargo, with winch. 3 T/O 8-510, February 28, 1942, is changed as follows: Line Column 1 2 4 6 6 19 20 Technician, jxade 4| Technician, grade sjlnclurtlni 02 (1) f 15 1 37 M 1 85 ffi 6 10 31 22 Private ) 4 } * (S) "8 0 hi (3) hi u 60 217 20 45 77 252 20 Plate 4. T/O 8-510, February 28, 1942, and Change 1. Field Hospital. THE MEDICAL SERVICE OF A FIELD FORCE 825 ggg a a 238 2g Q Truck, ti-ton, command and reconnaissance Q Truck, %-ton, weapon carrier Q Truck, cargo, in- cluding Cargo Q Truck, M-ton 0. Truck, V-ton. carry-all Private—Continued. Q Ambulance, %-ton . Q Trailer, 1-ton, 2-wheel, n D J* “ • | Technician grade to 3- j - | Battalion headquarters I | and personnel section Headquarters detach- ment - ccM ; i 1 1 Detachment headquar- "H‘ 1 i ters section *• g» - j ; j Battalion supply section c* 3 >-* : 1 | Motor maintenance see- ! tion 03 ; I Total headquarters de- ww<5° M H HMH 1 ! . tachment -j 33*0 - _* H-t-* j | Company headquarters 3 medical companies, ambulance (each) 0= 5 | 3 platoons (each) *= S3« - - g j Total company © " 1 Total (headquarters detachment and SSw S oi ** >->*■>*** <5 j 3 companies) c • ; j j ; j • j ; j | Enlisted cadre 13 9 I s 5 Plate 5. T/O 8-315, April 1, 1942. Medical Ambulance Battalion, Motor. 1 2 l 5 6 i 2 3 j 4 5 6 7 S I 9 10 llv 12 13 Unit •c £ u. a | Headquarters detach- ment 3 medical companies, ambulance (each) i Total (headquarters detachment and 3 companies) X3 •o c w Remarks | Battalion headquarters ! and personnel section 1 Detachment headquar- ters section j Battalion supply section ! Motor maintenance sec- tion i Total headquarters de- tachment | Company headquarters | 3 platoons (each) | Total company “ 1 b«l bdl be] 4 1 b 2 b 1 b 2 6 T 1 1 (b2) 5 b 1 b 11 • Battalion com- bi 1 b 1 — 1 b 1 1 b 3 4 Total commissioned 7 8 9 10 11 12 13 14 15 10 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 .40 41 42 43 44 45 46 47 48 49 ' 1 1 (1) 1 2 0) 0) 1 2 (1) (1) 1 (1) = 1 (i) (1) 4 2 (1) (1) 16 (4) (3) (9) 16 (1) 0) (9) (5) 13 (9) (4) f 13 18 1121 |14S (5) (4) / (3) 1(128) (2) (2) (3) (4) (5) (8) (7) (7) (6) (90) (1) (4) (26) 353 372 T (i) 2 (i) (i) 10 (4) (3) (3) ,3 ... (9) (4) 4 (4) 7 8 b Medical Ad- ministrat'ive Corps. 0 Executive offi- cer, plans and training officer d Battalion adju- tant. • Personnel offi- cer. < Motor officer. < Bus type motor ambulance may be substituted for the Q ambulance, \i- ton, shown in this table. The serial num- ber symbol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupa- tional specialist whose qualification 1 — — — — U) 1 1 1 Technical sergeant, including.. 1 (1) 1 (i) 1 (1) 2 (1) (1) 1 (i) i (i) (i) (3) 4 1 (1) 2 1 4 (1) 0) 1 a) a) "T (i) 23 (11) (3) (1) 4 (3) 0) 84 (1) (1) (37) (lj (i) (2) 1 (1) 1 Assistant section leader (652). a) 13 (1) 48 (2) 0) (15) (2) (2) (3) 0) (2) (2) (4) (4) (3) (1) 15 (1) 0) (4) Technician, grade 41 Technician, grade 5L , Private, first class.. fin“Ud)ng.. Private j 16 (2) 6 13 Bugler (803) o) (3) }(4> (21 (2) (31 (5) (3) Clerk, headquarters (055).. . . Clerk, headquarters (055) 4 (1) 0) (4) (4) (2) (3) 49 49 number above 500 refers to a military occupational spe- cialist listed in Circulars Nos. 14 and 67, War De- partment, 1942. 4 5 (1) (2) (2) 0) (1) (2) (1) (1) (1) (ioj (1) 0) (2) 0) (1) (1) (30) Mechanic, automobile (014).. Mechanic, automobile (014) 4 5 (4) (3) "(2) 0) (1) 5 (1) (1) (1) 14 15 0) (1) (5) 59 66 (1) (1) 20 21 (2) 26 *27 (1) (7) 98 102 Basic (521) (1) 19 23 (2) 18 19 (1) 8 9 826 MILITARY MEDICAL MANUAL services are needed. They may be used to augment the personnel of evacuation and surgical hospitals of an army. In each surgical group there are an administrative head- quarters, surgical teams, splint teams, shoc\ teams, gas teams, maxillo-facial teams, re- search teams, and other teams for miscellaneous assignment. The teams are organized so as to permit them to be sent equipped for work to any part of the front or to the rear. The personnel is specially selected for their professional attainments. Tables for other units which may be held in reserve or rehabilitated in the medical department concentration center of the GHQ are shown in this chapter. The Surgeon, Communications Zone. At the headquarters of the communication zone, a medical officer is detailed on the staff of the commanding general as the surgepn, com- munications zone. 1 2 3 4 1 Unit Tech- nician grade Total detach- ment a Remarks 2 b 1 » For theaters of 50,000 men or larger. b Sanitary Corps. This detachment to be assigned within the theater on the recom- 3 Total commissioned 1 4 1 5 6 Technician, grade 4] J 1 mendation of the theater surgeon. The serial number symbol shown in parentheses is an in- separable part of the specialist designation. A number below 500 refers to an occupational spe- cialist whose qualification analy- 7 8 Private, firk class-) 4 1 2 (1) (1) (1) (1) (1) 9 10 11 5 12 4 number above 500 refers to a mili- tary occupational specialist listed in Circular No. 14, War Depart- ment, 1942. 13 6 14 7 15 1 T/0 8-697, April 80, 1942, is changed as follows: Column Line 2 3 5 3 6 1 7 1 0 Delete entire line 12 4 (2) Plate 6. TO 8-697, April 30, 1942, and Change No. 1. Medical Detachment, Museum and Medical Arts Service. The officer, under the commanding general, supervises Medical Department activities within the communications zone. He has under his supervision all medical units in that zone except those retained under the direct control of the chief surgeon of the field force. The units under the direct supervision of the surgeon, communications zone, are general hospitals, hospital centers, convalescent camps, general dispensaries, the general medical laboratory, the communications zone laboratories, sanitary companies, veterinary general hospitals, and those hospital trains which are assigned for his use. He maintains technical supervision over medical sections of general supply depots, station hospitals, veterinary station hospitals, and other Medical Department activities under the control of local commanders. The Office of the Surgeon, Communications Zone (T/O 8-500-1). The office of the surgeon, communications zone, is organized on a functional basis, i.e., into sections con- cerned with the several activities that together comprise the responsibility of the Medical Department as an administrative, technical, and supply service. Activities of the Medical THE MEDICAL SERVICE OF A FIELD FORCE 827 Department are coordinated through the general staff of the communications zone. Liaison with the general staff sections, on important matters, is conducted by the chiefs of sections of the office of the communications zone surgeon. Every officer, however, whether he is a section chief or not, should maintain active liaison not only with the general staff officers in matters with which he is concerned but also with the representa- tives of other supply branches, e.g., the Quartermaster, Engineer, etc. 1 2 3 4 5 6 7 8 9 a S 2 ambulance sections, 2-engine, transport (each) Remarks 1 Unit Specialists’ ratings (class) Squadron headquarters Headquarters section Ambulance section, single engine, t port -Total squadron (squadron headqua headquarters section; 1 ambulancs tion, single engine, transport; a ambulance sections, 2-engine, trans Enlisted cadre •Commanding officer, squadron, airplane ambu- lance. b Executive officer and squadron liaison officer. 0 Commanding officer, sec- tion airplane ambulance. d Includes 1 dental officer. •Airplane ambulance sur- geons. ' 1 assistant to command- ing officer and liaison officer, section airplane ambulance; 1 section aid station surgeon; 6 airplane ambulance sur- geons. 2 Lieutenant colonel. »1 1 * 1 assistant to command- ing officer and liaison officer, 3 Major. bl »1 4 section airplane ambulance; 4 Captain.. d «2 t 2 g 2 8 1 section air station surgeon; 5 First lieutenant • 2 t 6 *12 32 12 airplane ambulance sur- geons. This organization companion medical zation for the Air 6 Total commissioned 2 4 9 15 45 is the >rgani- Corps 7 First sergeant (585) 1 1 1 8 Staff sergeant, including 1 1 1 4 2 transport group (T/O 1-352 9 Medical technician (123) (1) (1) (3) (1) 9 (1) (1) 3 and 1-357). When necessary 10 Motor (068) (1) 1 suitable light airplanes capa- 11 Sergeant, including 6 1 ble of operating from small 12 Clerk, administrative (055). Medical technician (123) (1) (1) (6) (2) 8 (1) 0) (1) 2 fields will be substituted in 13 (6) the Air Corps squadron transport (bi-engine) on the basis of 18 single-engine air- planes for 12 bi-engine air- 14 Surgical technician (225) (1) 3 15 Corporal, including 1 1 16 Clerk, administrative (055). Medical technician (123) (1) (1) (1) (1) (1) 56 (4) (2) (2) / 66 17 (1) \(1) }9 planes. 18 Surgical technician (225) Medical personnel will be messed with Air Corps or Army units to which they are attached. 19 20 21 Private, first dassjinduding..- 28 56 5th (3) (3) (1) (2) (3) (3) (4) \ 130 (ID (14) (1) (3) (1) (1) 22 Chauffeur (245)... 6th „ , , ,, , 23 Clerk, administrative (055). 4th 24 Clerk, administrative (055). Mechanic, automobile (014). Mechanic, automobile (014). 5th (1) (1) Num- ber 25 3d (1) (1) Class 26 4th 27 Orderly, ambulance (696)... (8) (12) (32) (1) (6) (10) (23) (12) (23) 28 Technician, dental (067) Technician, medical (123)... Technician, medical (123)... Technician, medical (123)... Technician, surgical (225)... Technician, surgical (225)... 4th (1) 0) (2) 3d 13 29 4th (2) (4) (6) (3) (9) (2) (3) (6) (2) (7) 4th 32 30 5th 5th 61 31 6th (5) (5) (2) (2) 6th 37 32 33 3d 4th Total. 143 34 35 Technician, surgical (225)... Basic (521) 5th .... (5) (3) (12) (6) (10) (6) (37) (21) (2) The serial number symbol shown in parentheses inseparable part of th is an 36 Total enlisted 32 64 61 218 17 e spe- cialist designation. A num- 37 Aggregate 2 36 73 76 263 17 ber below 500 refers to an occupational specialist whose qualification analysis is 38 Q Ambulance, field, cross 2 4 10 39 country. Q Car, sedan, 5-passenger 1 1 1 4 found in section I, AR 615-26. A number above 500 refers to 40 Q Truck,A4-ton 4 1 1 7 a military occupational spe- cialist listed in section II, 41 Q Truck, cargo 1 1 1 4 AR 615-26. Plate 7. T/O 8-455, November 19, 1941. Medical Air Ambulance Squadron. The sections and sub-sections of the surgeon’s office, communications zone, with duties assigned to each are as follows: Administrative section. This section supervises the operation of the entire office. Its personnel includes the surgeon, the deputy surgeon, and the office executive. It may have subsections as follows: 828 MILITARY MEDICAL MANUAL The office service subsection deals with the interior office administration such as filing, records, receipt and dispatch of official mail, courier service, information, print- ing, mimeographing, and stenographic work. The detachment subsection administers, as a company or detachment, the enlisted men on duty in the office. It details chauffeurs, orderlies, clerks, etc., for the various sections and keeps the personnel records and the reports of the enlisted men who are members of the organization. The historical subsection formulates the plans for collection of historical data and 1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 61 52 53 64 1 2 3 4 5 6 7 8 9 | Total company J g 11 12 Unit © t: c? tl C ec o C -C © © c-> CO C © C 08 3 fl SZ •£ © >» C c3 6 O O | Division medical supply section 3 platoons (each) | Enlisted cadre Remarks 2 38 c o o 1 Litter bearer sec- tion | Ambulance section Treatment section [ Total platoon i 1 6 13 ... • Medical sup- ply officer. b Medical Ad- ministrati ve Corps. c Patient s’ mess. d Dental. •Driven by crew member. The serial number symbol shown in paren- theses is an in- separable part of the specialist des- ignation. A number below 500 refers to an occupational spe- cialist whose qualification analysis is found in A R 615-26. A number above 500 refers to a military occupa- tional specialist listed in Circular No. 14, War De- partment, 1942. l b"l .... (dl)3 2 4 First lieutenant •bi Total commissioned i 1 l 1 = 4 6 20 1 5 (1) (1) (1) (1) (1) 5 (1) (1) (3) T (i) 3' 1 (ij (i) (ij 0) First sergeant (585) 1 2 1 9 (3) (1) CD (3)1 (1) 9 (1) (1) 16) (1) 8 (3) O) (1) (3) 8 19 62 79 (1) (23) (1) (1) (3) (3) (3) (48) (1) (1) (4) (18) 0) (1) (3) (3) (3) (9) (3) (6) (15) (17) Staff sergeant, including 1 l 1 0) *> d> Medical (673) Medical supply (825). 0) Mess (824) 0) 0) .... .... d) Platoon leader (651) Supply (821)_. (ij 2 (1) U) Sergeant, including 1 ... 1 1 2 Communication chief (542) Motor (813) Section leader (652) 0) 0) (2) Supply (821)- 0) Corporal, including 2 l (i) 1 2 (1) Clerk, admission (055) Clerk, company (405) 0) 0) Communication, assistant (542). Section leader, assistant (652)-. ... 0) 17 (1) 48 Technician, grade 41 Technician, grade 51;„ 18 (1) (1) 6 • Deputy surgeon. «Medical inspector. d Dental. • Medical and surgical consultants. 1 Executive officer. k 1 epidemiologist; 1 food and nutrition officer. ••Meat, meat food, and dairy products in- spector. > May be Medical Administrative Corps. i Principal and assistant chief nurse. » Veterinary. Summary of specialists’ ratings Colonel __ 1 1 4 1 *1 *1 h r i » 2 °1 *2 • 2 a 1 1 1 1 1 11 1 dl First lieutenant • I il Total commissioned 3 4 2 2 2 3 1 2 2 5 26 i 2 " S 2 — — — — — — 1 (1) 1 (1) 3 (3) 7 (4) U) (1) (1) 16 (10) (1) (3) (2) 3 0) J 21 l 41 (1) (2) (6) (6) (ID (4) (6) (4) (12) (10) 1 (1) 1 1 (1) *1 (D 1 Staff sergeant, including. 1 (1) 1 (1) 1 (1) 1 1 (1) (1) Hygienist, meat and dairy (120) (1) Statistician (212) (1) 1 (1) Sergeant, including Clerk, general (055) Clerk, postal (056) 2 (« (1) 1 (1) 3 2 (2) 1 (1) 1 (1) 2 (2) 1 (1) T 2 Class Number Clerk, shipping (186) (3) 3d 4 10 19 8 (2) 1 (1) J 12 l 41 (1) (2) (3) ‘ffi Si (12) (10) 1 (1) } > 1 (1) 1 4 th 5th Private, first class|including 1 1 1 1 1 1 1 6th 5th 6th 5th 6th 41 Chauffeur (245) Clerk, general (055) Clerk, general (055) (1) (1) (1) (1) (1) (1) (1) (1) (1) The serial number symbol shown in paren- theses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification anal- ysis is found in section I, AR 615-26, A number above 500 refers to a military occupational specialist listed in section II, AR 615-26. 3d Stenographer (213) 4th 4th 5th Typist (247) _ Typist (247) Basic (521) ... Total enlisted Aggregate Q Car, light, 5-passenger sedan 57 5 5 4 3 3 4 3 3 5 92 62 9 7 6 5 6 5 5 5 10 120 2 1 2 1 Plate 8. T/O 8-500-1, November 1, 1940. Organization of Headquarters, Medical Service, Communications Zone. THE MEDICAL SERVICE OF A FIELD FORCE 831 1 2 3 4 5 6 7 8 9 •c«_» 5 a at cj eE 3 companies (each) 1 Unit Technician grade t: ° a os 5 & CTT o PS 3 c* 3-g oajj} I Company head- quarters | 2 platoons (each) | Total company Total battalion | Enlisted cadre Remarks 2 »1 l S Captain » 1 »1 *1 4 4 First lieutenant « b 1 *»1 ab2 7 6 Total commissioned 3 X l 3 12 » Mounted on horse. 6 1 1 1 tive Corps. • Veterinary Servioe. T Veterinary Corps. The serial number sym- bol shown in parentheses Is an Inseparable part of the specialist designation. A 7 (1) 0) 3 (1) 3 8 First sergeant (585) .' 1 *1 »i 9 2 2 1 10 U) (1) (1) U) 11 (1) 12 12 Staff sergeant, including... 2 i 4 6 13 Mess (824) (1) (i) (3) (3) 14 Platoon (651) (M) (‘2) (6) an occupational specialist whese qualification analy- sis is found in AR 615-28. 15 Stable (710) (*1) (*l) (3) (3) 16 Sergeant, including 1 1 3 11 3 17 (I) (1) (1) 18 Motor (813) O) to a military occupational specialist listed in Circular Xo. 14, War Department, 1942. 19 Section leader (652) (*1) (*2) (6) 20 Suoply (821) 0) 1 (1) (3) (3) 21 1 3 9 3 22 Assistant section leader (652) (*1) (»2) (6) Clerk, company (405) 1 0) 0) (3) (3) 24 25 26 27 28 Technician, grade 41 Technician, grade 5- „ 1 3 L 19 2 7 18 23 CD (3) 7 24 56 72 (3) 5 2 Private J Bugler (803) 3 L .... 29 Chauffeur (345) (2) (3) (11) 30 5 Si 0) (1) (1) 31 32 Cook (060) 4 (1) (1) (3) (2) 33 Cook (060) 5 (1) O) (1) (3) (1) 34 Cook’s helper (521) (1) (3) 35 (•lj (1) (*1) (*D (*3) (10) 36 Horseshoer (094) 4 (1) (1) (4) (3) 37 Leather worker (192) 5 (1) (1) (3) 38 5 (1) (1) (30) 39 Orderly, ambulance (696) (5) (10) 40 s (1) (2) (8) (5) (16) (15j 41 (48) 0) 42 Technician, veterinary (250) 5 (•lj (•1) 43 U) 44 (1) 0) (6) (3) OS) 45 Basic (521)........ (3) 46 Total enlisted 14 17 22 61 197 24 47 17 18 23 64 209 24 48 Q Ambulance, animal-drawn 10 20 60 49 Q Animal, including .... 3 9 25 59 HO 50 Horse, riding (S' (5) (4*i 51 Mule, draft .... (4) 1 (20; (44’ 1 U32) 52 Q Trailer, 1-ton, 2-wheel, cargo .. .. 3 53 Q Truck, }4-toa 1 1 1 4 1 1 55 connaissance. 1 3 56 Q Truck, 2’ 2-ton, cargo.. 1 1 3 57 Q Wagon, escort 7 1 1 Plate 8A. T/O 8-55, Aug. 11, 1942. Medical Ambulance Battalion, Animal Drawn. 832 MILITARY MEDICAL MANUAL placement or requisition from the zone of the interior, local purchase or transfer from the Red Cross or an allied power or captured enemy material. The storage and distribution subsection deals with all matters pertaining to the storage and distribution of medical supplies. The finance and accounting subsection is in charge of a medical department officer experienced in military auditing, accounting, and disbursement. He and his assistants supervise, control, or conduct the financial transactions of the chief surgeon’s office and all Medical Department functions controlled by it. This subsection may be further divided as follows: Allotment and disbursing: Dealing with the accounts of available funds, the alloca- tion of funds to projects and the allotment of funds to medical supply or other Medical Department officers for the local purchase of supplies or service, and the handling of disbursements and disbursing accounts. Auditing: Dealing with the examination of money vouchers in connection with the procurement of supplies or services and the final audit of hospital or other fund statements or accounts pertaining to the Medical Department under the control of the surgeon, communications zone. Legal: Furnishing legal advice on matters in connection with the activities of the supply and finance divisions with special reference to claims, contracts, and leases. Personnel section. The personnel section deals with all matters relating to appointment, assignment, transfer, promotion, and returns of personnel. It is important because the functioning of all units of the field force depends upon its conduct. It may be subdivided into the following subsections: Commissioned: Medical Corps Dental Corps Veterinary Corps Medical Administrative Corps Sanitary Corps Nurse Corps. Enlisted men of the Medical Department. Civilian employees of the Medical Department. Evacuation section. This section deals with primary, secondary, and special evacuation of sick and wounded; transportation and assembly of special classes of patients; estimates of transportation required for sick and wounded; records and statistics of evacuation; hos- pital train assignment and the use of light railways and waterways. Sanitation section. This section deals, generally, with all matters pertaining to health and control of disease within the communications zone. Through subordinate agencies, it initiates or directs the execution of special disease-control measures, the conduct of epi- demiological studies and procedures for the control of existing or potential epidemic con- ditions. It exercises general supervision over sanitation by means of sanitary inspections and surveys and promulgates special instructions relative to measures to be taken for the prevention of disease. It also supervises the operation of medical laboratories. Vital statistics section. This section deals with inspection, correction, and compilation of all statistical data relating to the sick and wounded and correspondence pertaining thereto. Consultant section. The consultant section acts as an agency in carrying out the policies formulated by the chief of professional services on the staff of the chief surgeons, GHQ. The section must function in cooperation with the hospitalization and personnel section and also with the Medical Department Concentration Center. The officer in charge should possess a wide knowledge of the professional qualifications of the large number of civilian practitioners of the United States who come into active service in time of war in order that assignment may be made in accordance with professional qualifications. It will usually have two subsections: surgical and medical. It is imperative that each subsection be supervised by officers who are pre-eminent in that particular branch of medicine and who at the same time possess administrative ability. These officers, in addition to routine duty, prepare the bulletins issued from THE MEDICAL SERVICE OF A FIELD FORCE time to time by the chief surgeon which announce the latest approved methods of technique and treatment for the information of the medical officers of the field force. The surgical subsection, under the supervision of a medical officer of the highest sur- gical attainments, may be subdivided as follows: 833 General Surgery Urology Orthopedics X-ray Nerve and brain surgery Ophthalmology Maxillo-facial surgery Oto-laryngology The medical subsection, under a medical officer of high professional attainments, may also be subdivided as follows: General medicine Neuro-psychiatry 1 2 3 4 5 6 7 8 9 10 1 Unit | Technician grade Headquarters section Medical section » Surgical section *> Eye, ear, nose, and throat section « | Dental section • Total Enlisted cadre Remarks T Lieutenant colonel 1 1 3 1 1 d 1 3 4 1 1 1 1 i 1 4 »Includes— 1 major, chief of service. 1 captain,internist, 1 lieutenant, general med- ical. •> Includes— 1 major, chief of service. 5 First lieutenant 11 1 d j 4 6 Total commissioned 2 3 2 2 3 12 — 7 First sergeant (585) 1 1 1 1 8 Technical sergeant, including 1 9 Pharmacist (149). (1) 20 (1) 6 8 (1) 4 4 10 11 12 13 14 Technician, grade 4] Technician, grade 5[,inpll1(1iT1£, 7 Private, first class.. j 6 Private ) (2) (2) (1) (1) 5 8 (2) (2) (1) (1) (1) (1) ... 1 captain, general surgeon. «Includes— 1 captain, chief of service. 1 lieutenant, oculist. d Dental. • Includes— 1 major, chief of 15 16 17 5 (1) (1) 18 4 (1) m 19 5 20 4 (1) (1) 21 4 (2) (2) (l) (1) (2) (3) (1) (1) (2) C31 (2) (2) (1) (1) (2) (3) (1) (I) (1) (1) (1) (1) 22 Technician’ dental (067) 5 23 5 1 captain, assist- 24 Technician’ medical (123) t 25 Technician’ medical (123) 5 ice, oral sur- geon. i 26 Technician, medical (123) 27 Technician’ surgical (225) 4 (1) 28 Technician’ surgical (225) 5 (1) general opera- 29 Technician, surgical (225) (2) (3) 30 Basic (521). ~ 1 Medical Adminis- trative Corps. 31 Total enlisted 8 21 29 10 personnel indicated hereon is advisory; con- siderable variation therefrom is left to the 32 Aggregate.... 10 31 41 10 33 Q Ambulance, %-ton 1 1 1 34 Q Truck, J4-ton 1 35 Q Truck, %-ton, carry-all 2 2 manding officer of the dispensary. The serial number symbol shown in pa- rentheses is an insepar- able part of the specialist designation. A num- ber below 500 refers to an occupational spe- cialist whose qualifica- tion analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Cir- culars Nos. 14 and 67, War Department, 1942. Plate 9. T/O 8-650, April 1, 1942. Organization of the General Dispensary Communications Zone. 834 MILITARY MEDICAL MANUAL Dental section. This section cooperates with the personnel and supply sections and makes recommendations relative to the assignment of dental officers and to the procure- ment, storage, and issue of dental supplies. It compiles pertinent statistics from current dental reports and returns and recommends policies governing the extent and character of the dental service. Veterinary section. A veterinary officer of appropriate grade, with a proper number of assistants, conducts this office. It deals with: veterinary hospitalization and evacuation, veterinary supply, veterinary sanitation including inspections of the condition of animals, veterinary statistics, veterinary administration, inspection of all foods of animal origin, inspection of forage, and veterinary public health administration of occupied territory. Medical Establishments of the Communications Zone. The hospitals of the communi- cations zone and hospital trains are discussed in a succeeding section of this chapter, Hospitalization and Evacuation. Medical depots are discussed in the section relating to supply. A brief description of other medical installations of the communications zone is related in this section. General dispensary communications zone. (T/O 8-650). These small units are organized for the purpose of providing medical and dental attendance for the com- missioned, enlisted, and civilian personnel on duty at all large military headquarters within the theatre of operations. They are also established to provide general profes- sional attendance in large communities having a floating military population. They may function directly under the communications zone commander or under local command. 1 2 3 4 5 1 Unit Special- ist’s rat- ings (class) Pand W Enlist- ed cadre Remarks 2 »l 3 2(»1)(*1) • Flight surgeon. 4 • 3 (d 1) t Flight surgeon or ophthal- mologist-otolaryngologist. » May be flight surgeons, d Flieht sureeon or neuro- 5 6 6 1 l 7 1 Summary of specialists’ 8 1 ratings: 9 Private, first J 4 1 10 11 12 Private \ 7 (1) (1) 1 Class P and Clerk (55). 4th. (1) W 13 Clerk (65) 6th (1) 14 15 16 17 IS 19 Clerk (55) 6th IS (1) (2) (2) (1) Third 1 3d (1) Fourth.. 3 Typist (247) 4th Fifth 3 5th Sixth 1 8 20 Total enlisted. 14 3 21 20 3 The serial number symbol shown in parentheses for certain specialists is an in- 22 23 24 1 1 separable part of the spe- 2 c i a 1 i s t designation. For qualification analysis, see corresponding serial number in section IV, MR 1-8 (old number 1-3). Plate 10. T/O 8-141, Aug. 1, 1939. Organization of the Medical Examining Unit, Aviation. Medical examining unit, aviation (T/O 8-141). These are usually authorized at the rate of one per army in the field. They are small units usually attached to the larger avia- tion centers where men are being trained or conditioned as fliers. Its principal function is to determine whether personnel is physically fitted for flying and what particular type of flying an aviator is qualified or best suited. THE MEDICAL SERVICE OF A FIELD FORCE 835 gg2S 82 g Q | 5? Unit - i II Technician grade » _w _ J| S I Headquarters CO i i i s Basic platoon * 40 i IIs Ward platoon b - Total a Enlisted cadre *4 Remarks i Plate 11. T/O 8-780, April 1, 1942. Organization of the Veterinary Evacuation Hospital 1 2 3 4 5 6 7 8 1 Unit | Technician grade | Headquarters | Basic platoon • | Ward platoon >> H | Enlisted cadre Remarks 1 1 1 1 1 2 3 » May be divided into— Receiving section. Operating section. Pharmacy section. Forwarding and evacuation sec- tion. b May be divided into— Surgical ward. Medical ward. Contagious ward. 1 6 2 1 3 6 Mess (824) ,0) a) (2) (1) (1) 9 (1) (2) (1) (1) •d) a) Supply (821) (i) Ward (793) (1) 6 3 (6) (6) (3) 1 (1) (1) (3) 1 symbol shown in pa- rentheses is an insepa- rable part of the spe- cialist designation. A number below 500 re- fers to an occupational specialist whose quali- fication analysis is found in A R 615-26. A number above 500 re- fers to a military occupational specialist listed in Circulars Nos. 14 and 67, War De- partment, 1942. (1) 16 (1) [ 1 5 <13 (1) "s’ 18 19 Technician, grade 3] Technician, grade 4 24 33 21 22 23 Private, first class. . Private J Bugler (803) (i) 24 1.30 (1) U) (1) (3) (1) (1) 2) (1) (1) (1) (1) (2) (8) (14) (2) (1) (3) (10) (1) (1) (3) (3) (7) (i) (i) (1) (4) (1) (1) (1) (1) (2) 29 (i) (i) Cook (060) (1) (1) 33 4 a) (i) (i) (1) 34 36 (1) (1) 37 a) 38 (6) (2) (1) (1) (1) (1). (1) 39 (12) (1) 40 41 42 (2) (9) (1) 43 44 3 45 (1) (2) 0) (3) (1) 46 5 (1) (2) (4) 47 48 49 20 836 MILITARY MEDICAL MANUAL Medical general laboratory (T/O 8-610). A medical general laboratory is estab- lished only in a theatre of operations when the latter is at a distance from the zone of the interior. Its functions include the standardization of technique and material for the laboratory service within the theatre of operations. Other activities are the production and standardization of diagnostic sera, standard chemical solutions, stains, biologicals, etc. Scientific investigation is another special function and this research is restricted to problems which offer in their solution a distinct contribution, directly or indirectly, toward the successful prosecution of military operations. Medical laboratory, army or communications zone (T/O 8-611). (See Chapter IV.) The medical laboratory (army or communications zone) functions primarily as an epidemiological laboratory for the purpose of making such laboratory analyses, studies, and investigations as may be required in the control or prevention of disease. It may be utilized for diagnostic purposes where other laboratory facilities are lacking or in- adequate. The communications zone laboratory usually operates under the immediate control of the communications zone surgeon, except when the communications zone is divided into sections. It may then be placed under the immediate control of a section surgeon. Veterinary units. These comprise veterinary companies (separate) (T/O 8-99), veter- inary evacuation hospitals (T/O 8-780), veterinary convalescent hospitals (T/O 8-790), veterinary general hospitals (T/O 8-750), and veterinary station hospitals (T/O 8-760). The veterinary company (separate) is discussed under the “Army Veterinary Service” in Chapter IV because the army area is the usual area of operation for this unit. The veterinary evacuation hospital (T/O 8-780) has a normal capacity of 150 animals with an emergency expansion to 300. These hospitals have transportation sufficient for their own movement. They are established at points which have advantages similar to sites for evacuation hospitals for men, although they need not have direct rail-siding facilities. Veterinary evacuation hospitals receive animal casualties from the veterinary clearing stations of cavalry divisions and from veterinary aid stations of animal organ- izations not provided with veterinary troops. Evacuation of these casualties to the evacuation hospital from the division areas is accomplished by the veterinary company, separate. In general, evacuation hospitals for animals carry on the functions similar to those performed by evacuation hospitals for men. They should be established within one day’s march for animal casualties from the division veterinary aid stations or veterinary clearing stations. All cases requiring further evacuation are sent to the veterinary general hospitals of the communications zone by stock train or by evacua- tion columns of led animals. When the veterinary evacuation hospital is operating in the army area, the army veterinarian makes the arrangements for the evacuation of animal casualties from the evacuation hospital in much the same manner as is done for the evacuation of men. The veterinary convalescent hospital (T/O 8-790) (See Plate 12) has a normal capacity of 1000 animals. It furnishes a place for the reconditioning of worn-out or convalescent animals within the combat zone, thus avoiding the necessity of further evacuation for this purpose. It is usually located in the rear part of the army area and is not moved unless it is necessary to conform to major changes in the army area or the location of the veterinary evacuation hospitals. Army animals fit for duty are turned over to the army or corps remount depots. The veterinary general hospital (T/O 8-750) has a normal capacity of 500 patients with facilities of expansion for 500 more. They are located centrally with reference to the veterinary evacuation hospitals from which animals will be received; that is, on or immediately off the main arteries of railway traffic leading from the combat zone. They may also be located to serve the needs of base remount depots or near similar animal concentrations. The veterinary station hospital has a normal capacity of 150 patients. They are designed to meet local needs and are established in division training or rest areas, along main lines of communication where there are sufficient animals to justify their maintenance, and where it would not be in the interest of economy to utilize a veterinary general hospital. They function under local commanders. 1 2 3 4 5 6 7 8 & g IS _ C0 •O « 2C cQ © a © © 1 Unit £ a bfi © .2 tx © 8 8 Remarks 03 o4 2'S 2 © O © T3 c3 © - © o a o © o a CG o M fc- w 2 Lieutenant colonel ._ l 1 3 Major 1 1 4 Captain °i 1 2 4 * May be divided into re- 5 Lieutenant i 3 4 operatlng wards Total commissioned 6 3 2 5 10 b May be divided into surgical, medical, and con- Master sergeant, including 7 1 1 1 tagious wards, o Medical Cort Summary of sp ratings 8 Sergeant major- (052) (1) 0) 1 (1) 0) 3 (1) (1) 1 )S. ecialiste' 9 10 First sergeant (585) 11 Staff sergeant, including 1 1 12 Section leader (652)1 (1) (1) (2) 13 Supply (18S) 0) 3 (1) 9 (1) 3 14 Sergeant, including... 3 3 Class Number 15 'Forage inspector (085) 0) (1) 0) 16 Mess (124) 0) (•1) (1) (1) (6) 12 (1) 0) 17 Technician, medical (123) 2d 1 18 Wardmaster (793) (3) 4 (3) 7 3d .. 14 19 Corporal, including 1 1 4th 23 20 Assistant wardmaster (793) (3) (1) (7) (10) (2) 1,3) 5th 24 21 Clerk (055) (1) (1) 6th 37 22 23 Private, first class} indudiag 33 115 11 Total 99 24 Bugler (021) (1) (i) 25 Carpenter, general (050) 5th (2) (3) (3) (2) 26 Chauffeur (245).. 5th (3) (3) (1) The serial number sym- bol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to 27 Chauffeur (245) 6th 28 Clerk, general (055) 6th (i) 29 Clerk personnel (055) 5th (1) (1) (1) 30 Clerk, receiving & shipping (186) .. 5th (1) 31 3d (3) (3) (4) (1) (3) (3) (4) (1) (2) (1) 0) an occupational specialist whose qualification analy- sis is found in section I, Alt 32 Cook (060) 4th 33 Cook’s helper (521) 34 Forage inspector (085 4th (1) 35 Horseshocr (094) 3d (2) (4) (2) 500 refers to a military oc- cupational specialist listed Horseshoer (094) 4th (4) 37 Horseshocr, clinical (094). 3d (2) (1) 38 Mechanic, automobile (014) 3d (1) (1) (1) (1) 39 Motorcyclist (678) 6th (1) 40 Orderly (695) (1) (10) (9) (2) (1)' (60) (18) (3) (70) (27) (2) (1) (1) 41 Orderly, stable (697) 42 Orderly, ward (696) 43 Pharmacist, veterinary (150) 3d (1) 44 Saddle and harness maker (192) Stenographer (213) 4th 0) (1) 45 3d 46 Teamster (235 5th (1) (2) (l) 47 Teamster (235) 6th (2) (2) (2) 0) (2) (2) (1) (1)1 48 Technician, laboratory (051) 4-th (2) (2) 0) 49 Technician, laboratorv (051) 6th 50 Technician, medical (123) 4th (Ol) (o 2) 0) (1) 51 Technician, sanitary (196) 4th 52 Technician, sanitary (190) 6th (•2) (•1) 53 Technician, surgical (225) 3d 1 (1) 0) 54 Technician, surgical, veterinary 2d (1) (226). 55 Technician, surgical, veterinary (226). Technician, surgical, veterinary 3d (1) (1) (2) .... 56 4th (3) (1) (4) (226). 57 Technician, surgical, veterinary 5th (4) (2) (6) (226). 58 Technician, surgical, veterinary 6th (8) (4) (12) (226). 59 4th (2) (6) (10) 0) (8) (2) (4) (10) 0) 60 6th (4) 61 6th (4) (14) 0) 62 4th 63 Basic (521) 1 (15) (23) 253 64 Total enlisted.. 40 87 120 18 65 Aggregate 43 89 131 263 1 18 66 Q Car, light, 5-passenger sedan 1 67 Q Motorcycle, with side car.. 1 1 68 Q Mule, draft 12 12 69 2 2 70 Q Truck, 2K-ton, cargo 3 3 71 3 3 Plate 12. T/O 8-237, Nov. 1, 1940. Organization of the Veterinary Convalescent Hospital. 838 Section Surgeons. In order to secure centralized control and decentralized operation of supply and administration, the communications zone may be subdivided from front to rear into three parts: an advance section, an intermediate section, and a base section. The communications zone will not be organized in the same manner in each theatre of opera- tions. Its organization must be adapted to the plan of operation and be based on a careful study of the actual conditions in the theatre of operations. When the depth of the zone is considerable, there is normally an advance section. If the communications zone is very extensive, an intermediate section may be established between the base and advance sections. The extent of this subdivision is determined by the location of centers of commerce and population, the location and direction of the principal lines of com- munications, and the number of activities and total personnel that can be supervised by one staff. Section surgeons are assigned accordingly. The office of the surgeon of a section. The office of the surgeon of a base or other section is organized in a manner similar to that of the office of the surgeon of the com- munications zone, although on a smaller scale. The surgeon must so organize his office as to be free to circulate among the various and dispersed activities within the section as he exercises supervisory control over various Medical Department activities which are under the control of the commanding general of the section. The functions of the latter are principally those of an area commander; he exercises no authority over general supply establishments. Medical activities usually include station hospitals, general dispensaries, medical laboratories, veterinary establishments, and sanitation of the area. The Surgeon of an Embarkation-Debarkation Camp. The surgeon of an embarkation- debarkation camp bears the same relationship to the commanding officer of the camp as the surgeon to the commanding officer of a garrison. He has additional responsibilities imposed by the arrival and departure of troops and casuals. Embarkation and debarka- tion camps for large expeditionary forces will usually consist of one or more large concen- tration camps or centers conveniently located to base ports. The office of the surgeon of such a camp is organized as related below. The organization herein does not con- template that the surgeon be also surgeon of the port proper. If such is the case, addi- tional sections of the office are necessary. Administration section. This section coordinates the duties of the office and receives, records and distributes mail. Hospitalization section. This section has general supervision over the care and hos- pitalization of all sick and wounded passing through the camp, both to and from the zone of the interior. Hospitalization and care of sick and wounded may be extensive, especi- ally if large numbers of troops and casuals are moving. Receiving and forwarding section. This section receives the sick and wounded for return to the zone of the interior and inspects troops received from or returning to that zone. The section may be subdivided as follows: The receiving subsection arranges for the examination of troops or sick passing through the port and disposes of those found disabled. The latter are usually sent to the hospitals of the camp. The forwarding subsection arranges for the transportation of the disabled to the zone of the interior. The physical examination subsection conducts the physical examination of troops. By examining those received from the zone of the interior, diseases that may be a menace to the field forces may be detected. Homeward-bound troops are also examined to detect diseases that may be a menace to the homeland. Examining teams also conduct the medical supervision of bathing and delousing establishments through which all home- ward-bound troops, and on occasions those arriving from the zone of the interior, must pass. Teams are designated to meet every train filled with sick and wounded to be embarked, to examine all cases that give evidence of lack of condition for further travel, and to render any medical assistance in case of sudden sickness or injury among troops arriving or departing. The personnel of these teams is also assigned to accompany troop trains for the purpose of medical attendance. MILITARY MEDICAL MANUAL Liaison (with overseas transport) subsection keeps the office informed as to the arrival and departure of vessels pertaining to the expeditionary force. These may be operated by the navy, army transport service, or other agency. Sanitation section. The functions of the sanitation section consist, generally, of super- vising the sanitation of the camp and the execution of measures for the control of com- municable diseases. The nature and functions of these embarkation-debarkation camps are such that special attention must be devoted to the prevention of epidemics, particu- larly of respiratory diseases. Because of these conditions, the sanitation section is especi- ally concerned with the supervision of the physical inspections of troops and the sanitation of housing facilities. Supply section. The supply section supervises the medical supply activities of the camp. The Suregon, Army Group. Two or more armies may be organized into a group of armies under a designated commander. The surgeon of an army group is the advisor of the group commander upon medical matters relating to the group. He is a coordina- tor of medical activities between the armies and general headquarters. He forwards im- portant communications upon medical subjects from the surgeons of the armies to the chief surgeon of the forces, but beyond this does not conduct an office of transmittal. He maintains no office of record, beyond keeping a file of communications of immediate interest. The Surgeon, Army. The surgeon’s office, or headquarters, army medical service, is organized into sections concerned with the control of the activities of the medical service within the army. These sections are: administrative, hospitalization, supply, evacuation, sanitation, consultant, dental, and veterinary. (See Chapter IV.) The Surgeon, Corps. As the administrative functions of corps headquarters are limited, the surgeon’s office has only four sections, administrative, consultant, dental, and veterinary (See Chapter IV.) The Division Surgeon. From a tactical and administrative viewpoint, the infantry divi- sion is the basic organization of an army. It comprises in its organization the essential combat and administrative branches, all in correct proportion and so organized as to make it tactically and administratively a self-sustained unit. The division is the combat and tactical maneuvering unit of the combined arms. Its role in battle is the execution of tactical missions vital to the combat success of the corps. See Chapter III for the organization of the division surgeon’s office. THE MEDICAL SERVICE OF A FIELD FORCE 839 HOSPITALIZATION AND EVACUATION Definitions. Military hospitalization may be defined as the process of providing shelter, care and other environmental factors needed to restore the disabled to health and physical fitness. Evacuation of the sick and wounded may be defined as the withdrawal of casualties to a place where proper care and treatment may be given. Hospitalization and evacuation of the sick and wounded are co-related subjects. When either is discussed, the other must be considered. It may be said that military hospitaliza- tion is but a phase of evacuation. It may be said in turn that evacuation is a phase of hospitalization. The evacuation of advanced units is influenced by hospitalization facili- ties in the rear. As the distance from the front increases, the necessity for evacuation decreases and hospitalization becomes more fixed. Hospitalization, in a broad sense, refers particularly to fixed as distinguished from mobile hospitalization. It embodies not only shelter from the elements but all other appurtenances in the way of bedding, food, clothing, heat, light, nursing, treatment by surgical and medical specialists, X-ray and laboratory facilities, and opportunity for con- valescence and recreation. Hospital “beds” is a numerical term referring to hospital capacity. Hospital Allowances. Hospital allowances for a theatre of operations are expressed in terms of total “fixed beds” to be provided and not in terms of units. Only those beds established in fixed hospital units designed to give definite treatment are considered. 840 The total number of beds provided for a theatre of operations may not necessarily be located within the theatre. If the theatre of operations adjoins the zone of the interior, with only a shallow communications zone, the majority of fixed beds for the casualties of the theatre may lie within the zone of the interior. The farther the theatre of opera- tions is removed from the zone of the interior, the greater the proportion of beds that must be authorized for establishment within the communications zone. The number of beds to be thus established also depends on many other factors, among them being the nature and extent of combat, the shelter and other facilities within the theatre, the resist- ance of the enemy, and conditions which may influence health among troops. In deter- mining the policy of evacuation and the number of beds to be provided, these variables should be analyzed. It is important that the allowances be fixed in each specific war plan in order to assure an equal and balanced flow of units to the theatre of operations sufficient to meet hospitalization requirements at all times. Such allowances are generally fixed on a sliding scale, i.e., the percentage of beds increases as a war develops or becomes pro- longed. During the period of mobilization, before combat begins, beds are necessary for the sick only. When combat begins, additional beds must be available for the wounded. As many of the wounded require prolonged treatment, they accumulate in hospitals, making necessary a still larger proportion of beds. The percentage of beds required gradually increase in proportion to the severity and intensity of combat. Since many cases requiring long treatment eventually recover, the percentage of beds required gradu- ally becomes more constant. Average bed allowance. It should be realized that each condition cited represents a different situation. The number of treatment beds to be provided for a given theatre and the time they should be available will vary. The policy of evacuation must be decided; on this depends the proportion of treatment beds that are to be provided in the theatre of operations. The most constant factor will usually be the number of beds that must be provided for the casual sick, that is, 5 beds for every 100 men. Sic\ rates. Taking all factors into consideration and allowing a slight increase of the admittance rate (1.4 per M to 1.5 per M) to cover normal seasonal and other varia- tions above the average, treatment beds for sick alone under usual conditions may be estimated as follows: MILITARY MEDICAL MANUAL Daily admittance Average days Beds required rate per M in hospital per M 1.5 X 27.29 = 40.9 or 4.09 per cent Additional beds should be allowed for dispersion of patients, making this figure ap- proximately 5 per cent. Battle wounds require longer treatment than sick casualties. The average stay in hos- pital of the sick and wounded increase with the proportion of the latter. The average duration of treatment during the world war was 48.6 days. The average treatment beds required at the end of a year for a force of constant size under such conditions may be estimated as follows: 2.65 X 48.6 = 128.8 per M. or 12.88 per cent. Additional beds should be allowed for dispersion of patients, increasing this figure to 14 per cent. With such battle losses as occurred during the severe combat of the Meuse-Argonne offensive (September 26 to November 11, 1918), the daily admittance rate to treatment beds for both sick and wounded was increased to 3.2 per thousand of the total strength of the A.E.F. Under such conditions, the ultimate number of beds required may be estimated as follows: Daily rate - Average days Ultimate No. Kind of cases of admission per case in hospital Disease and non-battle injuries 1.65 X 27.29 — 45.03 Gas injuries .45 X 41.77 = 18.79 Gunshot injuries 1.10 X 94.84 = 104.32 Total per 1000 strength . .. 168.14 The rate of 168.14 per thousand will be the actual number of patients in hospital. If 10 per cent is added for the dispersion of patients the number of beds required would be 184.96 per thousand strength or 18.50 per cent of the total strength. Of all casualties inflicted by gunshot and gas, excluding the killed: 65 percent returned to duty in the theatre of operations within 90 days. (33 per cent recovered within 30 days; and 32 per cent recovered within the following 60 days). 6 per cent died in hospitals. 9 per cent were evacuated to the U. S. 20 per cent remained in hospitals in France after 90 days. Of all battle casualties, excluding the killed, 21 per cent were a permanent loss as a military asset. In smaller forces and over shorter periods of time, there will be a wider variation in the averages rates as given above. Buildings for Hospitalization (Hospital Program). Some of the units destined to estab- lish fixed hospitalization in the communications zone will usually be able to utilize ex- isting shelter in permanent buildings. Accommodations for the remaining units must be provided by new construction. It may be accepted as based on experience that authorized construction will not become available for occupancy before the lapse of six months following authorization. Therefore, new construction for hospitals must be inaugurated in advance of the arrival of the troops for which intended. The Medical Department, if it is to keep its hospitalization program abreast of the needs, must be given authority to provide in advance, by construction or otherwise, the hospitals necessary to cover this delay in construction and to meet expected requirements. The program must anticipate the expected demand and by timely action insure that it is met. The chief surgeon of the field force keeps in his office a balance sheet of the hospitalization program showing, in one column, the total bed requirements estimated, and, in the other column, the number of beds actually established, plus the number of beds in process of establishment in suitable buildings or to be provided by new construction. Hospitals in the Theatre of Operations. Medical units provided in the theatre of opera- tions for the hospitalization of armies in the theatre comprise mobile and fixed hospitals. Mobile hospitals. Mobile hospitals accompanying the armies in the combat zone are equipped with sufficient tentage for sheltering patients; but, as a rule, advantage is taken of any opportunity to occupy and utilize existing buildings. These units comprise clear- ing companies, surgical hospitals, evacuation hospitals, and convalescent hospitals. The beds provided by them are not included in the term “bed” or “hospitalization allow- ances” for a theatre of operations. Only in specific instances, where they are to be con- verted to use as fixed hospitals, are they so classed. Fixed hospitals. Fixed hospitals are the installations in the communications zone to which the sick and wounded are sent for definite treatment. They comprise general hospitals, station hospitals, hospital centers, and convalescent camps. Hospital Units of the Communications Zone. General hospital (T/O 8-550). (See Plate 13.) The personnel of the general hospital unit is divided into two general groups, the administrative services and the professional services. The professional services constitute about four-fifths of the personnel of a unit. The personnel, when properly organized and trained, can operate efficiently a hospital of 1000 beds. General hospitals of the communications zone are standard establishments with a normal capacity of 1000 patients, but they may be expanded in an emergency to care for more than that number. Two thousand should be the limit of expansion and then only temporarily in extreme emergency. These establishments are equipped to give definite medical and surgical treatment to all cases, but they do not necessarily do so. When once located, a general hospital usually remains in that place throughout the period of operations. Hospital center (T/O 8-540). (See Plate 14.) General hospitals are often grouped to form a hospital center. The unit consists of a headquarters and service company, a center laboratory, a convalescent camp, and the number of general hospital units assigned to the group. The center is commanded by a brigadier general, Medical Department. THE MEDICAL SERVICE OF A FIELD FORCE 841 1 2 3 4 I 1 ! 5 | 6 7 | 8 9 10 11 12 | 13 14 15 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1ft 10 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 Unit Administrative service Professional service j Total j Enlisted cadre Ren^rks Technician grade Headquarters Registrar, receiving and 1 patients’ detachment Detachment, medical department Medical supply s 1 1 Oeneral supply and j utility | Medical | Surgical Q . j Laboratory 1 1 • 1 1 6 14 19 13 3 56 1 105 3 (2) (1) 1 6 (2) (1) (1) (1) (1) 13 s (1) (1) (2) 22 (6) (7) (3) (3) (1) (2) 25 (10) (1) (2) (12) 15 83 97 112 143 0) 0) (1) 1 (1) (2) 3 <8 8! to (2) a (16* (17) 1 (1) (1) 1) 2 (1) (1) 1 3 '(ij to 5) 5) 5) 21) - hygienist (120).. mobile (014) mobile (014) )pedic (366) lc plant (077).— Y (ij (ij Y (3) (5) i7" (5) 12j 15 * 38 SI 85 84 (ij (4) (4) "(ij Line Column 1 17 Technician, nursing ('!-’>) T/0 8-650, April 1, 1942, is changed as follows: Line Column 4 4 ‘1 Plate 13. T/O 8-550, April 1, 1942, and Changes 1 and 2. Organization of the General Hospital, Communications Zone. THE MEDICAL SERVICE OF A FIELD FORCE 843 Each hospital center will require laundry, motor transport, bakery, and other quarter- master facilities and military police, finance, postal, and signal corps detachments. The amount of this additional personnel depends upon the size of the center. The total patient capacity of a center is dependent on the number of general hospitals assigned to it. A center with 3 general hospitals and 1 convalescent camp will have a normal capacity of 4000 beds. A center of 10 general hospitals will have a maximum capacity of 22,000 beds; this capacity includes crisis expansion. l 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Administrative service Professional service X3 §1 1 T3 § Unit .9x3 1! >% 1 Remarks 1 '3 £ Headquarters zy si it 2 ll St 1 Medical supp 8 s | General su util | Medical 5 | Dental | Laboratory = 5 P5 j Total | Enlisted cadr Private—Continued (1S) 75 76 (50) (50) (2) (2) 78 79 80 81 82 83 84 3 (1) U) (2) (2) (1) (2) (2) (2) (2) (2) (2) 4 (2) (3) (1) (3) (4) (2) (2) 87 (3) (3) (6) (6) 89 Technician, laboratory (411) 3 (3) (1) 90 Technician, laboratory (411) 4 (4) f4 91 Technician, laboratory (411) 5 (o) j® 92 (14) (14) (1) 94 95 90 97 5 (21) (21) m (491 (1) (1) (3) <2) (S) >») (9) U) (9) (9) U> US) US) us) I IS) 4 (3) (3) (1) 5 m (3) (1) f3) (3) 105 106 Technician, X-ray, dental (264).. 3 (31) U) (3l| 107 Total enlisted 230 270 500 30 108 Aggregate 251 411 662 30 8 8 2 4 4 4 113 114 1 3 3 Plate 13. T/O 8-550, April 1, 1942. Organization of the General Hospital, Communications Zone (Continued). Hospital centers are particularly advantageous in large field forces as they permit economy in Medical Department personnel, simplify supply and evacuation problems, and facilitate administration. Grouping permits specialization of hospital units and pro- vides better treatment for patients, as the latter may be distributed direcdy from hospital trains to those hospitals best fitted for the treatment of particular types of cases. Hospital centers are not advantageous unless three or more general hospitals are grouped therein. The administrative overhead required is considerable, and economy in personnel does not result if a smaller number of general hospitals are grouped. Con- siderable time is required for the necessary construction. Hospital centers usually require new construction as existing buildings are not often available or adaptable to such large institutions. Convalescent camps are located in the vicinity of and as a part of hospital centers. Their function is to relieve the general hospitals of the necessity for caring for patients who no longer need hospital treatment but who are not yet fit for duty and to restore to physical fitness such convalescents. The type camp has a capacity of 1000, although in actual practice it is equipped to accommodate 20 per cent of the total capacity of the center to which it belongs. Station hospitals (T/O 8-560). (See Plate 15.) The personnel of this hospital unit 844 MILITARY MEDICAL MANUAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 § Headquarters and service company « o* | Attached chaplain a e tuO „ 1 Unit Technician grade § S3 1 a s o* 03 w General head- quarters section J Personnel section Company head- quarters section Evacuation and receiving section Sanitation section Medical supply section Center laboratory Convalescent cam Total (exclusive o eral hospital) Enlisted cadre Remarks 2 3 4 1 1 0 1 1 » Normal patient capacity, 1,000. (41). 5 1 i 7 b Personnel jn this table is the basic requirement. The commanding gen- U 1 8 1 (41)2 i 6 6 7 (hl)!2 1 1 i 1 (4 2)4 10 eral of the center may call on the (42)4 4 general hospitals for personnel re- quired to supplement certain center facilities. These center facilities will 8 9 9 1 2 l 1 3 11 i 29 Warrant officer.. nr kl 1 — 1 — ■ — — — — V — decrease the personnel requirement in the general hospitals. Centralization of receiving, evacua- tion, medical supply, general supply, utilities, sanitation, transportation, laboratory, and guard will reduce the 10 Nurse a 1 11 12 13 14 15 16 17 18 10 20 — ~—r — — — — — r 2~ T (i) (i) (2) (i) requirements of personnel for similar 1 4 5 i duties in the general hospitals as- i i 1 1 1 1 1 7 signed to the center. (i) (1) The total patient capacity of the (i) (1) (1) (3) center is dependent on the number of (1) (1) general hospitals and convalescent (1) (1) camps assigned to the center. (1) (1) Each hospital center will require i 2 2 3 3 1 1 13 2 laundry, motor, transport, baking, 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 (D (1) and other quartermaster personnel, (2) (2) (1) (1) (1) 1 (3) (1) (1) (10) (1) also military police, finance, postal, (1) (1) and Signal Corps detachments. The (1) amount of this additional personnel 2 3 2 depends upon the size of the center (1) (1) (1) and whether the centers are to be (1) (1) (2) (1) located in the zone of the interior or 8 8 the communications zone. (8) (8) . Executive officer. Technician, grade 31 Technician, grade 4 26 23. 12 22 11 7 10 14 92 ' 1 50 56 8 8 4 Dental. «Includes— 1 medical inspector. Private, first class Private ) 4 (7) (8) (11) 49 61 (7) 1 medical service, coordinator. 1 surgical service, coordinator. 1 dental service, coordinator. 5 (8) 1 laboratory service, coordina- (ID tor. (3) (3) t Center receiving and evacuation 5 (1) (1) officer. Cha*plain’s assistant (534) 5 (1) (1) * Biochemist, Medical, or Sanitary 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 68 69 60 61 62 63 64 65 66 67 68 09 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 (2) D (1) (3) (1) (4) (1) (22) (3) (5) (7) (15) (1) (3) (12) (12) (13) (1) (1) (ID (1) (2) (3) (2) (3) (2) (3) (1) (2) (2) (2) (3) (3) (8) D (2) (1) (!) (D (6) (3) (23) Corps. *> Adjutant. 1 May be Medical Administrative Corps. i Band leader. k Chief clerk. 1 Principal chief nurse of center. m Veterinary. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A num- ber below 500 refers to an occupa- tional specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Cir- culars Nos. 14 and 67, War Depart- ment, 1942. 5 (4) (1) (1) (1) (2) (5) (1) (2) (1) (7) 4 5 (1) 1) (2) (5) (1) (1) 1) 2) 3) s 4 4 5 4 5 (1) (1) u) (3) (2) (1) (2) (4) Cook (060) (3) (3) (3) (9) (9) (10) Cook (060) 4 5 (“ 1) (1) (3) ' (4) (1) 3) 1) 2) 3) 1) 1) 2) 3) 4 5 5 4 5 4 5 3 4 5 (!) (1) ":(ij "(ij (D (2) (D (2) 2) (2) 4 5 3) 3) 8) (i) 5 (1) (2) Technician, surgical (225) 4 5 1) 1) 1) 1) (i) Technician, surgical (225) Typist (247) ~ 5 (2) (2) 8! (1) (1) (i) Basic (521) (3) (3) (2) (15) Total enlisted. 28 27 15 27. 15 7 12 15 109 255 22 39 28 "16 28 17 8 14 18 120 1 289 22 5 5 9 4 6 3 4 2 2 1 1 1 1 2 1 4 1 1 1 Plate 14. T/O 8-540, April 1, 1942, and Change 1. Organization of the Hospital Center. Column 7 0 15 6 «1 • 1 ' Delete. 1 Medical Administrative Corps. T/O 8-540, April 1, 1042, is changed as follows: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 84 35 36 37 88 80 40 41 42 43 44 45 46 47 48 40 60 1 | 2 3 4 6 6 | 7 8 0 10 11 12 13 14 15 18 17 18 19 20 | 21 j £2 | 23 Unit Technician grade 'O £2 £ s £2 uS l> T3 £2 o o V £ O -o jj T3 £ © £2 8 'O £ 8 £ g T3 O £p T3 £5 TJ -C O o £> © TJ a* £> co £ o o © Enlisted cadre I 25- to 75-bed, inclusive i00- to 200-bed, inclusive 250- to 4 50-bed, inclusive 1 500-to 900-bed, ! | inclusive i 3 (4 1)5 (4 l)bc 10 (dl) belli * 3 1 3 (4 1)»6 (4 1) be pi (d2)bce]2 « 3 1 3 (d 1)0 6 (d 1)be 11 (d2)be!14 * 3 i (4 1)4 (4 1)» 6 (4 l)bo12 (dl)belH « 3 i (4 1)4 (4 l)8b 8 (d i)bo12 (d 2)0' 14 e 4 1 (4 1)4 (d 1)ob g (d 1)bee 14 (d 2)1 14 * 4 1 2 (4 1)»8 (41)beg « 2 1 2 (4 1)»8 (4i) big « 3 1 2 (dl)bcjo (4 1) ■ 9 * 3 l (4 1)4 (41)bo n •8 « 3 i (4 1)4 (dl)be 1) ' 10 e 3 1 (dl)2 1 • 1 i (41)3 “ 3 1 (41)3 “ 3 « 1 1 (41)4 “4 e 1 I (41) **6 »5 « 1 1 (41)*7 *6 « 2 Second lieutenant T ota) comm issioned - Warrant officcer .... 5 7 8 10 13 16 21 23 25 27 29 33 35 40 43 46 b 1 b 1 h 1 h 1 b 1 b 1 >■ 1 h 1 b l = Nurse 4 () 8 10 15 20 30 3o 40 45 50 55 62 70 75 80 90 Master sergeant, including 1 1 i 1 1 2 (1) 2 (1) 2 (1) 3 (1) (1) 0) 1 4 0) (1) 3 (1) 0) (1) 1 4 (1) (1) 3 (1) (1) (1) 1 5 (2) U) 3 (1) U) (1) 1 5 (2) 0) 1 2 0) (1) 1 1 (1) (1) 1 2 (1) a) i 3 (1) (1) 1 4 (1) (1) (1) 1 4 (1) (1) (1) 1 4 (1) 1 4 (1) 1 4 (1) 1 3 CD (1) 1 2 1 1 (1) 1 1 (1) .... (1) 1 1 (1) Technical sergeant, in- cluding Clerk, chief (052) .... 1 (1) 1 (1) 1 (1) Mess (824).... 0) U) (1) (1) 6 (1) (2) U) (1) 0) (1) (1) 5 0) (2) (1) 0) (1) 0) (1) 7 (2) (2) (2) - (1) (1) (1) 4 (1) (1) (1) (1) (1) 4 0) (1) (1) (1) (1) 5 (1) (2) (1) (1) (1) 7 (2) (2) (2) 0) (1) 8 (2) (3) (2) (1) (1) 8 (2) (3) (2) (1) (1) 8 (2) (3) (2) (1) 0 l) 3 (1) 0) 3 0) (1) (1) StafT sergeant, including.. .... 1 1 1 2 2 4 5 0> (1) (1) 1 1 Medical (673) 0) (1) (1) (1) 0) 0) (1) (1) Mess (824). (1) (Vi) (1) Mess and supply (824).. (1) (1) Supply (821) 0) (1) 1 (1) (1) 1 (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) .... 1 2 3 3 1 3 4 4 7 7 0) ((3) 8 (2) (3) 9 (2) (4) 9 (2) (4) 9 (2) (4) 3 1 4 Medical (673) (1) (1) (1) (1) (1) (1) (2) (2) (3) (1) (1) (1) (1) ft (5) (1) 0) (2) (1) (1) (1) 15 (2) (5) (1) U) 0) 16 (2) (6) (1) (1) (1) 18 (3) (0) (1) (1) 0) 18 (3) (6) (1) 0) 0) 20 (3) (7) on 0 1) 1 (1) (1) (1) (1) (1) 6 (1) (2) (1) 0) 6 (1) (3) (1) (1) 8 0) (3) (1) (1) (1) 12 (1) (4) (1) (1) (1) 13 (1) (5) (1) 0) 0) 14 0) (5) (1) (1) 4 (1) (2) 4 (1) (1) 9 (1) (3) 0) (1) 12 0) (4) (1) (1) (1) (4) 4 19 33 30 42 12 (1) (4) (1) (1) (1) (4) 5 22 40 35 51 1 (l) 2 (1) 1 (1) Medical (673) Motor (813) (1) .... O) (1) 0) (5) 6 25 46 40 58 0) (? 28 51 43 65 0) (6) 9 34 65 49 74 (1) 0) 0) 0) (6) 9 38 60 55 81 (1) 0) (1) 0) (7) 12 44 71 67 98 (1) (1) (1) 0) (7) 14 50 83 74 111 (1) (1) (1) (1) (8) 15 52 86 79 117 U) (1) (1) (1) (8) 15 67 88 85 126 (1) (1) (2) (1) (9) 18 63 97 95 140 (1) (2) (1) Ward (793) (1) (2) 1 5 11 9 14 (2) 1 9 11 11 17 (3) 2 13 19 19 29 (3) 3 16 25 26 38 Technician, grade 31 Technician, grade 4 in- Tcchnician, grade 5>clud- Privatc, first class ing (--- ::: 4 5 3 7 4 6 3 10 9 12 1 4 4 5 5 8 1 7 8 Baker (017) Baker (017) (1) (1) (1) (1) (1) (1) (1) (1) (1) 0) 0) 0) (1) (1) (1) Baker (017) 61 (1) (1) (1) (D (1) 0) (1) (1) 0) 0) (2) (2) (2) (2) (2) (2) 62 5 (1) (1) (1) 0) (1) (1) (1) O) 53 (1) (1) (1) 0) 0) 0) O) (1) 64 Carpenter, general (050). Carpenter, general (050). Chaplain's assistant (534). 5 0) 0) (2) 0) (1) 65 (1) 0) (1) (1) (1) (1) (6) (1) (2) (2) (1) (1) (1) (6) (2) (1) 0) (1) (7) (1) (2) (2) (1) (D (1) (7) (1) (2) (2) (1) (1) (2) (2) (1) 0) (2) (2) (1) (2) (2) (2) 66 (2) (1) (2) 0) (2) 0) (2) 67 (1) (1) (1) (1) (1) (D (1) 68 5 (1) 0) (1) 0) 0) 0) 69 (3) (3) (3) «) (5) (1) (1) (5) (1) (1) (7) (?) (2) (10) (2) (2) (10) (2) (10) (131 (13) (13) 60 4 (1) (2) (2) (2) (3) (3) 61 Clerk, general (055) 6 (1) (1) (1) (3) (3) (3) (3) (4) (1) (2) (lj 62 ID (1) (1) (2) (1) (2) (1) (4) (1) (4) 01 (3) 01 (3) 01 (4) 01 (5) (5) (5) (7) 63 Clerk, mail (056) 5 01 01 0) (1) 64 Clerk, mail (056) (D (1) (!) (!) (2) (2) (2) 65 m (1) (1) (1) 0) (2) (1) (3) (1) 0) m 0) (l) (1) (6) (6) (ID (12) (1) (2) 66 6 (1) (i) (1) s') (2) (4) (4) (4) (4) (5) (5) (6) (6) 67 (1) (1) (i) (1) (3) (7) (4) (5) (6) (6) (6) (7) 68 Cook (060). 4 (1) (D 0) (1) (2) (3) (4) (6) (8) (9) (9V (10) (ID (12) (13) 0) 0) 0) (2) (2) (3) (3) 69 Cook (000) 5 (1) 0) (2) (2) (3) (4) (5) (7) (8) (9) (9) (10) (10) (11) (12) (13) 0) 70 (2) (3) (3) (4) (4) (6) (7) (9) (10) (12) (13) (14) (15) (16) (16) (18) (18) 71 Meat and dairy hy- gienist (120). 4 0) 0) (1) 0) (1) 0) 0) 72 Mechanic, automobile (014). Mechanic, automobile (014). 4 (1) (1) (1) 0) 0) 0) (1) 0) (D 0) 0) 73 5 0) (1) (1) (1) (1) (1) 74 Mechanic, orthopedic (366). 4 0) (1) 0) 0) 0) 0) 76 (2) (2) (3) (3) (4) (4) (5) (5) (6) (6) (7) (7) (8) (8) (9) (9) (10) 76 (1) (1) (1) (2) (3) (4) (6) (7) (9) (ID (13) (16) (16) (16) (2) (1) (2) (2) (1) (3) (3) (1) (2) (19) (23) 77 (1) (1) (1) (1) (1) (1) 0) (1) (1) (2) (1) (2) (2) 78 4 (1) (1) (1) (1) (1) (1) (1) 0) (1) (1) (1) (1) (2) 0) 79 5 (1) (1) (1) (1) (1) CD 0) 0) (1) (1) (D (1) (D (2) (2) (2) (2) (2) (2) (2) (2) 4) (4) (“ 1) 0) (1) 60 Repairman, utility (121). (1) (1) 0) (1) (2) 81 6 (1) (1) (1) (1) (1) (1) 0) (1) (1) (1) (1) (2) (3) 82 4 (1) 0) (1) 0) 0) (1) (2) (2) (3) 0) 83 5 (1) CD (1) (1) (1) (2) (2) (2) (2) (2) (3) (1) (2) (3) (1) 64 Technician, dental (067). 3 0) (1) (1) (1) (1) (1) (1) (3) (2) (3) 66 4 (1) (1) (1) (1) (1) (1) (1) (2) (2) (2) 68 Technician, dental (067) Technician, dental (067). Technician, laboratory (858). 5 (1) (1) (1) (1) (1) (1) (1) 0) (2) (2) (3) (3) (3) (2) (2) (2) (3) 87 (1) (1) (2) (1) 0) (1) (1) (1) (l) (2) (2) 0) (2) (2) (2) (2) 68 3 0) (1) 0) 0) (1) . CD 89 Technician, laboratory (858). Technician, laboratory (858). 4 (1) (1) (1) (1) (2) (1) (2) 0) (2) (1) (2) (2) (3) (2) (3) (2) (4) (3) (3) (3) (3) (3) (3) 0) 0) (1) 90 5 (1) (1) (1) 91 Technician, laboratory (858). Technician, medical (123). (1) (3) (1) (4) (1) (4) (1) (5) 0) (5) (2) (6) (3) (7) (3) (9) (3) (11) (2) (12) (2) (13) (2) (14) 92 4 (1) (2) (5) 93 Technician, medical 6 (1) (1) (2) (2) (4) (6) (7) (7) (8) (101 (10) (13) (17) (18) (19) (22) 0) 0) (1) 0) (123). 94 (3) (3) (4) (7) (ID (13) (17) (19) (19) (25) (25) (34) (41) (45) (52) (56) (123). 96 Technician, sanitary (196). 5 (1) (1) 0) 0) 0) 0) 0) (1) (1) 0) 0) 90 Technician, sanitary (196). Technician, surgical (225). (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) 0) (1) (2) (12) (2) (12) (2) (12) (2) (14) 97 3 (1) (1) (2) (3) (4) (5) (5) (0) (7) (7) (10) 98 Technician, surgical 4 (1) (1) (1) (2) (3) (4) (4) (5) (6) (8) (8) (8) (10) (12) (12) (13) 05) 0) 0) (225). 99 Technician, surgical 5 (1) (1) (2) (3) (5) (7) (8) (10) (ID (13) (14) (16) (20) (23) (24) (25) (26) (1) (2) 0) (1) (225). Plate 15. T/O 8-560, July 22, 1942, and Changes 1 and 2. Organization of the Station Hospital, Communications Zone. WAR DEPARTMENT, Washington, September 5, 1942. 100 (2) (2) (3) (5) (8) (8) (10) (11) (13) (15) (16) (20) (24) (25) (25) (33) (225). 101 Technician, X-ray (264). 4 (D (1) (1) (1) (1) (1) (1) (1) (1) (1) (11 (1) (2) (2) (2) (2) (2) (IV (1) (1) 102 5 (1) (1) (2) (2) (2) (2) (2) (3) (3) (3) (3) (1) 103 (1) (1) (1) (1) (1) (1) (1) (2) (2) (2) (2) (2) (1) 104 Basic (521) 0) (4) (5) (6) 00) (12) (13) (16) (19) (22) (25) (27) (32) (37) (39) (41) (45) 105 Total enlisted 25 41 42 62 07 125 150 175 200 223 251 275 328 371 392 415 459 8 16 25 28 106 Aggregate. 34 54 65 82 125 161 201 233 266 206 331 364 420 480 508 539 596 8 16 25 28 107 2 2 2 2 3 3 3 3 4 4 4 5 5 5 6 6 6 ioa ~1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 . sedan. 109 1 1 1 1 1 1 1 1 2 2 2 110 1 1 1 1 1 1 carrier. 111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 112 1 1 1 2 2 2 2 2 2 2 2 2 2 2 113 Q Truck! 2H-ton, dump. 1 1 1 1 1 1 Size of hospital Head dietitian Dietitian Head phys- ical therapy aide Physical therapy aide Seamstress 600- to 700-bed inclusive. 1 2 1 2 1 760- to 900-bed inclusive 1 2 1 2 2 : Red Cross personnel j Red Cross aides may be assigned to hospitals prior to movements to a theater, in accordance with assign- ment schedule agreed upon by the War Department and the American Red Cross. Distribution of personnel indicated hereon is advisory. Variation therefrom will be left to the discretion lof the commanding officer of the hospital. Normally hospitals are divided into administrative and profes- sional services. Professional services are usually further subdivided into medical, surgical, dental, labora- tory, and X-ray services. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number below 600 refers to an occupational specialist whose qualification analysis is found in AR 015-26. A number above 500 refers to a military occupational specialist listed in Cir. No. 14, War Department, 1942. Plate 15. T/O 8-560, July 22, 1942, and Change 1 and 2. Organization of the Station Hospital, Communications Zone. (Continued). T/O 8-560, July 22, 1942, is changed as follows: Line Column 5 105 49 Changes No. 1 COLUMN 24-REMARKS flnsert number of hospital. « 1 Medical Administrative Corps. * 1 Corps of Chaplains. * 2 Medical Administrative Corps. a Dental Corps. « 1 Sanitary Corps. <•3 Medical Administrative Corps. * Medical Administrative Corps. <>• Administrative (clerical, medical), assistant registrar. Must be qualified in sick and wounded report procedure. i In a 450-bed hospital, chief clerk (052) for cadre should be master sergeant instead of technical sergeapt. i in a 250-bed hospital, medical supply sergeant (825) for cadre should be staff sergeant instead of technical sergeant. kina 75-bed hospital, mess sergeant (824) may be used instead of mess and supply sergeant (824) to form cadre. > In la 200-bed hospital, supply sergeant (821) and medical supply sergeant (825) for cadre should be staff sergeahts instead of sergeants. “ In a 75-bed hospital, pharmacist (149) lor cadre should be technician grade 4, instead of grade 5. Civilian personnel In addition to military personnel listed hereon, services of the following civilians are required in the Iarger.station hospitals. WAR DEPARTMENT, Washington, September 18, 1942. COLUMN 24—REMARKS Civilian personnel In addition to military personnel listed hereon, services of the following civilians may be required in the larger station hospitals: (Table follows, unchanged) T/0 8-560, July 22, 1942, is changed as follows: Changes No. 2 is divided into two services, administrative and professional. Station hospitals for the theatre of operations are establishments of the communications zone, having a normal capacity of 150 beds. They render general medical and surgical treatment for those areas where there are sufficient military populations to justify their maintenance but not sufficient to justify general hospitals. Geographical Distribution of Fixed Hospitalization (Beds). The railway net in a theatre of operations is an important factor to consider both as to the organization of the theatre and the conduct of military operations. It is particularly true regarding the medical service. The arrangement of the transportation lines controls not only the loca- tion of the evacuation hospitals in the combat zone but also the location of the general hospitals of the communications zone. The latter are located with relation to the main lines of railway traffic. Keeping in close touch with existing and prospective military operations, particularly with reference to sectors where the maximum effort is to be made, the chief surgeon of the field force should recommend the distribution of general hospitals along railway lines radiating from regulating stations. In all contemplated military operations tentative locations for regulating stations should be selected as far in advance as possible. These are essential data, and only when the surgeon has them at hand can he recommend intelligendy and develop an adequate hospitalization program. General hospitals must also be located with regard to their safety, that is, removed from the com- bat area a sufficient distance so that a military reverse may not disturb their functioning. The important things to bear in mind as to location of fixed hospitals are: The principles governing the geographical distribution of hospitals. That the hospitalization project must meet the conditions pertinent to the particular theatre of operations considered. Temporary needs. Occasional provision must also be made for immediate local re- quirements in the case of troops being sent into territory where no established hospitali- zation exists. The chief surgeon must be informed of any contemplated movements of this nature in order that steps may be taken in advance to provide proper hospitalization for such detached forces. If the new area to be taken over is to be permanently occupied, fixed hospitals must be provided; if for temporary occupancy, mobile organizations, such as evacuation hospitals, may accompany the troops and provide for their temporary needs. Tactical coordination. The chief surgeon of a field force, having in mind a compre- hensive estimate of the problem with which he is confronted, cannot act independently in making recommendations for the location of hospitals. This feature has a strategic application. The chief surgeon must be admitted to the council of the high command and kept familiar with the details of contemplated operations. Only by knowing these details in advance can he be expected to establish adequate, fixed hospitalization. General Principles of Evacuation. Our present system or method of evacuation is an evolution of that employed in the World War and experiences to date during the present war. There are certain general principles which control efficient evacuation. Be- ginning with the moment that a man is wounded at the front, there must be a con- tinuity in his handling and treatment until he is again fit for release from the control of the Medical Department. Commencing at the front, there is a constant sorting of casualties with a view of determining which are to be evacuated and how. All cases who can perform duty and are not a menace to the health of the command are returned to their organization as promptly as possible. No cases are sent farther to the rear than the military situation and their own condition demand. Cases which can be treated successfully within a command are not evacuated unless it is necessary to relieve the command of their care in order to free it for movement or to make room for new cases. Serious cases are transported the shortest possible distance consistent with the military situation and their proper treatment. Cases requiring prolonged treatment are sent to the communications zone and from there to the zone of the interior. The medical per- sonnel attached to each unit collects and gives immediate care to casualties within its own area. Evacuation from each area is made by units in rear thereof. During periods of activity, casualties are evacuated rapidly through forward clearing stations and hos- pitals to the communications zone; in periods of inactivity, the evacuations are less numer- ous and less rapid. Plans and orders for evacuation are made in conformity with combat THE MEDICAL SERVICE OF A FIELD FORCE 849 850 MILITARY MEDICAL MANUAL plans and orders. The proper execution of evacuation requires that the medical service be familiar with the combat plan in ample time for it to make proper arrangements. Bed Requirements for Combat. It has been intimated before that evacuation presumes established beds to which the wounded may be evacuated. Arrangements for evacuation for any given combat operation must, therefore, include provisions for hospitalization. In estimating the number of fixed beds to be made available to meet the requirements of a single severe engagement, the losses of the 1st Division in the Aisne-Marne operations, July 18-23, 1918, may be taken as a basis. The rates given below are daily rates for a severe engagement, not average rates. Infantry regiment 12-15 per cent Infantry division 6-8 per cent Infantry corps 3 per cent These rates include the killed: (16 per cent to 20 per cent of all casualties). The ratio of killed to the wounded by gas and gunshot missiles is 1:6. The ratio of killed to the wounded alone is 1:4. In making an estimate as to the number of beds to be made available to meet the needs of one field army, the number of front line divisions engaged may be taken as a basis. This will usually be a more accurate method of estimating than by using a casualty rate for the corps or for the army in entirety. All divisions will not be engaged in severe combat, hence an average casualty rate of 6 per cent is a liberal estimate. The great majority of corps and army troops are not subjected to hostile fire as are the divisional troops; neither are all corps likely to be engaged equally. Thus one army of 9 divisions may have 7 front line divisions engaged: Troops engaged, 154,000 X .06 = 9240 casualties, of which 16 per cent (1478) are killed. 9240 minus 1478 equals 7762 wounded and gassed. While some of these casualties will not reach fixed hospitalization, some sick from the entire army will do so. These factors should partially equalize themselves. There will also be some batde casualties among corps and army troops. On this basis, it may be estimated that 8000 fixed beds should be available for an army with 7 divisions in the front line for each day of severe fighting. Available beds to meet evacuation requirements for expected engagements will vary from these figures (or more) to those required to meet the average rates given in paragraph, “Hospital Allowances.” Policy of Evacuation. The general policies regarding evacuation and hospitalization within the theatre of operations are formulated by general headquarters. The methods of carrying out these policies is described later. Classification. Evacuation includes two classifications, primary and secondary. Primary evacuation includes evacuation within the theatre of operations, while secondary evacua- tion includes that from the theatre of operations to the zone of the interior. The policy of evacuation, announced by general headquarters, determines what classes of casualties arc to be treated in the theatre of operations and what classes are to be sent to the zone of the interior. What the policy may be has a great influence on the medical activities of the communications zone and affects particularly the hospitalization project of this zone. The few who do finally return to duty will do so after prolonged treatment and probably will be fit only for special service. Therefore, the total number of patients, less the percentages adjudged to be permanently incapacitated, should be the maximum treated in the theatre of operations. Primary evacuation within the theatre of operations is of two types: evacuation to army (combat zone) hospitals and evacuation to communications zone hospitals. It is with the latter that the discussion of evacuation will deal. Evacuation within the com- munications zone is often necessary. Although this is in the nature of a secondary evacua- tion, the term “secondary evacuation” refers to the transfer of casualties to the zone of the interior. Means of Evacuation (FM 8-35). The means of transporting sick and wounded from evacuation hospitals in the combat zone to a hospital in the communications zone THE MEDICAL SERVICE OF A FIELD FORCE 851 consist of hospital trains, trains for patients, hospital ships, hospital boats, and, occa- sionally, motor convoys and airplane ambulances. The usual method of transporting patients from the evacuation hospitals in the combat zone to general hospitals in the communications zone is by means of hospital trains. Hospital trains. (T/O 8-520). Hospital trains are Medical Department organizations, the type train having a capacity of 360 patients. Their distribution and use is controlled by the Medical Department. As regards personnel, supply, and maintenance of their medical equipment, they are administered under the direction of the chief surgeon of the field force except those assigned for evacuation within the communications zone. As railway units, they are operated and maintained mechanically under the direction of the Corps of Engineers. The number of hospital trains required depends on the type and severity of combat and the location of the theatre of operations and the conditions existing within it. Hospital trains are of two types, the standard and the improvised. 1 2 3 4 5 1 Unit Tech- nician grade Hos- pital train En- listed cadre Remarks 2 Major 1 a In charge of dressing room, ward car. The serial number symbol shown in parentheses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Department, 1942. 3 1 4 2 5 4 6 6 7 First sergeant (585) _ 1 1 8 Staff sergeant, including 1 1 9 Mess and supply (824) (1) 1 (1) 10 Corporal, including ... 11 Technician, surgical * (225).. (1) 1 12 Technician, grade 31 Technician, grade 4 Technician, grade 5[-including 13 14 6 8 2 2 15 Private, first class.. 1 6 16 9 17 5 (1) (1) (2) (2) (2) (1) (2) (3) (7) (1) (1) (2) (2) (3) (1) IS 19 Cook (060). . .I 4 (!) (1) 20 Cook (060) .. 5 21 22 4 (1) 23 Technician, medical (123) Technician, medical (123) 4 24 5 25 26 Technician, surgical (225) Technician, surgical (225) Technician, surgical (225) 3 27 4 28 6 29 30 Basic (521)J_....". 31 Total enlisted 33 6 32 Aggregate. 43 6 Plate 16. T/O 8-520, April 1, 1942. Organization of the Hospital Train. The standard hospital train as used in the World War consisted of 16 cars, of which 10 were ward cars exclusively devoted to carrying the sick and wounded and the remain- ing 6 were given over to administration, messes, pharmacy, operating room, train per- sonnel, and stores. The train had a capacity of 360 patients recumbent and 720 sitting. In the ward cars, the beds, 36 in number, especially designed, were removable and in case of necessity could be used as litters and could be folded against the side of the coach or lowered to the floor. In the double tier arrangement, the lower tier may be used as a settee while the top tier is still being used for recumbent cases. By this arrangement the less seriously wounded are made comfortable and can either sit or lie down. A so-called “sitting case” cannot remain so for a prolonged period; it is therefore necessary during a long journey to provide beds for sitting patients. As far as personnel, material, supply, and other conveniences are concerned, trains of this type are virtually rolling MILITARY MEDICAL MANUAL 49 50 51 52 53 54 55 66 67 58 59 60 61 62 i 2 3 4 5 6 7 8 9 10 11 12 13 14 Unit Technician grade Administra- tive Professional | Total Company Personnel required for each 100 1 increase in patient capacity | Enlisted cadre Remarks | Company headquarters 1 Registrar, receiving and evacuation section | Medical supply section | Medical service | Laboratory service | Surgical service | Roentgenological service | Dental service Private—Continued . Technician, dental, laboratory 5 4 5 4 6 3 4 5 5 U) 0) 1 (4) | (5) (1) (6) (1) (3) (4) 1 (4) (5) (1) (12) Technician, laboratory (411) Technician, laboratory (411) Technician, medical (123) Technician, medical (123) Technician, medical (123) Technician, surgical (225) Technician, surgical (225) Technician, surgical (225) Technician, surgical (225) Technician, X-ray (264) Basic (521)-. (3) (2) (i) 2 .... 1 2 (1) (i) (i) Total enlisted 35 7 4 53 99 11 17 Aggregate 38 9 4 96 147 17 17 Plate 17. T/O 8-537, April 1, 1942. Organization of the Medical Hospital Ship Company. 1 1 2 3 4 5 6 7 9 10 11 12 13 14 Unit | Technician grade Administra- tive Professional | Total company 1 Personnel required for each 100 increase in patient capacity | Enlisted cadre Remarks | Company headquarters 1 Registrar, receiving and evacuation section | Medical supply section Medical service 8 1 8 •$ >. ! j ~ ! i—• i | Roentgenological service | Dental service *1 1 1 2 1 ... 1 1 <*1 5 1 bo i (1) 1 .. <*1 3 1 6 b 1 1 ministrative 2 1 2 2 1 2 17 2 « Also medical 8 Warrant officer 1 1 supply officer. 9 Nurse ®1 === == 34 35 —T <* Dental. • Chief nurse. === 1 = 1 ~r Clerk, chief (052) a) (1) (it 1 1 i 1 2 3 3 a) (1) (1) the specialist 1) (1) (1) i (11 (11 number below 1 1 i 3 3 500 refers to an a) ni ni occupational spe- 19 Supply (825) (1) *?i) (i) ni a) (ii cialist whose qualification 1 2 3 2 analysis is found (i) (1) (1) in A'R 615-26. A 23 1) (1) i) O) (11 500 refers to a 1 1 1 military occupa- (i) (1) (1) tional specialist 27 Technician, grade 31 (2 1 listed in Circu- 28 Technician, grade 4 16 3 lars Nos. 14 and 31 5 3 48 <23 2 30 Private, first class 17 ment, 1942.J 129 (1) (i) a) a) a) (i) (i) a a) (D a) a) (7) (7) 1 m 5 (7) (71 1 to (10) (10) 2 (i) (1) 42 Nurse, malej operating room 4 (1) (1) 43 Nurse, male, operating room 5 1) (1) a) 2) (31 1) (1) (i) (1) m (1) 48 Technician, dental, laboratory (067) 4 w (1) — (i) THE MEDICAL SERVICE OF A FIELD FORCE 853 hospitals. They must be vestibuled to permit the serving of hot meals and the giving of surgical attention enroute. Another type of hospital train employed is one made up of the desired number of ordinary Pullman or tourist sleeping cars, and engine and baggage car to which is added a so-called “unit car.” The unit car may be an altered baggage, coach, or dining car; it contains the kitchen, pharmacy, operating room, a few beds for special cases, and other facilities needed by patients en route. While such trains lack the refinements found 1 2 3 4 6 6 7 8 0 10 11 12 13 44 15 18 17 18 19 20 >21 22 23 21 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 48 47 1 2 3 4 5 6 7 8 9 10 Unit Technician grade From zone of interi- or to oversea thea- ters and bases » From oversea theaters and bases to zone of interior (Transport- ing sick and wounded)b Remarks Patient capacity of ship 25 50 75 100 250 500 «1 » No other medical personnel required be- cause all types of med- ical service can bo efficiently provided by the attached and or- ganic medical units of the troops being transported; these units will operate under the direction of the ship surgeon. •> Additional person- nel required, pe’ pa- tient capacity. «Ship surgeon. 4 Dental Corps. • Medical Adminis- trative Corps. * Permanent comple- ment of the ship. The serial number symbol shown in pa- rentheses is an in- separable part of the specialist designation. A number below 500 refers to an occupa- tional specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military oc- cupational specialist listed in Circular No. 14, War Department, 1942. (41)2 2 (dl)2 «1 3 (■*1)3 • 1 First lieutenant 1 1 2 Second lieutenant 1 1 1 2 3 5 7 2 3 4 5 10 20 1 1 1 Stall sergeant, including.. 1 2 Si 2 .81 (1) (1) 1 (1) 1 1 1 1 2 (2) 2 (2) Medical (673).. (1) (1) (1) (1) 6 6 1 (1) f --- Technician, grade 3] Technician, grade 41 Technician, grade 5 .. Private, first class Private ) 1 8 13 14 20 (1) (1) (1) (1) 1 fl) ' (3) (4) (8) (1) (2) (1) l! 2 5 2 4 2 7 4 7 (1) 4 12 8 12 U) (1) 1 1 1 3 2 3 U) 4 (1) 85 s (1) (2) Clerk, typist (405) Cook (060). 0) (2) (1) 0) (2) (2) Cook (060) U) (1) (1) (2) (1) (1) 4 5 5 4 5 (1) Technician, laboratory (409).. (1) (1) (1) (1) (1) (1) (1) (1) (3) (4) (1) (2) (2) (7) (1) (2) (3) (8) (1) (2) (2) (2) Technician, medical (123) (1) (1) 3 4 5 (2) (1) (D 1) (2) (1) ffi Technician, surgical (225) .... as (1) (1) 4 (1) 12 Basic (521) J a) (2) (3) (4) (6) 4 9 14 22 40 60 f 13 7 13 20 30 55 88 Plate 17A. T/O 8-534, Oct. 27, 1942. Medical Hospital Ship Platoon, Separate. in the standard hospital train, their use offers certain advantages of which the most important are availability, economy, and flexibility. Trains of this type may be made large or small to suit the demands of each journey. The type train, T/O 8-520, April 1, 1942, however, has a normal capacity of 360 patients. Agencies Involved in Evacuation. The agencies involved in the process of evacuation from the combat zone to the communications zone are: the evacuation hospital, the 854 MILITARY MEDICAL MANUAL hospital train, medical hospital ship (see Plate 17, T/O 8-537 Medical Hospital Ship Company), the surgeon of the army, the G-4 of the army, the regulating station, the chief surgeon of the field force and G-4, GHQ. The surgeon of the communications zone also has a function in that he allots specific “bed credits” to regulating officers. The regulating stations play the most important role in insuring expeditious evacuation. These stations are the agencies which control the movement of all sick and wounded evacuated from the mobile medical installations of the combat zone to the fixed hospitals in the communications zone. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Unit Technician grade Administrative Professional Total company Personnel required for each 100 increase in patient capacity Enlisted cadre Remarks Company headquarters Registrar, receiving, and evacuation section 1 | Supply section Medical section Laboratory and phar- macy section 1 j Surgical section Roentgenological section Dental service • 1 1 2 3 2 1 tlnsert number of company. * Commanding officer. b Also in charge of laboratory and pharmacy section. * Medical Administrative Corps. d Dental Corps. * Also medical supply officer. f Chief nurse. The serial number symbol shown in parentheses is an insepa- rable part of the specialist designa- tion. A number below 500 refers to an occupational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circular No. 14, War Department 1942. 1 1 1 1 b V (0 1 1 « 1 d 1 « • 1 2 a) 1 2 - 2 1 — 1 9 2 f 1 1 5 13 20 4 Warrant officer. — 1 1 = 1 (1) i to 1 3 (1) (1) (1) 2 0) (1) 2 (2) 1 (1) 1 " 1 l 22 (1) (1) (2) (1) (1) (6) (6) (10) (1) (3) (1) (1) (1) (1) (2) (3) (S) (2) (2) ’(«) (1) (0) (1) 1 1 l (1) 2 (0 (i) to 1 0) 1 2 (1) (1) 1 0) 1 (1) 1 4 4 to 1 (1) 1 0) 21 22 23 24 26 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 d) 29 (1) Technician, grade 3] Technician, grade 4 4 2 14 , 3 11 2 1 2 3 3 3 Private, first class. Private.. 1 5 5 (0 (i) (i) (i) 5 4 5 '''(CO '0) (10) (1) 0) (i) to (1) (2) (2) (2) (i) (i) (0 4 0) (i) 5 4 a) (2) (3) (7) 0) (1) (1) (2) (1) (1) (2) to 4 5 (2) (2) (5) (0 (1) (i) 3 (1) (3) (i) (1) (I) 5 11 16 32 6 3 15 12 2 1 76 35 9 3 22 5 27 3 2 106 17 16 Plate 17B. T/O 8-538, Oct. 27, 1942. Medical Ambulance Ship Company. Regulating Stations. Regulating stations are established and administered under the direction of G-4, general headquarters. Each regulating station serves a definite area, usually one army. They are usually located in the rear of such areas at controlling points where the necessary trackage exists or can be quickly installed. They should be near enough to the front so that trains can arrive at railheads in 12 hours. They should have 2 railroad lines to the front and rear and also a line for lateral movement. The limits of the army areas are therefore often fixed by general headquarters with these particular features in mind. A regulating station consists of a rather large railroad yard with a sufficient number of tracks, with the necessary crossovers, switches, sidetracks, and facili- ties for handling a one day’s supply of food, forage, ammunition, and other items that might be kept there for urgent use. THE MEDICAL SERVICE OF A FIELD FORCE 855 Regulating officer. The regulating officer commands the station and all installations thereat for the operation of which the use of trackage or of routes leading to the front is necessary. He is a direct representative of the commanders of the theatre of operations, who assigns him a suitable staff representing the various services. Priorities in move- ments from rear to front are fixed by the regulating officer pursuant to the demands of the command that his station serves. All calls for supplies, all notices and requests for troop movements, and all requests for evacuation are sent to the regulating officer who, in accordance with these advices, controls the flow of supply and movements between front and rear. Medical Department Activities at Regulating Stations. Medical Regulator. At the regulating station there is a medical group on the staff of the regulating officer. The senior of this group is known as the “medical regulator.” This officer supervises the movement of hospital trains and handles all evacuation matters. The commanding of- ficers of hospital trains assigned to his station are directly answerable to him in all matters pertaining to Medical Department administration. A veterinary officer is detailed as an assistant to the medical regulator to handle matters relative to the evacuation of ani- mals. The regulating officer (or medical regulator), upon the receipt of a call from G-4 of the army, will assign trains and arrange the necessary schedule, advising the evacuation hospital and the G-4 of the probable time of arrival and the period of time allotted for loading and the class of cases that can be loaded on it. The commanding officer of the evacuation hospital will be charged with seeing that the necessary steps are taken in order that the train may be promptly loaded in the time allotted. Specific loading directions as to the class of cases to be taken abroad are necessary, as the medical regulator may order the train on its trip to stop at other hospitals to take on selected cases. In directing a movement of this sort, the medical regulator is guided by the availability of beds in the rear. These beds are allotted daily by the surgeon, communications zone. Data. Hospital trains are assigned to or placed under the immediate control of regulat- ing stations by G-4, GHQ, on the recommendation of the chief surgeon of the field force. Suitable railroad yards for them are designated by the regulating officer. With the requisite number of hospital trains at his disposition the medical regulator must be furnished daily with two essential data: First, regular reports from G-4, Army as to the number of patients he will be ex- pected to evacuate by hospital train. These “reports” will frequently be direct requests to evacuate specific hospitals in definite priorities instead of routine information. Second, regular reports from the rear as to the number of beds available to which patients can be evacuated. Reports. Evacuation hospitals report daily or as often as may be necessary to G-4 Army (through the army surgeon) the following information: Number of evacuable wounded, sitting and lying cases. Number of non-evacuable wounded. Number of evacuable sick, sitting and lying cases. Number of non-evacuable sick. Number of vacant beds. Bed credits. The surgeon, communications zone, maintains in his office a daily bal- ance in terms of beds, showing the current condition of hospitalization resources. Each general and station hospital in operation notifies him daily by telephone, telegraph, or mail, of certain essential data, among which are the total number of vacant beds and the number of patients in hospital. These he tabulates and from the aggregate so obtained reviews the general situation and makes allotments for primary or other evacuation move- ments. The surgeon, communications zone, wires daily to the medical regulator the number of beds set aside exclusively to receive evacuations being handled through that particular regulating station. Once these allotments are made they cannot be changed except by mutual consent of these two officials. The medical regulator must always know that his credit in terms of beds at certain hospitals is at par until he himself has used it; otherwise; confusion in the movements 856 MILITARY MEDICAL MANUAL of hospital trains and needless suffering on the part of the patients might ensue. A bed- credit in a specific hospital is of little use to a regulating officer unless the credit is at least 300 beds, that is, enough to take one train load of patients. In emergencies and particularly with sudden changes in the battle front, the chief surgeon may set aside certain hospitals in the forward areas of the communications zone for use by the medical regulator, notifying the surgeon, communications zone, promptly as to this action and at the same time directing the hospital commanders to report the number of vacant beds direct to the medical regulator. Bed-credits in a specific hospital center or general hos- pital should be allotted to a single regulating station only. A practicable arrangement that was occasionally sanctioned during the World War was to permit regulating stations to “trade” bed-credits. That is, when one station became short of bed-credits or desired to avoid a long haul on account of the type of train being used, the medical regulator at one station called up the regulator at another station and requested an allotment to him of a requisite number of beds at some hospital credited to the latter. As soon as this was done, the beds so loaned passed out of the control of the second regulator and were stricken from his daily balance as no longer available. When it is necessary to relieve evacuation hospitals of their encumbrance of wounded, it may become necessary to evacuate patients before they have received surgical treat- ment. Such cases are classed as “pre-operative” and are sent to general hospitals in the forward areas of the communications zone. Regulation of trains. In addition to regulating evacuations, the medical regulator must work in close touch with the railroad technicians as to the movements of empty trains on return, trips as well as for the preparation of “operating schedules” for the loaded trains. When the latter are not kept constantly moving, space where they can be side- tracked, yet remain available for use in any emergency, must also be designated. The medical regulator is the representative of the chief surgeon of the field force in all matters relating to the medical personnel on the trains and, under the direction of the regulating officer, he must also provide facilities for the supply of rations, general medical supplies, distribution of mail, and for rations for patients. The latter is most important. Trains entering the combat zone must carry with them sufficient rations to feed the capacity of the train throughout the journey. Evacuation Within the Communications Zone. Allotment of trains. In addition to the by G-4, GHQ, directly under the control of the commanding general, communications trains specifically assigned to regulating stations, a number of hospital trains are placed zone, and held at suitable places designated by the latter. These trains are utilized in ac- complishing what may be termed “communications zone” evacuation or “intermediate” evacuation. This is a second stage of primary evacuation. Train movements are coordi- nated by G-4 at headquarters communications zone on recommendations of the surgeon, communications zone. Through a working agreement, usually sanctioned by G-4, the surgeon, communications zone, calls direct upon the Director of Transportation for such movement of those hospital trains as the Medical Department may desire. Necessity for evacuation. Evacuations from the communications zone become necessary because approximately 20 per cent of all sick and wounded remaining under treatment for more than two weeks become permanently incapacitated for further military duty and require evacuation to the home territory for eventual discharge from the service. This fact alone necessitates a constant flow of such patients to hospitals at base ports, or where water transportation is not necessary to those hospitals near important railway junctions serving as exits to home territory. During periods of comparative inactivity at the front the medical regulator attempts to select patients for evacuation from the combat zone and to route them to those hospitals of the communications zone that are best qualified to render the particular treatment required. Thus he may direct a hospital train to call at several evacuation hospitals and to transport all fracture cases to a general hospital peculiarly equipped to take care of them. Likewise, he may select those patients offering prospects of speedy recovery and return to duty and direct their transfer to hospitals near the front. This reduces the mileage demands on rolling stock and facilitates replacement procedure. However, in times of stress, a medical regulator can seldom afford to observe THE MEDICAL SERVICE OF A FIELD FORCE 857 this desirable selection of patients or to make primary evacuations far to the rear. By doing so, he would suffer considerable loss in the “utility schedule” of his hospital trains. Whenever combat activity becomes intensive, with great numbers of sick and wounded flowing into the evacuation hospitals, the medical regulator, guided by his bed allot- ments, is forced to play safe and prescribe the shortest trips possible for the hospital trains under his control, in order that his resources may be utilized to maximum advan- tage. The medical regulator relies upon the surgeon, communications zone, to accomplish communications zone evacuation and keep the hospitals near the front as empty as possible. Therefore, in very active periods, instances will arise where a hospital may be receiving patients from the front on a hospital train dispatched by the medical regulator, and at the same time be sending out to hospitals toward the base specially selected patients on trains independently ordered up for that purpose by the surgeon, communi- cations zone. Hospital trains operating under communications zone control usually cover much greater distances in quicker time than can be done by hospital trains operating in the combat zone. In the combat zone, the daily traffic density may reach 72 trains per 24 hours, a supply, troop or hospital train passing through a given station every 20 minutes. When rail lines are thus crowded, movement is slow. Secondary Evacuation. Evacuation to the home territory by hospital ships or by hospital trains requires no special description as they resolve themselves into those of routine selec- tion, classification, formation into sick and wounded convoys for purposes of record, delousing whenever necessary, and transfer as accommodations become available. Dur- ing World War I ordinary troop ships and not hospital ships were generally utilized. While aboard ship, the sick and wounded being transported to the United States were under the control of the Navy by special agreement entered into between the Secretaries of War and Navy. Upon debarkation, the patients reverted to the control of the Army and were distributed from debarkation hospitals at the ports to the military hospitals throughout the country. Hospital trains of the zone of the interior were operated in a manner similar to that used in operating hospital trains under communications zone con- trol. When the communications zone adjoins the zone of the interior, hospital trains pass from one zone to the other. In this case there is joint control, movements in and out of the theatre of operations being controlled by a regulating station near the rear boundary of the communications zone, and movements within the interior being con- trolled by agencies of the latter. Responsibility. The chief surgeon of the field force is responsible for Medical Depart- ment personnel matters relative to requirements, distribution, priority of replacement, and training in accordance with the general policies of the commander of the field forces. Medical Department personnel within the theatre of operations is administered and con- trolled in accordance with the policies announced for all classes of personnel within the force, the major part of this administration being performed by the organization to which the officers, soldiers, or nurses are attached or assigned or of which they are an integral part. The surgeon’s office, communications zone, functions as an administrative agency in carrying out the policies of general headquarters. As such it initiates all actions look- ing toward the distribution of the great numbers of Medical Department personnel re- quired by an expeditionary force. The Personnel Section, Office of the Surgeon, Communications Zone. The primary function of the personnel section of the communications zone surgeon’s office is the dis- tribution of Medical Department personnel. This section, however, does not work alone. The other sections of the office are interested to some extent in personnel matters. Each activity within the theatre involves medical personnel. Successful handling of personnel matters is dependent on a well-organized personnel section which coordinates the demands made upon it. Its principal contacts will be with G-l, the Adjutant General, and with those sections of his own office that are particularly interested in the distribution of profes- sional talent. The chief of this section should be ap officer of the permanent establishment PERSONNEL 858 MILITARY MEDICAL MANUAL whose experience has given him a broad acquaintance with the medical profession of the nation and with the members of his own corps. Advise with reference to dental, veter- inary, and nursing personnel questions must always be available to this section of the office; a representative of these corps should therefore be on duty therein. Classes and Distribution of Medical Department Personnel. The Medical Department is responsible for the procurement and distribution of the following classes of personnel: Commissioned: Medical Corps. Dental Corps. Veterinary Corps. Medical Administrative Corps. Nurses: Nurse Corps—graduate. Nurse’s Aides—undergraduate. Enlisted: Medical Service. Dental Service. Veterinary Service. Civilian Dieticians. Physiotherapists. Clerks and others. This personnel is dispersed throughout a field force in one or another status as follows: Assigned to units. Attached to organizations. Detailed as representatives. # Replacements. Detailed to civil work or with relief societies. Percentage of Medical Department Personnel. The percentage of Medical Department personnel in a field force varies according to several factors, the principal one being the general nature of the military effort which determines the amount of fixed hospitalization that is to be established in the theatre of operations. Taking into consideration all mili- tary forces, in both the zone of the interior and the theatre of operations, it is estimated that Medical Department personnel will constitute approximately 12 per cent of the ag- gregate military personnel required for a major effort. In a minor effort, where com- paratively little combat is expected, the proportion would be smaller. War strength tables of organization are based upon a contemplated major effort in which the Medical Department requirements are estimated as follows: Officers 1.2 percent Nurses .8 Enlisted 10.5 12.5 per-cent Classification. A detailed percentage classification may be given as follows: Commissioned: Medical Corps .75 per cent Dental Corps .1 Veterinary Corps and Sanitary Corps .3 Medical Administrative Corps .05 1.2 Enlisted: Medical Department (including medical and dental attendants), approximately 9.5 Veterinary Corps 1. 10.5 Nurses: Nurse Corps .8 TOTAL 12.5 percent Basis for Estimating Medical Personnel. The Medical Department personnel required in either the combat zone or the communications zone cannot be estimated with any degree of accuracy without a knowledge of the specific theatre of operations and of the organizations of the forces therefor. THE MEDICAL SERVICE OF A FIELD FORCE 859 While it is sound policy to assume that Tables of Organization show all the personnel required within a field force, experience has shown that in practice the medical per- sonnel problem presents difficulties if the allowances given in Tables of Organization are adhered to strictly. Unusual or un-anticipated situations are almost certain to occur in connection with combat activities. Medical establishments are often obliged to care for more than double the number of patients for which they were organized. Differ- ences therefore may exist between the totals shown on Tables of Organization and the total medical troops actually required in a given theatre of operations. In planning for the organization of a field force, each theatre of operations will present a different problem. Medical personnel should therefore be considerd not only on a table of or- ganization basis but also on the basis of estimated needs. Whether the latter should be on a percentage basis is immaterial except that such is a convenient method in keeping track of the medical personnel accruing to the field force. A specific war plan must further indicate the basis upon which medical units will accrue to the credit of the forces. It is desirable to stress the statement that the Medical Department personnel that is to accrue to the credit of the force must keep pace with or be slightly in advance of the authorized allowance based upon the strength and com- position of the forces in question. Experience indicates that this is a policy difficult to maintain. Changing conditions in a theatre of operations demand changes in the rate of delivery of combat troops to the theatre. If the flow of medical personnel to the theatre does not keep pace with the flow of combat troops, just that much will the operations of the combat forces be hampered by lack of medical support. Personnel Replacements. It is essential that medical units within the theatre of opera- tions be maintained at full strength if they are to function efficiently. Provisions for replacement of personnel is an important feature of any war plan, the rate varying ac- cording to circumstances. From past experiences it appears that not enough considera- tion has been given to this subject. The matter of furnishing trained replacements to a field force is a function of the zone of the interior. The chief surgeon in the theatre of operations, however, is materially concerned as to Medical Department replacements and must make representations as to his requirements when necessary. The adminis- trative details necessary to the distribution of replacements, once they arrive, are func- tions of the communications zone authorities. The priority of such distribution is made in accordance with the policy of general headquarters. Priority is usually given to the combat zone, although such a policy may not always be desirable regarding medical replacements. In order to permit flexibility, replacements are echeloned in depth. In a small field force, medical replacements, except perhaps in the case of nurses, may be advantageously placed in the general replacement pool, depot, or battalion. With a large task force, however, many advantages are offered if medical replacements within the communications zone can be grouped in camps or areas controlled by the Medical Department, i.e., Medical Department Concentration Centers. Concentration and Distribution of Medical Department Personnel and Units. Depend- ing on the character of the theatre of operations and the geographical distribution of the field forces, one or more Medical Department Concentration Centers are established in the communications zone. Medical Department Concentration Center (see T/O 8-600-1). If only one center is established, it should be centrally located at a place having good communications with the front and rear, but particularly with the front. It should also be near a com- munications zone medical depot. In the case of a deep communications zone, two such centers are desirable. One of these should be at the base, situated on or within easy reach of the avenues of approach into the theatre of operations. The other should be well forwarded and centrally located behind the combat zone. These centers serve not only as reservoirs for the reception and distribution of replacements; they have other functions which are perhaps more important. Incoming units. All Medical Department troops arriving in the theatre of operations, except those regiments and detachments that are components of divisions, should be sent to the concentration center at the base unless they are to be immediately assigned to 860 MILITARY MEDICAL MANUAL operate an establishment. The medical units pertaining to the communications zone (general and station hospitals, laboratories, veterinary general and station hospitals, etc.) and those belonging to the army medical service (evacuation and surgical hospitals, etc.) all require bulky equipment. The personnel of these units will ordinarily arrive in the theatre of operations unaccompanied by this equipment. The concentration of this per- sonnel under coordinated central control at a center facilitates their administration and distribution, permits them to continue training under proper supervision, and allows the assembly of their equipment. It is not contemplated that the equipment necessary to operate communications zone establishments, such as hospitals, be sent to a center. These supplies are forwarded by supply agencies to the places where the establishments are to be located. The mobile units of the army medical service may be furnished their or- ganizational equipment at the center. This may be done either at the center, at the base, or in the forward area of the communications zone, depending on the policy of GHQ. The equipping of the units is greatly facilitated by having them thus grouped. An organization remains at a center until its assignment has been determined or the establishment it is to operate is available for it. Reserve units. A Medical Department Concentration Center also has a strategic feature in that the evacuation, surgical, and veterinary evacuation hospitals and the auxiliary surgical groups pertaining to the general headquarters reserve may be assembled and used as a pool under central control. Not only these units but other medical organiza- tions that are normally components of a field army may be held and distributed to that army area where their services are most needed. A center also provides a place to which a unit, depleted in personnel and equipment by long operation at the front, may be withdrawn, overhauled, and rehabilitated. Without such a center the medical service would lack the elasticity necessary to utilize its replacements and reserves to best ad- vantage in conserving the strength of the field forces. Control. Medical Department Concentration Centers are controlled by the chief sur- geon at general headquarters. As those headquarters are not usually concerned with the details of supply, administration, and operation, the direction exercised by the chief surgeon may be only the control of the assignment of units or replacements to such centers and their distribution therefrom. If such is the case, the local administration of the activities of the center, i.e., training, supply, equipping, overhauling, and rehabili- tation of the units, are supervised by the surgeon, communications zone. MEDICAL SUPPLY Introduction. The Medical Department is responsible for the supply of all medical material necessary for the health of the troops and for the care of the sick and wounded in the theatre of operations and in the zone of the interior. This responsibiltiy involves provision for the care of animals as well as men. It includes all activities from the de- termination of supply requirements to the delivery of supplies to the individuals who use them. See Chapter VII, Part I, “Supply and Evacuation of Large Units.” Estimate of Requirements. Any plan for contemplated military operations must include a plan of supply for the theatre of operations. A plan suitable for one situation probably will not fit all situations. However, certain general principles have been adopted in order to insure the flow of supplies from the zone of the interior to front line troops. These fit into any general scheme of supply and are susceptible to comparatively little change in varying conditions of warfare. One of the phases of the supply plan is an estimate of the material required and the date and place at which it must be made available. Such is an important feature of every special war plan. Factors. Some of the factors to consider in estimating medical supply requirements are: The plan of operations. Mission. Size, organization, and equipment of the force. Plan of concentration, rapidity, and location. Time and dates of various phases of mobilization, concentration, and operations. Rate of movement to the theatre. Type and probable duration of operations. THE MEDICAL SERVICE OF A FIELD FORCE 861 Character of the theatre of operations. Location adjacent to, or near, the zone of the interior or overseas. Roads, railroads, and other means of transportation and lines of supply. Resources which may be made available locally. Construction required for lines of communication, i.e., hospitalization, and shelter required for medical supplies. Climate and health conditions. Population. Characteristics of the enemy. Military preparedness. Military capacity. Type of armament. Probable movements and objectives. Length, capacity, vulnerability, and type of lines of communication between zone of the interior and theatre of operations. Medical supply plan in zone of the interior. Plan of mobilization of resources. Status of program for mass production, procurement, and storage. Availability of supplies at various dates. Medical estimate. An intelligent estimate of the medical material required cannot be made by the Surgeon General unless the above mentioned factors have been furnished and considered. A further necessity in making such an estimate is a list of items that constitute the medical material and the amount required under varying conditions. The medical supply catalogue lists every item that is routinely issued by the Medical Department. It is apparent that there must appear therein every medical item that is contained in any equipment table. An equipment list, based upon the supply catalogue, is provided for each type medical unit. Each list shows all of the medical equipment necessary for a unit to begin func- tioning. It is intended to include in each of these lists all equipment necessary for a unit to function, including that furnished by the Quartermaster Department and other supply agencies. Renewal of supplies consumed are provided for in the supply catalogue, allowance tables, and other directives. Initial, Maintenance, Reserve, and Automatic Supply. As the impetus of supply is from the rear, the Surgeon General in the zone of the interior is responsible for the pro- curement of medical supplies and their delivery to the theatre of operations. The Sur- geon General, however, is influenced by the demand of the theatre of operations from time to time as to the general character and quantity of material required. The com- munications zone authorities are responsible for the utilization of local resources of the theatre, under policies established by general headquarters. Classes. The requirements of medical supplies for a field force may be divided into three categories: initial equipment for troops and Medical Department units, material for maintenance, and that required to establish a reserve. The material required as initial equipment of troops and Medical Department units, often termed organizational equipment or unit equipment, is covered as to quantity, type, and weight in equipment lists. Organizations entering the theatre of operations ordinarily are accompanied by this type of material. The equipment pertaining to many Medical Department organizations, e.g., general hospitals, is so bulky that it may not actually accompany the personnel. In all such cases, it is important that such equipment arrive in the theatre of operations simultaneously or before the arrival of the personnel which is to use it. Maintenance supplies, to replace those consumed, are forwarded from the zone of the interior at the time field forces enter the theatre of operations or immediately thereafter. These supplies constitute the initial stock of the depots that are to be established in the theatre of operations. These depot stocks are maintained by a continuous flow of sup- plies from the zone of the interior. The kind and quantity of material needed to keep 862 MILITARY MEDICAL MANUAL the command fully equipped and supplied for the duty upon which it is engaged is dependent upon factors that differ widely with each situation. The climate, health con- ditions, local resources of the theatre of operations, the nature of military operations, and the military characteristics of the enemy all have a bearing. Reserve supplies are shipped to the theatre along with the maintenance supply until the desired reserve is established. The purpose of a reserve is to assure a source of supplies for the furtherance of military operations. The amount of reserves established is usually expressed in days, as 45 days’ reserve. The size of this reserve is dependent upon many factors, some of which are: The length, capacity, and vulnerability of the lines of communication between the zone of the interior and the theatre of operations. The type of the operations and the armament and strength of the enemy. The availability of local resources in the theatre of operations. The probable duration of operations. The automatic supply is based upon an estimate of the amount of medical supplies required to meet the daily needs of troops (maintenance) and that required to establish a reserve estimated on the basis of the amounts that experience has shown to be required for a fixed number of troops for a given time. The monthly consumption rate for a unit of 25,000 men is estimated for each item of supply, based on authorized allowances and experience. The quantity thus arrived at for each item is designated as the “automatic supply unit.” The multiplier for the “automatic supply unit” is the number of troops in the theatre of operations divided by 25,000. Shipments of these units to the theatre of operations are continued at a designated rate until a change is requested. Exceptional supply. This includes special items and articles the need for which can- not be determined far in advance. The requirements for such are computed as the needs develop, and calls are made therefor in specified quantities. Organization for Supply. The cardinal principles governing an efficient supply system are flexibility, elasticity, mobility, and simplicity. Large accumulation of supplies close in rear of combat troops tends to rigidity, rendering the system incapable of adjustment to changes in the situation. To provide against this and also to permit decentralized operation, the communications zone is often divided into sections: base, intermediate, and advance. The base section depots provide for receiving, classifying, assembling, and stor- ing supplies received from the zone of the interior. The intermediate section depots keep a store of balanced stocks nearer the troops but far enough from the front to be safe from hostile interference. The advance section depots contain balanced stocks in quantities only sufficient to meet the immediate needs of troops in combat. Modification. The organization and administration of the supply system in different theatres of operations will not usually be the same. The tendency is to assume a fully organized and multiple sectioned communications zone under all conditions or at least that a different organization would be unusual. The reverse will usually obtain. The communications zone will be built up from the simplest base even in major operations. In minor operations, the communications zone may be nothing more than a base. The situation may vary from a more or less elaborately organized communications zone to one sufficient only to establish contact with the zone of the interior, the resources and establishments of the latter being drawn upon directly for the maintenance of troops. If the theatre of operations is in the home territory or contiguous thereto, or if geographical conditions do not favor an elaborate organization along the lines described, it may be advisable to eliminate the intermediate section altogether or to omit the division of the communications zone into sections. In the latter case, the communications zone is or- ganized as described for the advance section, and the classification and assembly of sup- plies are made in depots of the zone of the interior. Depending upon the distance of the theatre of operations from the zone of the interior, the size of the forces in the theatre of operations, the character of the operations, and availability of the communica- tions net, supplies received from the zone of the interior are collected into depots of the communications zone or forwarded without transloading direct to railheads of the combatant troops. The latter condition obtains normally only at the beginning of op- THE MEDICAL SERVICE OF A FIELD FORCE 863 erations in theatres contiguous to the home territory; the movement of supplies is then controlled by regulating stations inserted in the communications net at or near the rear boundary of the theatre of operations. Storage. Storage may be looked upon as an agency of distribution by which the move- ment of supplies is facilitated rather than as an agency for keeping supplies safe and in order. It would be ideal to keep supplies rolling from the point of origin to the place of consumption. However, it is always necessary to have reserves. By storage, reservoirs of supplies are maintained with which to meet uneven demands and irregular trans- portation facilities and with which to balance production with demand. Storage should be sufficient for this purpose and no more. The commander of the theatre of operations, in conjunction with the commander of the communications zone, decides on the location of all important supply installations and the amount and distribution of supplies. Storage space in the communications zone is allotted to the Medical Department by the com- manding general, communications zone. This includes determination as to the location of depots as well as other supply establishments pertaining to the Medical Department. The surgeon, communications zone, keeps adequate record of all storage space allotted to the Medical Department, including its disposition and utilization. He makes applica- tion and recommendation to the commanding general, communications zone, for any additional storage space or depots that may be required from time to time by the Medical Department, in order to meet his responsibilities. The surgeon, communications zone, stores and maintains at the prescribed level the special supplies procured by it, such gen- eral supplies as are used exclusively by it, and such other general or special supplies used by medical troops as may be authorized by the commanding general. Depot administration. Each general depot is commanded by an officer designated as “Commanding Officer,” such and such “General Depot,” etc. (See Chapter VII, Part I.) At each general depot in which medical supplies are stored, the Medical Department is represented by a Medical Department officer known as the Depot Medical Supply Officer. Each depot medical supply officer is responsible for: The proper storage, care, maintenance, and issue of all supplies, equipment, and mate- rial pertaining to his branch, under such instructions as may be prescribed by the chief of his branch. The control of the necessary technical personnel, military and civilian, to handle and record supplies pertaining to the Medical Department. Supervision of the unloading and loading of supplies pertaining to the Medical De- partment, proper marking of all shipments and transmission of information in regard to shipments to consignees, through prescribed channels, in accordance with instructions issued from time to time by the surgeon, communications zone. Under no circumstances will a depot supply officer arrange for transportation except through the duly constituted transportation agencies under the supervision of the commanding officer of the depot. Whenever any shortage of stock is indicated or anticipated in any article of supply, or the necessity arises for special control of expenditures or reduction of allowances, a depot medical supply officer will bring the matter at once to the attention of the communica- tions zone surgeon, and the latter will take the necessary steps to relieve the shortage. Depot supply officers communicate directly with the depot commander concerning matters pertaining to storage space. Correspondence pertaining to technical matters is directed to the surgeon, communications zone; all other correspondence is governed by orders and regulations on the subject issued from time to time. Medical Depots (T/O 8-661). (See Chapter IV). Location. Ordinarily, the existing facilities of a theatre of operations will be utilized for medical depots, as time may not permit the months of delay entailed by construction. Transportation may not permit the movement of construction material. Certainly the first depots established must utilize existing shelter. Buildings so selected must not only have suitable and sufficient storage space but also adequate transportation facilities. They should be located with railroad siding advantages on or immediately adjacent to a main railway line having good connections with both front and rear. 864 MILITARY MEDICAL MANUAL Construction. When it becomes necessary to construct a medical depot, the following factors should be borne in mind: The space should be laid out in separate areas for each class of supplies represented at the depot in the necessary proportion. Each storehouse area is divided in sections, each section having a ladder rail track to each side connected by house tracks about 1700 feet long, there being one for each three warehouses. These tracks should be about 150 feet apart, giving space enough for open storage on the opposite side of the track from the houses and at the same providing a firebreak. There should be no dead end in the track system except where particularly desired for unloading vehicles, so that railroad cars can be moved with the greatest facility. Different types of storehouses should be distributed on separate tracks so that one par- ticular commodity can be stored on separate tracks, as it is desirable for facility in re- ceipt and distribution that the commodity be loaded on one track while it is being received on another. Storehouses should be of such size as to involve the minimum amount of labor in handling stores. A 60-foot width and a length of 400 to 500 feet are considered the most economical from the standpoint of both operation and construction. When time, labor, and material permit, which is seldom the case, operation is facil- itated by placing the floor of the storehouse on a level with the floor of the average freight car. However, it will usually be necessary, due to dearth of material, to con- struct many storehouses without floors and to place drainage wherever required. Storehouses (or open storage) from which shipments are made by truck, should be on a flank so as to avoid crossing railroad tracks and the delay usually caused thereby. These storehouses should be located as far as practicable on existing roads. Storehouses should not be located so as to interfere with existing roads, as it takes more time to construct new roads than any other feature and the material for their construction is often difficult to obtain. Receiving, classification, and departure yards are essential features of all large depots. The building program must be carried out so that expansion is feasible and so that each unit is completed progressively and in succession in such a way that it can be used immediately. For example, it is wrong to start construction on a number of storehouses when only one house is needed at once, and it is wrong to lay ten railroad tracks in a yard before alining and ballasting any, when perhaps only three tracks are needed immediately. The loss of efficiency due to using small units is insignificant compared to the importance of fulfilling the requirements of the military situation. Storage space is usually expressed in terms of square feet of floor space. Storage space required for Medical Department supplies for a 45 day reserve may be estimated as 0.5 square feet (8-foot stack) per man in the forces. This amount will vary according to the amount of reserve and maintenance stores contemplated. Echelonment of Medical Depots. The system of supply contemplates that medical units with troops shall normally be encumbered with the minimum of supplies, thus insuring a maximum of mobility. The agencies of distribution of medical supply in a large communications zone, completely organized, are echeloned from rear to front as follows: Communications zone depots (medical section): base, intermediate, and advance. The base depot or depots are established first. The others are established as the neces- sity for such becomes evident. The communications zone depots serve the entire theatre of operations and, therefore, stock all medical supplies (medical, dental, and veterinary) authorized for communications zone medical activities. The stock of advance depots may, however, be limited to that required by combat zone troops, the base or inter- mediate depots supplying the needs of fixed installations of the communications zone. If intermediate depots are established, they will usually contain the bulk of medical supplies within the theatre of operations. Combat zone depots: One army medical depot serves each army, although it may be divided to operate in several places. Whether operating as a unit or in sections it procures or stocks practically all medical, dental, and veterinary articles of medical THE MEDICAL SERVICE OF A FIELD FORCE 865 supply that are authorized for the units of a field army. As field armies are mobile, the supplies maintained in army depots are ordinarily limited in character and amount to those essential to maintain combat efficiency for a period not exceeding three days. The articles actually stocked by army medical depots are therefore those that require frequent replenishment. An army depot requisitions supplies through the army sur- geon and regulating office, from a designated communications zone depot, and the supplies are received therefrom through the regulating officer. The depot issues direct to army establishments (evacuation hospitals, etc.) and issues to the headquarters and service companies of army medical regiments and to the headquarters detachment of corps, and division medical battalions who in turn issue to organizations served by them. Units drawing supplies from an army depot ordinarily send their own transport for them. Army medical depots must therefore be located on a railroad line leading from the rear and on good roads leading to the front. They are usually established near evacuation hospitals or in rear thereof at central points in the road net of the army service area. A corps medical par\ is a temporary expedient utilized when a corps is acting inde- pendently. Ordinarily, it will be operated by the headquarters detachment (reinforced or otherwise) of the corps medical battalion. The supplies carried will usually be limited to the capacity of the available transport. When a corps is heavily reinforced and has a number of evacuation hospitals and surgical hospitals attached or is operating in an entirely independent campaign, the corps medical park may be operated by a por- tion of an army medical depot. Medical supplies for a corps medical park are obtained through the army medical depot or obtained direct from a designated communications zone depot through the regulating station. Medical supply sections of the headquarters and service company of the army medical regiments serve the components units of their respective regiments and the medical detachments of the army troops. The medical supply sections of the headquarters and headquarters detachment of the corps medical battalion serves the component units of the medical battalion and the medical detachments with corps troops. Likewise the medical supply section of the headquarters and headquarters detachment of the division medical battalion serves the component units of the medical battalion and the medical detachments of the division troops. As these units are mobile and as transportation is always a controlling factor, the supplies carried consist of those items of field medical supplies authorized for these troops that are likely to require frequent replenishment. All medical supply sections ordinarily replenish their medical supplies from the army medical depot. Division medical supply sections in an independent corps obtain them from the corps medical park. Regulating stations. The regulating station intervenes between the communications zone depots and the army medical depots. It is the agency in the system of supply distribution for the area or army it serves. As explained in the section on “Hospital- ization and Evacuation,” each regulating station has a medical group attached. This group is responsible for the systematic, orderly movement of the medical supplies to organizations served by the station and for the evacuation of men and animals there- from. The group should be advised in ample time of proposed changes at the front that affect medical supply operations and make appropriate dispositions accordingly, They make suitable drafts for supplies on designated depots in rear to insure the nec- essary flow of supplies. Shipments are not forwarded to any regulating station, nor to any point in the zone of the armies served by such station, except by order of the regulating officer or in accordance with a definite shipping schedule previously approved by him. Officers commanding medical sections of depots and others in charge of shipments are responsible that advance notice is given the medical regulator of all ship- ments made to his regulating station. Medical supplies for an army are ordinarily sent by the regulating officer to the army medical depot in carload lots although less than carload lots are forwarded when necessary. The army medical depots then make all distributions within the army. This method is particularly desirable in combat where 866 speed in supply is important. The rule is not inflexible, however. Supplies may be sent directly from communications zone depots to evacuation hospitals, convalescent hospitals, or other large units, located at railheads. Carload lot shipments may be thus expedited. Less than carload lot shipments are only sent in this manner when speed in supply is not of great importance, that is when troops are out of contact with the enemy or are in stabilized or semistabilized warfare. If this latter method is used, it is necessary that all such supplies be requisitioned through the army medical depots and the delivery acknowledged to the latter, even though the supplies do not pass physically through the army medical depots. Medical Department Central Control. Successful supply coordination is dependent upon a well organized supply section in the office of the surgeon of the communications zone, for upon this machinery rests the responsibility for the execution of all policies and plans for storage and distribution of medical supplies for the field force. The major portion of medical supplies will come by automatic shipment from the zone of the interior; there must, therefore, be on file in this office duplicates of all automatic schedules of supplies and equipment released from depots in the zone of the interior for shipment to the theatre of operations. Provision must be made for ready modification of the amount of the constituent items of the automatic supply unit in order to meet the changing needs of the forces in the theatre of operations. The supply division, Surgeon General’s office, is entirely dependent for its information relative to the supply situation in the theatre of operations upon the data prepared by the surgeon, communications zone. There must, therefore, be established a close reciprocal liaison between these two agencies. The Army surgeon is entirely dependent for his replacement upon the depots of the communications zone. The supply division of the office of the surgeon, communications zone, must therefore have at all times an accurate knowledge of what is required by the armies, what is available in storage, and what supplies are in transit. Medical supply reports. In the early development of communications zone activities, depots are established. These depots should send to the surgeon, communications zone, periodical and special reports covering the following: Stoc\ Issued Remaining Space Utilized Available Car movement Into depot Out of depot The information thus received is used as a basis for the office charts and graphs of the supply division. Data with reference to stock issues will be used in the study of usage factors and in connection with the modification of the automatic schedules referred to above. Consolidated stock balance reports serve as distribution sheets for the equalization of stock in depots. That is, issues or distribution of stock to depots are made in reports of expenditures. All details of storage space within depots must be available for ready reference. This data should cover storage space authorized, provided, utilized, and vacant. Distribution of Medical Supplies. The responsibility of the communications zone sur- geon for the distribution of medical supplies extends from the base depots into the combat zone, but this responsibility ends with placing the supplies at the regulating station. Ultimate distribution within the combat zone is a responsibility of the Army surgeon. Methods. Distribution is effected by two methods. Distribution on requisition is the routine peace-time method and is also the old estab- lished method used in war and the one that is emphasized in FM 100-10 Field Service Regulations (Administration). It is particularly applicable to small units, to front line troops, and to short lines of communication. Its chief advantage is that it is specific and, when successfully executed, results in the exact supplies required being received by the unit when needed. Its chief disadvantage is that, with the size and complexity of MILITARY MEDICAL MANUAL modern forces, the distance at which they may operate from their bases, and the rapidity of movement demanded, times does not suffice. Distribution by the establishment of credits is a method utilized to cut the time and effort of requisition. This method makes definite quantities of supplies in storage available to the commands to which allotted. The latter call directly on the designated depot for their shipment. It is particularly applicable to the supply of larger units with items the need for which can be foreseen but for which the time or place of de- mand are indefinite. Time may be too short and space may be too great for the greatest efficiency, and the method requires supplies in such quantity that they can be earmarked and held available. Supply by this method is meeting with increasing favor where it is applicable. Requisitions. The requisition method of obtaining supplies will generally be used for the distribution of medical supplies from the various depots to the units that are to use the supplies. During combat operations, these requisitions will often be informal. Requests are normally filled from supplies actually on hand or at the disposition of the various headquarters. Only under exceptional circumstances will requests be forwarded for action to higher authority while subordinate agencies still have supplies at their disposal from which such requests may be filled. In such cases the reason for for- warding the requests to higher authority will be indicated. When a depot cannot supply all articles called for on a request it forwards such articles as may be available and notifies the surgeon, communications zone, by telegraph as to the unfilled portion of the requisition. The surgeon should direct another depot to forward direct to the requisitioner the supplies necessary to fill the requisition. The surgeon, communications zone, when authorized by the commanding general of that zone, may keep the entire stock of certain classes of articles of which the supply is limited at one or more desig- nated depots; in such a case other depots will forward thereto their requests for these supplies. In general, when it is known that items cannot be supplied within fifteen days after receipt of requisition by the supply agency concerned, they should be stricken from the request and the officer initiating the demand should be notified at once. Arrearages on requests are not allowed to accumulate. Prompt action on every request must be taken, within the limits of his power, by each officer through whom a requisition passes. Organizations will not make duplicate requests for articles which they have called for on previous requests until they have received notice that such articles have been stricken from previous requests; provided, however, that: Supply officers may at intervals of not less than fifteen days include in requests all items previously requested and not supplied, but they will indicate opposite each such item the number of times and the dates and reference numbers of the requests on which it has been previously stricken out. A reasonable period must be allowed for transmis- sion of requirements and for delivery of supplies. Within the combat zone during active operations, all medical units send their requisi- tions direct to the medical supply unit which normally supplies them. At other times they send them to their respective headquarters. Credits. Specified quantities of medical supplies stored in depots in rear of the army may be allotted to and placed at the disposal of the army surgeon for a definite period of time. Such quantities of supplies are called “credits,” and after allotment are subject to draft on demand direct from any headquarters without further reference to GHQ or the communications zone. The credit method of distribution is advantageous in supplying army medical depots during combat operations. The purpose of allotting such credits is to assure the army of a definite amount of medical supplies for the period stated and at the same time relieve the army of the necessity of caring for them in army medical depots. The commanding officers of the depots at which stores are actually located thus become warehousing agents for the army for the amount of medical supplies covered by the credit allotment. Upon receipt of drafts from army headquarters for supplies covered by “credits,” the commanding officer of a depot arranges through the proper regulating officer for necessary transportation and causes cars to be loaded by the medical depot THE MEDICAL SERVICE OF A FIELD FORCE 867 868 MILITARY MEDICAL MANUAL officer. One copy of each draft made against the credit will be sent by army G-4 to the regulating officer. By arrangement between army G-4 and the regulating officer, the orders may direct shipment in carload lots at a fixed rate for a number of days. At the end of the period named in the credit allotment, all undrawn balances revert to depot stock; but, on request made prior thereto, a new credit will have to be arranged by head- quarters of the field forces (G-4) for the next succeeding period. The army surgeon may, at his discretion, make similar credit allotments of supplies in army medical depots to subordinate units and establishments. Method of Supply Within the Communications Zone. Medical units within the com- munications zone obtain their supplies in the following general manner, details of which are prescribed by the surgeon, communications zone. All articles of ordinary medical supply needed by an establishment are issued by a pre- viously designated supply depot on requests approved by local commanders and sent direct to the depot. Requests for exceptional supplies are submitted to the surgeon of the communications zone who, after approval, sends them to the proper depot for filling. In authorizing credits and making drafts on depots for supply of medical units in the communications zone, the surgeon of the communications zone must use due care to protect the interest of the troops in the combat zone. Copies of orders and general instructions in regard to medical supplies distributed by the surgeon of the communications zone should be forwarded to the headquarters com- munications zone to GHQ for information and file. It is a function of the chief surgeon at general headquarters to review such publications in order to insure that the general supply policies are maintained and that supplies are distributed in conformity with the strategical situation. American Red Cross, Supply Function. The American Red Cross constitutes a part of the medical service in war. This is the only civilian relief organization authorized to procure and distribute medical supplies for use of the army. This procurement and dis- tribution, whether at home or abroad, must be carefully coordinated with military needs if useless expenditure of money and needless duplication of effort are to be avoided. “It is not intended that the Red Cross shall duplicate or parallel the work of the War Department in the procurement and distribution of medical supplies. Standard medical supplies procured by the Red Cross shall be held as a reserve to meet unforeseen emer- gencies or to supplement standard medical supplies in grave situations. Ordinarily, special or nonstandard medical supplies furnished by the Red Cross should be turned over in bulk to the Surgeon General to be distributed by his agencies. The Red Cross may pro- cure and issue certain nonstandard and less essential remedial supplies when the military situation permits, provided such supplies cannot be obtained through the usual channels.” (Par. 9 b, AR 850-75.) The supply activities of the Red Cross operating with a field force should be limited to supplying those items not furnished as standard supplies by the Medical Department, and distribution thereof should be controlled by the Medical Department. Red Cross supplies for a field force should be furnished upon a definite basis and in accordance with a well-balanced procurement plan which keeps pace with the progressive increases in strength of the force. This can only be accomplished as a result of a well-coordinated study of the needs carried out by supply representatives of the Medical Department and the American Red Cross. To assure this coordination within the theatre of operations, it is desirable that a Red Cross representative be assigned to the supply section of the office of the surgeon, communications zone. SANITATION IN THE THEATRE OF OPERATIONS Definition. The term military sanitation when used in its broadest sense includes all measures employed to prevent or control infectious diseases, and to conserve the health or to maintain or increase the physical fitness of military personnel. The procedures, measures, or activities included in military sanitation may be classified as environmental sanitation, epidemiology, physical examinations and physical inspections, and personal hygiene. THE MEDICAL SERVICE OF A FIELD FORCE 869 Medical Department Responsibility. Generally, the Medical Department is responsible to higher authority for investigating, reporting upon, and triaking recommendations per- taining to all phases of military sanitation. Specifically, the Medical Department is charged with the supervision, in an inspectorial and advisory capacity, of environmental sanitation, with the conduct of epidemiological investigations or studies, with the per- formance of all physical examinations and inspections, and with studying and making recommendations pertaining to measures which will protect or promote the physical fitness of the individual soldier. Administrative Responsibility and Control. The administrative control of sanitation is exercised by organization commanders of all grades who are responsible for sanitation within their commands. Sanitary measures are executed by the personnel of the organiza- tion concerned or by special troops. Except in Medical Department organizations, Medi- cal Department personnel does not execute sanitary measures, other than those involving professional activities, such as physical examinations, immunizations or the operation of laboratories. Principal Factors in the Sanitation of a Theatre of Operations. The basic principles of sanitation in the theatre of operations are the same as those obtaining in the zone of the interior, but the methods employed in their application are modified by differences in the disease resisting characteristics of the personnel, by changes in environmental factors, by the nature of the military mission and operations, and by the facilities available. During the mobilization and training period in the zone of the interior, the control of infectious diseases introduced by cases or carriers entering the army from civil life and the rejection or elimination of the physically unfit by means of physical examinations and inspections are of paramount importance and constitute the principal features of military sanitation. A newly mobilized military force possesses a relatively high degree of group susceptibility to infectious diseases but, on the other hand, effective environmental sanita- tion as a means of controlling the spread of these diseases can be more easily maintained in the zone of the interior than in the theatre of operations. In a theatre of operations, the introduction of infection into a military force from out- side sources is minimized by the absence of extensive or numerous contacts between the troops and a civilian population. Further, troops in a theatre of operations may normally be expected to be more resistant to infection, especially some of the respiratory diseases, than recently mobilized men. Epidemics in mobilization and training camps have served to increase the group immunity to certain diseases by increasing the number who have had these diseases or who have had repeated contacts with sources of infection. The resistance of the group to all diseases is further augmented by the physical training inci- dent to military training and by the elimination of physical defectives. However, cases and carriers remain among the members of the forces and constitute sources of infection. Also, the more primitive environment in a theatre of operations,* and frequently the character of military operations, render it more difficult to protect the troops from en- vironmental sources of infection or to control or remove these environmental factors which serve to spread disease. Consequently, under the usual conditions, military sanitation in a theatre of operations is principally concerned with: first, the prevention of disease spreading from sources, such as cases or carriers within the military forces; and second, with environmental sanitation. Plan of Sanitation for a Theatre of Operations. Any complete plan for military opera- tions in a given theatre of operations includes provisions for protecting the health of the troops. A special war plan should, and usually does include a definite sanitation plan which provides for all sanitary measures of a general nature as well as for those special disease control procedures, the need for which can be anticipated. A plan of sanitation which forms a part of a special war plan is based on a study of health conditions existing in the theatre in question and of the character of the troops, with regard to the length of service and training, which will be sent to this particular theatre of operations. As the factors of health significance vary gready in importance in different theatres of operations, the special disease control procedures which may be provided for in different plans will likewise vary considerably. Thus, the season of the year, the nature of the 870 MILITARY MEDICAL MANUAL diseases that are epidemic or endemic among the civilian populations in a particular theatre, or troop movements which will result in abnormal crowding may necessitate the formulation of plans for special procedures to control a particular disease or groups of diseases. In one theatre it may be expected that respiratory diseases will predominate while in another an insect borne disease may be the most prevalent. Principal Features of Sanitation in a Theatre of Operations. Given a type theatre of operations, consisting of a communications zone divided into sections and a combat zone, the health problems presented in one portion of the theatre will differ to some ex- tent from those encountered in another part of the same theatre. Communications zone. The communications zone is primarily a zone of concentration and movement. If the zone is deep and troops must be transported for long distances by railroad, the crowding incident to troop movement in railway cars promotes the spread of diseases transmissible by contact and by lice. The evacuation from the combat zone of those sick with communicable diseases to- gether with the constant arrival of carriers and mild or early cases from the zone of the interior tends to concentrate sources of infection in the communications zone. In the base section of the communications zone the health conditions are similar to those of the zone of the interior. Conditions are usually sufficiently stable to permit the execu- tion of sanitary measures by agencies operating directly under the control of section headquarters, rather than by subordinate units. Thus, water supply systems of a perm- anent or semi-permanent character are usually installed and operated by the section engineers of the Engineer Corps. The operation of delousing facilities, waste disposal agencies or systems is a function of section headquarters or of organizations attached to those headquarters, and not of the individual units concentrated in or passing through the base section. Diseases transmissible by indirect contact, especially the respiratory diseases, constitute the most serious health problem in the typical base section. Troops arriving from the zone of the interior bring with them carriers and cases of disease which serve as sources of infection. The carriers may be chronic or temporary carriers of such diseases as diphtheria or epidemic meningitis. Mild cases which have not been isolated, cases in the incubationary stage, or missed cases among troops who have recently arrived in the theatre of operations frequently constitute sources from which epidemic disease may spread. The concentration of large numbers of troops in a base section, where housing facilities are frequently inadequate, will almost inevitably result in crowding. These conditions in the presence of sources of infection render it necessary that adequate measures be taken to control those diseases which are transmissible by indirect contact, such as the respiratory diseases. In the advanced section of a communications zone, the health problems encountered differ from those of the base section only in that the environmental sanitation must to a greater extent be accomplished by the units concerned. As a rule, the incidence of in- testinal diseases increases, due not only to a greater number of uncontrolled local agencies of transmission, particularly water supplies and food, but also to cases evacuated from the combat zone. The combat zone. In the combat zone the control of communicable diseases is ac- complished mainly by the early detection and evacuation of cases and carriers and by such control of transmission agencies as military operations will permit. Usually, the control of intestinal and insect-borne diseases present the greatest difficulty. The puri- fication of the water supply, either by Engineer Corps agencies or by the using organi- zations, protection of the food supply from contamination, and delousing where louse- borne diseases are present, are usually the most important of the measures employed to prevent the transmission of disease among the troops in the combat zone. Organization for Sanitation. General headquarters. The chief surgeon of a theatre of operations at GHQ formulates and recommends to the commanding general of the forces general policies pertaining to the prevention of disease and the conservation of health among the military personnel in the theatre of operations. If conditions are such that civilian populations are brought under military jurisdiction, the chief surgeon also prepares policies relative to such public health measures as may be required to protect the health of the civilian inhabitants. In a typical theatre of operations, the chief surgeon does not directly supervise the execution of disease control measures. He is concerned only with general policies and delegates to the lower echelons all Medical Department activities pertaining to the supervision or prosecution of sanitary measures under such policies. He coordinates sanitation in the combat zone and the communications zone through the GHQ staff and by contact with the army surgeon, or surgeons, and the surgeon, communications zone. The communications zone. The surgeon, communications zone, supervises and directs the sanitation of the communications zone. He has a medical inspector who, with his as- sistants, inspects and makes recommendations relative to all activities in the field of sanitation in the communications zone. In situations where the communications zone is divided into sections, the surgeon of the communications zone may, and as a rule does, delegate to the surgeon of the various sections responsibility for the immediate supervision of sanitation within their respective sections. He continues, however, to exercise general supervision over and to be respon- sible to the commanding general, communications zone, in a staff capacity, for the sanitation of the entire zone. The principal medical laboratory installations employed in the conduct of epidemio- logical studies and in the execution of disease control procedures are the medical general laboratory and the communications zone laboratories. Hospital center, general hospital, and station hospital laboratories, though primarily organized and equipped for clinical work, may also be employed in the conduct of analyses and studies connected with disease control, especially where such activities relate to commands served by these hospitals. The combat zone. The army surgeon, or surgeons, if the combat zone is occupied by two or more armies, under the chief surgeon, GHQ, through the staff and com- manding general of the army, supervises the sanitation of the combat zone. The army surgeon is direcdy concerned with all sanitation activities in the area occupied by the army. Corps and division surgeons are responsible for the supervision of sanitation within the commands to which they are assigned and the areas occupied by those com- mands in conformity with sanitary orders issued or policies promulgated by army head- quarters through corps or division headquarters. In a type army, sanitation of the army area is, to a large extent, supervised direcdy by army headquarters. To accomplish this function the army medical inspector and his assistants, under the army surgeon, make sanitary inspections, conduct epidemiology sur- veys or studies, or make such other investigations as may be required throughout the entire army area. They may also assist in or direct the health activities of the corps and divisions of the army, especially with regard to environmental sanitation. The laboratory facilities which the army surgeon has at his disposal for employment in the conduct of health measures consist of the army laboratory and the dispensary laboratories of the medical regiments. The laboratories of the evacuation and surgical hospitals, like the hospital laboratories of the communications zone, are organized and equipped for clinical work. They may, however, under unusual conditions, or more particularly where the commands they serve are directly concerned, be utilized for the performance of epidemiological work. Laboratories of the Theatre of Operations. The medical general laboratory and the army or communications zone laboratories are organized, staffed, and equipped pri- marily for the conduct of epidemiological studies and other laboratory functions pertaining to the control of communicable diseases. The medical general laboratory (T/0 8-610). The medical general laboratory is a fixed installation in the communications zone and operates under the direct control of the surgeon of the communications zone. There is normally but one medical general laboratory in a typical theatre of operations. As far as practicable, it is established permanently where adequate facilities for extensive laboratory work are available and at a point which is centrally located from a service viewpoint. Its principal function is THE MEDICAL SERVICE OF A FIELD FORCE 871 872 the general technical supervision of epidemiological work throughout the theatre of operations with a view to obtaining uniformity of methods and to establishing adequate control of disease, Specially trained individuals or groups may be sent from the Laboratory to various parts of the theatre of operations for the purpose of making epidemiological investigations or assisting in the control of some particularly difficult disease situation. MILITARY MEDICAL MANUAL 1 2 3 4 1 Unit Tech- nician grade General labora- tory Remarks 2 1 3 (»1 bl)c4 (“2 dl)'5 (»4 bl (1)e7 (»6 »l)i>8 ' 1 a May be Sanitary Corps. 4 b Veterinary Corps. 5 c Includes— 6 1 epidemiologist. 1 pathologist. 1 sanitary engineer (Sanitary Corps). 1 bacteriologist and pathologist with special training in laboratory examina- tion of food (Veterinary Corps). 7 8 20 9 1 10 11 (1) 1 12 3 1 scrologist. 1 bacteriologist—pathologist (Dental Corps). 1 chemist with special training in bio- 13 (1) (1) (1) 2 14 15 1G chemistry, water chemistry, and 17 Duty (566) (1) (1) 2 toxicology (may be Sanitary Corps). 18 Mess (824)... 1 bacteriologist—epidemiologist. 1 entomologist (may be Sanitary Corps). 1 May be Medical Administrative Corps'. 19 20 Dutv (566) (1) (1) 2 21 22 1 serologist (may be Sanitary Corps). 1 pathologist (photography and collec- tion of specimens). 1 bacteriologist (may be Sanitary Corps). 1 chemist (may be Sanitary Corps). 1 office executive (may be Medical Administrative Corps). 1 parasitologist (may be Sanitary Corps). rbacteriologist—pathologist, with special training in the laboratory examination of foods (Veterinary Corps). 28 (2) f 7 15 i 19 24 25 Technician, grade 31 Technician, grade 4 27 28 29 Private, first class. . 1 Private. J 20 l 29 (1) (1) (1) (2) (2) (2) (3) (1) (7) (8) (1) (7) (1) ((b 1)1 7) ((b2)mll) ((b2)15) (11) (9) 30 31 19 5 33 34 35 36 37 Cook (060) 4 Cook (060) 5 1 sanitary engineer (may be Sanitary Corps). 1 entomologist (may be Sanitary Corps) 1 serologist (may be Sanitary Corps). 3 bacteriologists (maybe Sanitary Corps). 1 supply and transportation officer (may be Medical Administrative Corps) Driver, light truck (345) 5 38 39 40 4 41 4 1 clinical pathologist. > Trained in bacteriology, i Trained in pathology. k Trained in serology. 42 43 44 45 Technician, laboratory (411) Technician, laboratory (411) Technician, laboratory (411).... 3 4 5 46 2 trained in medical biology. 1 trained in veterinary laboratory work. 47 101 1 trained in bacteriology. 1 trained in pathology. 48 127 49 6 50 1 1 1 trained in veterinary laboratory work. 51 52 i 1 trained in chemistry. 1 trained in dental bacteriology and pathology. The serial number symbol shown in paren- theses is an inseparable part of the specialist designation. A number below 500 refers to an occupational specialist whose qualification analysis is found in AR 615-26. A number above 500 refers to a military occupational specialist listed in Circulars Nos. 14 and 67, War Department, 1942. Plate 18. T/O 8-610, April 1, 1942. Medical General Laboratory. The Medical General Laboratory conducts research studies pertaining to disease con- trol problems encountered in the theatre of operations. It distributes pertinent technical literature on disease control and laboratory methods. It may also supply, and, where necessary, manufacture biological products of a special nature. THE MEDICAL SERVICE OF A FIELD FORCE 873 Medical laboratories Army or communications zone (T/O 8-611). (See Chapter IV.) The army or communications zone laboratories are classed as mobile installations. They are smaller than a medical general laboratory and can be more readily moved and re- established to meet the demands of changing military or disease situations. These laboratories are operated under the direct control of the surgeon, communications 1 2 3 4 5 6 7 1 Unit Cl> 05 H b£ fl .2 o *3 X! o rnipany headquarters S' B CJ w a o o 2 3 2 03 o Remarks E-* o Cl Eh w 2 »1 i 3 First lieutenant. .\ b 1 ( } a Medical Medical Corps, Administrative Corps, or Sanitary Corps. b Medical Administrative Corps. This company may be as- signed to any zone of the in- terior or theater of operation hospital of approximately 1,000 beds or larger, for such general duties as the com- manding officer may pre- 4 Second lieutenant/ i i 5 1 1 3 6 1 1 1 7 2 1 4 2 8 (1) (1) (2) (1) 4 (1) 9 (1) 10 (1) (1) 11 2 12 (2) 3 (4) 7 13 1 1 14 (1) (1) (6) 1 42 (1) 15 (3) 44 The serial number symbol shown in parentheses is an inseparable part of the spe- cialist designation. A num- ber below 500 refers to an oo- 16 17 Technician, grade 4| Technician, grade 5l,n<,ln<1in(, 11 1 2 Private, first class.. j 6 19 l 53 20 5 (1) (1) (1) (2) (2) (1) (1) (1) (2) (2) (1) (1) (1) (78) (11) cupational specialist whose qualification analysis is found 21 Cook (060).“ .'...I 4 (1) (1) 22 Cook (060) 5 23 above 500 refers to a military occupational specialist listed in Circular No. 14, War De- partment, 1942. 24 25 26 e (1) (1) 27 (1) 28 (39) (5) 29 (1) 30 15 50 115 7 31 16 51 118 7 T/0 8-117, April 1, 1942, is changed as follows: Line Column 1 7 10 Supply (821) aMedical Corps, Medical Administrative Corps, or Sanitary Corps. Plate 19. T/O 8-117, April 1, 1942, and Change No. 1. Medical Sanitary Company. zone, or direct control may be delegated to a section surgeon. If in an army area, they may be under the control of the army surgeon. An army or communications zone laboratory is primarily an epidemiological labora- tory, and its principal functions are the investigation of epidemic conditions and the 874 MILITARY MEDICAL MANUAL performance of routine laboratory analyses in connection with the control of com- municable diseases. Coordination of Sanitation Activities. The chain of responsibility for the technical supervision of all activities affecting the health of the troops in a theatre of operations passes from the chief surgeon at GHQ to the surgeon, communications zone, and from the chief surgeon to the army surgeons. If there are communications zone sections, each section surgeon is responsible to the surgeon of the communications zone. The divi- sion surgeons are responsible direedy to the army surgeon. The corps surgeons are responsible to the army surgeon for those activities which concern the corps troops, but they do not normally supervise the sanitation of divisions belonging to their corps. Administrative responsibility for sanitation coincides with command, and commanders of all grades are responsible to the commanders of the next higher echelon for sanitation within their commands, except that division commanders are normally responsible to the army commanders rather than to the corps commander. Military sanitation is accomplished by administrative action through the proper mili- tary authority, which is in turn based on the technical advice and recommendation of the surgeon of the command concerned. The surgeon of a command discharges his respon- sibility for the technical supervision of sanitation principally by recommendations to his commanding officer. These recommendations are based on the results of inspections or studies made by the surgeon or by such of his subordinates as the medical inspector, laboratory personnel, or the surgeons of subordinate commands. Administrative action is obtained by the issue of orders or instructions by the proper military headquarters. In the case of the small units, such as a division or a fixed in- stallation, all routine sanitation matters are usually provided for by a sanitary order issued by the commanding officer. The commander of such a unit, or his representative, may provide for special sanitary measures by special or administrative orders, circulars, or memoranda of instructions or by informal verbal or written instructions. In the higher echelons, such as the communications zone, sections of a communica- tions zone, or an army, action with regard to sanitation is normally controlled by means of circulars, bulletins, letters, Or memoranda of instructions issued to the lower echelons of the command concerned. CHAPTER VI TRAINING OF MEDICAL UNITS Purpose of Military Training. The ultimate purpose of all military training is the assurance of victory in war. Specifically, at this time, our objective is to defeat the Axis powers. Our army must be trained to do its job in an effective manner if it is to accomplish this result with the least possible losses to our country. Next to the actual conduct of active military operations, training is the greatest consideration of our army. The effectiveness of our fighting forces when they meet the enemy will depend upon the degree of our training. Attached medical personnel and Medical Department units must be prepared to sup- port the offensive spirit and actions of the armed forces. This is true not only for such organizations as medical regiments, medical battalions and medical detachments attached to subordinate units of the arms and services, but also for all medical estab- lishments extending from the combat zone into the zone of the interior. Units must be trained to function effectively in any type of war. The well trained medical unit will increase the offensive spirit by assuring the combat personnel of adequate medical service at all times. Therefore, the medical personnel like the troops of the combat forces must be trained to be aggressive, resolute, and thoroughly capable. This training begins in the replacement training centers. From the replacement training centers troops are sent to specialist schools and to units of the arms and services where these skilled individuals develop teamwork in the execution of military missions for the organizations which they serve. Finally, these medical organizations as part of units of the separate arms and services must be developed to serve divisions, army corps, and field armies. In this training they must develop teamwork with all the agencies of the ground forces, services of supply, and air forces. The basis of initial training is the individual, but the ulti- mate requirement is teamwork from the smallest unit to the largest. Analysis of the Training Process. Field Manual 21-5, Military Training, prescribes training doctrines, principles, methods, and management for all components of the Army. A point which stands out after study of this important document, is that the principles of training of individuals of each arm and service, and of each component of the Army of the United States is essentially identical. The qualities to be developed in the individual or unit are the same for all. Differences in training are confined to special subjects relating to tactical and technical proficiency. Medical Department soldiers like enlisted men of other arms and services must be good soldiers and they must have the same high standard of discipline; of health, strength and endurance; of morale, initiative and adaptability, and they must have the same fine leadership in order to produce the final goal of teamwor\. Pride in an individual’s organization and pride in his own small unit are desirable qualities which should be encouraged by officers. Such pride is engendered chiefly by the accomplishments of a unit and of individuals in the unit. It cannot be acquired by command. However, an officer may, and should, direct the attention of his men to the value of their organization to the military service. Recalling to the minds of the men the various experiences held in common by mem- bers of the unit is a valuable approach to pride in organization. Care must be taken that pride fostered in a unit does not degenerate into consider- ing the unit to be the only vital military organization. Each organization has certain particular duties, produced by its own special training. Each organization has a definite role to play in the functioning of the entire army. The interdependence of all units should be stressed by all officers. The war will be won by proper coordina- tion of all branches of the service. Pride must be directed in a manner which en- courages the conviction among the troops that every branch is equally important, and that their branch and their own units will not fail in their duties. Each unit must be placed in the proper perspective as regards the whole military service. MILITARY TRAINING ESTIMATE OF THE TRAINING SITUATION CLASSIFICATION Basic, Technical, and Tactical PRINCIPLES AND DOCTRINES (Of Arm or Service) TRAINING PROGRAM METHODS Lectures, conferences, demonstrations, group per- formance, and coach-and- pupil. TRAINING SCHEDULES STANDARDS (Condition, quality, performance) TRAINING OBJECTIVES (Time, facilities, instructors, students) TRAINING GUIDES (Instructors' guides) SIX STEPS (Mechanics) OF INSTRUCTION Preparation Application Explanation Examination Demonstration Discussion MASTER WEEKLY INSTRUCTIONAL AIDS Charts, movies, and public address system. DAILY ACTUAL INSTRUCTION (Character of training for the period of instruction) Conference Lecture Demonstration Application (practice) Examination Tactical test Oral Quiz Drill exercises Applicatory exercises Critique Command exercises Tactical rides Maneuvers Discussion (work by committee) EXPERIENCE MILITARY EFFICIENCY Plate 1. Elements of the Training Process. TRAINING OF MEDICAL UNITS 877 Responsibility and Direction of Training. Training management is a function of command and, therefore is the responsibility of every unit commander. The direction of training to secure uniformity and cooperation of effort is exercised through the es- tablished chain of command from the highest to the lowest headquarters. The announce- ment of policies and doctrines, assignment of training objectives, allotment of time and means and the promulgation of plans for the training of individuals and units are ac- complished through the medium of training orders. Training orders, issued as training directives, general orders, mobilization regulations, administrative letters and training circulars are usually issued by higher headquarters. Training programs and schedules embody the more detailed training plans of tactical commanders down to and including commanders of companies and similar units. The training plan results from the estimate of the training situation and is announced in training programs and schedules. TRAINING PROGRAMS AND SCHEDULES Estimate of the Training Situation. The higher headquarters prescribe the training objectives, allot the use of facilities to units in turn, and designate the periods for maneuvers and tactical exercises. The commander of a subordinate unit must make a careful analysis of the objectives to be met, the steps required to attain each objective, survey his own problem with reference to the existing state of training of his unit, determine the facilities which will be required, and make detailed plans for the best use of the time which is available to him to execute all his missions. The following factors are considered in an estimate of the training situation: 1. Mission (Training objective) (stated in directives of higher headquarters) 2. Essential subjects (given in MTP 8-1) (a) Basic (common to all soldiers) (b) Technical (specifically related to the particular unit) (c) Tactical (movement of the unit, inc. maneuvers) 3. Time available (from higher Hqs., first and last dates of training period) 4. Equipment and facilities available (instructional aids which are available, buildings and grounds which may be used) 5. Personnel available as instructors (an analysis of the officers who are to conduct training; their qualifications, military and civilian experience, temperaments, etc.) 6. Local conditions (a) Climate, (b) Terrain (an estimate of conditions and their effects on training) 7. Existing state of training (what military experience, or what civilian experience of military value have the men had?) 8. Organization for training (a breakdown of the unit into its component parts for specialized training according to particular functions to be performed) 9. Obstacles (a) Administrative (“housekeeping” duties which interfere with training of all personnel) such as— (b) Physical (lack of buildings and grounds) (c) Human (personal and emotional problems of officers and men, changes in environment of newly recruited men, various fears and misgivings.) After the commander has made the estimate and arrived at a plan he is ready to promulgate his plan in orders, and then which are issued as a training program in a schedule which may well include delegation to subordinate leaders the task of con- ducting phases of the training process. The next and final step is that of carrying out the plan by execution in which the commander must supervise the instruction given by others to make very certain that it is given correctly and that it will be completed satisfactorily within the available time. Training Program. The estimate of the training situation results in the development of the training program and the training schedules. There is no prescribed form for training programs. Every officer who prepares such a document must be guided by the training project for which the training program is provided. Completeness, logical 878 sequence, and clarity are the essential features of a good training program. The fol- lowing form is suggested for a medical unit: (also see FM 21-5). MILITARY MEDICAL MANUAL UNIT TRAINING PROGRAM 1. Place and Date of Issue with Introductory Remarks: Training Memorandum No. 1 (unit) (station) The following regulations governing the training of Co., Med. Bn. during the period to , are published for the information and guidance of all concerned. 2. Mission: A concise explanation of the training requirements and expectations, with a time limit set for attaining proficiency in the various subjects. 3. Scope of the Course: An explanation of the division of the course into basic, technical and tactical subjects with note of the approximate number of weeks to be devoted to each group of subjects. 4. Allotment of Time: A statement of the length and limits of the training day, the duration of the training hour, and the days on which training will be scheduled. 5. Subjects to be Taught: Taken from MTP 8-1 and slighdy modified as necessary to fit the situation of the particular unit. 6. Distribution of Training Duties: A listing of subjects with designation< by name of the officers assigned as instructors. Consideration must be given to the abilities and professional knowledge (military and civilian) of officers assigned to instruct. 7. Methods of Instruction to be Employed: The specific methods to be used should be designated and, in general, should be chiefly applicatory in character. Attention should be directed to training films and to types of examinations or quizzes to be given. 8. Coordination in Use rtf Training Facilities: A designation of any limitations imposed by higher authority in the use of particular facilities. Days and hours when facilities are available should be stated here. 9. Coordination of Training and Administrative Duties: Designate men who have had basic train- ing to carry on routine duties to relieve the new enlisted men from such duties until they have received the first two weeks of basic training. 10. Schools: A designation of schools for officers and for noncommissioned officers, with days and times for classes stated. 11. Plan for Training of Specialists: An announcement of the number of <“r lir—-1 men to be sent to the several army schools for training technicians, as well as specialist schools conducted by the unit itself. Designation should be made of the particular specialists to be trained. 12. Date effective: (date) order of Distribution: Master Schedules. Master schedules are submitted to the next higher commander for revision or approval. They are entirely tentative and must be so considered. The master schedule is merely a budget of hours issued in tabular form. It shows the training subjects, and hours for each subject allocated by training weeks. Of necessity, it is always based on the program of the next higher echelon. In preparing either the weekly or master schedules it is essential that certain prin- ciples be kept in mind. These are convenietnly listed as: 1. Continuity—indicating that certain subjects run continuously throughout the training period. Dismounted drill or first aid fall into this category. 2. Progressive training—refers to the slow and gradual building up of a unit in a given subject. Training starts with the simple and gradually leads to the complex. For instance, anatomy and physiology would be taught before splints, appliances and bandages. 3. Variation—means specifically the alternation of subjects in such a manner that the same general types of subjects do not follow each other too closely on the same day. For example, it would be poor policy to give calisthenics and drill in the early morning, litter drill in the late morning and a practice march on the afternoon of the same day. All of these require physical exertion. It is more desirable to intersperse classroom instruction and thus modify the days work. TRAINING OF MEDICAL UNITS 879 4. Decentralization—refers to the breakdown of training duties so that several in- structors participate. This serves to train more instructors, varies the type of instruction as given to the class and distributes the burden of training more equitably. A suggested form for preparing a master schedule is shown on Plate 2. Weekly Training Schedules. The weekly training schedule should be posted several days prior to the ensuing week of training. It prescribes the daily current training by subject, day and hour. It is derived originally from the master schedule and is issued by the commanding officer of the unit involved. Master Schedule of from — 19- — 1 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Remark* Week Ending Reserved for Superiors — Subject Total Hours — Plate 2. Sample Form for the Preparation of the Master Schedule. 880 MILITARY MEDICAL MANUAL Weekly schedules muse be approved by the next higher authority and may not be sub- sequently revised except on order of higher authority. A complete weekly schedule should be so arranged that those using it will have all necessary information. To achieve this end the weekly schedule should contain the following information: 1. What is to be taught 2. Who is to do the teaching 3. How will the instruction be conducted 4. When will the instructing be done 5. Where is the instruction to be held 6. What equipment is required 7. What text references are there For details required and a workable form see Plate 3. Other arrangements of the form may be made to fit the particular training problem and the subject taught. Training Schedule. Hq„ Prom (Date) to (Date) (Station) (Unit) (Date) Day and date Hours Personnel partici- pating Subject Place Officer or NCO in charge Uniform and equipment Text references, if any, including paragraphs Remarks From To Plate 3. Form for the Weekly Training Schedule. Training Guides. Experience indicates that in order to conduct training successfully, regulations and orders pertaining to the subject must be supplemented by “Training Guides” to cover each subject of training. Properly prepared training guides serve four distinct purposes: They assist in guiding inexperienced officers and noncommissioned officers. They direct and hold the attention of the instructor to the most important features of the subject. They insure the use of methods of training appropriate to the subject. They prescribe a definite training objective or standard of proficiency. Illustrative training guide. The following illustrates a training guide for instruction in individual equipment of the Medical Department: Training Guide No. Subject: Individual equipment. I. References: Field Manuals 21-5 and 21-100. Infantry Drill Regulations, FM 22-5, Pargaraph 241. II. Additional Data: The adjustment of equipment will be given constant attention by all officers and noncommissioned officers. Section leaders will be held responsible that each man of their section properly adjusts all equip- ment before each formation. The ability of soldiers to march reasonable distances without undue fatigue depends to a great extent upon the proper adjustment of equipment. Each individual will receive careful training in the assembling, use, and care of his personal equipment and the manner of displaying it for inspection. (See pamphlet included.) III. Analysis of Instruction. The early training will be by the group method. Later training by organizations by application and correction of errors. IV. Objectives: All individuals to know how to wear, carry, and use the various articles of equipment issued to them, how to adjust the same properly, how to care for and clean them under all probable conditions, and how to correctly display them for inspection. V. Inspections: 1. Inspector— a. Detachment (company) commander. 2. Methods of inspection— a. By quiz. b. By execution. c By observation. Instructors’ Guide. An instructors’ guide was published by the Medical Field Service School, Carlisle Barracks, Pennsylvania, September 1942, for the Medical Department Mobilization Training Program 8-1 which outlines the procedure of instruction for each instructional period shown in the MTP 8-1. It provides uniform training for the Medi- cal Department during the present emergency. The Fundamentals of Military Training. Every officer and enlisted man who plans, supervises, or conducts training must constantly bear in mind the following funda- mentals of military training (Field Manual 21-5, “Military Training,” Mobilization Regulations 3-1, Training Film 7-295, “Military Training”): That military training is but the application of common sense to military ends. There is little in military training that the average man cannot grasp if it is properly presented to him. That, as a rule, those under instruction come to the instructor with an open mind, anxious to accept instruction and ready to interest themselves in their new work. The example of keenness and enthusiasm in the instructor will be reflected by those under training. Half-hearted or leisurely methods will carry a heavy penalty later in battle. That the average man is more quickly and permanently impressed with a fact when it is taught to him as something which has a practical value. It is the instructor’s duty to make his pupils understand the practical battle value of the knowledge taught. That evidence to the student of satisfactory progress stimulates his interest and enthusiasm. Praise must be given where it is due, genuine effort encouraged, mistakes corrected by constructive criticism. TRAINING OF MEDICAL UNITS 881 Introduction. The success in reaching the standards provided by the training program will depend primarily on the care which is taken on the selection and training of in- structors. Knowledge of the subject is not alone sufficient. The programs of the special service schools are devised to instruct the students in “how to teach” as well as “what to teach.” The instructor must be able to arouse the student’s interest in his subject and then, by use of proper methods of instruction transmit the necessary knowledge to the student (paragraph 61, FM 21-5). Instructor. From time to time, in all phases of training, it is necessary for the unit commander to utilize most of his officers and noncommissioned officers as instructors, in order to complete the training program as planned. Instructing is one of the means by which leadership and initiative are developed. It is essential that the individuals selected as instructors either possess or develop the following personal and professional qualifications: (Section II, TM 1-1000). Personal. The instructor must be experienced in handling men. He must be a model of neatness in dress and cleanliness of person. He must have a personality that inspires confidence and stimulates interest. His manner must be pleasant but firm in dealing with students. He must have a keen interest in his subject. THE CONDUCT OF INSTRUCTION Plate 4. Display of Individual Equipment (newl. Dismounted, Medical Department. (To accompany Training Gkiide. See legend on opposite page) TRAINING OF MEDICAL UNITS 883 He must be sympathetic with the students problems and must be able to put himself mentally in the position of the student. His voice and speech should be pleasing, forceful and clear. He must possess the enthusiasm and cheerfulness of good health. He must be as courteous to classes as to his superiors. He must be able to exert self-control and patience in handling his students. Professional. He must have a complete knowledge of the subject to be taught, as well as closely related subjects. He should be able to plan instruction and must be competent to carry the plan into effect. This includes detailed work in securing supplies and equipment. He must be able to demonstrate successfully the subject which he is to teach. He must have a knowledge of proper instructional methods, and be able to apply them. This is meant to Include a definite aim, limited to a few fundamental points. It may include preparation of questions in advance in order to simulate the class and direct attention toward the vital facts presented. The instructor must always bear in mind the education, the age, and the physical condition of the student. The language used must be that which the student under- stands. Examples, comparisons, and contrasts cited must be within the student’s ex- perience. Training of Instructors. Regardless of the source of instructors, the officer responsible for the attainment of the training objective, for which the Instruction is to be given, is charged with the responsibility of preparing die instructors to teach the assigned subjects. Those who are deficient in the technique of their subject are brought up to standard. Coordination and uniformity of instruction must be assured by conferences and troop schools for instructors held prior to the commencement of training. The unit commander must verify the instructor's ability to teach and his knowledge of correct methods, as well his zeal and enthusiasm. In training instructors, they must be impressed with the importance of planning their work to make full use of the available time. They must assure themselves that all necessary equipment and such aids to instruct as are available are in proper con- dition before the period begins. Mechanism of Instruction. The process involved in teaching must be understood and mastered by the instructor. It applies in teaching a single lesson, a specific item of information or procedure, or an entire subject. It consists of: preparation by the in- structor, explanation, demonstration, application, examination, and discussion. Preparation by the Instructor. The instructor must have mastered the subject which he is to teach. He must analyze the subject and the schedule he is to follow, considering the purpose of the subject and the essential facts which must be taught. He must select 1. Instrument case and medical pouches; flaps underneath, tags and pencil pulled up. 2. Medical suspender: no spaoe between sus- pender and shelteihalf. 3. Two cantle straps and 2 litter carrying straps. 4. Raincoat. 8%" x 10" folded flush to edges of shelterh&lf. 5. Shelterh&lf and blanket. 6. Tent pins; begin 1" from pole. 7. Tent pole; end with nail toward Inspect- ing officer. 8. Shirt; flush to edges of shelterhfllf. 9. Drawers; half over shirt. 10. Handkerchief; to bottom edge and center of drawers. 11. Web pistol belt, first aid pouch. 12. Tent rope. 13. Canteen pouch. 14. Haversack; no space between it and sus- pender flaps. 15. Meat can cover, I" from handle. 16. Shoe laoes, neatly rolled. 17. Oanteen cud: line up with the outer edge of middle buckle and edge of canteen. 18. Meat can. knife, fork, and spoon, *‘TJ. S." up. handle l" from edge of haversack. 19. Toothpowder. 20. Socks, heels to left of Inspector, bottom of sock toward him, toes apart. 21. Shaving brush. 22. Shaving stick. 23. Raaor 24. Raaor blades. 25. Toothbrush. 26. Comb. 27. Soap. 28. Towel; fold extends to edge of haversack only. 29. Handaxe. 30. Canteen, line up with edge of haversack and edge of meat can. 31. Helmet. 32. Field ration. 33. Gas mask. I - Service Hat 2- Service cap 3- overcoa t,wO-D 4- 5- Uniform,W.O.D. S- .. . C.O.O. (summertime only) 7- clothes 8- O'coat. 9- Bag' 10- Shoes,heels to the Front 11- heels to the rront 12- Leather belt 1 und cmmnrs. woolen 2 on AWE ns, WOOLEN 3- SHIRTS. WOOLEN OD 4- TOWELS. OATH 5 SHEETS fy PILLOW CASES 6- SUITS. WORKING. CLEAN 7 ■ UN I FORM-COTTON —* CO HHM mow © o a Truckdriver (068) (246) (845) Motorcyclist (678) t This instruction applies especially to chauffeurs, motorcyclists, messengers, liaison agents, and any other Individuals of Medical Battalions or Regiments, as determined by the Commanding Officer. For other individuals, this time may be utilized for additional Instruction in any subjects. 900 MILITARY MEDICAL MANUAL Hours per week Subject References Total hrs. Basic train ing Technical, tactical, and logistical training 1 2 3 4 6 6 7 8 9 10 11 12 13 A. BASIC (1) Military courtesy and discipline FM 21-60, 21-100, 22-6, 26-5; AR 600-26, 600-365 and 616-290; AW 110; MCM; TF 11-157, and TF 11-235 6 4 2 (2) Personal hygiene, and first aid. Chs. 6 and 8-10, FM 21-100; FM 21-100. TM 8-220; FS 8-6, FS 8-7, FS 8-8, TF 8-33 and 8- 160 (40 min.); TF 8- 164 and 8-166 (30 min.) 5 4 1 (3) Equipment, clothing, and shelter tent pitching. Secs. I-V, FM 21-15; FM 22-6; AR 616-40; FS 8-24 9 4 4 1 (4) Individual de- fense against chemical attack. Secs. I-Y, FM 21-40; FM 21-45; FS 3-1, 3-2, 3-3, 3-4, 3-6, 3-6, 8-7; TM 3-206 , 3-215 , 8-220, 8-285; TC No. 3, W.D., 1942; TF 3-216, 3-217, 3-218, 8-304 6 2 4 (6) Individual de- fense against air, parachute, and mechaniz- ed attack. Sec. VII, Ch. 3, FM 25-10; pars. 245-262, FM 100-6; TF 6-146, 6- 146, 6-147, 6-148, and 5-149 (65 min.), TF 7- 35 , 7-109 (18 min.), TF 7-110 (7 min); FS 4- 2; TC 10, WD, 1940, TC 31, WD, 1941, TC 47, WD, 1941, TC 73, WD, 1941; FM 21-46 5 1 1 1 1 1 (6) Interior Guard Pars. 1-31, FM 26-6 3 1 1 1 (7) Dismounted Drill FM 22-6; TF 7-143, 7- 144 , 7-248 , 7-249; FS 7-23 29 6 6 2 2 2 2 2 2 1 1 1 1 1 (8) Marches and Bivouacs Ch. 8, FM 21-10, ch. S, FM 26-10, 21-26, chs. 9 and 10, FM 100-5; FS 4-2; TF 6-146, 6-147 45 4 8 3 3 4 4 4 4 4 4 3 (9) Physical training Chs. 1-3, FM 21-20; AR 605-110; TF 11-184 39 3 3 3 3 3 3 3 3 3 3 3 3 3 7. Detailed Programs TRAINING OF MEDICAL UNITS 901 Hours per week Subject References Total hrs. Basic train ing Technical, tactical, and logistical training 1 2 3 4 5 6 7 8 9 10 11 12 13 B. TECHNICAL (10) Hasty en- trenchments and shelter (camouflage) Secs. I, VIII, and IX FM 5-15; Secs. 1-4, F- M 5-20; TF 7-35 (30 min); FS 6-3 12 4 4 4 (11) Elementary anatomy and physiology Ch. 2, TM 8-220 21 3 3 3 4 4 4 (12) Nomenclature and care of organization equipment App MD Sup Cat; T/ BA 8, App I, II, and III; FM S-10' TM 8- 220 6 2 2 2 (13) Field medical records FM 8-45; Ch. 6, TM 8-220; AR 40-1025 5 1 2 2 (14) Treatment of gas casualties Ch. 7, TM 8-220; TM 3-205, TM 8-285; FM 21-40; TC No. 3 and 4, WD, 1942; FS 3-1; TF 8-304. 8 4 2 2 (15) Litter drill in- cluding ambu- lance loading and unloading; and passage of obstacles Chs. 3 and 4, FM 8- 35; FS 8-16; TF 8-33 10 2 2 2 2 2 (16) Field sanita- tion and sani- tary appliances FM 8-40; FM 21-10; Ch. 6, TM 8-220; FS 8-1 to 8-5; FS 8-9 to 8-12, incl. 20 1 3 2 2 4 4 4 (17) Materia Medica and Pharmacy TM 8-233; 8-220 12 4 3 3 2 (18) Medical and surgical nursing Ch. 4, TM 8-220; 8- 260; 8-500: FM 8-45; AR 40-1005; 40-1025, 40-590 16 1 1 2 4 2 2 2 2 (19) Heavy tent pitching. App 1, FM 8-5; Sec. VI, FM 21-16; FS 8-39 6 2 2 2 (20) Organization and function of the arms. Ch. 2, FM 4-5; Secs. I- IV FM 5-5; Secs. I and II, FM 6-5; App. II, FM 7-5; appropri- ate T/O’s; FM 8-10; 100-5; 101-6; 101-10; TF 7-236 9 1 3 3 2 (21) Organization and function of the medical unit. FM 8-5, FM 8-10, T/O 8-series 9 1 1 2 3 2 !22) Medical aid (splints and splinting; ban- dages and dressings). FM 8-50; Ch. 10, FM 21-10; Ch. 3, TM 8- 220; FS 8-7; 8-15; 8- 25 to 8-31 incl; 8-35 to 8-37 incl; TF 8-33* 8-150 60 2 7 5 6 7 8 8 5 6 4 2 902 MILITARY MEDICAL MANUAL Hours per week Subject References Total hrs. Basic train ing Technical, tactical, and logistical training 1 2 3 4 6 6 7 8 9 10 11 12 13 0. TACTICAL AND LOGISTICAL (23) Movement by motor (prac- tice in entruck- ing and de- trucking, only 2 hrs. daylight. 2 hrs. dark) Par. 190, FM 22-6; Sec. V, FM 25-10; Ch. 9, FM 100-6 4 • 2 2 (24) Movement by rail, entraining and detraining Sec. I, Ch. fi, TM 5- 400; 26-10; Sec. I, Ch. S, FM 100-10; AR 80- 910, 80-020, 80-946, W D Cir. No. 66, 1940 4 2 2 (26) Scouting and patrolling, use of cover and concealment Pars. 201, 206, 236, 281-233, and 286, FM 7-6; pars. 222 , 224, 231 and 232, FM 21-100; FM 30-30; FS 6-8; 6-10, TF 7-234; FM 21-46 a 3 8 (261) Map and aerial photograph reading* FM 21-26. 21-80; FM 21-26; FS 6-1; FS 5-2; TF 6-12, 7-238 16 (16)* 2 6 7 (27) Orientation in night combat* Par. 212, FM 7-6; pars 687-601, FM 1004S 14 (8)* 2 2 2 4* 3 2 4* 3* 2* (28) Communica- tions in com- bat* Ch. 8, FM 11-6; Chs. 2, 8, 6 and 6, FM 24-6; FS 11-1; TF 7-18 10 (6)* (29) Technical and tactical em- ployment of medical field units (Batta- lion and regi- mental medical detachments, medical batta- lions and regi- ments and/or similar regi- ments) t FM 6-20; 7-6; 8-5; 8 10, 8-60, 8-66, 21-10, 21-100, 22-6 , 25-10, 100- 6, 100-10; TM 6-400, 8220, 8260, 8286, 8 600, 12-260; FS 81, 8 3, 87, 89, 817 to 822, Inch, and 826 to 831 inch 96f (96)* 1 2 3 4 10 10 21 21 23 (80) Troop move- ments by motors* Ch. 3, FM 26-10: Ch. 9, FM 100-6 16 (16)* 8 8 (31) Inspections Sec. IV, FM 21-16; FM 7-6, 21-6; pars. 239- 242, FM 22-6; TM 10- 645; AR 40-206; AMB No. 28, Sid Edition 17 1 1 i 2 1 2 2 1 2 1 1 1 1 Open time (see par. Sb) 60 2 4 4 4 4 4 4 4 4 4 4 4 4 Total 672 44 44 44 44 44 44 44 44 44 44 44 44 44 NOTES *The time marked with parentheses ( )*, in the detailed programs, is available for training basic medical and surgical technicians! in professional subjects. See paragraph 8 for the scope of this 139 hours of instruction. t Technical and tactical employment of field units. The distribution of the 96 hours marked (f) in the Detailed Program is shown In the following table. Six of the training subjects in the table below are marked with an asterisk. The instruction in subjects so marked will be conducted concurrently by the various elements of the unit in which such subjects are common. TRAINING OF MEDICAL UNITS 903 Elements and Hours Head- quarters Training Subject Attached and Collect- Clear- Ambu- Profes- Medical Service ing ing lance sional 29(a) Functions and combat dispositions of sec- tions of headquarters and service, collecting, ambulance, or clearing elements 15 16 16 16 29(b) Reconnaissance, use of cover and con- cealment 10 10 10 10 10 29(c) ‘Collection and evacuation of casualties from the field (day and night) 29(d) ‘Ambulance driving shuttle (day and night) 29(e) ‘Ambulance driving convoy (day and 30 80 night) 29(f) ‘Nursing and ward management (see scope 16 of instruction for junior medical and surgical technicians) (95 hours) 30 96 29(g) “Transportation and supply requirements 16 29(h) ‘Procurement and issue of supplies 29(i) Selection and occupation of various sta- 15 tion sites, and the functioning of integral parts of station 29(j) Forward displacements and withdrawals 15 15 15 15 » during action 29(k) Operation of regimental and battalion 5 5 5 6 E dispensaries IS 29(1) Battalion or regimental training (field exercises) 20 20 20 20 20 Total 96 95 95 95 95 95 8. Technicians, Basic (medical or surgical) Hours, scope of instruction, and text references. See paragraph yc. subjects (26) to (30) inch for hours allotted. Subject Number of Hours Scope of Instruction References General 13 Responsibility for public property; Medical department property lists, issue, exchange and credit; patient’s property and effects; personal effects in case of death; care of linen (soiled and clean); special linen. Sec. in, Ch. 6, TM 8-220 Ward Management es Duties of ward masters; duties of ward attendants; ward discipline; prison wards; care of ward supplies, medicines, narcotics, whiskey and poison; isolation in care of communicable diseases; care of, and reports in connection with, seriously ill and insane; care of mail and telegrams. Structure and mechanism of ster- ilizers. Preparation of linens and instruments (for sterilizers) and their sterilization. Antisepsis and asepsis as applied in preparation of patients, surgeon and assistants. Ch. 4, TM 8-220 Care and treatment of patients 39 Admission and bathing of patients. Taking and recording pulse, temperature, and respiration; change in appearance of patients; bed making and changing of linens; use of urinals and bed pans; alcohol rubs; care of hair, njouth, and nails of patients; administra- tion of medicines, routine and special; ice bags, hot water bags, uses and cautions in placing them; enemas, all types, their composition, preparation, use and methods of administration. Ch. 4, TM 8-220 Diets 10 Care of dishes, set-up of trays, size of servings; diets, light, soft, liquid, regular, and special. Sec. IV, Ch. 6, TM 8-600 Ward records 12 Admission cards, and Medical Department 66-series forms. Inter-ward transfer cards, diet lists, ward morn- ing report, laundry lists; disposition roster, seriously ill roster; patients’ pass list; notice of death. Duty cases. Riling of all records. Sec. I, Ch. 8, TM 8-220 I'M 8-46 Total ISO 904 q. Dental Technicians, Basic (Chair Assistant) (For the periods, the ist-6th and nth-i3th weeks, inclusive see par. 7, Detailed Programs. Section II.) MILITARY MEDICAL MANUAL Hours per Week References Total 7 8 9 10 Hours BASIC Dismounted drill Pars. 114-168, PM 22-6 4 1 1 1 1 Physical training PM 21-20; AR 606-110 4 1 1 1 1 Inspections Pars. 239-242, FM 22-6 8 2 2 2 2 Total Basic 16 4 4 4 4 TECHNICAL Orientation of men in 2 2 general duties Anatomy and phys- Ch. 2, Sec. II, TM 8-220 12 6 6 iology Any standard text. TM 8-226. General care of a dental clinic Ch. 5, TM 8-226 10 6 4 Medical and dental Ch. 6, TM 8-220; Chs. IV. VII, TM 10 5 5 supplies and equip- ment 8-405 Oare of equipment and supplies Ch. 6, TM 8-220 10 6 4 Duties at the chair Ch. 6, TM 8-220 10 4 6 Clerical duties Ch. 0, TM 8-220; Chs. VI, X, TM 10 3 7 8-405 Diagnosis, dental first Ch. 3, Sec. II and Ch. 4, Sec. V, 8 6 2 aid, materia medica, and therapeutics TM 8-220; FM 8-35 Oral hygiene Ch. 5, Sec. VUI, Ch. 4, Sec. II, 6 4 2 Par. 206, Sec. V, TM 8-220, Ch. 5, TM 8-405 Transporting, setting Ch. 5 and 6, TM 8-220; Ch. VIII, 10 4 6 up and packing dental field equip- ment, MD Chest No. TM 8-406 60, and kits Steriization. dressings' Ch. 6, Sec. Ill, TM 8-226 6 3 8 and bandages Personal hygiene of Ch. 6, Sec. I, TM 8-226 6 1 3 2 dental personnel Practical test 40 10 30 Inspections and examin- ations 4 1 1 1 1 Total Technical 144 36 36 36 36 Open Time 16 4 4 4 4 Grand Total 176 44 44 44 44 TRAINING OF MEDICAL UNITS 905 io. Veterinary Technicians, Basic (For the Periods the ist*4th and nth-i3th weeks inclusive, see Par. 7, Detailed Programs Section II.) Hours per Week Subject References Total 5 6 7 8 9 10 Hours BASIC Dismounted drill Pars. 114-158, FM 22-5 6 1 1 1 1 1 1 Physical training Chs. 1-8, FM 21-20, AR 605-11® 6 1 1 1 1 1 1 Inspections Pars. 289-242, FM 22-6 12 2 2 2 2 2 2 Total Basic 24 4 4 4 4 4 4 TECHNICAL Elementary Anatomy Ch. 3, FM 25-5; Par. 4, AR 40-2260; 21 9 9 3 and Physiology appropriate text book Field Veterinary Sec. HI, AR 40-2246; FM 8-6; AR 40- 6 2 8 Records 2000 series Ambulance (animal) None 10 1 1 1 7 Loading and Un- loading Medical and Surgical FM 25-5; AR 40-208®; AR 40-2086; AR 16 8 8 Nursing (animals) 40-2090; AR 40-2095; AR 40-2125; AK 40-2136 Medical Aid (Splints Par. 137, FM 26-5 67 18 18 18 13 and Splinting; Bandages and Dressings) Technical and Tactical FM 8-5; FM 8-10; T/O 2-11; T/O 6-11; 97 14 16 34 33 Training (Veterinary Elements) T/O 8-89; FM 8-15; T/O 8-99 Total Technical 216 36 36 36 36 36 36 Open Time 24 4 4 4 4 4 4 Grand Total 264 44 44 44 44 44 44 (See Sec. IV, Chap. 3 for the instructors guide to this training.) 906 MILITARY MEDICAL MANUAL n. Sanitary Technicians, Basic (Junior) (For the periods ist through 4th, and 9th through 13th weeks, inclusive, see detailed program, Section II.) Subject Text References Total Hours Hours per Week 6 6 7 1 8 BASIC Dismounted drill Pars. 114-168, FM 22-8 4 1 1 1 1 Physical training Chs. 1-3, FM 21-20; AR 606-110 4 1 1 1 1 Inspections Pars. 239-242, FM 22-6 8 2 2 2 2 Total Basic 16 4 4 4 4 TECHNICAL Basic principles of Chs. 1-2, AMB 23; Ch. 1 and Sec. 1, Ch. 7 7 military sanitation 2, FM 8-40; Chs. 1-2, FM 21-10 • Control of Respiratory Chs. 3-4, AMB 23, Sec. H, Ch. 2, FM 8-40; 9 9 diseases, and hous- Ch. 3, FM 21-10 lng Pood-borne disease of Chs. 6, 8, 9, 10, 12, 18, AMB 23; Sec. Ill, 14 14 the intestinal tract Chs. 2, 6, 6, 7, FM 8-40; Secs. I, II, V, and mess sanitation VI, Ch. 4, FM 21-10 Water treatment and Chs. 6-7, AMB 23, Ch. 3, FM 8-40; Sec. Ill, 24 6 18 purification Ch. 4, FM 21-10 Disposal of wastes Chs. 13, 14, 16, 16, 17, AMB 23; Ch. 4, FM 34 18 16 8-40; Sec. IV, Ch. 4, FM 21-10 Insect-borne diseases Chs. 19 , 20 , 21, 22 , 23, AMB 23; Chs. 8, 28 20 8 and control of insects 9, 10, FM 8-40; Ch. 6, FM 21-10 Control of venereal Ch. 24, AMB 23; Sec. V, Ch. 2, FM 8-40; 3 » diseases Ch. 6, FM 21-10 Hass physical examina- Ch. 27, AMB 23; Ch. 13, FM 8-40 4 « tions and mass im- munizatlon Sanitary surveys, re- Ch. 26, AMB 23; Ch. 11, FM 8-40; Sec. II, 11 11 ports and orders Ch. 8, FM 21-10 Vital statistics Ch. 28, AMB 28; Ch. 16, FM 8-40 10 10 Total Technical 144 36 36 36 36 Open Time 16 4 4 4 4 Grand Total 176 1 44 1 44 1 44 1 44 TRAINING OF MEDICAL UNITS 907 12. Bandsman (021). (For the periods 1st and 2d, and nth-i3th weeks inclusive, see par. 7 Detailed Programs Section II.) SECTION III. PROGRAMS FOR COMMON SPECIALISTS’ TRAINING Subject References Total Hours Hours per Week 3 4 5 6 7 8 9 10 BASIC Dismounted drill Pars. 114-168, FM 22-6 8 1 1 1 1 1 1 1 1 Physical training Ohs. 1-3, FM 21-20; AR 605-110 8 1 1 1 1 1 1 1 1 Inspections Sec. IV, FM 21-16; pars. 239-242, 12 l 2 1 2 2 1 2 1 FM 22-6 Total Basic 28 3 4 3 4 4 3 4 3 TECHNICAL Field music Chs. I and II, FM 28-6 12 4 4 2 2 Military bugle music Ch. I, TM 20-250 152 15 14 21 20 20 21 20 21 Band training Ch. I, TM 20-250; Chs. 1 and 2, 20 < 4 4 4 2 2 FM 28-5 Bugler Ch. I, TM 20-260 28 10 10 2 2 2 2 Salutes and cere- AR 600-30 28 2 2 4 4 4 4 4 4 monies Messenger Chs. 2 and 3, FM 24-5 62 2 2 8 8 8 8 8 8 Total Technical 292 37 38 37 38 38 37 36 37 Open Time 32 4 4 4 4 4 4 4 4 Grand Total 352 ! 44 44 44 44 44 44 44 44 908 MILITARY MEDICAL MANUAL 13. Clerk (052) and (055) (For the periods 1st, 2d and nth, 12th, and 13th weeks. See par. 7 Detailed Programs, Section II.) — — Hours per Week Subject References Total 3 4 5 6 7 8 9 10 Hours BASIC Dismounted drill PM 22-5 8 1 1 1 1 1 1 1 1 Physical training PM 21-20; AR 605-110 8 1 1 1 1 1 1 1 1 Inspections PM 21-15, 22-6 12 1 2 1 2 2 1 2 1 Total basic 28 3 4 3 4 4 3 4 3 TECHNICAL Military correspondence, au- AR 040-5: (h. 20. TM 12-250: AR 14 4 6 6 thorized abbreviatons, filing 860-150: Ch. 10. TM 12-250: pp. 7-2:1: W.D. correspondence file Morning report AR 345-400; Ch. 6, TM 12-250 22 3 5 4 6 4 1 Service record AR 345-125; Ch. 4, TM 12-250 12 4 5 3 Payrolls, final statement, AT' .>5 5 20: AR :ui5 155: AR 46 22 4 6 3 6 5 allotments 476: Oh. 12 and 13, TM 12-250 Personnel records (discharges \R 34 5- and (115-seres: TM 12- 22 6 2 5 3 7 certificates, desertion, trans- ■0 letter \VD. 'GO 320 2 (10- fer, appointment and re- 30-40), Subject “Reorganization duction of N.C.O., rating of Army Personnel System” and disrating of spec, ists) and rosters (tro ! and duty) Property record and com AR 35-6520 to 35-6700; AR 40-1706 8 4 2 2 pany supply Charge sheets P. 233, App. 3, MCM 6 6 1 War Department publications AR 1-10, 1-16; AR 310-50; TM 12-260 10 5 2 3 and Army Regulations Medical Department reports AR 40-1025 ; 40-1080; AR 345-416; 18 8 5 6 B (sick and wounded. Mati«- tical, daily sick report, death report) AR 000-660 Comp an y funds and collec- AR 210-60; TM 12-260 6 8 8 tion sheet Typing (applicatory) Standard text 152 22 16 22 16 21 17 21 17 Total technical 292 37 30 37 36 36 37 36 37 Open time 32 4 4 4 4 4 4 T T Grand total ■ 352 44 44 44 44 44 44 44 44 TRAINING OF MEDICAL UNITS 909 14. Supply Sergeant, Receiving and Shipping Clerk (186). All the individuals will for the first 2 weeks receive the same basic instructions. Sec Detailed Programs, par. 1, Section II. Training for the nth-i3th weeks is to be in addition to, and after com- pletion of, course of instruction (3d through 10th weeks, inclusive) of clerk (055). See detailed program for clerk (055) and (052). Subject Inferences Total Hours Hours per Week 11 12 18 BASIC Dismounted drill Pars. 114-168, PM 22-6 1 1 Physical training Chs. 1-3, PM 21-20; AR 606-110 8 1 1 1 Inspections Sec. IV, I'M 21-15; pars. 239-242, PM 22-5 2 1 1 Total basic 6 2 3 1 TECHNICAL Supply and equipment rec- Ch. 11, TM 12-260 22 22 ords, requisitions and- transfer Care, handling and storage Secs. Ill, IV, and Y, TM 10-260 10 10 of property Organizational property T/BA 8 8 8 Med. Dept, instruments and MD Sup. Cat.; T/BA 8 36 86 equipment Preparation of Med. Dept. MD Sup. Cat.; T/BA 8 16 lfl requisitions Vehicles T/BA 8 7 7 Unserviceable property Ch. Ji, TM 12-260 8 4 4 Property records Ch. 11, TM 12-260 8 8 Total technical 114 38 37 89 Open time 12 4 4 4 Grand total 132 44 44 44 910 MILITARY MEDICAL MANUAL 15. Mess Sergeant (124) and Cook (060) (All individuals for the first 2 weeks will receive the same basic instruction. See par. 7, Detailed Programs, Section II. Practical cooking (7th to 13th weeks) and preliminary instruction (3d to 6th weeks) are mutually interchangeable at times.) References Total Hours Hours per Week 3 4 6 6 7 8 9 10 11 12 13 BASIC (all Individuals) 4 2 2 2 2 2 2 2 2 2 2 2 Dismounted drill Physical training Inspections Pars. 114-168, FM 22-6 Ch. 1-3, FM 21-20; AR 605- 110 Pars. 239-242, FM 22-6 11 11 22 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 Total Basic 44 4 4 4 4 4 4 4 4 4 4 4 TECHNICAL — Cook, general duties; mess sanitation TM 10-406; AR 40-206 8 8 Care ol all kinds of food TM 10-406 8 8 Preparation (cooking and baking) of vari- ous kinds of food: nutrition TM 10-405; TM 10-410 64 20 24 20 Meat cutting TM 10-406 16 8 8 Mess management; men- us; accounts; all types of rations TM 10-406; AR 30-2210 24 4 8 12 Field cooking TM 10-406 16 16 Messing on trains and transports Practical cooking TM 10-406; Cir. 66 and 63, WD, 1940; Cir. 39, WD, 1941 8 164" 8 28 28 28 20 20 20 20 Field exercises, marches, camps Ch. 8, FM 21-10; Chs. 9 and 10, FM 100-6; Ch. 8, FM 26-10 88 8 8 8 16 16 16 16 Total Technical 396 36 36 36 36 36 36 36 36 36 36 36 Open Time 44 4 4 4 4 4 4 4 4 4 4 4 Grand Total 484 44 44 44 44 44 44 44 44 44 44 44 TRAINING OF MEDICAL UNITS 911 16. Truckmaster (068), Foreman Mechanic (086) and Automobile Mechanic (014). (All individuals for the first 2 weeks will receive the same basic instruction). (See par. 7, Detailed Programs, Section II). Subject References Total Hours Hours per Week 3 4 5 6 7 8 9 10 11 12 13 BASIC Dismounted drill Physical training Inspections Pars. 114-158, FM 22-5 Chs. 1-3, FM 21-20; AR 605-110 Pars. 230-242, FM 22-5; TM 10-545 11 11 22 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 44 1 1 2 44 1 1 2 44 Total Basic 44 4 4 4 4 4 4 4 4 4 4 4 TECHNICAL Occupational: Automobile repair tools FM 25-10 8 4 4 Maintenance methods AR 850-15 4 2 2 Motor terminology, units and assemblies Secs. II, VIII, and IX, TM 10-510; FS 10-43 36 12 12 12 Vehicle Inspection TM 10-545 24 4 4 4 4 4 4 Driver maintenance Ch. 5, FM 25-10 36 8 8 10 10 Second echelon mainte- nance TM 10-510, 10-515, 10-540, 10-550, 10-565, 10-570, 10- 680, 10-586; FM 25-10 252 6 6 10 22 32 32 36 36 24 24 24 Company repair equip- ment T/BA 8 86 12 12 12 Total Tecbi leal 386 36 36 86 36 36 36 36 36 36 36 86 Open Time 44 4 4 4 4 4 4 4 4 4 4 4 Grand Total 484 44 44 44 44 44 44 44 44 44 44 44 912 MILITARY MEDICAL MANUAL 17. TrUCKDRIVER (245) AND MOTORCYCLIST (678). (For the periods the is*. 2d, and 7th-i3th weeks inclusive, see par. 7, Detailed programs, Section II.) Subject References Total Hours Hours per Week 3 4 5 6 BASIC Dismounted drill Pars. 114-16®, FM 22-6 4 1 1 1 1 Physical training FM 21-20" AR 605-110 4 1 1 1 1 inspections Pars. 239-242, FM 22-5 8 2 2 2 2 Total Basic 16 4 4 4 4 TECHNICAL Starting engines FM 25-10; TM 10-510, 10-560 2 2 Shifting gears FM 26-10; TM 10-510, 10-585 2 2 Driving Ch. 2, FM 25-10 40 8 8 8 16 Brakes and braking FM 25-10; TM 10-610; 10-566; AR 860-15 4 4 Traffic rules Ch. 2, FM 25-10 8 2 2 2 2 Speci al instruction, AR 850-15; Ch. 3, FM 25-10; FS 10-43 4 2 2 safe driving Lubrication TM 10-540 4 * 4 Convoy operations Ch. 8, FM 26-10 40 10 16 14 Care of vehicles TM 10-610, 10-515; FM 25-10; FS 10-38 32 8 8 8 8 Trouble shooting TM 10-550, 10-680 8 2 6 Total Technical 144 36 36 36 36 Open Time 16 4 4 4 4 Grand Total 176 44 44 44 44 CHAPTER VII PLANS AND ORDERS (THE SOLUTION OF THE MEDICAL PROBLEM) Introduction. Control of a military unit by its commander is exercised by means of orders. Capacity to announce sound tactical decisions and plans in the form of orders is an essential element in the art of troop leading. (See Chapter VII, “Leadership,” Part I.) The commander must depend upon subordinates for the execution of his orders. Hence, the subordinates must be informed of their tasks and missions in such clear and unmistakable terms that misunderstanding is eliminated. A Chinese proverb has it that “an order which can be misunderstood will be misunderstood.” Battles have been lost by faulty orders just as they have been lost by faulty decisions. The officer who succeeds in command of troops in battle or campaign must acquire adeptness in this art. This chapter deals with the processes by which the medical officer may reach sound and logical decisions as to the accomplishment of his missions, and how he may translate his decision and plans into orders to carry them into execution. The medical officer faces problems of decision and of planning in the same degree and for the same reasons as his brother of the arms. If his assignment places him within the infantry or cavalry division he will exercise command of medical troops who will be organized into detachments attached to the subordinate units of the division, or he will be with the medical battalion, or squadron as the case may be. Whatever his assign- ment he must seek and obtain information about the proposed operation of the troops for which he is to provide medical support, he must estimate and analyze the situation which confronts him; he must arrive at a decision and make a plan for its execution; finally, he must transmit his decision and plan to the subordinates who are to execute it or assist him in its execution. It is a difficult task. Mistakes or omissions cannot always be quickly corrected or adjusted. Within the Army time-proven procedures have been developed as a guide in acquiring this necessary ability. But they must serve only as a guide because each situation in battle will present its own special requirements which may vary widely from preconceived notions. Medical officers must learn these essential troop-leading procedures in order that they may carry out their humanitarian missions with the smooth and certain execution which efficiency dictates. The Medical Mission. The specific mission for medical troops is rarely included in the commander’s orders incident to the conduct of battle or other military operations. In general, the mission of the Medical Department is to provide continuous medical service for the troops supported under all situations. The mission of the combat troops influences the general type of the medical operation. For this reason, the medical mission is stated specifically in conformity with the operations in which the troops sup- ported are engaged, e.g. “To provide medical support for the division (regiment) in an enveloping attack.” In making plans or recommendations, the specific medical mission must always be paramount. The Surgeon’s Recommendation, or Medical Plan. An important function of all staff officers is the preparation of plans for proposed operations. These plans elaborate the commander’s directive and supply the major details necessary to carry out the operation. Planning of transportation, supply, and evacuation is initiated at a G-4 conference at which the commander’s directive is announced. Time may be allowed for the staff officers to make reconnaissances and secure any other information necessary to formu- late their recommendations. These recommendations are submitted at the final G-4 conference, where each staff officer submits a plan for the employment of his particular unit. When the plans are coordinated and any conflicts such as locations, traffic cir- culation, and methods of employment are adjusted, G-4 approves the recommendations. Pertinent extracts of the approved plans are published in the administrative order or annex and distributed to all units concerned. The division surgeon is a member of the division special staff. He is responsible for submitting the medical plan at the G-4 conference. Many of the details for the medical 914 MILITARY MEDICAL MANUAL plan may be supplied by the medical battalion commander or he may actually prepare the plan. In either case the policies of the division surgeon will greatly influence the tactical employment and disposition of the medical battalion. Division S.O.P. will often establish the onus of responsibility between the division surgeon and the com- manding officer of the medical battalion for the actual labor of preparation of the de- tailed medical plan. The battalion surgeon is likewise a member of the infantry battalion staff, and as a staff officer is responsible for submitting recommendations for the employment of the medical section of the infantry battalion. In this instance the medical plan is brief and simple and may contain only the recommendation for the location of the battalion aid station. This recommendation is submitted to the infantry battalion commander or the executive officer for approval. The mechanics of making an estimate of the situation involves no more than the adop- tion of a logical process of thought. It is the negation of “snap” judgment. It is an attempt to insure consideration of all the factors. While it may not, in fact, produce in all cases the “best” solution, it should provide a “workable” solution, at the least, provided always that the officer making the estimate has the requisite training and exercises sound judgment. In its application it may be oral or written, brief or lengthy, completed in a brief period or require considerable time for its completion. War plans for the defense of the nation against potential threats to our peace and safety, for example, are developed continuously and perhaps may never be said to be completed. It requires the ultimate degree of pains- taking, time-consuming care. On the other hand, a commander in battle “lives” with the situation and attempts to foresee all of the hostile capabilities, and in the exercise of this foresight he devises tentative plans to meet them. Under these conditions a commander may announce his decision and plans with only momentary delay after the occurrence of an event which requires a decision. The time consumed to make the estimate may be said to “float” between these wide limits, but the commander of troops in battle will rarely have more than a bare minimum of time for this exclusive purpose. He must use fore- sight to gain the required time. Since Time is dominant in war the commander is faced continually with the two ever-conflicting requirements: First, a succession of sound decisions is necessary for success; second, the substance of his decisions and plans must reach the subordinate commanders in the form of orders in time to be applied. There is no open road to the development of logical processes of thought. Educators have striven with the problem for centuries with results which they would not claim to be entirely adequate to the need. It is not a simple problem. The ability to reason, analyze, and decide must be present, or all mechanical aids will fail, however adequate or useful they may be in other hands. The form reproduced below for the use of medical officers in the solution of their own tactical problems is a guide, an aid, and ex- perience indicates that it is a useful one. Its use in training to develop proficiency should serve to fix in the mind of the student a sequence of reasoning which may be followed with confidence to arrive at a decision involving the use of medical means. It serves only to stress the important factors. It can be followed in any given situation only in so far as it is practicable. THE ESTIMATE OF THE SITUATION 1. MISSION.—State the mission assigned by higher authority or deduced from in- structions from that source. Note: The mission is the governing element in every plan. It must never be disregarded. While it is true that a medical mission invariably includes the provision of some phase, or phases of medical service, the adaptation of the medical service to tactical requirements is definitely a part of the medical mission. For example, a mission “to provide medical support for the division in a night withdrawal” imposes quite different limitations upon a plan than a mission “to provide medical support for the division in defense of a position.” 2. SITUATION. a. Elements of the situation. (1) Enemy capabilities. List the capabilities of the enemy for influencing the medical problem through: FORM FOR A MEDICAL ESTIMATE OF THE SITUATION (a) Strength. (b) Position. (c) Weapons. (d) Casualty producing agents. (e) Air action. (f) Training. (g) Other means. (2) Own situation. (a) Plan of Commander. State so much of the tactical plan of your commander as may influence the medical problem. (b) Strength. An index of the number of casualties to be expected. (c) Position. The position of our troops from the point of view of providing shelter, cover, etc. (d) Movement. The probable extent, direction and rate of movement of the whole force or any major component thereof. (e) Any other elements in own situation that may affect the medical service. Note: Tables of Organization give the authorized strength of units. In map problems, unless it is stated otherwise, or there are factors present which specifically require special computation of strength, it can be assumed that all units are at war strength. (3) Physical factors. (a) Terrain. List the terrain features that may influence the medical service either in the number of casualties or in their collection and evacuation, e.g.t cover, shelter, etc. (b) Communications. Consider the condition, availability, practicability and re- strictions imposed by higher authority on roads, railroads, water routes, or other routes of communication as they affect the medical problem. (c) Weather. Present and predicted weather, including moonlight if that be a factor in the medical problem. (d) Other physical factors that should be considered. (4) Supply. Amount and availability of supplies, sources of replenishment, and difficulties of supply distribution. (5) Physical condition of command. Poor physical condition will multiply the number of casualties requiring evacuation during combat. Physical conditions may be affected by the origin of troops (urban or rural), presence of communicable diseases, food supply, water supply, proper clothing, fatigue, training, and many other factors. (6) Combat experience and morale are also governing factors. b. Analysis of situation. Analyze the elements in subparagraph a balancing the favorable against the unfavorable. This should include a discussion of the probable enemy reaction to our scheme of maneuver and the final disposition and location of the forces as a result of the action. Note: A thorough understanding of the mission of the command and knowledge of the de- cision of the force commander is essential in making a medical estimate. The purpose of considering the tactical plan first in the estimate is to establish early the tacdcal basis of the medical task to be accomplished. Sufficient information regarding the combat strength and dis- position of the enemy is usually available to the end that his probable reaction in reference to time and to contemplatad action can be deduced. Only by full consideration and complete understanding of the tactical1 maneuver in all of its phases can the requirements in terms of medical service be planned for and provided as the action ensues. (1) Estimated number and probable distribution of casualties. Estimate and record by localities the approximate number and type of casualties to be expected. This is a product of the combined influences of relative strength, enemy capabilities, own scheme of maneuver, physical, factors, morale and physical condition upon expectation shown in experience tables. (See Army Medical Bulletin No. 24, for casualty estimates). (2) Areas of casualty density. From an analysis of the scheme of maneuver and the probable enemy reaction, locate approximately the areas where the greatest number of casualties can be expected, together with the approximate time of their incidence. Note: In estimating the number and location of casualties all of the factors enumerated must be considered. Relative fire power and its effect upon casualty expectation, terrain features PLANS AND ORDERS 915 916 MILITARY MEDICAL MANUAL favoring the effectiveness of enemy fire, and the effect and its extent on the casualty rate that any special advantages of our own force will have in offsetting the effectiveness of enemy fire should be considered here. The greatest number of casualties will ordinarily occur in those areas where the main or decisive effort is made. The units making the decisive effort, together with the loca- tion where it will occur, are usually mentioned in map problems or can be deduced from a study of the scheme of maneuver. In the attack, these areas arc extended into the hostile position. In all units a study of the terrain, coupled with the location of enemy weapons is essential in locating areas where enemy fire will be most effective and will, therefore, produce the most casualties. These areas are known as areas of casualty density. (3) Available medical means. (a) Organic medical means. State the current status of the available medical means and its capabilities for further effort. Consider the following factors: The nu- merical strength and composition of the unit; the morale, physical condition and state of training; the condition of its equipment, including transportation; time and space factors in relation to its availability to the medical task. (b) Medical support. Evacuation and other medical support by higher echelons not under control of own unit. 3. PLANS. a. Possible plans. Under (1), (2) list all workable plans for a satisfactory medical support for the operation. Practicable plans should include those which may re- quire an augmentation of means for their operation. One or more basic plans may have variants that can be stated in sub-paragraphs of the paragraph giving the basic plan. b. Analyses of plans. Determine the practicability and weigh the advantages and disadvantages of each plan listed. Do not discard a practicable plan requiring an aug- mentation of means until it is certain that no reinforcements will be available. Note: In studying any situation, two or more possible plans will present themselves. In order to select the best plan, a comparison of their values through the process of weighing the ad- vantages and disadvantages of each against all others must be made. These plans must not only be practicable from a medical standpoint but also must be acceptable tactically and logistically. It is neither necessary nor desirable to discuss the minute details of any plan. The basic factors should be stated and discussed. In the division these will usually be restricted to the use of collecting and clearing units or to the location of aid station sites; in the corps, to the location of clearing stations; and in the army, to the movements of and the location of evacuation and surgical hospitals and medical regiments. Medical doctrines, principles of employment of medical units, and time and space factors, are all important items to be considered in the study of each plan in this paragraph. The discussion of the various plans should be so complete and logical that the best plan will be by contrast an easy choice. A satisfactory plan should be simple, comprehensive, and flexible. 4. DECISION.—A statement in concise terms of the best possible plan. Note: The decision should be the final result of the discussion in paragraph 3. The con- clusion arrived at by this process of reasoning is analogous to the basic decision of a commander and should include what, when, and where the task will be done. It forms the nucleus for the addition of any supplemental decisions necessary to complete the details of a complete plan. These supplemental decisions can often be made by the staff of the commander, if he so delegates authority. Situations will occur when, due to lack of information, all of the elements of what, when, and where the task will be done cannot be supplied—when this occurs the estimates should terminate with a conclusion only as complete as the situation at the specified time warrants. The scope of the conclusions, which is warranted by the situation must be determined in each case by the student. Abbreviated Estimate of the Situation. When a decision must be reached rapidly, time will not be available for a complete written estimate of the situation. Neverthe- less, it is imperative that the outline be followed mentally in the sequence described. Once an officer has schooled himself in the use of the complete form he will be able to select the most important considerations and arrive at a sound conclusion without a complete discussion or consideration of all the factors shown. A running estimate, constantly revised as events transpire, results in conclusions which are evolved element by element. The medical estimate will usually fall in this category in practice, as a planned medical service must be furnished a command continuously from the creation of the unit until its final dissolution. PLANS AND ORDERS 917 The basic plan for medical service is an essential part of the development of the esti- mate of the situation. Peculiar to the Medical Department and the other services, before orders for the employment of their units can be issued, those parts of their plans liable to interfere with plans of the other services or the arms and those that will be of interest to the command as a whole are submitted in the form of recommendations, as previously discussed, to the commander or his representative for approval. The medical plan covers the recommendations for the employment of the unit as a whole. As an example the plan for the medical battalion will state the location of the collecting station or stations, the location of the clearing station, the location of the battalion command post and the headquarters detachment. The unit plan is based on the medical plan and contains all details necessary for the operation of a subordinate unit. Each unit plan is prepared by the commander of the subordinate unit. This preparation is a command function and the unit plan does not ordinarily require approval of higher authority. The material contained in the unit plan is information that appears in paragraphs 2, 3, 4 and 5 of a written field order. As an example the collecting station site and the ambulance routes to be used will be stated in the medical plan. From this information the collecting company com- mander developes the unit plan for the operation of the collecting company. This may include such details as: the arrangement of the various departments of the station at the site given, the distribution of the litter bearer squads, routes to be used as well as the method of litter evacuation, and the details for operation of the ambulance section such as location of relay posts in the shuttle, and the location of the basic relay post and the command post of the ambulance section. The commander cannot be expected to handle personally the innumerable details which constantly beset each unit in combat. The principal reason surgeons of higher echelons are furnished a staff is to relieve them of the burden of these details, which if given full attention would divert them from their prin- cipal responsibility, which is the supervision of the operation of the unit medical service. The impression should not be gained that a long period of time will elapse before orders for action can be issued. In instances where necessary, fragmentary orders will be issued as soon as parts of the plan are formulated and coordinated. Warning orders to sub- ordinates should be issued early during the preparation of plans as this action saves time and will provide a general basis for the receipt of subsequent detailed orders. The ideal is that medical troops will never be delayed in accomplishing their part of the medical task by the absence of orders. THE UNIT PLAN Purpose. Control of any military organization in battle or campaign is exercised through the medium of orders. An order is defined as the will of the commander con- veyed to his subordinates. The contents of an order result, in principle, from the estimate of the situation which culminates in a decision and basic plan which, in turn, is followed by the development of supplemental or detailed plans. Hence, the “order” is merely the medium by which the contents of the detailed plan are communicated to the subordinates who will execute it. This does not mean that all orders are pre- ceded by this complete process, since many orders involve supplementary or incidental instructions or administrative routine. It would be difficult to overemphasize the im- portance of clearly expressed, simply worded, grammatically sound phraseology. The novice in the art sometimes becomes unduly impressed with a need for "canned” language, or for the "telegraphic” style that omits, in order to obtain brevity, words which may be essential for understanding. The use of well-understood terms, of short, clear expressions, the avoidance of complex sentences, of brevity itself, are each im- portant, but none are so important as clarity so that the subordinate who reads or hears the order will have no opportunity to misunderstand his mission. The subject is es- pecially important to the medical officer on duty with troops in the field. He must be able to understand the orders which he will receive, and he must be able to issue the necessary orders to his subordinates in the exercise of his command function. The state of training of subordinate commanders has a direct bearing upon the extent to which ORDERS 918 MILITARY MEDICAL MANUAL details of execution must be prescribed in orders; this important factor must be constantly considered. The ideal order is one that allows of no misunderstanding. Classification. Orders may be divided into two general classes: routine orders and combat orders. Routine orders concern camp or garrison activities or administration, i.e., general orders, courts-martial orders, bulletins, circulars, and memoranda. Combat orders are those pertaining to operations in the field. They are classified as follows: Letters of instruction. Field orders. Administrative orders. Letters of instruction. Letters of instruction are issued by higher commanders, or the War Department, prescribing operations over large areas and for a considerable period of time. They deal with the broader phases of operations and are generally confined to stating the mission and the part each major unit is to play in its accomplishment. They are usually secret and the information contained is not for general distribution. Field orders. Field orders are issued by a commander setting forth the military situation, the tactical mission and the plan of action decided upon, and such details as to the method of execution as will insure coordinated action by the whole command. They are designed to bring about a course of action, in accordance with the intention of the leader, which is suited to the particular situation and with the purpose of attain- ing full cooperation between all elements of the force. Field orders may (1) direct operations, or (2) warn of impending operations (warning orders). A warning order is a field order issued as a preliminary to an order which is to follow. Its object is to give advance information in order that subordinates can make timely arrangements to facili- tate the carrying out of the order which is to follow. In the medical service, especially in the higher echelon units, their use is extremely important to proper functioning, due to the initial location of units usually far to the rear of the combat forces and the relative immobility of the larger medical installations. Administrative orders. Administrative orders are used to announce to the command the administrative, supply, and evacuation details which are of interest to the command as a whole. In the division, the administrative order is prepared by G-4, in cooperation with G-l. Preparation of Combat Orders. Scope. Combat orders announce the situation, state the purpose of the commander, and define the task that each next subordinate unit is to perform in the execution of this purpose. As combat orders are the expression of a fixed decision they must state definitely the end in view. Combat orders should not attempt to arrange matters too far in advance as this may lead to their recall and substi- tution. Such action lessens confidence in the commander, injures morale and is apt to impose unnecessary hardships on the command. Combat orders of an army recite the decision of the commander and assign the task each corps or other subordinate unit is to perform in carrying out the decision. Similarly, combat orders of corps assign the tasks of divisions, those of the division the task of regiments. Combat orders of the medical battalion assign the tasks of the separate companies. The orders of the surgeon of an infantry battalion assign tasks to the various groups or individuals of the battalion medical section. Details of technique. (1) Purpose. Technique has only one object and that is to further the purpose of the combat order. It has no value or importance except as it accomplishes this object. It should never be degraded into a burden nor furnish an ex- cuse for delay in the issuance of orders. (2) Amount of detail. A complete order always contains three essential com- ponents: the situation, the mission of the command, and instructions regarding execution. The commander informs his subordinates, to the extent useful to them, of the situation of the enemy and friendly troops. The amount of detail in an order depends upon the composition, size, training of the force, the time available, the situation, and on the per- sonality of the one issuing it and of those who are to receive it. The larger the force the more general will be the order. An order for a small or untrained unit will require more detail. When the transmission of orders involves a considerable period of time PLANS AND ORDERS 919 during which the situation may change, detailed instructions are avoided in the order. The same rule applies when orders may have to be carried out under unforeseen circum- stances. In such cases it is better to give general directions, stressing the object to be attained, but leave to subordinate commanders the choice of the means to be employed. For a march not in the presence of the enemy, all that need be given is the order of march, the initial point, the route, and the time of starting. On the other hand, for an attack, it is usually necessary, in addition to the decision, to give the line of departure, the direction and time of attack, the zone of action, the mission of each combat unit, and the axes of signal communication. The use of an operation map saves time in por- traying these details. (3) Time. The 24-hour clock is the official time system. Time is expressed as a group of four digits ranging from 0001 to 2400. The first two digits on the left are the hours after midnight, and the remaining two digits indicate the minutes past the hour. When the hour can be expressed by a single digit, it is preceded by zero (0); for example, 0625 is 6:25 a.m. 12-hour system 24-hour system 12:01 a.m. 0001 7:05 a.m 0705 Noon 1200 7:35 p.m 1935 Midnight 2400 The date is expressed in either of two ways: a. For the current month, the day may be indicated by preceding the four-digit time-group with a two-figure date-group indicating the day of the month. For example, 150600 is the fifteenth day of the month and the time is 6:00 a.m. b. The date and time may be stated by using the four-digit time-group followed by the month, day and if desirable, the year, as for example, 0600 September 15, 1942. When stating a night, both dates being included, the statement should read: night, September 15-16, 1942; In general, where the word “hour” is used, the word “time” should be substituted. A statement of date and hour should be expressed “time and date”. If the order, message, dispatch, or report is sent by electrical means, the six digit time-date group will be used. Greenwich Civil Time (London) is used in all communications to or from the War Department, between headquarters not having a common local time, between Army and Navy, and between armed forces of the asso- ciated nations. This time (London) is designated by the letter suffix “Z” immediately following the last digit of the group, as for example, 151150Z indicates the fifteenth day of the current month at 11:50 a.m., Greenwich Civil Time. Unless the suffix “Z” follows the time-group, the time-group indicates a common local time. (4') Place. Details of place should be stated in orders with extreme care and accuracy. Expressions depending upon the viewpoint of the observer, such as right, left, in front of, behind, on this side, beyond, and similar words and phrases are to be avoided; reference being made to points of the compass instead. The terms right and left, however, may be applied to individuals or bodies of troops, to boundaries of zones or sectors, or to the banks of a stream. In the latter case the observer is assumed to be facing downstream; in the other cases he is assumed to be facing the front (direc- tion of the enemy). In all cases where these terms are used, the compass direction should be inserted in parentheses immediately following the word right or left, thus: Right (east) boundary. The hostile left (north) flank. Geographic names are printed in capital letters. This minimizes the chance of error and makes the places mentioned stand out prominently in an order. There is one exception to this, viz, in the naming of maps in the heading of written field orders. The spelling in the order is the same as on the map used. When spelling does not conform to the pronunciations, the latter is shown phonetically in parentheses, thus: BICESTER (Bister), GILA (Hila). 920 MILITARY MEDICAL MANUAL All topographical features and places, which are at all difficult to find on a map should be identified by coordinates each time they appear in a different subparagraph of an order when the maps used are provided with grid lines, or by reference to prominent nearby points when the map is not gridded. When coordinates are used, geographical features or places named or numbered on the map may be identified by giving the coordinates of the south-west corner of the grid square in which they are located; those unnamed or unnumbered will be identified by giving the exact coordinates thereof, sufficiently close (according to the scale of the map) that they can be definitely identified. A road is designated by its name, as the BALTIMORE TURNPIKE, or by connect- ing two or more names of places on the road with dashes, thus: the road: EMMITS- BURG—FAIRFIELD—CASHTOWN. A road is similarly designated, thus: RJ 560 (361—749)—CR 403A(360—749)—RJ 458B(358—748)—GERMANTOWN. Areas are designated by naming, counterclockwise, a suitable number of points de- limiting them. The first point so named, regardless of whether the area pertains to friendly troops or to the enemy, is one on the right front from the viewpoint of our own troops. Lines parallel (or nearly parallel) to the front and lines perpendicular, (or nearly per- pendicular) (boundary between units) to the front are designated by naming points thereon in succession from right to left and rear to front respectively, from the point of view of one’s own troops. In designating a boundary between units it is necessary to specify to which unit each point named on the boundary belongs. This is done in the case of zones of action or sector boundaries by placing the word exclusive or inclusive after the terrain .features named, and in the case of boundaries between units by placing in parentheses after the terrain features named the designation of the unit to which they are assigned. For example: Division zone of action: East (right) boundary: TWO TAVERNS—M. Fink—RJ at (361.7-849.9)— NEWCHESTER (all incl). WEST (left) boundary: WHITE RUN (excl)—GRANITE HILL (incl)—knoll at (359.8-754.2) (excl)—OAK GROVE S. H. (incl). Boundary between regiments: LOW DUTCH ROAD (to 2d Inf)—GULDENS (to 1st Inf)—PINE CHURCH (to 1st Inf). (5) Designation of units. The numerical designation of an army is written in full, as: First Army; of a corps in Roman numerals, as: II Corps; of a division or smaller unit in Arabic numerals, as: 1st Infantry Division, 3d Infantry, 1st Medical Regiment, 3d Medical Battalion. (6) Legibility. Written orders should be so plainly written as to be legible even in poor light. It must be envisioned that the reader may have but a candle or flashlight by which to read. Carbon and mimeographed copies should be checked before issue for legibility and correctness. (7) Language. An order is faulty if it does not convey to the recipient the exact meaning and intention of the author. Exactitude of language is necessary, and conse- quently care in the choice of words is required. Vague and ambiguous orders indicate vacillation and the absence of definite decision on the part of a commander. Troops must be told in terms that are direct and unmistakable as to what their leader wants them to do. Combat orders should be brief but clarity should not be sacrificed to obtain brevity. Short and terse sentences are easily understood and therefore are preferable to long involved ones. Conciseness, brevity, and the use of simple English arc paramount. Conjectures, expectations, reasons for measures adopted, and detailed instructions for a variety of possible events must be avoided as they weaken the force of an order and undermine confidence in the commander. The affirmative form of expression should be used, e. g., “Headquarters Detachment will remain in GETTYSBURG” is pre- ferable to "Headquarters Detachment will not accompany the battalion." In the latter, the gist of the order depends on the word "not". Such expressions as attempt to care for, try to reach, as far as possible, if possible, as well as you can should be avoided. They tend to shift the responsibility for the decisions to the subordinate, which is incompatible with command. In combat orders technical military language should be used only when there will be no doubt that all subordinate officers have the training and experience to comprehend it. This applies to the use of the so called “canned language.” Most of these technical terms can be clearly expressed in words of common understanding although a few more words may be necessary. (8) Abbreviations. The purpose of using abbreviations is to save time, therefore they should be used when this purpose is served and not otherwise. The following arc habitually used in writing orders: PLANS AND ORDERS 921 RJ for road junction. No for number. CR for cross roads. BM for benchmark, incl for inclusive, excl for exclusive. Only authorized abbreviations are used. (See AR 850-150 and Field Manual 21-30, “Conventional Signs, Military Symbols and Abbreviations”). The use of abbreviations is not mandatory, except in listing annexes and in the distribution in the ending of orders. Periods are not used in writing abbreviations. Field Orders. General. Every order issued for the purpose of governing the action of troops in the field in connection with a tactical situation is a field order. Field orders set forth the situation, the decision and general plan of action, and the tasks of subordinate units in such detail as will insure the proper operation of these units and coordination with the command. A field order may contain complete detailed instructions to a unit, or simply a statement of the task assigned, leaving to the initiative and resourcefulness of the subordinate the method of execution. A prescribed form for field orders has been adopted to provide uniformity of issuing orders throughout the service, to insure that the plan of the commander is readily under- stood and that all essential instructions are included and to facilitate reference. If every commander who issued a field order should follow a form of his own choosing, no two of these forms would be the same. Confusion and misunderstanding would result and essentials would be overlooked. A standardized form is necessary in order that those receiving it may know exactly where to look for pertinent information and instructions. The current form for a field order has been developed as a result of experience and furnishes a clear and natural sequence of issuing instructions. Sequence. All field orders have the same sequence, namely: Paragraph 1. A concise word picture of the situation limited to information of the enemy and friendly troops, only to the extent that this information affects the subordinates. Paragraph 2. A definite, clearcut, brief decision and plan for the command as a whole. Paragraph 3. Instructions for each subordinate element of the command stated in such a way as to assure teamwork and unity of effort by the whole command. Paragraph 4. Instructions governing the administration and supply of the com- mand in the particular operation involved. Paragraph 5. Definite arrangement for communication between the commander and subordinate commanders. Preparation. The art of preparing a concise and understandable field order cannot be acquired over night. The development of proficiency is slow and requires painstaking work, through the medium of practice. Officers should take advantage of every oppor- tunity in peace time to express tactical decisions in the form of field orders and these efforts should be closely supervised. The degree of clarity with which orders will be issued on the field of batde, where conditions will affect adversely the mental acuity of the commander, will be in direct proportion to the proficiency attajned in the art through prior training and practice. Some officers may issue orders from a map after a short period of study. However, until that state of proficiency is attained, the preparation of a field order should consist of the following steps: (a) The planning of the operation on a map. 922 MILITARY MEDICAL MANUAL (b) The blocking out on paper of the various paragraphs in standard sequence and the noting in each of the information or instructions to be given. (c) A thorough check of the draft to insure that no essential has been omitted. (d) Writing the order with all details arranged in proper order. (e) Final examination for completeness and clarity. Methods of issue. (1) The commander (having evolved a plan of operation) must select the method to be used in issuing the field order. Depending upon how quickly the action must be initiated, the order will be issued orally, dictated, or written and in fragmentary or complete form. In general, the field orders of armies and corps are written; those of the division and regiments are fragmentary and in many instances are issued orally. The method of issue is a matter for determination by the commander in each case. The invariable rule is that the order must reach the lowest subordinate conserned in its execution in sufficient time to afford him a suitable opportunity to make his reconnaissance, plans, and to issue his orders prior to the hour set for the beginning of the action. The wide use of radio, especially two-way voice radio, reduces the time required for the mechanical transmission of messages and orders. Further developments place emphasis on oral orders rather than the use of written field orders. (2) Complete written field orders have the advantages of being accurate, of giving complete information, and of lessening the chances of misunderstanding. When the commander decides to issue fragmentary orders to initiate action these fragmentary orders are assembled into complete written field orders at the earliest opportunity and every effort made to have them available to subordinates prior to the beginning of the action. Regardless of whether the complete written field order can be issued or not prior to the action, it is formulated and issued without delay for purposes of record. Fragmentary field orders. (1) In warfare of movement it will be unusual for divisions and smaller units to issue written field orders. The tactical requirement in moving situations that the forward movement of troops into combat be continuous, demands that orders be issued in fragmentary form. In units having greater mobility than in- fantry the issuance of fragmentary orders is mandatory. (2) Fragmentary orders are prepared following the same sequence and technique prescribed for the written field order as permitted by the information and instructions to be furnished the subordinate. If it is desired to insure instructions which are contained only in paragraphs 2, 3, and 5 of a complete written field order, they are arranged in that sequence, and paragraphs 1 and 4 are omitted. (3) Fragmentary orders may be issued orally, dictated, or written and whenever possible should be accompanied by an operation map or sketch. Orders may be trans- mitted by means of messengers, telephone, radio, or other methods. When issued other than written they should be followed as soon as possible by a written confirmation. When time and space factors permit, officers are used invariably for the delivery of fragmentary field orders to insure accuracy and reliable transmission. Oral and dictated field orders. (1) Oral and dictated orders are similar in that both are spoken orders. Oral orders are not taken down verbatim, but notes are taken. The method of issue rests with the commander. He may say, “Copy this order,” meaning a dictated order; or he may say “Take notes,” meaning an oral order. (2) The advantage of oral orders is the short time required for issuance. They have their particular application in rapidly changing situations. When an oral order is' issued, a record is made of its provisions by the commander issuing it and by the sub- ordinates receiving it for inclusion in the journals of their own units. When important orders are issued orally by a commander he furnishes to each subordinate receiving it a copy of the entry made in his own journal pertaining to the order. (3) The dictated order is taken down verbatim. It then becomes a permanent, ready reference for later use, and the chances of error due to forgetfulness or misun- derstanding are much less than in the case of oral orders. However, training of per- sonnel in issuing and receiving oral orders will eliminate the need for dictated orders. (4) The prescribed sequence of field orders must be adhered to strictly in issuing spoken (dictated or oral) field orders. The written order can be modified or otherwise PLANS AND ORDERS 923 corrected before issue. The moment a commander changes his instructions during the course of a spoken field order he creates confusion, misunderstanding, and a lack of confidence as a commander by his apparent indecision and vagueness. In issuing spoken field orders the commander does not indicate where one paragraph begins and ends, but the subordinate writing the orders should do so. Subordinates are not responsible for words put into orders. They are responsible, however, that they carry away the correct meaning. This implies that the notes taken must be intelligible to others. (5) The formulation of a field order which is to be issued orally is a delicate task requiring meticulous care for the best results. Before issuing an order of this type the commander must have his plan thoroughly crystallized. He should block out on paper the various headings and paragraphs of the order, noting the instructions to be given each subordinate unit There are three methods possible of use in formulating and issuing oral and dictated field orders. The commander may write out the order in full and then read it to his subordinates; he may prepare notes and select the words of the order as he issues it; or he may issue it without notes. The first method is safest but can rarely be used due to lack of time. The second method is safe and the one most often used. The third method is a poor one and only mentioned to be condemned. Subordinates receiving orders should not be forced to erase, substitute, interline, or alter what they have already written. (6) Spoken orders should be issued from an observation point where points and areas on the terrain in reference to similar places on the map and the contemplated action can be used to orient the subordinate. Orientation between the map and the ter- rain must be completely understood by all, especially if the order is couched in terms referring to points on the map. The pointing out of features on the terrain during the issuance of spoken field orders is good practice only when it is assured that the sub- ordinate receiving that part of the order is not busy writing at the time. In issuing in- structions to subordinate units, the official tide of the organization or its commander should be used rather than the appellation “You.” While there is more room for ex- planation to subordinates in the oral type of field order the need for explanation shows a lack of preparation and training either on the part of the commander or the receiver. Complete written field orders. The form for the complete written field order prescribed for use throughout the service is divided into the following sections, each of which contains a certain assigned class of information or instructions. The heading. The body. The ending. (1) Heading. The heading contains the title; the place, time and date of issue; the number of the order; and reference to the map used. (a) Title. The title appears in the upper right hand corner of the first page. It is the official designation of the command; as, 1st Medical Battalion. It may, where circumstances require, be written in code. (b) Place of issue. Appears in the same corner and on the line next below the title. Because of the need for secrecy, it may be omitted. (c) Time and date. The 24-hour time system is used, beginning at midnight, and ending at night. (See subparagraph under preparation of combat orders of this chapter). (d) Number. The number of the order appears in the upper left corner of the first page. Field orders of a command are numbered consecutively for the period of the war. (e) Map reference. The map reference appears next below the number of the order and designates the map(s) required, giving the scale, the names of sheets, and the year of edition (when necessary), in sufficient detail to identify the exact map(s) used in the preparation of the order. When an order is accompanied by an operation map which is complete within itself, the reference is: Map: Operation Map (Annex). 924 MILITARY MEDICAL MANUAL Example i st Medical Battalion TANEYTOWN, MD 1630, September 15, 1942. FIELD ORDERS No. 6 Maps: General Map, Gettysburg (1925), 1 inch equals 5 miles. Topographical Map, Gettysburg-Antietam (1925), 1: 21,120, Bonneauville and Gettysburg sheets. (2) Body. The body of the field order contains the information and instructions for the command in the following order: (a) Paragraph 1. Information—include appropriate information of hostile and friendly forces. This is divided into two subparagraphs, a and b. (la) Enemy. Composition, disposition, location, movements, strength; identi- fications; capabilities. Refer to intelligence summary or reports when issued. (lb) Friendly forces. Missions, or operations, and location of next higher and adjacent units; same for covering forces or elements of the command in contact; support to be provided by other forces. Example 1. a. Enemy force is estimated to be an infantry regiment reinforced by light artillery. Cavalry is pro- tecting the right (south) flank. It is believed the hostile force will take up a defensive position on the high ground southeast of GETTYSBURG, pending the arrival of the remainder of the hostile division known to be at YORK. 1. b. The 1st Infantry Division will attack and secure the line ROCKY GROVE SCHOOL (353-750)— WOLFE HILL (352-748). Formation. 1st and 2d Infantry abreast, 2d Infantry on the right. Boundary between regiments. STATE HIGHWAY 231 (all to 2d Inf.) Line of Departure. RJ 531-C (354-750)—CR523B (352-746). 701st Surgical Hospital will be established adjacent to clearing station by 0700 September 16, 1942. Evacuation by army commences 0900 September 16, 1942. (b) Paragraph 2. Decision or Mission. Decision or mission; details of the plan applicable to the command as a whole and necessary for coordination. Example 2. This battalion moving into assigned position at 2000, Sept. 16, 1942, will provide medical support for the division during the attack. or 2. See operation map, Annex 1, accompanying this order. Troops. Composition of tactical components of the command, if appropriate. Its use generally is limited to march, advance guard, rear guard and outpost orders, and to the first field order issued by a newly created command. (This follows paragraph 2 of the order, without number). (c) Paragraph 3. Tactical Missions for Subordinate Units. Specific tasks as- signed to each element of the command charged with execution of tactical duties, which are not matters of routine or covered by standing operating procedure. A separate lettered subparagraph for each element to which instructions are given. Subparagraph x. Instructions applicable to two or more units or elements or to the entire command, which are necessary for coordination but do not properly belong in another subparagraph. Example 3. a. Company A will follow Combat Team 1 and establish collecting station in vicinity of RJ 458- J (354-746). b. Company B will follow Combat Team 2 and establish collecting station in the vicinity of MT. VERNON SCHOOL (356-748). c. Company C will move at once to LITTLESTOWN (363-739) and remain in battalion reserve. d. Company D will establish clearing station in LITTLESTOWN. x. (1) All movements will be made without lights and be completed prior to daylight. (2) Secrecy will be maintained. (3) All units will be at station at 2100. or 3. a. See overlay operation map, annex 1. (d) Paragraph 4. Administrative Matters. Instructions relative to tactical units PLANS AND ORDERS 925 concerning supply, evacuation, and traffic details which are required for the operation (unless covered by standing operating procedure or administrative orders; in the latter case, reference will be made to the administrative order). Example 4. a. The Headquarters Detachment will follow Company D without distance to LITTLESTOWN and establish unit and medical distributing points in the vicinity of the clearing station. b. Medical Supply Point: UNION MILLS (369-730). c. Ambulance routes: (See Overlay) (e) Paragraph 5. Signal Communication. Divided into two subparagraphs. (5a) Orders for employment of means of signal communication not covered in standing operating procedure. Refer to signal annex or signal operation instructions, if issued. (5b) Command posts and axes of signal communication. Initial locations for unit and next subordinate units; time of opening, tentative subsequent locations when. appropriate. Other places to which messages may be sent. Example 5. a. Division surgeon’s office: GETTYSBURG (350-750) opens at 1930. b. Command Post: 1st Medical Battalion, LITTLESTOWN (363-739) opens at 2000. (3) Ending. The ending contains the signature, authentication (except on the original), a list of annexes, if any, and a statement of the distribution. (a) Signature. The field order is signed by the commander or his principal staff officer—customs differ in this respect. When signed by other than the commander the expression “By Command of” or “By order of’ (when other than a general officer com- mands unit) should be placed directly above the signature. The signature is placed toward the right hand side of the page, immediately following the body of the order, and consists of the signer’s name, rank, corps or arm (except for general officers) and office (Commanding, Chief of Staff, or Executive Officer). (b) Authentication. The authentication of copies of the order is made by the staff officer responsible for the preparation of the order. In the medical battalion, this is usually the Plans and Training Officer (S-3). It is placed on the left hand side of the page immediately following the body of the order and consists of the word “Official” followed by the signature, rank, corps, or arm, and office of the authenticating officer. (c) Annexes. Whenever the detailed instructions for the operation of any service or other component of the division or higher unit are too long to be included in the field order, an annex containing these instructions is prepared by the staff officer concerned and submitted for approval to the commander. These, when approved, become annexes to the field order. They are signed by the chief of staff or executive in the manner pre- scribed in (a) above, and the original and all copies are authenticated by the appropriate staff officer as indicated in (b) above. Annexes to the same field order are numbered serially in the sequence in which reference is made to them in the order. In the medical battalion it is usual to have but one annex, that being an operation map. The list of annexes appears just below the authentication. It consists of the title and serial number of each. (d) Distribution. A statement showing the distribution of the order is essential as a check to insure that each officer and unit directly concerned with the execution of the order receives a copy. This statement may be in detail or reference made to a standard distribution list (e.g., “Distribution A”) already adopted, which shows in detail the distribution used. Each copy of a combat order is usually numbered and a record kept showing the specific copy numbers distributed to each officer or unit. The distribution is shown immediately following the list of annexes. 926 MILITARY MEDICAL MANUAL Example By order of Lt. Colonel “A” “X” Major, Medical Corps Executive Officer OFFICIAL: “Y” Major, Medical Corps, Plans and Training Officer (S-3) Annex 1— Overlay of Operation Map. Distribution: C Of S G-l G-2 G-3 G-4 Div Surg Div Arty Hq Co., Div MP Plat Sig Co Ren Tr QM Bn Engr C Bn 1st Inf 2d Inf 3d Inf Med Bn CO, Med Bn Hq Det Co A .. Co B . Co C Co D Surg Hosp Surg, Army ... Surg, Corps Pile Diary Distribution: A Operation Map. An operation map is a graphic presentation of a commander’s decision and tactical plan placed upon a map through the use of authorized abbreviations and conventional signs. It consists of that part of a field order which can be shown graphi- cally on a map in such detail as will not be confusing. It shows the important details of known enemy dispositions at the time the map is prepared and the contemplated dis- positions and plans of action of our own troops, in so far as this information can be graphically shown without destroying its legibility. With the modern means available for the transport of troops in the combat zone there is a direct necessity for increased speed and accuracy in the issuing of field orders. The tendency toward error is greater as the time available for issuing orders is reduced, hence the need for development of simple methods and means in the process of issuing orders. The graphic method of presenting the ideas and intentions of a commander on a map is considered the greatest aid as yet developed in the simplification process. A few lines on the map, carefully set down, will depict a situation much better in every way than a long paragraph in a written order that must be read and then staked out on a map before the reader can gain an insight into the situation. In the preparation of operation maps, the following points should be observed: (1) The meaning of all data shown must be unmistakable. (2) Military symbols and authorized abbreviations should be used. If other sym- bols are used a legend explaining them must be included. (3) Legibility is paramount. The amount of detail possible of depiction is con- trolled by this factor. (4) When colors are used data relating to enemy troops or operations are shown in red, and similar data for friendly troops in blue. (5) The operation map must have a tide showing that it is an annex to the field order that it accompanies, the office of issue, place of issue, time and date of issue. It is signed by the principal staff officer (Executive Officer in the medical battalion) and au- thenticated by the G-3 or S-3 as the size of the unit dictates. In the use of overlays a map reference in addition to the above is essential for orientation. (6) Before issue, it should be carefully checked, in conjunction with any written part of the field order, for completeness and accuracy. PLANS AND ORDERS 927 Overlay. An overlay is a sheet of transparent paper on which information is placed by means of abbreviations and military symbols (with a minimum of written informa- tion) to be used in conjunction with a map. The intersection of two sets of coordinates must be included on the overlay to enable the user to apply the information to his own map in correct positions. The “staking out” of a military situation consists of placing information in its proper position on a map (generally by the use of colored pencils). This informa- tion is obtained in connection with the progress of an operation, or from data con- tained in orders. This information is placed on the map as it is obtained, and shows the situation at a particular time. This is called a "situation map.” A sketch is of value when maps are not available to the subordinate receiving the order. A sketch shows prominent terrain features, roads, houses, etc., drawn to a cor- rect scale and direction, the latter being indicated on the sketch. Standing Operating Procedure. The use of standing operating procedures will have an important effect upon the extent of the detail included in orders. The purpose of. standing operating procedure is: (1) To simplify and abbreviate combat orders and expedite their transmission. (2) To simplify and perfect the training of troops. (3) To promote understanding and teamwork between the commander, staff and troops of the same or combined arms and services. (4) In general, to facilitate and expedite operations and minimize confusion and errors. (See Chapter V, Part I). Administrative Orders. Administrative orders are issued by armies, corps, divisions, and smaller independent commands when the administrative details of interest to the command as a whole are too voluminous to be contained in paragraph 4 of the field order. They are formal orders and follow a prescribed form. The administrative order is based on the administrative plan of the commander which is controlled by the tactical plan for the operation and the administrative plans and orders of higher authority. Their object is to outline the operations of the several technical, supply, and administrative services; to coordinate their activities; and to transmit to the command the commander’s plan of administration. Administrative orders may be complete in themselves or accom- panied by annexes. The “Medical Plan” is included in the administrative order of the command. Note: For further details relative to orders the student is referred to Field Manual 101-5, “The Staff and Combat Orders.” MEDICAL REFERENCE DATA The forms, outlines, and other data supplied below have been selected from publications of the Medical Field Service School where they are used as the basis for the solution of school problems. They are especially useful as guides and check lists; they are intended for these purposes only. CHECK LIST OF A COMPLETE FORMAL MEDICAL PLAN (DIVISION) 1. SUPPLY. a. Medical supply point (s). Location, hour of opening or closing, organizations served. b. Other medical supply matters. Recommendations concerning policies and general instructions to be issued. 2. EVACUATION. a. Casualties. Pertinent data regarding the following installation(s) such as location, units served, hour of opening or closing. Collecting station (s). Clearing station(s). b. Burial. Arrangements for burial of the dead at medical installations. c. Salvage. Arrangements for the disposition of clothing and equipment of casualties, left in medical installations. d. Prisoners of War. (1) Arrangements for security of sick and injured PW. (2) Utilization of able-bodied PW to augment the medical service. e. Other evacuation matters. Such as evacuation policy, special instructions to lower echelons, etc. 3. TRAFFIC. a. Circulation. Special priorities desired for ambulances or other medical transport. 928 MILITARY MEDICAL MANUAL b. Construction and maintenance of routes. Necessary construction and maintenance of roads and bridges in the vicinity of medical installations or for use in evacuation. 4. TRAINS. Recommendations with reference to movement of medical units on the march, release from march control, and control in bivouac. 5. PERSONNEL. a. Stragglers. Arrangements for the disposition of stragglers and malingerers in medical installations. b. Mail. Arrangements for postal service for medical units and installations. c. Shelter. Shelter required for medical units and installations. 6. MISCELLANEOUS. a. Attachment of medical troops. Instructions desired with reference to attachment of medical units to subordinate units. b. Movement of medical units. Instructions desired covering changes of location of medical units in rear areas. c. Arrangements with higher echelon for evacuation. The arrangement desired. d. Sanitation. Any instruction concerning sanitation which should be published. e. Medical matters not otherwise covered. f. Other medical details. No change (when applicable). Note: Many of the above details will be covered in Standing Operating Procedure (SOP). A FORM FOR AN ORDER FOR A MEDICAL BATTALION DURING COMBAT Title Place Time, month, day, year. FIELD ORDER NO. Maps: 1. Information. a. Enemy—location, strength, composition, and other pertinent facts sufficient for a clear com- prehension of the enemy picture by subordinates. Refer to operation map if one is used. b. Friendly troops—position and mission of combat units; general plan of the division for the action, including: mission; formation; zone of action (when given); time of attack; scheme of maneuver; line of departure; boundary between regiments (combat teams); artillery positions and such other information as is pertinent. Supporting medical units (army evacuation, surgical hospitals, medical refilling points). Make proper reference to operation map if used. 2. Decision of battalion commander—usually to furnish medical support to the division for the particular action. If all organizations are to begin movement into position at the same hour it should be stated here; otherwise, the hour of movement of each subordinate unit should be stated in paragraph 3. 3. a. Instructions for Company A—to include movement, route(s), mission, location of collecting station(s), direct service to artillery, cavalry, or other unit, movement of foot troops. •b. Instructions for Company B—to include movement, route(s), mission, location of collecting station(s), direct service to artillery, cavalry, or other unit, movement of foot troops. c. Instructions for Company C—to include movement, route (s), mission, location of collecting station(s), direct service to artillery, cavalry, or other unit, movement of foot troops. d. Instructions for Company D—to include movement, route(s), establishment of clearing station(s), number of platoons to be active. e. Instructions regarding battalion reserves—may be one company, platoon or section, with location and any movement of units necessary. x. Instructions applicable to two or more units or to entire battalion which are necessary for coordination but do not properly belong in another subparagraph; such as: secrecy measures, hour of completion of movements into position, priority or restrictions on roads, time of opening of installa- tions, time of closing of stations or time of relief of units. 4. a. Instructions for the Headquarters Detachment:—to include movement, route, location of distributing point, with pertinent instructions of supply status, either general or medical, is other than normal. b. Location of rear echelon. c. Ambulance routes. 5. a. Location of the Command Post. b. Location of division surgeon’s office. (Signature) (Authentication) Annex: (If operation map, overlay, etc., is used mention here.) Distribution: TIME AND/OR VEHICLE REQUIREMENTS FOR EVACUATION PURPOSES Time requirements for evacuation. The following time requirements will serve as a guide: For men: For round trip evacuation (including loading and unloading)— Litter squads: 1000 yards in 1 hour (Total 2000 yards) Wheeled litters: 1000 yards in 45 minutes (Total 2000 yards) Motor ambulances: 10 miles per hour (Total 20 miles) Animal-drawn ambulances: 4 miles per hour (Total 8 miles) To calculate the time required for evacuation of wounded men from the field, or the lumber of ambulances required to evacuate casualties in a given time, use the following ormulae: W—Number of sick and wounded. N—Number of patients per load. t—Time required for round trip. T—Time required or allowed. M—Number of vehicles or litters. Wxt _ Wxt MxN TxN For animals: For round trip evacuation (includes tieing and untieing)—' Lead line: 1000 yards in 30 minutes (Total 2000 yards). Vehicular requirements for evacuation (capacities)— PLANS AND ORDERS 929 Vehicles Men Animals Ambulance, animal-drawn Sitting 8 Recumbent 4 Ambulance, %-ton 4x4 7 4 Ambulance, mobile ward (proposed) 23 121 Truck, *4-ton, 4x4 2 2 Truck, %-ton, weapon carrier 8 42 Truck, 114-ton, 4x4 15 103 Truck, 2 %-ton, 4x4 17 184 Railway car, Coach Pullman car, 12 section 88 48 24 16 section 64 32 Hospital Train s 360® Ward car, Hospital train Ambulance, veterinary, motor 36 Trailer, 2-wheel 2 Semi-trailer, 6-ton 8 Stock car 12 Box car 12 Veterinary lead line (2 60-foot lines) 20 1 5 sitting cases additional. 2 With Inserts. * In tiers suspended by side rail assembly with 2 litters on floor. * In tiers suspended by side rail assembly with 6 litters on floor. 8 This figure is variable depending upon type of cars which make up the train. 8 Normal capacity (see T/O 8-520, April 1, 1942). CLASSIFICATION OF SICK AND WOUNDED FOR EVACUATION PURPOSES (Figures are based on World War I) 1. The following table has been developed from American experience in active opera- tions in World War I: Battle casualties, including killed, in percent of unit strength Unit Average for all Severe Maximum days in line battle day battle day Infantry Regiment 2.5% 12-15% 35% Division 1.0% 6-8% 12% Corps Army 0.5% 2-3% 5% 0.2-0.35% 0.7-1.5% 2.5% 930 2. In estimating battle casualties in an army, an estimate based on front-line divisions engaged will usually be more accurate than if based on a rate for corps or army as a whole. 3. The battle casualties of an entire expeditionary force or theatre of operations can best be estimated by using the rates incurred in the component divisions or armies, as the relative proportion of front-line troops to the total force will vary widely in each situation. 4. The following data relative to battle casualties are approximately accurate for a severe engagement and can be used as a basis for calculations: (a) In Temperate and Tropical Zones, the ratio of killed to wounded is as follows: Open operations about 1:5 Trench operations * about 1:4 Hence from 16%% to 20% of all batde casualties may be expected to be classed as killed. In the Arctic Zone, the ratio of killed to wounded will be considerably higher due to death of the wounded from exposure to cold. (b) The transportation requirements for batde casualties of a division are as follows: Dead 20% Able to walk to the collecting stadon, but requiring transporta- tion (sitting) to the rear : 40% Require transportation (recumbent) 40% Of all casualties, about 1% are nontransportablc beyond the sur- gical hospital, except by air Total 100% Note: The foregoing indicates that the estimation of probable casualty rates in advance is not a simple matter that can be reduced to a general formula. While casualty expectancy tables have been prepared and are being used for purposes of instruction in service schools, it must be under- stood that such tables bear no closer relationship to actual experience than do map problems to actual combat. MILITARY MEDICAL MANUAL PLANS AND ORDERS 931 General Types of Operation 1 2 3 4 5 6 7 Infantry Units Below Division Artillery Cavalry All Other Arms and Services Front Line Division Reinforced Division Corps and Army Troops (except Cavalry) Combat Troops in Corps and Army Reserves Dead To Clr Sta Dead To Clr Sta Dead To Clr Sta To Evac Hosp To Gen Hosp Dead To Clr Sta Dead To Clr Sta To Evac Hosp To Gen Hosp Dead To Clr Sta To Evac Hosp To Gen Hosp Dead To Clr Sta To Evac tlosp To Gen Hosp Attack in a Meet- ing Engagement . 16.0 80.0 1.9 9.3 1.2 16.3 16.0 11.0 1.3 6.5 6.0 32.4 32.0 27.0 0.6 6.6 6.6 4.5 0.3 6.6 65 4.5 Attack of a Position r First Day of Attack Succeeding Days 25.0 125.0 2.9 14.6 2.0 20.4 20.0 14.0 2.0 10.1 10.0 51.0 60.0 42.0 1.0 10.2 10.0 77.0 0.5 7.6 7.6 5.3 12.0 82.0 1.4 7.3 1.0 15.3 15.0 10.4 1.0 6.1 6.0 25.5 25.0 21.0 0.5 7.7 7.5 5.2 0.3 6.4 6.3 44 Attack of a Zone First Day of Attack Succeeding Days .. 12.0 210.0 4.9 24.3 3.2 27.6 27.0 19.0 3.4 17.0 17.0 86.7 84.0 70.0 1.6 13.7 13.4 9.4 0.8 9.4 9.2 6 4 21.0 105.0 2.4 12.2 1.6 18.4 18.0 12.5 1.7 8.5 8.0 42.8 42.0 35.0 0.8 9.2 9.0 6.3 0.4 7.1 7.0 49 Pursuit 8.0 42.0 0.9 4.9 0.6 13.3 13.0 9.0 06 3.4 3.0 17.4 17.0 14.0 0.3 6.6 6.5 4.5 0.2 5.9 5.8 4.1 Combat and Cover- ing and Security Forces . . 6.0 80.0 0.7 3.5 0.4 12.8 12.5 8.5 0.5 2.4 2.0 12.3 12.0 10.0 0.2 6.3 6.2 4.3 0.1 5.7 5.6 39 Defense in a Meet- ing Engagement „ 10.0 50.0 1.2 5.S 0.8 12.8 12.5 8.5 0.8 4.1 4.0 20.4 20.0 17.0 0.4 6.3 6.2 4.3 0.2 5.7 6.6 3.9 Defense of a Position Against Attack: First Day of De- 15.0 60.0 1.7 7.0 1.0 15.3 15.0 10.0 1.2 4.8 6.0 24.6 24.0 23.0 0.5 7.7 7.6 5.2 0.3 6.4 6.3 4-4 Sueceeding Days — 7.6 30.0 0.9 3.5 0.6 11.2 11.0 8.0 06 2.4 3.0 12.3 12.0 11.5 0.3 5.8 5.7 3.9 0.15 4.9 4.8 3.3 Defense of a Zone First Day of De- 25.0 100.0 2.9 11.6 2.0 18.4 18.0 12.5 2.0 8.1 10.0 40.8 40.0 36.0 1.0 9.2 9.0 6.3 0.5 7.1 7.0 49 Succeeding Days ... 12.5 60.0 1.5 6.3 1.0 13.3 13.0 9.5 1.0 4.0 5.0 20.4 20.0 18.0 0.5 6.7 6.6 4.8 0.25 6.4 5.3 3.6 Periods of Stabilized Defense 6.0 20.0 0.6 2.3 0.4 12.2 12.0 8.6 0.4 1.6 2.0 8.2 8.0 7.0 0.2 6.1 6.0 4.2 0.1 5.6 5.5 3.9 Retirement and De- laying Action , 4.0 20.0 0.6 2.3 0.4 12.2 12.0 8.6 0.3 1.6 2.0 8.2 8.0 7.0 0.2 6.1 8.0 4.2 0.1 6.6 5.5 3.9 Under All Other Conditions of Under conditions of campaign not enumerated above casualty rates for men will be approximately the same for all troops. The following rates will be assumed: Dead, negligible; To clearing station, 4.5 per 1000; evacuation from clearing station to evacuation hos- pital, 2.5 per 1000; from evacuation hospital to general hospital, 1.5 per 1000. Daily Losses of Personnel From All Causes in Campaign Per iooo of Actual Strength Casualty Table from Bulletin No. 24—“War Casualties and their relation to Medical Service and replacements” by Colonel Albert G. Love, M. C. NOTES: 1. Disregard enemy casualties abandoned on the battlefield unless specifically called for In the statement of the requirement. S. The factors given in the above table are Intended for school purposes only. 932 MILITARY MEDICAL MANUAL General Types of Operation 1 2 * 4 5 Infantry, Artillery and Other Units Cavalry Front Line; Division in Corps or Reinforced Division Corps and Army Troops (except Cavalry) Combat Troops in Army Reserve Dead To Yet Clr Sta Dead To Vet Clr Sta To Evac Hosp To Gen Hosp Dead To Vet Clr Sta To Evac Hosp To Gen Hosp Dead To Vet Clr Sta To Evac Hosp To Gen Hosp Dead To Vet Clr Sta To Evac Hosp To Gen Hosp Attack in a Meeting Engagement 32.0 40.0 5.0 17.6 16.0 20 12.0 17.6 16.0 3.0 1.2 4.4 4.0 0.6 0.6 3.6 3.3 0.5 0.5 Attack of a Position: First Day of Attack Succeeding Days „ _ 50.0 62.6 8.0 22.0 20.0 3.0 20.0 27.6 25.0 5.0 2.0 5.5 5.0 0.7 1.0 4.1 3.7 24.0 31.0 4.0 16.5 15.0 20 10.0 13.7 12.5 2.0 1.0 4.1 3.7 0.5 0.6 3.3 3.2 04 Attack of a Zone: First Day of Attack Succeeding Days 84 0 105.0 13.0 29.7 27.0 40 34.0 16.0 6.0 4.0 8.0 46.2 42.0 7.0 3.2 7.4 6.7 0.9 1.6 5.1 46 0.6 42.0 62.5 7.0 19.8 18.0 3.0 23.1 21.0 4.0 1.6 5.0 4.5 0.6 0.8 3.9 3.5 0.6 Pursuit 16.0 21.0 2.5 14.3 13.0 2.0 ' 9.4 8.5 2.0 0.6 3.5 3.2 0.5 0.4 3.2 2.9 0.4 Combat of Covering and Se- curity Forces 12.0 15.0 1.6 13.2 12.0 20 ' 6.6 6.0 1.0 0.4 3.4 3.1 0.4 0.2 32 2.8 0 4 Defense in a Meeting Engagement 20.0 25.0 3.0 13.2 12.0 2.0 11.0 10.0 2.0 0.8 3.4 3.1 0.4 0.4 3.2 2.8 0.4 Defense of a Position Against Attack: First Day of Defense Succeeding Days 30.0 30.0 4.0 16.5 15.0 2.0 12.0 6 0 13.2 12.0 3.0 1.0 4.1 3.7 0.5 0.6 3.5 3.2 0 4 0.3 16.0 16.0 2.0 12.1 11.0 20 6.6 6.0 2.0 0.6 3.1 2.8 0.4 0.3 2.6 2.4 Defense of a Zone: First Day .of Defense Succeeding Days 50.0 50.0 8.0 19.8 18.0 3.0 20.0 10.0 22.0 20.0 4.0 2.0 6.0 4.6 0.6 1.0 39 3.5 0 6 25.0 25.0 4.0 14.3 13.0 2.0 11.0 10 0 2 0 1.0 3.6 3.3 3.3 0.5 0.6 2.9 2.6 0.4 Periods of Stabilized Defense — 10.0 10.0 1.5 13.2 12.0 20 4.0 4.4 4.0 1.0 0.4 3.0 0.4 0.2 3.0 2.7 0.4 Retirement and Delaying Action _ 8.0 10.0 1.6 13.2 12.0 2.0 4.0 4.4 4.0 1.0 0.4 3.3 3.0 0.4 0.2 3.0 2.7 0.4 Under All Other Conditions of Campaign The following rates will be assumed: Dead, negligible; Evacuation from veterinary collecting s per 1000; From evacuation hospitals to general hospitals, 0.1 per 1000. tations to evacuation hospitals, 1.25 Daily Losses of Animals From All Causes in Campaign Per iooo of Actual Strength Casualty Table from Bulletin No. 24—"War Casualties and their relation to Medical Service and replacements” by Colonel Albert G. Love, M. C. NOTES: 1. Disregard enemy casualties abandoned on the battlefield unless specifically called for in the statement of the requirement. 2. The factors given in the above table are intended for school purposes only. CHAPTER VIII ADMINISTRATION Purpose of Chapter. This chapter includes useful information about the subject of Administration. Units of the Medical Department maintain the same records for their personnel, supply, mess, correspondence, and other administrative requirements as all branches of the Army. In addition, the department maintains records of the utmost importance which pertain to the execution of its own professional functions. The officer of any corps of the Medical Department must prepare himself to perform efficiently many duties in addition to his purely professional functions. He may, for example, be required to exercise command of a medical detachment, a unit of a medical battalion, or a hospital; in the performance of such missions he is confronted with problems of leadership, organization, mess and supply, training, discipline and morale, as well as administration. To the same extent as all other officers he may sit as a member of a military court or of a board of officers. He may be assigned to duty as executive or adjutant of a medical command. Thus, the officer within the Medical Department must be ready for a diversification of responsibilities of which his brother in civilian practice may be entirely unaware. The student of administrative procedures does well to become imbued at the outset with the need for absolute accuracy in the records which he will prepare. Many arc records of original entry and become the basis for other compilations, analysis, and summaries. They must contain the truth. Further, similar records must be pre- pared alike in all organizations, for otherwise no reliable comparisons can be drawn therefrom. The language or phraseology used is important. Unless exact phrasing is prescribed (as in the case of entries in the morning report) there is no acceptable substitute for good, clearly expressed, grammatical English, legibly recorded, which will impart the same meaning to all readers. Battles are not won by records and “pap>er work.” Still, the winning of battles may be simplified by having men, munitions, and transportation in necessary quantities at the right place at the time required. All this requires good administration and accurate records. It is an important part of good staff work which is vital to the commander for the efficient exercise of command. Skill in required administrative procedures is an important part of officer-training, and in this training accuracy, completeness, and clarity must be obtained. MEDICAL DEPARTMENT ADMINISTRATION Medical Department administration is the management of the medical activities of a military command, rather than the supervision of the affairs of the department itself. In the various types of Medical Department installations and units (e.gthe fixed hospital of the zone of the interior or the mobile units of the combat zone) details of administrative procedure may vary, but the broad principles remain applicable in all situations. While certain Army Regulations are epitomized, the text is not a complete abstract of them; neither will it completely replace Army Regulations and Manuals as a reference for the accomplishment of records, reports, and returns by medical officers. No effort has been made to reproduce more than a few of the many blank forms employed, though they are frequently referred to by name and number. The printed instructions on the blank form itself are detailed and specific and should always be consulted. An attempt has been made to explain essential duties of Medical Department officers and the means and methods of administering Medical Department activities. Some of these may be termed customs of the service inasmuch as they are not covered by Army Regulations. The duties of medical officers as such are three-fold in character: professional—duties incident to the practice of medicine, including physical examinations for the preservation and promotion of health; advisory—duties pertaining to a medical officer as a staff officer; and administrative— duties pertaining to a commander of medical department personnel 934 MILITARY MEDICAL MANUAL and establishments and the patients therein. In addition, officers of the Medical Depart- ment serve as members of courts-martial and boards of officers. The duties of the dental officers as such are similar to the medical officers in their pro- fession; however, their duties are included within the responsibility of the medical officer who is in command of the medical establishment or unit. The duties of the veterinary officers as such are usually professional and advisory. These include the preservation and promotion of the health of Army animals and the inspection of food and forage as purchased for the Army by the Quartermaster. The administrative duties of the Veterinary Corps are limited to those units within the veterinary establishment or unit—the unit surgeon or commanding medical officer is responsible in his absence. The duties of the Medical Administrative Corps officers are purely administrative. Their services are intended to assist the other Medical Department officers in the ad- ministration of Medical Department affairs. Medical Administrative Corps officers who are qualified as pharmacists may in addition serve in that capacity in hospital pharmacies. Titles of Medical Officers. The title of the senior medical officer at general head- quarters or with an expeditionary force is “chief surgeon.” The senior medical officer with any non-medical command, except as prescribed above, is designated as “surgeon,” thus: Command Staff Official Address Service command Post, camp, or station Army Transport Surgeon Station Surgeon . .. Transport Surgeon . Army Surgeon .... Corps Surgeon .... Division Surgeon . . Regimental Surgeon Battalion Surgeon . The Surgeon, Second Service Command The Surgeon, Fort The Surgeon, U.S.A.T The Surgeon, First Army Corps Division Regiment (except medical regiment) . Battalion (except medical regiment and medical battalion) The Surgeon, II Corps The Surgeon, Fifth Armored Division . . The Surgeon, Eighth Infantry The Surgeon, Second Engineer Battalion. The senior medical officer of a general hospital, dispensary, or other separate medical unit is designated as commanding officer, e.g., “The Commanding Officer, 32d Medical battalion, Carlisle Barracks, Pennsylvania.” Although the senior medical officer at a station may be the commanding officer of the hospital, he is referred to as the surgeon in order to distinguish him from the commanding officer of the garrison or component units therein. Functions of a Staff Medical Officer. There is normally a staff medical officer for each command larger than a company. The senior medical officer present for duty with the command is, in addition to his other duties, the staff medical officer. The basic title of a staff medical officer is “surgeon” which, as commonly used in the military service, indicates his staff or advisory position rather than his professional qualifications and is analogous to such terms and positions as quartermaster, adjutant, etc. The duties of “the surgeon” are advisory and administrative; advisory in his rela- tions as a staff officer and administrative in his conduct of the medical department as a technical and supply service under the control of his commanding officer. See Chapter III, “Duties of the Division Surgeon.” Duties in Connection With the Dental Service. The dental service is a specialized branch of the medical service. As such it is controlled by the surgeon. In the absence of a dental officer the surgeon may, under certain conditions, obtain the services of civilian dentists. Duties in Connection With the Veterinary Service. While appropriately united in one department and administered under one head—the Surgeon General—the veterinary and medical services are in a technical sense separate except as they may occasionally meet on the common ground of an animal disease which might possibly be communicable to man. Proper coordination of its activities as a branch can be assured only when there i$ but one representative of the medical department on the staff of the commanding ADMINISTRATION 935 officer. Such duty logically devolves upon the senior medical officer present with the command. The veterinarian furnishes the surgeon with such technical information concerning veterinary matters as may be necessary for him to represent properly that phase of the medical department’s activities to the commanding officer. The technical and professional activities of the veterinarian are not supervised by the surgeon. In general the duties of a staff medical officer in connection with the veterinary service are as follows: In the absence of a veterinary officer the surgeon is directly responsible for the veterinary service, including its administration. In the absence of all veterinary personnel (officers and enlisted men) the surgeon repre- sents the medical department in matters pertaining to the veterinary service, utilizing such facilities as may be at his disposal. He keeps the commanding officer advised as to the veterinary needs of the station or command. The principal agencies maintained for providing or initiating medical attendance in the Army are: At permanent stations—hospitals and dispensaries. In the field—aid stations, collecting stations, clearing stations, hospitals and dispen- saries. For Whom Authorized. Medical attendance is authorized for the following personnel: Military. Officers, warrant officers, cadets, Army nurses, enlisted men, and contract surgeons (full time) of the Army of the United States while in active federal service, general prisoners, and prisoners of war. Persons of the classes enumerated above who are on the retired list of the Army and who report in person at any Army dispensary or hosital. Medical officers and contract surgeons are not required to leave their stations to attend those on the retired list. Members of the National Guard not in federal service while in attendance at a federal training camp and under certain other conditions as prescribed in National Guard Regulations. Members of the Officers’ Reserve Corps and of the Enlisted Reserve Corps, when on an active duty status. Members of the Women’s Army Auxiliary Corps. Civilian. Members of the Reserve Officers’ Training Corps while attending a federal training camp. Trainees at a Citizens’ Military Training Camp. Persons in military custody or confinement and applicants for enlistment while under observation. Whenever practicable the families (including wife, minor children, other dependents, and servants of the household) of military personnel enumerated above, when residing with and actually dependent upon such persons. Civilian employees of the Army (in- cluding civilian employees of post exchanges) at stations or in the field where other medical attendance can not be procured. Civilian employees of the United States Government who receive personal injuries in the performance of official duty who may report for treatment at an Army dispensary or hospital upon request of the officer under whom they are employed, provided other government hospitals for the treatment of such employees are not more convenient of access. Civilian Medical Attendance. When medical attendance is required by an officer, war- rant officer, Army nurse, enlisted man, or contract surgeon (full time) on duty with any command or detachment, or by a prisoner in military custody, or by an applicant for enlistment under observation, and cannot otherwise be had, the com- manding officer may employ the necessary civilian service and just accounts therefor will be paid by the medical department. Regularly licensed civilian physicians may be authorized by the commanding officer to practice medicine upon military reservations or camps under certain conditions. In general, regulations provide that civilian physicians so practicing must observe Medical Attendance 936 MILITARY MEDICAL MANUAL the current rules relative to the protection of the command against communicable diseases, and the established ethics of the civil medical profession, and furnish data for preparation of sick and wounded records in the case of military personnel. Civil Medical Practice. Professional private and civil practice in civilian communities, the needs of which are being satisfactorily met by civilian practioners, will ordinarily be restricted to consultation practice with such civilian practioner, and to emergency measures necessary to save life or to prevent great suffering. (Par. 8, AR 40-505.) Releasing Information Regarding Condition of Patient. Medical officers may impart such information regarding the condition of a sick or wounded patient as may be necessary to allay the anxiety of relatives and friends. The furnishing to unauthorized persons of information which can be made the basis of a claim against the Govern- ment is prohibited. The Daily Sick Report. When an officer, contract surgeon, warrant officer, cadet of the United States Military Academy, flying Gadet, Army nurse or enlisted man is in need of medieal attention his (or her) name and grade, with Army serial number, is placed, preliminary to his attendance at sick call, upon the daily sick report (W. D., A.G.O. Form No. 5) of the organization or detachment. The daily sick report consists of two parts: The organization commander’s report. This is prepared in the organization (com- pany) and is signed by the commander thereof. If the organization commander can not state definitely whether the alleged sickness originated in the line of duty he places an interrogation mark (?) in the proper column pending investigation and decision. It is the duty of the organization commander to determine the line of duty status, particularly in the case of injury which is likely to result in partial or complete disability of the patient. The medical officer’s report. This is filled out and signed at the place of holding sick call. The line of duty entry is particularly important because an individual absent from, duty for more than one day because of disease incurred not in line of duty and as the result of misconduct has pay deducted for the period of such absence, and time so lost cannot be counted as service. Under peace-time enlistment conditions, an individual may be held in the service after the normal date of completion of the en- listment for a period equal in time to such absence from duty. The medical officer indicates in the disposition column the status of the patient as “hospital,” “quarters,” or “duty.” There is no such status as “light duty” or “part duty.” The daily sick report is referred to by each company in rendering its morning report to headquarters. Information on the sick report should be complete in accordance with the column head- ings as some of the entries may affect the soldier’s pay. Conduct of Sick Call. Sick call is a military formation held daily at an hour designated by the commanding officer, except when the command is in combat. At this time all sick or injured should be conducted by a noncommissioned officer to the surgeon at the hospital, dispensary, or other place for holding sick call to determine whether they can continue their regular duties or whether they should be taken up on the surgeon’s report of sick and wounded and admitted to hospital or quarters. This examination of the sick is in the nature of a “sorting” and should be conducted as expeditiously as possible and at a suitable hour so that the operations of the organiza- tion may not be delayed or interrupted. Those cases obviously needing “hospital” or “quarters” treatment are so marked on the daily sick report. Admission to hos- pital is accomplished after the“sick call” has been completed. Those able to do “duty” are so marked on the daily sick report and immediately sent back in charge of their noncommissioned officers to their organizations. Should any of the “quarters” or “duty” type require further examination or treatment, an appointment therefor should be arranged. In case of emergency, sick or injured may be admitted to the hospital at any hour. However, the proper notations should be made on the company sick report as soon as practicable. Patients not admitted to hospital or quarters but who are treated are recorded on Sick Call Body measurements >, Bones & joints Lungs n Heart Seats, beds, & cots as necessary Skin,G.U. hernia rectal,& abdomen general examining room Blood pressure Ear, nose a $ Throats Extra men Smallpox vaccine Tgphoid inoculation Eges Finger prints Pinal disposition table Dental - Dressing room Urinalysis Receiving [Desk Legend Medical officer Enlisted clerk Plate 1. Diagram Showing Suitable Arrangement of A Physical Examining Room. 938 MILITARY MEDICAL MANUAL an “out-patient” index card which shows in brief the diagnosis and treatment given. This index is useful in summarizing the number of out-patients treated and treatments given each month, the report of which is included on the monthly report of sick and wounded, M.D. Form No. 51 (see Plate 6.) Recruiting and Physical Examinations Under the provisions of the Selective Service Act, the majority of individuals enter- ing the army do so through the process of selection by local selection boards, and make their actual entry into the service through induction centers. For the duration of the war, enlistments in the Regular Army have been discontinued, but certain individuals with the approval of the selection board may be accepted for voluntary enlistment in the Army of the United States. For this purpose, when so authorized, at posts, camps, or stations a recruiting officer is designated to make enlistments. While such duties may be delegated to medical officers the latter are usually concerned only with the physical examination of the applicants. These examinations are made by medical officers or, in their absence, by civilian physicians hired for the purpose. The physical examina- tion of candidates for commission is also a function of the Medical Department. Physical Standards. Army Regulations prescribe standards of physical examination in order to insure efficiency and uniformity in the procurement of personnel that will be physically fit for the rigors of military service. In general the applicant must be able to see and hear well; his heart must be competent to stand the stress of physical exertion; he must have intelligence enough to understand and execute military maneu- vers, obey commands, and protect himself; and he must be able to transport himself by marching. The physical standards prescribed for candidates for commission are in some respects higher than those prescribed for applicants for enlistment, but, in general, the same physical standards apply to both. The physical standards for flying differ and are more exacting; officers who conduct such examinations are specially trained and qualified for that work. Since the outbreak of hostilities the high standards specified for peace time have been modified in order to permit the enroll- ment of individuals suitable for special service or particular military duties. Classifica- tions as to fitness for special types of service will depend upon the standards set at the time by the War Department. Conduct of Physical Examinations. The physical examination of a few applicants pre- sents no real difficulties. The examination of large numbers of men in time of mobilization, however, requires a high degree of organization. Any scheme of exam- ination for military service involves the following steps: preparation of records; physical examination; preparation of identification records; and immunization against smallpox, typhoid, and paratyphoid. The ideal plan for the examination of large increments will include the bathing, disinfection, physical examination, and the issue of uniforms and equipment under one roof. The room or rooms for the physical examination should have ample space and should permit an arrangement of the several examining groups so that quiet may be maintained. An even temperature, so that men in the nude may be comfortable, is necessary. It is important that the clerks and examiners be so arranged in the logical sequence of the examination that there be no congestion of examinees at any one place; if not, confusion will result. Teamwork is essential; there should be a continuous flow of examinees, moving on the one-way traffic principle. Plate 1 shows a suitable arrangement of an examining room. Additional examining personnel may be added to the stations as needed. Personnel for an Examining Team. A small examining team should have the follow- ing personnel: A general supervisor; an internist; a surgeon; an eye, ear, nose, and throat examiner; and a dentist. Each of these officers should have an intelligent enlisted assistant, capable of making entries on die physical examination form. In addition there should be a clerk to initiate the physical examination forms and another to complete them; also three noncommissioned officers or specialists to conduct the immunization and to take the fingerprint records. A noncommissioned officer and several orderlies are desirable to maintain order and to safeguard the clothing of disrobed applicants. A newly organized group outlined as above should be able to examine 12 to 15 persons per hour. By continuous functioning as a team and with proper supervision the group may examine twice that number. Larger teams will include specialists such as psychiatrists, orthopedists, and heart and chest examiners. The rate of examination per applicant examined does not increase in direct proportion to the size of the examining group. If many examiners and suitable space are available better results will be obtained in examining continuous large increments by utilizing several examining teams. Alternating teams in 4-hour shifts is a good method when space is limited. Physical Examination Records. The principal records accomplished on the entry of an individual into the service either by enlistment or induction are shown below. Only those marked by an asterisk (*) are usually made by the medical examiner; the others pertain more particularly to the duties of the recruiting, the induction, or other officer. Those records made at the time of enlistment are: Report of Enlistment. W.D., A.G.O. Form No. 13. Enlistment Record, Army of the United States. W.D., A.G.O. Form No. 22 (This contains the form* for the physical examination). *The F.B.I. Military Fingerprint Card. Service Record. W.D., A.G.O. Form No. 24. Individual Clothing and Equipment Record. W.D., A.G.O. Form No. 32. register. W.D., M.D. Form No. 81. Those records opened or completed in the process of induction either by the local board, at the induction station, or at the reception center are: Order to Report for Induction. D.S.S. Form No. 150. (initiated by the local board, but completed by the inducting officer). Information for Armed Forces. D.S.S. Form No. 140 (initiated by the local board and accompanies the individual throughout his service). Report of Induction. W.D., A.G.O. Form No. 221. (This contains the form* for the physical examination). *F.B.I. Military Fingerprint Card. Service Record. Individual Clothing and Equipment Record. (This is opened at the reception center). immunization register. (Immunizations are normally instituted at the reception center). Immunization. Inasmuch as the immunization of an individual cannot be completed at the time of enlistment, arrangements must be made to complete it. Medical personnel and a suitable place (usually the hospital) must be provided. Arrangements must also be made with organization commanders to insure that all personnel on which im- munization has begun will report on the proper date at the time and place designated. Cooperation between medical officers and organization commanders is an important factor in completing immunizations expeditiously. If large groups are being im- munized, one medical officer with several assistants will be needed for the admin- istration of the second and third doses of typhoid vaccine. One medical officer and an assistant are usually sufficient to determine the result of the smallpox vaccination and to revaccinate unsuccessful cases. Each soldier appearing should have with him his immunization register (Form 81 M.D.) on which the medical officer enters the date of administration and the result in case of smallpox vaccination. The same entries are made on the register retained in the hospital. Among newly mobilized units it is important that the surgeon take steps to insure that the record of completed immunization is entered on the soldier’s service record. In the case of officers and warrant officers the original record of completed immunization is given to them for their personal files. Report of Physical Examination. Forms for the physical examinations are standard- ized for officers and enlisted men, respectively. The officer’s physical examination is recorded on W.D.,A.G.O. Form No. 63 (Plate 2), except in the case of an officer of the Air Corps requiring a special physical examination conducted by an aviation medical examiner or flight surgeon, which is recorded on W.D.,A.G.O. Form No. 64. ADMINISTRATION 939 940 MILITARY MEDICAL MANUAL REPORT OF PHYSICAL EXAMINATION (See AR 40-100 and 40-105) Instructions—Unless otherwise prescribed, this form will be used for all physical examinations of officers, nurses, or warrant officers; applicants for appointment as such in the Regular Army, National Guard, or Officers’ Reserve Corps; and enrollment in the Reserve Officers Training Corps. Use typewriter if practicable. Attach plain additional sheets if required. (Last name) (Firat name) (Middle initial) Age. Years of service. (Serial number) 3. Nature of examination l. (Grade) (Organization and arm or service) Component of Army 2. (Nearest birthday) (Whole number only) 4. Typhoid vaccination. No. series completed 5. Date of last smallpox vaccination Last series Type of reaction 19. 6. Other vaccination or immunity tests 7. Medical history 3. 8. Eyes Distant vision: Right 20/.. correctible to 20/.. -by *. Near vision: Right J#. (Snellen type) Left 20/.. correctable to 20/.. correctible to J#_. -by4. .by *. Refraction 6 (under cycloplegic): Right Oaeger type) Left J#.. correctible to J#.. .by Left 9. Ears Color perception (red and green) 6_. Hearing (low conversational voice): Right (20. Left /20. Audiometer (percent loss): Right Left 10. Nose and throat 11. Teeth:7 Right (Examinee’s) Left 87654321 12345678 16 15 14 13 12 11 10 9 9 10 II 12 13 14 15 16 Indicate: Restorable carious teeth by O: nonrestorable carious teeth by /; missing natural teeth by X ■ Remarks, including other defects Prosthetic dental appliances Classification 12. Posture (Excellent, good, fair, bad) Figure (Slender, medium, stocky, obese) Frame (Light, medium, heavy) 13. Temperature expiration Height inches. Abdomen . inches. Weight inches. . pounds. Chest: Rest inches; inspiration inches: 14. Cardiovascular system: Heart Blood pressure: S. D. Pulse: Rate—Sitting Immediately after exercise Arteries Two minutes after exercise Character Varicose reins 15. Respiratory system 16. X-ray of chest 8. 17, Skin and lymphatics Endocrine system 18. Bones, joints, and muscles Feet 19. Abdominal viscera . 20. Hernia Hemorrhoids * Appointment, promotion, retirement, annual, active duty, special. 3 Regular Army; National Guard; Officers’ Reserve Corps; Reserve Officers* Training Corps. * If annual physical examination, record only for past year. 4 If annual physical examination, record only distant and near vision, and state whether defect is properly corrected. * When indicated. 6 Not required for annual physical examination. _ 7 If rejected for appointment in Regular Army because of malocclusion, send plaster models to the Surgeon General. 8 Required for candidate* for commission. yr, D., A. d. O. Form No. 63 August 1, 1939 Plate 2. Report of Physical Examination (Front). ADMINISTRATION 941 21. Genito-urinary system 22. Nervous system 23. Laboratory procedures: Kahn *. Wassermann Urinalysis: Sp. gr. Microscopical (if indicated) Albumin Sugar 24. Remarks on defects not sufficiently described Other laboratory procedures 25. Corrective measures, or other action recommended 26. Is the individual permanently incapacitated for active service? If yes, specify defect 27. If applicant for appointment: Does he meet physical requirements? Do you recommend acceptance with minor physical defects? If rejection is recommended, specify cause 28. Examinee states he is drawing a pension, disability allowance, or compensation or retired pay from the U. S. Government. If yes, state disability (Name and grade) Corps. (Place) (Name and grade) Corps. (Date) 19 Corps. 1st Ind.2 (Name and grade) Headquarters To the Commanding General Remarks and recommendations (Name) (Grade) (Organization and arm or service) 2d Ind.2 Commanding. 19. To The Adjutant General. 1 Required for candidate* for commission. * State action taken on recommendations of the board. If incapacitated for active service, state whether action by retiring board is recommended. 0. *. GOVCRNMCNT PRINTING OFFICE 18—10006 Plate 2. Continued. Report of Physical Examination (Reverse). 942 MILITARY MEDICAL MANUAL Phraseology used in completing these forms should indicate accurately the actual physical condition of the officer or officer-candidate. Military Hospitals (TM 8-260) Mobile Hospitals. In time of war mobile hospitals form a constituent part of the mobile forces. These hospitals are established in the combat zone and comprise evacuation hos- pitals, surgical hospitals, convalescent hospitals, and the clearing stations (emergency and in camp) operated by the clearing companies of medical regiments, medical battalions, or medical squadrons. These field medical installations are discussed in Chapters II, III, and IV. Fixed Hospitals. The fixed or nonmobile military hospitals are identical in time of war or peace and serve the same general purposes. (See Plate 3.) They are established in the zone of the interior and the communications zone. Whenever practicable three or more Plate 3. Brooke General Hospital, Fort Sam Houston, Texas. general hospitals may be grouped at one place into an administrative and clinical organ- ization known as a “hospital center.” A convalescent camp constitutes a part of the hospital center. The administration of these fixed hospitals is similar to that of the fixed hospitals of peace time. In time of peace or war at home or abroad, only two types of fixed hospitals are maintained. These are station hospitals (at times called post or camp hospitals), and general hospitals. Station Hospitals. These are provided for the hospitalization of sick and wounded of local commands of the station to which it pertains, and will ordinarily have facilities to hospitalize approximately 5 per cent of the local command. In peacetime and in the zone of the interior in wartime they are identified by the type, title of the hospital, and its location, for example, Station Hospital, Fort Benning, Georgia. They function under local commanders, e.g., the station hospital at Fort Benning is conducted by the surgeon at Fort Benning who functions under the commanding officer, Fort Benning. Station hospitals in a wartime theatre of operations are designated and iden- ADMINISTRATION 943 tified by their number, type, and title, for example, 7th Station Hospital. Their location is not given. General Hospitals. These consist of two types, the numbered and the named. The numbered general hospitals are designed for employment in theatres of operation, and are designated by number and type (e.g., 112th General Hospital). The method of their employment is discussed in Chapter V. The named general hospitals are established in the zone of the interior and are designated by type, title, and location (e.g., O’Reilly General Hospital, Springfield, Missouri). The names of these general hospitals are usually those of deceased medical officers of the Army of the United States whose services were of a distinguished character. Exceptions to this rule are the re- cently established Valley Forge General Hospital in the vicinity of Valley Forge, and the Woodrow Wilson General Hospital at Staunton, Virginia. In the zone of the interior, general hospitals are established to afford better facilities than can be provided in station hospitals for the care and disposition of those cases requiring prolonged or special treatment. The organization of a general hospital is shown in Plate 4. In wartime they operate under the administrative control of the Service Command in which located except for certain features directed by the Surgeon General. During the period of the emergency and since the outbreak of hostilities, the number of named general hospitals has been considerably increased. Those which were in operation prior to the current expansion are: Army and Navy General Hospital, Hot Springs, Arkansas. Fitzsimons General Hospital, Denver, Colorado. Letterman General Hospital, San Francisco, California. Sternberg General Hospital, Manila, Philippine Islands. Tripler General Hospital, Honolulu, Hawaiian Islands. Walter Reed General Hospital, Washington, District of Columbia. William Beaumont General Hospital, El Paso, Texas. Veterinary Hospitals. Hospitals of both the fixed and mobile types are provided by the veterinary serVice for the care of animals and are indicated by adding to the usual basic title the word “veterinary,” i.e., “veterinary general hospital” and “veterinary station hospital.” Army Dispensaries. To provide medical attention for groups of military personnel not located at army stations, or where there is an excessive amount of out-patient clinic service, general dispensaries staffed with Medical Department officers and enlisted men are established at these centers of military activity. Administration of Fixed Hospitals Hospital Services. For convenience of administration and in the interest of profes- sional efficiency, the commanding officer of each Army hospital organizes the professional and other activities of his hospital into services and prescribes the number and the line of control over them and their relationship to each other. The following represent the services customarily established in large hospitals, though considerable variation therefrom is allowed to the discretion of the commanding officer of the hospital concerned: administrative; dental, eye, ear, nose, and throat; laboratory; medical; neuropsychiatric; nursing; orthopedic; physical reconstruction; roentgenological; surgical; urological. The administrative service of a fixed hospital includes such personnel and activities as the commanding officer of the hospital may prescribe. The personnel and activities that follow properly belong in the administrative service: Personnel. Commanding officer, executive officer, adjutant, personnel officer, detach- ment commander, registrar, mess officer, supply officer, chaplain, and chief nurse. Activities. Admission and discharge of patients; hospital inspection; hospital mess; fire control; summary court; recruiting; post exchange; Detachment, Medical Depart- ment, etc. 944 MILITARY MEDICAL MANUAL Titles of Duty Personnel. The personnel performing the more important administra- tive and clinical duties at a hospital are designated as follows: Duty Title Commanding hospital (the surgeon) In charge of a service Commanding officer. Chief of service. Assistant service. Registrar. Ward officer. Assistant ward officer. Head nurse. Ward master. Ward attendant Commissioned assistant on a service , Officer in charge of records of sick and wounded Officer in charge of a ward Commissioned assistant in a ward Nurse in charge of a ward Principal enlisted assistant in a ward Other enlisted assistant in a ward Medical Officer of the Day. A medical officer of the day is detailed by roster daily to serve as such for 24 hours. His functions are both administrative and professional, al- though in large hospitals the duties may be apportioned among several individuals. Dur- ing his period of duty he holds himself available for emergency professional service, par- ticularly during hours when other medical officers are off duty. He is in charge of the hospital at night, makes inspections at stated intervals, inspects the mess at each meal, and represents the commanding officer of the hospital in the latter’s absence. In large hospitals, both a medical officer of the day and an administrative officer of the day may be designated. If this is done the duties of the medical officer of the day are limited largely to strictly professional activities connected with the care and disposition of patients. Duties of Commanding Officer of Hospital. The commanding officer of a hospital is responsible for its proper discipline and administration, including the care and prepara- tion of reports, registers, and records as well as for the care and safeguarding of all public property which may come into his possession; for the proper expenditure of supplies and funds; and for the preparation of requisitions, returns, and pay rolls of the hospital. While thecommanding officer is not charged with the execution of duties properly delegated by him to an assistant, yet he is responsible for exercising such supervision over duties thus delegated as to insure their prompt and efficient performance by the designated subordinate. Relations to Patients. The commanding officer (or one of his commissioned assistants) determines what patients are to be admitted to or discharged from the hospital. Admit- tance and assignment of patients to wards are usually accomplished by the medical officer of the day. The commanding officer is responsible for supervising the care and treat- ment of all patients. He, or a commissioned assistant designated by him, commands the detachment of patients. Within the continental limits of the United States when the condition of a patient has reached a stage which seriously endangers life, the com- manding officer communicates the fact (by telegraph or otherwise) to the person designated by the patient to be notified in case of an emergency. Outside the continental limits of the United States such information is forwarded to the Adjutant General who, in turn, notifies the emergency addressee. The commanding officer will also notify the Army chaplain on duty at the station where the hospital is located. Relations to Duty Personnel. The commanding officer (or one of his commissioned assistants) commands the duty personnel as a detachment commander. He assigns the personnel to appropriate duties and prescribes and enforces regulations as to the sanitary, disciplinary, and other requirements of the hospital. Inspections by Hospital Commander. Depending on its size, the commanding officer inspects or directs the inspection of the entire hospital daily, and on Saturdays he inspects or causes to be inspected the Detachment, Medical Department. Hospital Commanders The Registrar Duties of Registrar. The office of registrar is peculiar to the Medical Department. The registrar has charge of all medical and surgical records, and sees that careful and ADMINISTRATION 945 accurate clinical histories, statistical tables, etc., are kept. He prepares all reports and returns pertaining to the sick and wounded. He customarily is the commanding officer of the detachment of patients and unit personnel officer. In this capacity he has charge of the service records, accounts, and returns of patients. He is also custodian of their money and valuables. Report of Sick and Wounded. When a patient is admitted to “Quarters” or to a hospital that is not part of a field force, his name is entered on a Register Card (MD Form 52) (see plate 7). This card provides a summary of the case, entries being made as data is obtained from the patient’s clinical record (MD Form 55) which is maintained by his ward officer. While the patient is in hospital or quarters the card is filed alphabetically according to patient’s last name with the cards of other active cases, thus constituting the current register and providing a ready index to such cases. Upon completion of the case (return to duty, transferred, died, etc.) the Register Card is filed according to its register serial number with other completed cases, comprising the permanent register and providing a permanent record of the sick and wounded of the military establishment. The Register Card must be complete and accurate in all respects. The patient’s name, serial number, etc., must be correct so as to establish his identity without question. Diagnoses and operations should follow the detailed nomenclature prescribed in Army Regulations (similar to those shown in publications of the Bureau of Census). The “line of duty” status must be noted correctly inasmuch as reference may be made to this record in case of a claim for pension. In order to complete the soldier’s record in the War Department, an exact copy of the Register Card is made on the same MD Form 52 and is called the Report Card. Together with the Report Sheet (MD Form 51) (see plates 5 and 6), the Report Cards of all cases completed during the month are forwarded each month to the Surgeon General. The Report for December also includes temporary report cards known as “Remaining Cards,” which account for incompleted cases remaining in hospital or quarters on December 31st. Of the reports a hospital is required to render, this monthly Report of Sick and Wounded is one of the most important, providing as it does an invaluable source of information. Units other than hospitals, such as the regimental medical detachment, when located in garrison on a post, camp, or station in the Zone of Interior, prepare a monthly Report of Sick and Wounded for patients under their control in the same manner as hospitals. However, when moving between stations, in the field on maneuvers, or in the Theatre of Operations, these units use the Emergency Medical Tag (MD Form 52b) in lieu of the MD Form 52 (see Emergency Medical Tag, Chapter I). Hospitals that are part of a field force also render a monthly Report of Sick and Wounded, but use the Field Medical Record (MD Form 52c & d) in lieu of the MD Form 52 (see Field Medical Record, Chapter IV). Statistical Report (MD Form 86ab and 86c). (See Plates 8a, b, and 9a). For in- structions as to use of the statistical report see Plates 8c, and 9b. Ward Management Ward Officer. The professional service in the wards of military hospitals is similar to that in civil hospitals. Ward officers, however, have functions other than the strictly professional ones. A ward officer is responsible for the professional care and welfare of the patients of his ward, the preparation of all clinical records and reports, the discipline and the work performed by the duty personnel, and all property pertaining to the ward. Responsibilities of Ward Assistants. The head nurse, or the ward master in wards to which Army nurses are not assigned, is directly responsible to the ward officer and, under him, has general supervision of the ward, the enlisted assistants, and patients, and is obeyed and respected accordingly. The head nurse (or the ward master) is responsible for the following: the administration of medicine and other treatment pre- scribed, the keeping of records, the cleanliness and order of the ward, the public prop- TRAINING OFFICER REGISTRAR Patier.S * Effects Sick & Wounded Reports Co. Det. of Patients Clinical RECREATION OFFICER , PROVOST MARSHAL Watchmar RECEIVING 4 EVAC. OFFICER Ward Assignments •Radio AMERICAN RED CROSS Receiving •Discharges " Recreation Social Service ADMINISTRATIVE DIVISION MESS OFFICER SUMMARY COURT . COMMANDING OFFICER MED DET. Purchase & Storage ■ Messes Dietitians Detachment Med. Dept. Fire Marshal Athletics Recruiting Officer Plate 4. Organization of a General Hospital, Zone of the Interior. QUARTERMASTER I . Bakery Finance Officer ” S’Officer POST EXCHANGE OFFICER P 'ice Officer Q. M. Detachment Administrative Officer of the Day Civilian Employees Utilities MEDICAL SUPPLY OFFICER Procurement 4 Storage Issue & Repairs Medical ■ Library Chaplain Chapel Ward Visits COMMANDING OFFICER Laundry Offi cer ADJUTANT HOSPITAL INSPECTOR Investigations Audits •Chief Nurse Nurses and Aides Nurses Home )bstetric and Gynecology Sec. Anesthesia and Operating Sec. Eye-Ear-Nose & Throat Sec. Section * y Roentgenological * Section PROFESSIONAL OFFICER OF THE DAY SURGICAL SERVICE Gen. Surgery Section Septic Surgery Section Orthopedic Surgery Sec. Benito-urinary Section - Respiratory & Gen. Med. Sec. Enterology MEDICAL SERVICE Tuberculosis " Section Contagious “ Section PROFESSIONAL DIVISION Officers & Womens Section Cardio Vascular Renal Section Neuro,-Psychiatric f Section — -Prison Ward LABORATORY ' SERVICE Pathology ~ Microscopy Serology Basal Metabolism OENTAl SERVICE Operative Section Prosthetic _ Section Oral Surgery " Section Emergency Dental Officer .OUTPATIENT SERVICE •Pharmacy Officer ADMINISTRATION 947 Form 51 Mxdical Department, U. 8. Ajkmt (Revised Nov. 25,1940) REPORT SHEET 1. REPORT OF SICK AND WOUNDED AT— Station Hospital, Fort School, Pa. (Here state the name or number of the hospital, or organixation, with location on the last day covered by the report, except in the theater of operations in time of war, whan the numerical designation only will be given.) 2. PERIOD Month of —S11.— , 19 42 (Give beginning and end of period, if less than a month.) (Here specify the command 3nd the regiments, companies, and detachments composing it on the last day covered by the report, together with either the tactical division. Army r -pa, or field Army, or the territorial corps area or department, of which it forms a part.) 3. COMMAND THIRD SERVICE COMMAND 1399th Service Unit consisting of: Medical Section, Quartermaster Section, Signal Section, Ordnance Section, DEML Section. 4. VARIATIONS IN COMMAND (8tate Important variations from the general composition of the command, as the arrival or departure of companies, giving the dates thereof respectively, and the names of accompanying medical officers. Reports relating to commands in the field should show the location of the principal camps occupied during the month, with the dates of arrival at and departure from each. When a hospital is opened or closed, or a Medical Department organixation discontinued, during the period of the report, the fact and date thereof should be recorded and the orders directing it be cited.) •August 15, 1942:- 150 enlisted men arrived from Camp Lee, Va, unaccompanied by any medical officer. (a) REGULAR ARMY (6) TRAINING UNITS 76 625 N. O. Com * F, R C 7 W. 0.1 2 N. G. Enl.*_ C. M. T. C.8-__ F. C.*„ R. 0. T. C.8_ A. N. C.« 8 0. R. C.« 1 i Total . | 711 (c) Civilians not included in (6): Men .148. __ Women .165 Children 86 Total .39.9. 6. MEAN STRENGTH OF COMMAND FOR THE MONTH (For method of computing the mean strength, see Instructions 5, reverse side of sheet. 1 Warrant officers. * Armv field clerks and field clerks, Q. M. C. ‘Army Nurse Corps. * National Ouard. ‘ Reserve Officers' Training Corps. • Officers’ Reserve Corps. T Enlisted Reserve Corps. • Citizens' Military Training Camp.) Hospital Quarters Hospital Quarters 3423 . 115 . R. O. T. C C. M. T. C Reserve Corps All others...DopOHdontS _ 58 3487 115 6. PATIENT DAYS Plate 5. Report Sheet (Front) 948 MILITARY MEDICAL MANUAL Number of patients Number of treatments (a) Out-patients: (1) Regular Army (5a) . 315 1157 (2) Training units (5b). (3) Civilians (5c). 71 243 Total 386 1400. 7. PROFESSIONAL WORK (NOT OTHERWISE REPORTED) (6) Physical examinations conducted (specify; see instruction par. 67g, AR 40-1025); Appointment of officers in Regular Array 8 Appointment of warrant officers in AUS 17 Enlistment in Army of the United States 15 EM for appointment to Officer Candidate School ... 39 Enlisted men for foodhandlers 24 Civilians for appointment in Civil Service 19 (c) Vaccination and immunization, and sensitization tests administered (specify): Typhoid 54 Smallpox 72 Tetanus Toxoid ..... 18 Dick Test 6 8. GENERAL REMARKS Organizations present on post but accounted for on their own Report of Sick and bounded: 1st Infantry, 10th Cavalry, 20th Field Artillery 3attalion. I certify that this sheet and the accompanying cards are a true and correct exhibit of the sick and wounded of the command specified above for the period indicated. Cards of — completed cases accompany this sheet: with the December report, cards for 9. CERTIFICATE remaining cases. (See par. 64 (4) a AR 40-1025.) Colonel, Med Corps y s Army Surgeon. 1. (a) The report of sick and wounded comprises the re* medical record jackets, Form 52d. (See Section VI AR 40- 1025.) made with typewriter when possible. When a typewriter in the field, when pencil is permissible. When a typewriter is used, the name of the offloer signing this form and signing or initialing the report cards should be typed immediately 2. See instructions in space 2 or par. 67b, AR 40-1026. 4. Bee instructions in spaoo 4 or par. 67d, AR 40-1025. oolored enlisted men, civilians, etc., separately) and divided’ by the number of days in the month tor which the report is cases in which the report is made for a period which Is less than a month, the totals will nevertheless be divided by the number of days in the month. See also par. 67e, AR 40-1025. 6. See par. 67f, AR 40-1026. 7. See par. 67g, AR 40-1025. 8. See par, 67h, AR 40-1025. Under Osnrral Rsmarks record any facts of importance not otherwise provided fcr. 9. See par. 671, AR 40-1026. INSTRUCTIONS u. 3. COVCRNUENT PRINTING OFPICC ie—19096 Plate 6> Report Sheet (Reverse). ADMINISTRATION 949 erty therein, the delivery of prescriptions to the pharmacy and of medicines to the ward, the delivery of diet cards to the mess officer, and the effects of the patients until they have been turned over to the proper custodian. Ward Rules. The following are some of the ward rules in effect in Army hospitals: No enlisted man except those authorized in writing by the responsible medical officer will administer medicine to a patient in hospital, and then only as directed under such limitations as his written authorization shall prescribe. Active poisons, alcohol, and alcoholic liquors when necessarily on hand in the ward will be kept under lock and key. Disinfectants and medicines for external use only will not be kept with medicines for internal administration. Patients upon reaching the ward will be bathed, clothed in clean hospital clothing, and put to bed unless their condition indicates otherwise or a specific order forbids. On the death of a patient the ward master will notify the ward officer or, in his ab- sence, the medical officer of the day. He will not remove the body from the ward until after it has been examined by the medical officer. All property of the ward will be checked by the ward officer or his assistant at frequent intervals, and all overages or shortages found will be adjusted. Ward Morning Report. A morning report of the ward (Form 72 M. D.) is forwarded by the ward officer to the registrar each morning immediately after the morning rounds have been made. This report is accompanied by diagnosis slips for new admissions, by change of diagnosis cards, by the clinical records of all cases completed in the ward or which depart from the ward otherwise than by transfer to another ward, and by the notices of cases transferred to other wards since the preceding report. It is important that the ward officer send in diagnosis slips promptly for all patients in order that the commanding officer and chief of service may be informed of the gen- eral type of cases being admitted to the hospital. Diet Cards. Diet cards (Form 73 M. D.) covering the diet requirements for the ensu- ing 24 hours are sent by the ward officer to the mess officer each morning. Clinical Record. A clinical record (Form 55 M. D.) is kept for every patient ad- mitted to the hospital. (See Plate 10.) Upon departure of the patient from the hospital all the sheets of the clinical record are arranged in their proper order, signed by the ward surgeon, and sent to the registrar’s office with the next morning’s report of the ward. Should a patient be transferred from one ward of the hospital to another his clinical record is sent with him to the new ward and the fact of the transfer is noted. Patient’s Effects and Pay Patient’s Property. The clothing and other effects of every patient admitted to hos- pital are tagged (Form 76 M. D.) for identification and listed in duplicate on the patient’s property card (Form 75 M. D.) in the presence of the patient. The list together with the effects is sent to a designated storeroom. Money and valuables belonging to patients are deposited in the hospital safe or in a bank by the commanding officer or officer designated by him, and the patient is given a proper receipt. Enlisted men on duty are forbidden to retain money or other valuables received from patients for safe- keeping or to have financial dealings with them. The soiled clothing of patients is washed as a part of the hospital laundry. Infected clothing is disinfected at Govern- ment expense. Government property brought to the hospital by the patients is also listed and accounted for and is kept intact whenever circumstances warrant. Pay of Patients. Patients at a station hospital are usually paid on their organization pay rolls, the money being collected by their company commanders and delivered to them. The commanding officer of a general hospital is also commanding officer of the patients therein and makes provision for their pay. Service Record of Patient Detached from His Organization. Whenever an enlisted man is detached from his organization for admission or transfer to a hospital, the soldier’s service record is sent to the commanding officer of the hospital or station im- mediately following such admission or transfer. Service records of patients are not 950 MILITARY MEDICAL MANUAL sent to the hospital so long as the organization to which they belong is stationed in the vicinity of the hospital. Disposition of Patients Patients are disposed of as follows: discharged to duty; discharged to quarters to be returned to duty later; discharged from the military service on certificates of disability; 14. CAUSE OT ADMISSION Fracture, simple, complete, transverse, one inch from distal end, right radius; accidentally incurred when patient slipped and fell on outstretched right arm while running the obstacle course at Fort School, Pa, August 12, 1942. Front Side Reverse Side Plate 7. Sick and Wounded Report Card or Register Card. transferred to other hospitals; discharged from the Army for other cause (e.g., in peace- time, expiration of enlistment); by death; by desertion. Return to Duty. Patients previously designated by the ward surgeon (or chief of service) as fit for duty are marked “duty” on the company sick books at the time of sick call and are returned to duty, usually immediately after breakfast. This day counts ADMINISTRATION 951 as a day of duty, and the organization takes credit for that day’s ration. The hospital receives a ration for the day that patient was admitted. Discharge for Disability. Enlisted men in the military establishment permanently un- fitted for duty because of physical disability are discharged. They are retained and given treatment, however, until they have received the maximum benefit from it. When an enlisted man in the hospital is considered a fit subject for such discharge, the surgeon notifies the soldier’s immediate commanding officer. A certificate of dis- ability is then initiated by the organization commander and forwarded to the com- manding officer of the station. The latter refers the case to a board of medical officers. The board examines the man and reports the cause, nature, and extent of disability, and whether or not it was incurred in line of duty, for military purposes and in con- nection with compensation under war risk insurance act. In event discharge is recom- mended by the board, the board findings are forwarded to higher authority for review and approval. Approval of the findings may be made by any general officer commanding an administrative unit (e.gthe Commanding General, Service Command, and the Commanding Officer of an Infantry Division which is both an administrative and tactical unit), or by the commanding officer of a named general hospital. After approval of the board findings the approving authority orders discharge of the individual and he is transferred to the Service Command agency exercising jurisdiction where the dis- charge is accomplished. The surgeon is notified of the fact of discharge so that hospital records may be completed. The diagnosis or degree of disability is not quoted on the soldier’s discharge papers, simply the fact. The certificate of disability is not given to the soldier but is forwarded to the Adjutant General with a report of action. Enlisted men may also be discharged on recommendations of boards of officers because of inaptness, or undesirable habits or traits of character under Section VIII, AR 615-360. When the findings of such a board indicate that disqualification may be due to physical disability, the case is referred to a board of medical officers for action. If the latter finds that physical disability exists and is due to mental irresponsibility, the discharging author- ity usually directs discharge on certificate of disability. If the medical board finds no physical disqualification or if they find it to exist as the result of misconduct, discharge may be directed under “Section VIII, AR 615-360.” Care and Disposition of the Insane. Cases of insanity occurring in the military service are disposed of by discharge on certificate of disability following observation, examina- tion, and recommendation for discharge by a board consisting of at least two medical officers, one of whom will be, if practicable, a specialist in nervous and mental diseases. Psychiatric cases among officers, army nurses, warrant officers, and enlisted men with over 20 years of service are transferred to general hospitals for disposition; others are disposed of locally by delivery to relatives, friends, or civil authorities following approval of the recommendation for discharge. Certain cases among nurses and enlisted men may be transferred to the Darnall General Hospital, Danville, Ky., after approval of such requests by the Surgeon General. Those cases entitled to compensation, care, and treatment under the war risk insurance act are discharged and cared for under the direction of the Veterans’ Administration. Disposition of compensable cases. Those requiring institutional care are sent to a hospital or to relatives or friends as determined by the Veterans’ Administration. Those not requiring institutional care are discharged and the Veterans’ Administration notified. Disposition of non-compensable cases. Those requiring institutional care may be (1) Discharged and placed in care of relatives or friends; (2) transferred to St. Elizabeth’s Hospital, Washington, D. C., if admission is authorized; or (3) discharged and turned over to civil authorities legally required to assume care. Those not requiring institutional care are discharged and liberated; relatives, friends, or civil authorities are then notified. Authority to discharge from the service. (a) Compensable. Commanding General, Service Command. (b) Non-compensable. Those not entitled to care and treatment at United States 952 MILITARY MEDICAL MANUAL expense are discharged by the Commanding General, Service Command, and placed in the custody of relatives, friends, or civil authorities. Those entitled to care and treatment, if not released to the care of friends, relatives, or state authorities, are ex- amined by an Army Commitment Board (A.R. 600-505) and final disposition is made by the Adjutant General. Sec Instructions at Back of Pad Plate 8a. Statistical Report (Front). ADMINISTRATION 953 Transfers to Other Hospitals. Patients may be transferred from one hospital to anothei for observation or to obtain better treatment or hospital accommodations. Transfers are accomplished from the larger station hospitals to named general hospitals in accordance with a system of bed credits established by the Surgeon General. The commanding officers of posts having bed credits allotted to their station hospitals may transfer patients without reference to higher authority provided they do not exceed their allotment of Plate 8b. Statistical Report (Reverse). 954 MILITARY MEDICAL MANUAL beds. Smaller station hospitals not having bed credits may transfer patients by authority of the Commanding General, Service Command. When a patient is transferred, the surgeon will send with him the original clinical record and a completed transfer slip, Form No. 52e, M.D. In the theatre of operations patients transferred from one hospital to another are accompanied by their field medical records. (See Chapter III.) Deaths. Whenever a death occurs in a military hospital the hospital commander re- ports the facts to the station commander in writing, and also to the deceased’s immediate (а) Plan and Purpose of the Report.—'The Statistical Report comprises three sec- tions, in each of which is incorporated specific information required by the various divisions of The Surgeon General’s Office and the office of the chief surgeon in a theater of opera*ons. The sections are designed to furnish the following informa- tion: First section (Form 86ab), data concerning sick, injured, and battle casualties, hospitalization, and other statistical data; second section (Form 86ab), movement of communicable diseases; and third section (Form 86c), status of Medical Depart- ment personnel, other personnel attached to the Medical Department for duty, and transportation and material available for utilization by the Medical Department. (Pare. 2a and 2b, AR 40-1080.) (б) By Whom Rendered.—All Medical Department units will render this report. In time of peace separate reports will be submitted during the summer training period for each character of trainees, as National Guard, Reserve Corps, Reserve Officers’ Training Corps, and Citizens’ Military Training Camp. (Pars. 2c and 2f (2), AR 40-1080.) (c) Time Interval for Rendition.—Unless otherwise directed by competent author- ity, the first and second sections of the report normally will be rendered weekly to include data appearing on the morning report for Saturday. Under exceptional circumstances any section of the report may be required daily. (Par. 2d, AR 40- 1080.) ( Telegraphic Reports.—Telegraphic reports will be rendered only when specif- y required or in emergency. Snch reports will bo forwarded in code and will com- prise the data on all items on the report marked with an asterisk. Capitals (A), (B>, etc. (immediately preceding or following the headings), will be used as code letters to designate the headIngs. In addition to the telegram, all sections of the completed report (86a, 86b, 86c, etc.) will be forwarded by mail as provided for in paragraph (d). (Par* 25, AR 49-1080.) The Third Section will be prepared by the senior medical officer of every station and command tn the field. Including commands and units under direct control of the War Department. Thus this report will be rendered by all Medical Department Schools, Corps Area Laboratories, Medical Department Training Centers and Detachments, Medical Supply Depots, newly formed cadres, Medical Department, Headquarters, etc., even though they arc not responsible for the treatment of the sick and do not render returns on Form 86ab. The numbers preceding the following paragraphs correspond with and relate to the numbers appearing on the face of this form SPECIAL INSTRUCTIONS FOR THE PREPARATION OF THIRD SECTION. STATISTICAL REPORT (FORM* Me) (See Par. 2. o and p. AR 40-1080) (1) In ft theater of operations the numerical designation of the unit only will be given. In the Zone of the Interior complete identification of unit by name and place will bo made. (2) Indicate specifically month, day, and year. Do not use figures to indicate month. In telegraphic reports omit the year. (3) Strength of command on last day of period covered by report will Include officers, warrant officers, nurses, and enlisted men (present and absent); Discharged soldiers or other civilians with the command will not be Included ia this strength. (4) When any National Guard or Reserve Officers are on active duty, the fact will be stated on the proper line. Thus: Medical, Dental, etc. (Reg. 2; NG 6; Res. 2)..Total 9. (5) Regular, reserve, or civilian nurses on duty at a station or with the command will shown. Thus: Army Nurso Corps (Reg. 20; Res. 6; Civ. 3) Total 28. (6) Under “Enlisted Personnel, M. D.” will bo noted the number allotted by the War Department and Ln the proper column—Total present, etc. Following (Y) ’Total— the numerical strength will be divided as to Regular Army, Regular Army Reserve, National Guard, and Selectees. Thus: (Y) ’Total (Reg. 10; RAR 2; NO 50; SS 40) ... _ Total 102. (7) Military personnel, other than Medical Department, attached for duty, 9uch as Quartermaster Corps, Finance Department, etc. Under civilians will be shown those paid from M. D. funds and all others. Thus: Civilians (M. D. 40; all others 50).Total 90. (8) Report under “Remarks (8)” statistical data pertaining to personnel and trans- portation as called for by higher authority. In case of each enlisted man in the first three grades upon first Joining his station or command, the name of the noncommissioned officer concerned and the number of his dependents will bo noted. Any change in the number of dependents will be noted on subsequent reports. (9) In each column Insert both the number being used by or under the direct control of the Medical Department and immediately thereafter, in parenthesis, any additional number at tho station, including those stored as a War Rcsorve. Zeros will be used iu the appropriate column or columns marked (9) to show that an entry has not been overlooked. Service* Unservice- able able Total PJxampte: Ambulances, motor, etc— 3 (8) 0(1) 3(9) This means that thero are 12 ambulances at the station, only 3 of which are belt* used by tho Medical Department. W—-J2S0H Plate 9b. Statistical Report (Reverse). Form 86c. ing the period. The name and status of the persons for whom expenditure is made, appliances used, and amounts of special dental materials expended are shown in each case. Amounts of special dental materials on hand at last report, amounts received, amounts expended, and amounts remaining on hand at the close of the period are entered together with such other explanatory remarks as may be necessary. Both the monthly report of services and the monthly statement of expenditures are for- warded through medical channels before the fifth day of the next succeeding month, sufficient copies being furnished to permit retention of carbon copies in the intermediate offices of transmission, as follows: From any station or command under the immediate control of the War Department directly to the Surgeon General, unless otherwise ordered by him. From any other organization, station, or hospital to the chief surgeon of an ex- peditionary force in a theatre of operations, or to the Surgeon of the Service Command or department, for transmission to the Surgeon General. 958 MILITARY MEDICAL MANUAL Plate 10. Clinical Record Brief. ADMINISTRATION 959 A full record of dental patients at every military station or separate command where a dental officer is on duty is made on register cards, Form 79 M.D. For authorized ab- breviations and diagnoses see pars. 6 and 7, AR 40-1010. These cards collectively form the dental register, each card being a case record. When a patient is confined to quarters or hospital as a result of dental conditions, the dental surgeon is required to furnish the surgeon with a duplicate of the case record on Form 79 M.D. It is then in- corporated in the patient’s clinical record. Veterinary Administration Veterinary Reports. The senior veterinary officer of a station or other command is responsible for the preparation, authentication, transmission, and safekeeping of the reports, returns, and records prescribed for the use of the Veterinary Service. In the absence of a veterinary officer, the surgeon takes charge of veterinary property and renders all reports pertaining to the veterinary service unless otherwise specifically excepted. An attending veterinarian or a civilian veterinarian rendering professional service to a command will, in the absence of a veterinary officer, sign or initial (if the name is typed in) register and report cards of sick and wounded animals. A veterinary history of each permanent station is kept by the veterinarian in a loose- leaf binder. A copy of the veterinary sanitary report (AR 40-2255), the meat and diary hygiene report (AR 40-2260), the forage inspection report (AR 40-2085), and the veterinary report of sick and wounded animals (AR 40-2245) is filed therein in a single chronological sequence. Additional sheets, measuring about 13 by 8 inches, for noting the occurrence of epizootic diseases and other data of general and veterinary interest are inserted as occasion requires at their proper chronological places. The prescribed en- dorsements on sanitary reports and W.D. Form No. 110 (Report of Veterinary Meat and Dairy Hygiene and Forage Inspection) are invariably made on the copy filed in the veterinary history. A clinical record (Form 55 MX)., modified) is kept for each patient in a veterinary hospital establishment. M.D. Form No. 55aV (Clinical Record Brief, Veterinary) and M.D. Form No. 55j (Clinical Record, Treatment) are used in every case; the other lettered blanks of M.D. Form 55 M.D. are used as the nature or importance of the case may warrant. Upon completion of the case all the sheets of the clinical record are ar- ranged in their proper order, fastened together at the top, all entries completed, and the record signed by the ward veterinarian. The record as completed is then sent to the hospital office with the next morning report of the ward. It is filed according to the register number thereon. A report of veterinary personnel is rendered monthly on M.D. Form No. 86c (Statistical Report, Third Section—Personnel and Transportation), in accordance with section IV, AR 40-2245. General. The purpose of the information which follows is to present illustrative mate- rial and explanatory memoranda about the preparation of required forms and records which pertain to the administration of any military unit. They are used within Medical Department units in the same manner and for the same purposes as in all branches of the service. The records described pertain particularly to the routine administrative re- quirements of the company, such as a company which constitutes a part of a medical regiment, or more commonly a medical detachment of a station hospital. The same methods would be applicable to the medical detachment of an infantry or artillery regi- ment, or to medical detachments of other field forces. The readoption by the Army of a centralized system of handling personnel records has relieved company and detachment commanders of much detailed labor in the conduct of routine administrative procedures. The handling and maintenance of the Service Record (the military history of the individual soldier), qualification cards, payrolls and other vouchers, and Reports of Change are now the responsibililty of the personnel officer. The records which are retained by the company commander are the Morning Report, the Daily Sick Report, the Duty Roster, the Individual Clothing and Equipment ADMINISTRATION OF MEDICAL UNITS 960 MILITARY MEDICAL MANUAL Records, Memorandum Receipts and other property records (in tactical units, the com- pany property book), the company fund and Council Book, and Company Orders. * The company remains an important administrative unit because many of the records which it maintains are records of original entry. A few of the important company records are discussed below. Morning Reports. Importance as a record. In the organization of a new company, troop, or battery, it is of paramount importance that a morning report be started on the first day as this report is the official record which accounts for all officers and enlisted men of the organization. All military personnel, on active duty, are accounted for daily on a morning report. Since the morning report is not only the daily history of the organization but also furnishes the basic information for many other vital records, it is of great importance that care be taken to insure that it is correctly made out in every detail. Plate 11. Model "Strength” Section of the Morning Report. Preparation. The company morning report (W.D., A.G.O. Form No. 1) is usually prepared by the 1st sergeant, under the supervision of the company commander, and submitted each morning to the commander of the next higher administative unit. All entries in the morning report are made in black ink or indelible pencil, and are initialed by the company commander daily following the last entry for that day under the “Re- marks” section. This record is submitted daily to the personnel section where it is in- spected and information extracted. The personnel officer then initials the daily entry in the column headed “Day of the month.” Morning reports cover the period from midnight to midnight; thus the report for the period commencing at midnight 3d-4th, and ending at midnight 4th-5th, is submitted on the morning of the 5th. The condition of the company at the end of the day is shown by tabulation, by appropriate explanatory remarks and any changes that have occurred in the duty and status of military personnel during the day. Sections. The morning report is divided into four sections: “Strength,” “Remarks,” “Station and Record of Events,” and the “Ration Account” sections, and will be con- sidered in that order. In connection with entries made in morning reports it is necessary to understand the meaning of the following terms: Assigned means permanendy belonging to the company. Casual or attached means temporarily with the company. Special duty means performing some duty other than routine duties which would be performed as a member of the organization. • A complete discussion of this subject will be found in Company Administration and Personnel Records, by Lt. Col. C. M. Virtue, The Military Service Publishing Company, Harrisburg, Pennsylvania. ADMINISTRATION 961 Detached service means on some duty which necessitates absence from the post for more than twenty-four hours. "Strength” section. On pages 4, 8, and 12 of the morning report form will be found spaces to make itemized numerical entries necessary to show the daily status, by grade, of all officers and enlisted men belonging to the company. Changes occurring from day to day will be shown by appropriate changes in the numerical entries. (Plate 11, Model “Strength” Section of Morning Report, is self-explanatory.) "Remarks” section. The “remarks” section is provided for the purpose of recording all changes of duty and status of officers and enlisted men by name and grade. If there is no change of status, the notation “No change” is entered. (See Plate 12.) Plate 12. Model "Remarks” Section of the Morning Report. Practically everything that happens officially to a member of a company will be covered under “Remarks.” Some of the more important entries will be: changes in commands, changes in the duty status of members of the company, such as discharges, change in grades, transfer, absences, furloughs, arrest, confinement, and sick. As examples: Change in command: “Capt Doe, duty to hosp; Lt Smith assumed command.” Discharges: “Pvt Jones, duty to disch.” Transfers: “Sgt Smith, trfd to 15th Inf.” Absences: “Sgt Pore, duty to fur 6 days.” “Pvt King, duty to AWOL 3 p.m." Arrest: “Cpl Henry, duty to ar.” Plate IS. Model "Station and Record of Events” Section of the Morning Report. MILITARY MEDICAL MANUAL 962 Confinement: “Pvt Ball, duty to conf.” Sick: “Sgt Smith, duty to sk in qrs.” Change in grade: “Pvt Doe aptd cpl.” "Station and record of events” section. The station and record of events section will be found in the last few pages of the morning report form. Here are entered remarks in reference to the location of the company and such events as may take place, such as changes of station, with dates and distance marched or traveled; engagements including names, places; the dates of those killed, wounded or missing in action; and such other items of interest relating to the company. (See Plate 13.) Plate 14. Model “Ration Account” Section of the Morning Report. “Ration account” section. A ration is the allowance for the subsistence of one in- dividual for one day; i. e., it provides for three full meals for one person. The daily average strength of rations is the number of persons for whom the com- pany is entitled to subsistence. This is found by dividing by three the total number of meals (breakfast, dinner and supper) served in the company, as shown by the figures in the strength section of the morning report and supported by the entries in ADMINISTRATION 963 the remarks section. The daily average for rations, less the number of men authorized to mess separately, gives the entries for the colunSn headed “No, men messing with organization.” (See Plate 14.) For computation of rations under the Field System, see Chapter IX. Authorized abbreviations. The list of abbreviations given below is a partial list of those authorized by AR 850-150 for use in connection with morning reports, pay rolls, rosters, returns, and other military records, and no others are authorized except some excep- tional cases which do not fall within the purview of this chapter: Absent without leave AWOL Acting Actg Appointed Aptd Army Regulations AR Arrest Ar Article of War AW Assigned Asgd Attached Atchd Authorities Auth Barracks Bks Battalion Bn Brigade Brig Bugler Bglr Caliber Cal Captain Capt Casual Cas Changes C Circular Cir Citizens’ Military Training Camp CMTC Civil authorities CAuth Class Cl Coast Artillery Corps CAC Colonel Col Commanding Comdg Commanding General CG Commanding Officer CO Company Co Confined or Confinement Conf Cook Ck Corporal Cpl Corps Area CA Corps of Engineers CE Corps of Engineers Reserve Engr-Res Current series cs Detached Enlisted Men’s List DEML Detached Officers’ List DOL Detached service DS Discharge Disch Dishonorable discharge DD Dismissed Dismd Disrated ...Disr Distinguished Service Cross DSC Division Div Document Doc Enlisted Enl Excellent Ex Expert rifleman ER Expiration of term of service ETS Field Service Regulations FSR Final statement FS Finance Department FD First xst First class icl From fr Furlough Fur General Gen General Court-Martial GCM General orders GO General Staff Corps GSC Grade Gr Headquarters Hq Hospital Hosp Inclosure incl Indorsement Ind Infantry Jnf Infantry Reserve Inf-Res Inspected and condemned IC Inspector General IG Inventory and Inspection Report . .1 & I Report Joined Jd Leave of absence Lv Lieutenant Lt or Lieut Lieutenant Colonel Lt Col Line of duty T.D Machine gun MG Major Maj Major General Maj Gen Manual for Courts-Martial MCM Marksman Mm Medical Med Medical Corps MC Memorandum Memo Motor transport MT Mounted Mtd National Guard NG Officer of the day OD Olive drab od Orders . O Organized Reserves OR Over, short and damaged OS&D Paragraph Par Pay roll p/R Post Exchange P Ex Private Pvt Private, first class Pvt icl Professor of Military Science and Tactics. PMS&T Quartermaster QM Quartermaster Corps QMC Recruit Ret Reduced Rd Reenlistment Reenlmt Regiment Regt Regular Army RA Relieved Reld Reserve Rcs Reserve Officers’ Training Corps ROTC Retired Ret Same date sd Second 2d Sergeant Sgt Special Court-Martial SCM Special Duty SD Specialist Sped Special Orders SO Station Sta Student Stud Summary Court Sum CM Training Regulation TR Transferred Trfd Unassigned Unasgd Verbal orders *. VO Very good VG War Department WD Warrant officer WO 964 MILITARY MEDICAL MANUAL The Sick Report. Sic\ call is a daily or routine performance in the military service. It is held by a medical officer and usually takes place in the early morning. Officers or enlisted men of an organization who are in need of medical attention have their names, rank and serial number entered on the Daily Sick Report, on “sick book” sick book of their organizations, and at the proper time report to the medical officer conducting sick call. In the case of enlisted men, they are grouped together and marched under a noncommissioned officer to the infirmary or other designated place. The noncom- missioned officer carries the sick book with him. In the case of an emergency it is not necessary for an individual to wait for sick call; he may be sent to the hospital at any time, or if he is unable to go to the hospital, a medical officer will call to see him. A sick book, like a morning report, is a vital record of the company and consequently no erasures are permitted. If the company commander makes an error he will line out the error and initial it. When a soldier goes into the hospital “Not in Line of Duty” AR 35-1440, the personnel officer is required to initial the Sick Report on the day of entry and upon the day of release from the hospital. Plate 15. Model “Daily Sick Report.” Organization commander's report. When a man’s name is entered on the sick book the company commander enters in the proper column whether or not he believes the sickness originated “in line of duty,” that is, not through the misconduct of the soldier and as a result of performance of duty. The company commander should be careful about making this entry; if he is not sure he should indicate it by a question mark. When all entries are made the company commander will sign the page immediately under the last entry. (See Plate 15.) Medical officer s report. The medical officer’s space on the sick book has two sections: a column headed “In line of duty,” and one headed “Disposition.” The medical officer fills these out and signs them at the place of holding sick call. In the column “In line of duty” he enters the remark, “Yes” or “No,” according to his decisions; in column “Dis- position” he enters the appropriate remarks, such as “Hospital,” “Duty,” or “Quarters.” Duty Roster. General. There are many factors which contribute to morale in any organization. One of these is the insuring that no member of the company is required to perform more than his share of the various tasks incident to the functioning of the company. In order to insure that this principle is carried out each company keeps a “Duty Roster.” This roster should be carefully kept, otherwise it may give rise to a great deal of dissatisfaction. The duty roster is a list of the enlisted men by name, together with a record of the duty performed by each. The roster is divided into two parts, that pertaining to guard duty and that pertaining to other duties. Normally, details are so made that the man longest off any particular duty is the first available for that duty. Other duties section. The Roster for Other Duties covers details other than for guard. At the beginning of the month there is inserted in the proper column, opposite each ADMINISTRATION 965 man’s name, the date when he last performed the duty specified, as indicated in Plate 16. When a man is again detailed for the same duty, a line is drawn through the last date on which he performed that duty and the new date is inserted. Guard duty section. In connection with the Guard Roster Section of the duty roster there are certain mandatory abbreviations which must be used. They are as follows: A Absent without leave. Ar Arrest in quarters. C Confinement. DS On detached service. F On furlough. p On pass. Ret Recruit. SD On special duty. Sk Sick. Plate 16. Model “Roster for Other Duties.” In keeping the Guard Roster Section, if a man is available for guard duty, there is placed opposite his name the number showing the number of days since he performed guard duty. If a man is in arrest, in confinement, or absent without leave, he is con- sidered available for guard in computing the number of days since he performed guard duty. (See Plate 17.) This is not true, however, if the man is sick, on furlough, or on detached service. Allotment of Pay. Allotment as used in the military sense means a definite portion of the pay of an officer or soldier which is authorized to be paid to another person, or institution, in a manner prescribed by the Secretary of War. The purposes for which allotments may be made are covered in Army Regulations. When an officer or soldier makes an allotment it is purely a voluntary act on his part and he may re- voke the allotment at any time he may so desire, or at any time he may make any change he desires as to the monthly rate or period covered by the allotment. Allotments are of two general classes: those which are made for the support of de- pendents, for the payment of premiums on commercial life insurance, or for deposit to a designated account with a bank, designated as “Class E Allotments”; and, those which are made for the payment of premiums on government life insurance, designated as “Class D, or Class N Allotments.” These allotments are made out on War Department, A.G.O. Form No. 29, and must comply with the provisions of army regulations as set forth in AR 35-5520. When allotments become effective the amount allotted is deducted each month from the allotter’s pay, proper entries having been made on the pay roll on which the allotter is paid to insure that such an amount is withheld by the local disburs- ing officer. A check for the amount of the monthly allotment is mailed to the allottee by the Finance Department. For the duration of the war all allotments will be continued in force, regardless of the expiration date, unless voluntarily terminated by the allottcr. 966 MILITARY MEDICAL MANUAL When an allotment is discontinued the deduction must be continued until notification is received from the Finance Officer, U. S. Army, acknowledging receipt of notification of discontinuance. Pay Reservations. To permit individuals in the military service to purchase war bonds, reservation of pay in the amount of $1.25 or multiples thereof are authorized. Requests for reservation of pay for this purpose (Class A Pay Reservations) are made on War Department, A.G.O. Form No. 29-5, and entries corresponding to the amount of pay reserved are made on the pay roll in the portion of the “Allowances” column headed “Subs.” Pay so reserved is held by the Chief of Finance, War Bonds Division until a sufficient amount has accrued to purchase the bonds designated. Deductions For Dependents. The Service Men’s Dependents Allowance Act provides for deductions from the pay of enlisted men in the grades of Private to Sergeant, in- clusive. Under this act dependents are divided into two classes: Class A—a wife and/or Plate 17. Model “Guard Roster.” children, and Class B—parents, grandchildren, brother or sister. For enlisted men with Class A dependents, deductions are mandatory, but in the case of Class B dependents are entirely voluntary. In the case of Class A dependents, $22.00 is deducted from the soldier’s pay to which the Government will add an allowance of $28.00 for a wife only, $40.00 for a wife and one child with an additional $10.00 for each additional child. Government allowances in the case of Class B dependents are similarly scaled but for lesser amounts. Application for this allowance is made on War Department A.G.O. Form No. 625, and the required deductions are entered monthly on the pay roll as Class F deductions. The column headed “Spec. Rating” is used for this purpose. (See Plate 18, Model Pay Roll.) Preparation of Pay Rolls. Permanent record. Soldiers are paid on pay rolls (W. D. Form No. 366) which are prepared and certified in quadruplicate by the organization commander. In view of the fact that these pay rolls are filed in the General Accounting Office as permanent records and may be subsequently used in connection with settlement of claims or questions affecting the pay of the men concerned, organization commanders should exercise great care that they are correctly made out. Entries. A pay roll consists of one copy of W. D. Form No. 366 and as many forms No. 366a (inside sheets) as may be necessary. Names of all enlisted men in the organization will be entered on the pay roll from the date of receipt of notice of their assignment, whether or not they have joined. The names of enlisted men should be entered in the column “names, present and absent, grade and serial number” in the order of their grades and alphabetically within each grade. The soldier’s name and serial number, date of enlistment, number of years service, and specialist rating, if any, should be written on the same horizontal line under proper column heading. Neces- sary remarks should be entered below the soldier’s name, the first line only commencing one inch from the left edge of the page, and such remarks may continue through but ADMINISTRATION 967 Plate 18. Model Pay Roll. 968 MILITARY MEDICAL MANUAL not beyond the “Date of enlistment” column. As many lines as necessary may be used. These remarks should contain all data which may affect the soldier’s pay and will be entered as provided for in “Model Remarks,” Section II, AR 345-155. The use of figures for months, ditto marks, and the word ditto are prohibited. In all cases, in making entries the last name will be written first, e.g., “Doe, John H.” and not “John H. Doe.” (See Plate 18.) Signing. When the pay roll has been made up, all men will be required to sign it. Signatures should correspond exactly with the names in the column “Names, present and absent, and grade,” except that in signatures, last names will be written last, e.g., “John H. Doe.” The original pay roll only is signed by the men of the organization. Forwarding. When the pay rolls have been signed by the men and rechecked by the organization commander, the original and the first carbon copy are forwarded to the disbursing officer not later than the 25th day of the month. The second carbon copy is filed with the permanent records of the organization. The third carbon copy is for- warded direct to The Adjutant General, in lieu of a monthly roster. Payments. Payments are made to the enlisted men in cash at the pay table on pay day, which is usually on the last day of the month. This payment is made by the disbursing officer or, in many cases, by the company commander, who secures the money from the disbursing officer. At this time, all bills which are owed to the company by the enlisted men are collected. When the payment of the company is completed the organization commander signs the certificate on the pay rolls, acknowledging that he has witnessed the payment of all men paid and he then returns the pay rolls to the disbursing officer, together with the pay of any men who were not paid. Names of men not paid should be deleted by drawing a line through their names, marking each “not paid.” These delineations must be initialed by the disbursing officer. Military Correspondence. General. In military correspondence the same grammatical rules apply as those used in civilian communications. To write a letter clearly is not sufficient; it is essential that military correspondence be so worded as to obviate any pos- sibility of its being misunderstood. Written correspondence should be limited and per- sonal or local telephone conferences should be the rule. When letters are received they should, when practicable, be answered within twenty-four hours. Official correspond- ence with officers or individuals not in or under the War or Navy Department will conform to good civilian practice. Channels of communication. The general rule is that, except as otherwise prescribed by the Secretary of War, communications, whether from a subordinate to a superior, or vice versa, will pass through intermediate commanders. This is known in the service as “going through channels.” Thus a letter from Lieutenant Jones of Company A, 392d Infantry, to his regimental commander, requesting a leave of absence, would first go to the commanding officer of Company A, 392d Infantry, then to the battalion commander, and finally to the regimental commander. Form necessary. In the preparation of a military letter there are certain general principles which must be followed. The letter should adhere to the prescribed form; it should be addressed to the commanding officer concerned and not to an individual; it should deal only with one subject; black ink only should be used; all letters should be written on one side only of letter-size paper (8 x 10x/z inches). Unused margins should conform to the following width: Top margin, first page 1 inch Top margin, second and succeeding pages l-% inches Left margin 1-14 inches Right margin % inch Bottom margin 1 inch Pages (if more than one) are numbered consecutively in a single series, midway in the lower margin and one-half inch from the bottom of the sheet. Prescribed form. (1) Heading. Nothing will be written in the upper third of the first sheet of each letter except the heading, which consists of the following: ADMINISTRATION 969 The designation of the headquarters The designation of the office The reference file number The post office address The date The subject To whom the letter is sent. (2) Body. The body begins just below the upper third of the first sheet. In military correspondence salutations common in civilian communications are not used, as for ex- ample: “Dear Sir,” “Very truly yours,” “Respectfully,” and similar salutations. When typewritten, the body of the letter is single spaced, with a double space between num- bered paragraphs. If a letter has more than one paragraph each paragraph is numbered serially with arabic numerals. (3) Signature. Following the body of the letter comes the ending which consists of the signature, and immediately below the signature appears the officer’s name typed identically with the signature, followed by the rank and organization or branch. If the officer signing the letter is in command, the word “commanding” will appear after the rank and organization. (4) Indorsements. In the military service when it is necessary to answer a letter, a new letter is not written, as in civilian correspondence, but the reply is placed on the original communication in the form of an “indorsement,” thus making complete, in one letter, everything which has been written in regard to the contents of the basic communication. The width of the indorsement will be the same as that of the letter and will begin one-half inch below the lowest element of the next preceding matter on the same page. (5) Inclosures. In the event that other communications or documents are inclosed with a letter, a notation to that effect is placed just below the body of the letter or indorsement and marked Incl. 1, etc. Example. An example of a military communication: Company A 392d Infantry Fort Benning, Georgia May 15, 1939. Subject: Leave of absence. To: Commanding Officer, 392d Infantry (Through Commanding Officer, 1st Battalion 392d Infantry) 1. Request that I be granted a leave of absence for ten days effective May 20, 1939. 2. My reason for this request is that I desire to attend to some business matters. 3. My address while on leave will be care of St. George Hotel, Chicago, 111. (Signed) Charles D. Green, CHARLES D. GREEN, Captain, 392d Infantry. 1st Ind. 201-Green, Charles D., Off. CTG-HB Hq. 1st Bn 392d Inf., Fort Benning, Ga., May 16, 1939.—To Commanding Officer, 392d Infantry. Approved. (Signed) Charles T. Stone, CHARLES T. STONE, Lt. Col., 392d Infantry, Commanding. 970 Correspondence file. The correspondence file of companies, detachments or similar units consists of ordinary 9/4- by 121/2-inch envelopes with information placed thereon as shown below. MILITARY MEDICAL MANUAL File No. Date Subject File No. Date Subject 1 16 2 17 3 18 4 19 5 20 (Company, troop, battery, detachment) (Regiment) Envelope No , 19 From File No 19 to File ,19 Each envelope used will contain the original copy or summary of all correspondence received and sent for the period indicated on that envelope. Additional envelopes may be used as required. Numbering. All correspondence will be numbered serially for each calendar year, the serial (file) number being plainly marked in the upper right corner of the first page of the communication, and is filed in numerical order without folding. Appro- priate entries are made following the corresponding number on the outside of the envelope under “date” and “subject” and the corresponding number is underscored. Index. To facilitate the location of correspondence in the file, and alphabatical index will be improvised. This may be in the form of a single sheet of paper, or the cor- respondence book, W.D., A.G.O. Form No. 8, may be used for this purpose. This index will be used for the calendar year and will then be filed with the envelopes for that particular year. Inspection. In order to prevent the accumulation of unnecessary and obsolete cor- respondence an annual inspection will be made of correspondence files by an officer designated by the post, camp, or station commander. This officer will eliminate such unnecessary correspondence, lining-out and initialling corresponding Entries on the envelopes and in the index. The War Department Correspondence File System. In headquarters of units larger than the company or detachment, a modification of the Dewey Decimal System of Library Classification is used as the basis of indexing and filing correspondence. The procedures to be followed in using this system are given in detail in the War Depart- ment publication, War Department Correspondence File, 1918 Edition. Free Postage. Penalty envelope. In conducting official military correspondence it is not necessary to pay postage provided “penalty” envelopes or wrappers are used. A “penalty” envelope derives its name from the fact that there is printed in the upper right hand corner the words “Penalty for Private Use, $300.” Use of penalty envelopes. The regulations provide that official communications and other mailable matter relating exclusively to the business of the United States, mailed by an officer of the army, will he transmitted free of postage in the domestic mails of the United States when inclosed in a “penalty” envelope or wrapper, and likewise to trans- mission free of postage in the mails, between places in any possessions of the United States, from one to another of such possessions, from the United States to such pos- sessions, and from such possessions to the United States; also from the United States to Canada, Cuba, Mexico, Newfoundland, and the Republic of Panama. If an officer has no penalty envelope available he may write in the upper left hand corner of the envelope “Official Business” over the name of the department, bureau, or office in- cluding the name of the officer sending it, and in the upper right hand corner the words “Penalty for Private Use, $300.” Recent legislation allows officers, enlisted men, nurses and others in the Army to send post free personal letters. Envelopes must contain the name and rank in the upper left corner, and in the upper right corner the word “Free” in handwriting. ADMINISTRATION 971 Use of penalty envelope for replies. When writing relative to official business to a person not in the military service, a properly addressed penalty envelope may be in- closed to cover the reply, when reply apepars necessary, but penalty envelopes will not be furnished to merchants or other dealers to cover the transmission of public property or the return of official vouchers, nor to a contractor or bidder to be used to send in the mails, free of postage, proposals or other matter concerning the business of the con- tractor or bidder with the government. Packages. Packages of official matter including articles of public property, which are not greater in size than 84 inches in length and girth combined, may be sent through the mails subject to certain restrictions. Air mail, special delivery, and registration. The prescribed air mail postage must be paid on all official mail intended for dispatch by airplane service. Official mail which is of such character as to require the more expeditious delivery thus afforded will be sent “Special Delivery”; however, postage stamps to cover special delivery must be affixed, as is required for nonofficial mail. When it is desired to register an official communication, stamps must be added covering the registration. Stamps for special delivery and registration are secured from the quartermaster. Company Orders. Preparation. Company orders are issued by the company com- mander and contain information which is deemed of sufficient importance to be pub- lished in formal written form to the entire personnel of the company. They are means by which a company commander records administrative matters and promulgates them to his organization. Such orders are also the means of announcing appointments, promotions and reductions made by the authority of the company commander. It is customary to number orders of this type serially within each calendar year. Form. The usual form for a company order is shown below: Company A, 392d Infantry Fort Benning, Ga. December 16, 1940 Order No. 8 1. The following appointment is announced in this organization: To be appointed private first class: Private Henry C. Benning, No. 687549. 2. The following reduction is announced in this organization: To be reduced to the grade of private: Private first class Henry R. Burke, No. 699845. (Signed) Harry H. Wilson, HARRY H. WILSON, Captain, 392d Infantry, Commanding. Copies to: 1 File 1 Personnel 1 Bulletin Board. History of Service. Preparation. Army Regulations now require that each company commander maintain a history of services of his organization; this may be kept in any suitable book or other permanent form. This record is a brief chronological history of the company from its inception and contains information concerning the original organ- ization of the unit, notations as to the sources from which the personnel was obtained. In the case of a newly organized reserve regiment a majority of the personnel would come from civil life. There also should be noted a record of the strength of the organization at all times, its different stations, its marches, campaigns, battles, and its losses in battle, its various commanding officers, together with members of the company who have distinguished themselves in action. Use. It is the paramount duty of each company commander to weld his company into a body capable of being commanded and accustomed to his leadership. He should instill into his men loyalty, sentiment, enthusiasm without limit, esprit de corps. It 972 MILITARY MEDICAL MANUAL will assist the company commander in accomplishing this mission if he uses the history of services as a basis for short talks, reminding the command of the history of their organization and the important engagements in which the unit has participated. Diary. Army regulations require that troops engaged in actual or threatened hos- tilities, or engaged in maneuvers, maintain a diary. Such a record is kept by all com- bat units from the company up to the higher organizations. In the diary is entered a detailed contemporaneous account of just what the company does each day, usually entered hour by hour as the events occur. There are also entered other items of military interest, such as positions reached, prisoners captured, and the morale of the troops. In preparing a diary, three copies are made, two being forwarded to the next higher commander and one retained for the company file. Use of Army Regulations. Index. In order to facilitate the finding of a desired reg- ulation on any subject, the War Department has issued two army regulations: AR No. 1-5 consists of an alphabetical index, and AR No. 1-10 consists of a list of current army regulations by title arranged numerically according to the serial classification which has been adopted. Orderly room file. In view of the fact that it will be necessary to consult Army Regulations, it is important that each organization commander maintain, in the Orderly Room, a complete file of the latest appropriate regulations. These regulations should be filed in a binder in numerical sequence, as determined by both the base and subnumbers. Army Regulations are altered from time to time by the issue of new regulations and by what are known as “changes.” Changes should be filed and kept with, and immediately preceding, the pamphlets to which they respectively pertain. It is good practice to mark, in red ink, that part of the regulation which has been changed, thus calling attention to the existence of the “change” next preceding. When new regulations are received they supersede all existing regulations of similar character on the subject, including any changes which may have been issued, prior to the publica- tion date of the new regulation. CHAPTER IX MESS MANAGEMENT1 Introduction. The subject of mess management is of particular importance to the medical officer. In the operation of a hospital the choice of diets and the skillful prepara- tion of foods will be a matter of his daily concern in the treatment of patients. Officers assigned to duty with units of a medical regiment or separate battalion will operate messes for the feeding of their own men. The usual station hospital operates a mess for its assigned personnel as well as diet kitchens for patients. Financial and stock records must be accurately kept. Mess personnel must be trained, organized and supervised. It is a great truth that there is no single factor which is more important in the stimulation of morale than the serving at proper intervals of an adequate quantity of well-cooked food. Good food is the sum of good ingredients, good cooks, and good tools with which to work in its preparation. The officer who is assigned to duty which involves responsibility for a mess must be well instructed or his supervision will be of doubtful value. Definition. Mess management is the supervision and control exercised over every phase of the operation of an army mess. The term mess is applied to those army groups who, for convenience, sociability, or economy, eat together. As used herein the term mess applies to company, battery, troop, squadron, hospital and detachment messes. Mess supervision is a function of command and is exercised, in some degree, by all commanders over the messes within their respective organizations. Direct control is exercised by the mess officer, who is assisted by the mess sergeant, cooks, and other mess personnel. Within the company the mess officer may be either the commander himself or a com- pany officer designated by him. The phases of operation involved are the preparation of menus; the procurement and storage of food; the preparation, cooking, and serving of food; the proper use of the mess equipment; the economical and efficient use of rations; sanitation; and mess accounting. Object. The object of good mess management is to build and maintain an efficient, economical, and attractive mess. Nothing contributes more to the morale of an organi- zation than the fulfillment of this mission. A good mess is the sum of good food in- gredients, good coo\s, good tools with which to work, and painstaking supervision. It is not necessary for a mess officer to be an expert in cooking and nutrition to accom- plish this task. He needs only to apply fundamental principles and check the operation daily to see that a variety of good food, balanced and properly cooked, is sanitarily served, without waste, in an attractive manner. Organization of the Mess. The company commander is solely responsible for the mess. It is his duty to make certain that the mess is operated efficiently and econom- ically, and that ample food of high quality is provided for the members of his com- pany as regular procedure. In view of his many other responsibilities, he should ap- point one of the lieutenants of the company as mess officer, thus giving the details of mess operation a closer supervision than would otherwise be possible. The mess officer has entire charge of the mess. He should inspect, in company with the mess sergeant, the kitchen, the mess hall, the storeroom, and the personnel daily. He should check the menus to make certain that a balanced diet will be prepared. He should check the bookkeeping and inventory records frequently and thoroughly so that an accurate financial statement of the mess can be produced at any time. He should observe the preparation of the food to make certain that it is being well cooked. He should be present each day during the serving of at least one meal. A check list for a thorough inspection is shown herein. The mess sergeant is one of the most important men in the company; he is one of the key men in the organization. He is in personal charge of everything that goes on in the mess. He has charge of the purchasing and the drawing of rations. He keeps all the 1 An extremely helpful book on mess management is Army Food and Messing—A Manual of Mess Management, The Military Service Publishing Company, Harrisburg, Pa. 974 MILITARY MEDICAL MANUAL accounts; supervises the preparation and serving of the food; is responsible for all the kitchen equipment and its sanitation, and for the cleanliness of all the personnel and the equipment, and is in charge of the training of the cooks. The coo\s, under the supervision of the mess sergeant, prepare and serve the food. They supervise and direct the work of the kitchen police. In the absence of the mess sergeant, the first-cook on duty is in charge of the kitchen. In every mess there should be several student cooks undergoing training. The dining room orderly is in charge of the mess hall and pantry and is responsible for their cleanliness. He is charged with the cutting and the serving of the bread. He also sees that any breakage of dishes is reported so that the person responsible may be charged therefor. Commanding Officer or Mess Officer Mess Sergeant First Cook Dining Room Orderly 2nd Cook Cook's Helpers and Table Waiters or K.P's. Organization of the Mess. The \itchen police are usually detailed daily from the company or members of the mess. In a mess of one hundred it will usually take three men to do the work required. The kitchen police work under the orders of the mess sergeant or the head cook. They police up the kitchen and dining room, wash the dishes, scrub the floors and cooking utensils, and perform such other duties which the cook in charge may direct. In tactical units under field conditions, cook’s helpers may be required to perform the usual duties of kitchen police. Inspection of the Mess. Organization commanders, mess officers, and other officers have frequent occasion to inspect the unit mess. These check-ups are useful and in- formative provided they are conducted by officers who know “where to look and what to look for.” A casual inspection by an officer who fails to discover things which are badly managed or wrong entirely will encourage sloth; the mess personnel will know the things which are not up to standard, and if the inspector fails to note them harm, rather than good, may be the result. When an inspection is made, take time to do it well. The check list below is useful. Reference should be made to Bulletin 27, The Soldier’s Mess; TM 2100-152, The Army Cool(; and to TM 10-205, Mess Management. 1. Bulletin board: Check the food handlers’ certificates. 2. Mess accounts: Add sales slips to check column 11, (See Plate 1, QMC Form No. 469). Check arithmetic of the form. Every 10 days: Check column 2 against morning report. Inventory; investigate any discrepancy. 3. Menu: Posted near cook. MESS MANAGEMENT 975 Foods listed being served? Time of preparation. 4. Serving of meals: Hot foods hot; cold foods cold. Serving system carried out? 5. Uniform and cleanliness of mess personnel. 6. Kitchen equipment and special points to observe: a. Cooking ranges. b. Baking ovens. c. Fryolator; any grease on inside? d. Steam cookers; any food stains on inside? e. Coffee percolators; any coffee stains on inside? /. Mixer; any food particles on inside or on attachments? g. Meat block. h. Pots and pans; examine edges and corners carefully. i. Utensils; examine handles carefully and test cutting edges. j. .Refrigerator room; temperature (40°—50° F.). Ice-cube freezer. /. Storeroom and bread box. m. GI cans for bulk foods; lids should fit tighdy. n. Sinks and dish washers. o. Potato peeler; any potato fragments on inside? 7. Dining room equipment: a. Steam table; examine corners and shelves carefully. b. Dishes and cafeteria trays; any grease film? c. Glasses; hold to light to observe any spots. d. Tables; any water streaks on top? e. Silverware; any food particles or food stains? 8. Floors: Any grease spots? 9. Garbage stand: Lids should fit tightly. Any refuse on cans, stand, or ground in vicinity of stand? 10. Wee\ly schedule of cleaning: On Saturdays make complete inspection; on other days make list of items you will inspect, always including inspection of mess accounts. Training Mess Personnel. The operation of a company mess requires the services of men who are skilled in the art of cooking and mess management with special reference to the problems of an army mess. The cost of feeding a company of 200 men for one month approaches $3000, a sum of sufficient size to indicate a need for care and skill in supervision. Mess personnel who are trained in the School for Bakers and Cooks are far better prepared for this task than men without that training. Preparation of food to satisfy the needs and preferences of a large number of healthy and (always) hungry young men is quite a different problem than cooking in a restaurant. The cry, “When do we eat?” rings out in camp more frequently and more soulfully than any other! Organization commanders will serve their interests best by accepting with alacrity each opportunity to send a man for training to a School for Bakers and Cooks. Cooks sometimes submit to human frailties or become “temperamental”; a reserve of several trained cooks to step in on short notice is convenient. But there is a worthwhile caution: If you hope to receive good men back from the School for Bakers and Cooks, send them good men to train. A Word for the Kitchen Police. Kitchen police are detailed as cook’s helper’s. Their various duties, most of them unpleasant, include scrubbing pots and pans, scrubbing floors, disposal of kitchen wastes, peeling potatoes, and similar tasks. The job starts very early in the morning and is not finished until well after the evening meal. It is unfortunate that all military personnel have not served, at some time or other, as kitchen police. Their tasks are very important! 976 MILITARY MEDICAL MANUAL If the job is made the stepping stone, when opportunity offers, for a real try-out as a cook, men may seek the assignment. Men who have been good kitchen police make fine cooks, providing they are good men to start with and receive adequate training. Some commanders award “KP Duty” as punishment. This practice, it is urged, is unwise, destroys morale, and places such an unsavory reputation on the job that some men feel disgraced to execute it, even for a day. This is unfortunate. Since it is a necessary task, the standard of performance desired is the same as for other military duties. Good KP service can be made to pay fine dividends in improving the mess. Food Functions. Food is the general term for what is eaten by man in order to sustain life. When all the foods required to furnish energy, build and repair the body, and keep the body in a state of health are provided in a correct proportion, the diet is said to be balanced. A Balanced Diet Chart is shown below. BALANCED DIET CHART Food function Class of foods Foods used: * Carbohydrates < Sugars Starches r Sugars Sirups Molasses Flour Breadstuffs Potatoes and other Furnish energy - starchy vegetables „ Cereals Build and repair the body . Fats Proteins lard, meat fats, oils Lean meats Cereals Eggs Fish Milk and cheese . Beans, peas Leafy vegetables Fruits Minerals Whole grain cereals Milk Fresh milk and cheese Fresh fruits and vegetables, espe- cially raw Vitamins - Canned tomatoes Butter Eggs Protect health \ L Bulk Whole grain cereals Fresh meats, espe- . dally liver Leafy vegetables Fruits Whole grain cereals The body performs its functions best when the prepared foods are consumed in definite ratio to each other, the total amount of each varying according to the type of work MESS MANAGEMENT 977 being performed. Computation is quite involved for the determination of the exact quantities of each kind of food required for different types of work. Insofar as the army is concerned in time of war or mobilization, this problem has been solved by the adoption of the field ration, which provides a reasonably well-balanced diet, assuming that it is properly issued, handled, and used. The prescribed ration components may be departed from in time of peace. A reasonably well-balanced diet may be obtained by serving meals during a day or over a period of days which: (1) Include foods from each class—carbohydrates, proteins, vitamins, fats, minerals, and bulk. (2) Have variety—different meats, different vegetables, salads, and desserts. (3) Include vitamins and bulk foods—especially vegetables, fruits, and milk. These should be served daily if possible. In determining whether a menu provides sufficient food of the proper type, the first point to consider is the nature of the duties performed by the individuals in question. A soldier in combat or at drill or fatigue expends more energy and requires more food than a soldier performing clerical duties. Under some conditions, there may be danger of insufficient health-protecting foods being served, but more frequently this danger is not due to lack of health-protecting foods but rather to improper methods of handling and cooking which partially or completely destroys those elements present. There is small danger of not enough food being included in the menu of an Army mess under normal conditions. RATIONS Definition. A ration is the allowance of food provided by the government for sol- diers, and other authorized personnel during active service, for the subsistence of one person for one day. Officers are not entitled to rations but may draw them when in the field. They must deduct the value thereof from their pay vouchers. Kinds of Rations. There are several different kinds of rations, each made up for certain conditions of service. The more common ones are: The garrison ration. The field ration. The travel ration. The Filipino ration. Garrison Ration. The garrison ration is that prescribed in time of peace for all per- sons entitled to a ration, except under specific conditions for which other rations are pre- scribed, and consists of the following: Meat: Bacon; fresh beef; fresh pork; fresh chicken. Eggs. Dry vegetables and cereals: Beans; rice; rolled oats. Fresh and canned vegetables: Beans, string and canned; canned corn; onions; canned peas; potatoes; canned tomatoes. Fruit: Canned apples; jam or preserves; canned peaches; canned pineapple; canned prunes. Beverages: Coffee, roasted or roasted and ground; cocoa; tea. Milk, evaporated and fresh. Lard; or lard substitute. Butter; wheat flour; baking powder; macaroni; cheese; sugar; cinnamon; flavoring extract; black pepper; cucumber pickles; salt; syrup; vinegar. The garrison ration is always issued in the form of a cash allowance, its value being computed monthly by the Quartermaster on the basis of the cost of specified amounts of the components of the ration. The use of the garrison ration is at present restricted to certain posts and installations. A more detailed presentation of the use of the garrison ration is included in the discussion of the “Garrison Ration System.” Types of Field Rations. Four types of field rations are prescribed for use under the different conditions of field service. These four different field rations are as given below: 978 MILITARY MEDICAL MANUAL a. Field ration A. This ration corresponds as nearly as practicable to the components or substitutes therefor of the garrison ration. This ration will be issued as often as circumstances permit. It is as good as the garrison ration and is used instead of the garrison ration primarily to simplify supply in the field and supply of large bodies of troops. When ration savings are suspended in time of peace during maneuvers, or when large bodies of troops are concentrated, the ration issued is practically field ration A. b. Field ration B. This ration corresponds as nearly as practicable to field ration A, except that items if of a perishable nature are replaced by processed or canned products —i. e., canned fruits in place of fresh fruit, etc. c. Field ration C. Field ration C consists of previously cooked or prepared food, packed in hermetically sealed cans. There are 6 cans per ration, as follows: 3 cans containing a meat and vegetable component; 3 cans containing crackers, sugar, and soluble coffee. The meat and vegetable cans contain a mixture of meat and vegetables similar to that used in a good vegetable soup. This mixture is very palatable when eaten, either hot or cold. The contents of one can is as much as the average soldier can eat at one meal, and it provides an excellent balanced diet, except for the lack of “roughage.” The crackers are saltless and slightly sweet. Packed in the same can with the crackers are two or three cubes of sugar and sufficient soluble coffee to make one canteen cup full of coffee. The coffee is soluble either in hot or cold water. Since the components of this ration are previously cooked and can be eaten cold as well as hot, this makes an excellent emergency ration. d. Field ration D. This ration consists of three 4-ounce bars of concentrated chocolate, or other components furnished for emergency use. A fifth field ration, Field Ration K, has been developed but is not yet generally pre- scribed. It comprises three different packaged meals, each providing two types of biscuit, a meat or cheese preparation, a beverage and a confection. All items are non- perishable and concentrated. No cooking or preparation whatever are required, though hot water may be desirable for the beverages. Mess kits are not needed. The gross weight, packed, of field ration K is two pounds, five ounces, at present. Packaging improvements promise to save about four ounces per ration. One K ration supplies over 3400 calories. This amount is considerably more than enough to meet the require- ments of a man at a relatively sedentary occupation but is less than is needed by a mountain trooper working hard to establish a position. Ration K is well adapted to the varying requirements of men according to the type of work they are doing because the several components individually packaged in the meal packet need not all be eaten at the same time. In other words, two meal-packages can be readjusted by the soldier to cover three actual meals when he is quietly resting in shelter or he can be issued an additional package for hard marching. Waste should be cut to a minimum in this way. The U. S. Army field ration K is the nearest approach to the ideal basic combat ration. Travel Ration. The travel ration is issued to troops, either in time of peace or war, who, while traveling, are separated from cooking facilities. It is usually issued in kind but the value of the coffee, milk, and sugar components may be issued as “iiquid-coffee money” when it appears probable that hot water and utensils for making the beverage cannot be obtained en route. THE GARRISON RATION SYSTEM Use. The garrison ration system is authorized for the Army War College, the United States Military Academy, all general hospitals, station of the Army Air Forces, and such other stations not exceeding an enlisted strength of 2500 men as may be approved by Service Command Commanders. In addition, at stations operating on the field ration system, the garrison ration system will be employed at station hospitals. The fact that the garrison ration is prescribed at all general hospitals, and at station hos- pitals makes it imperative that all officers of the Medical Department be familiar with the basic procedures employed in connection with this ration. Operation- In the operation of a mess, either hospital or organizational, the mess is entitled to one ration per day for every person assigned to it for rations by proper author- MESS MANAGEMENT 979 ity. The post quartermaster is charged with the supply of subsistence stores. He main- tains a sales commissary where subsistence stores may be purchased. On the first day of the month the quartermaster computes the cost of the ration and announces the price to the command for the current month, together with a price list of all subsistence stores kept on sale. The mess or organization opens an account with the quartermaster and purchases on credit at convenient periods such stores as may be needed. Such articles as cannot be obtained from the quartermaster may be procured from other sources, usually from the local market. At the close of the month or other settlement period the mess officer submits a ration return to post headquarters for all the rations his mess has been entitled to during the month. This return, upon the approval of the commanding officer, is sent to the quartermaster, who credits the mess account with the money value of the total number of rations to which it is entitled, based upon the cost of the ration for the current month. A balance is then struck and a settlement of the account made. If the ration credit does not cover the account charged against the mess, the mess officer or the organization commander as the case may be, is responsible for the difference. If the mess credit is more than the charge account, the difference is paid in cash to the mess officer in the form of savings. These savings, known as “Ration Savings”, are entered in the accounts of the organization and are maintained separate from other funds as they can only be spent for food or beverages. The Procurement of Food and Preparation of Menus. The procurement of food and preparation of menus are interdependent. Each operation requires advance planning and a careful consideration of the other in order to effect economy, variety, and satisfaction in mess operation. In peace time a careful study should be made of the commissary price list and of local market conditions. Fresh milk, fruits, vegetables, fish, and similar articles are usually procurable, at attractive prices, to supplement or replace components of the garrison ration. Menus should be prepared at least a week in advance and arrangements made for delivery of perishable stores on the day required when possible. The purchase of excessively large stocks of food should be avoided, especially the purchase of large quanti- ties of those foods which spoil readily. With a knowledge of what foods are available, menus can be prepared well in advance to provide for variety and a balanced diet. Numerous sample menus for various periods have been prepared and are readily avail- able to the beginner as aids and guides. In general, the various meals should include the following when possible: Breakfast—fresh fruit, a cereal, meat or a meat substitute, a vegetable, bread in two forms, butter and coffee. Dinner—soups; meat, poultry, or fish; at least two vegetables, one leafy and one root; a salad; bread; dessert; and a beverage. Supper—a little meat, a vegetable, plenty of bread and butter, a bit of sweet, and tea. Drawing rations. In order to determine just what articles of the ration it may be necessary to draw on any given day, one must consider the menus to be prepared from the rations drawn and the ration stock on hand in the kitchen storeroom. The frequency of drawing rations (other than fresh meat and bread) is governed by local regulations. At some posts “dry” rations (i.e., canned goods, flour, meal, etc.) are drawn weekly or semi-weekly. At other posts they may be drawn daily or as needed. Bread should be drawn daily from the post bakery (if established) or from the commissary, in order that it may be served fresh. Fresh meat also should be drawn on the day it is to be served. There is no prescribed War Department form for requisitioning rations for a company mess. Each post prescribes the form (if any) to be used. It should be made out and submitted in duplicate, one copy being returned to the organization for check of the articles received. It should be required that the form be signed by the mess sergeant and approved by the mess officer. When the rations are drawn the mess sergeant, or the first cook on duty in his absence, receipts for the articles actually issued. One copy of this receipt is delivered to the mess officer for his use in checking the mess accounts on the WD, QMC Form No. 469. Purchase from outside sources. All component articles of the ration and sales articles Plate 1. Monthly Mess Account. W.D..Q.M.C. Form No. 469 (Front). STOCK RECORD Plate 2. Stock Record. Reverse Side, W.D..Q.M.C. Form No. 469. 982 MILITARY MEDICAL MANUAL as published in commissary price lists must be drawn from the quartermaster commissary, when such articles are available. In most posts, however, there are a number of ration articles which are not ordinarily available to be drawn from the commissary, such as fresh fruits and vegetables, fresh milk, etc. These are classed as “exceptional articles,” and authority is granted to purchase such items from the Post Exchange or from civilian dealers. Ordinarily a list of the “exceptional articles” which the commanding officer authorizes to be purchased from outside sources is published by post headquarters. If the commissary is temporarily out of other items which are ordinarily available, such other items may be purchased from outside sources on a certificate signed by the commissary officer that such items are not available for issue to the organization. In some posts it is required that all exceptional articles which are purchased from outside sources must first be delivered to the commissary for inspection, after which, if they are found satisfactory, they are delivered to the mess which ordered them. This procedure, however, is not required at all posts. Monthly mess account. The monthly mess account is maintained on WD, QMC Form No. 469. The keeping of this form is not particularly difficult, the heading of each column explaining exactly what should be entered. The account must balance every day. At the end of the month the column headed “Standing with QM” should agree within a slight margin of error with the ration savings figures for the month. Inventory of stoc\. On the back of the Form No. 469 is provided space for an inventory of the mess stock on hand. This inventory must be taken on the tenth, twentieth, and last day of the month by the mess officer, and it is a good practice to re- quire him to place his initials on the form for each inventory. The total value of the in- ventory on the last day of the month must be transferred to the front of the form (lower left corner) so as to show at a glance the summary of the actual worth of the mess for the month. WAR DEPARTMENT Q'KevSd^ayll^lwe60<01d721 Quartermaster’s No. Ration Return of Company "I", 17th Infantry At .Leayonwprthi EBnaaa , /rom. August. .1. i$h3. , August 51, , Net number of rations due (including rations for men messing separately), all additions and deductions for percentage computed ..2m. Corrections for percentages (Pars. 11 AR 30-2210, and 44 a and b AR 345-400): Additions No 3-8 Deductions No GARRISON FILIPINO TRAVEL FIELD liaisons Required: No. 2355 No. No. No. i ••tify that this Ration Return is correct. * Approved: By order of ColOBfll PEKBYj ~y?1^/hs£7?i*eZZAy Sent to Archangel, Siberia, 389 Service of Supply (S.O.S.), 388 The Chief Surgeon, 388 Casualties by arm and service, 367 American Medical Association, 385, 386, 428, 429 American Red Cross, supply function, 868 Ammunition, Artillery, characteristics, 50 Amoebic dysentry, 383, 395, 407 Amphibian brigade, medical support, 751 Animals, antigas protection, 184 Animals, daily losses, table, 932 Ankle hitch and Spanish windlass, 529 Annexes to orders, 925 “Anopheles Brigade,” 382 Antiaircraft artillery, 59 See also Coast Aitillery Antiaircraft defense active measures, 121 in combat, 125 of bivouac areas, 124 protection of march formations, 122 of motor movement, 124 on the march, 123 on night marches, 123 passive measures, 122 Antiaircraft officer, duties of, 142 Antidotes for poisoning, 561 Antigas alarms, 182 Antigas protective clothing, 180 Antigas protective equipment, 179 Antimechanized measures antimechanized defense, 127 infantry measures, 44 Antitank defense, See Antimechanized measures Anti tetanic serum, 537 Antitoxin, diphtheria, use of, 380 Antityphoid immunization made compulsory, 384 Ants, 478 INDEX 999 Apoplexy, 555 Appointments, requirements for in Army Nurse Corps, 417 in Dental Corps, 416 in Medical Administrative Corps, 417 in Medical Corps, 415, 416 in Officers’ Reserve Corps, 418 in Veterinary Corps, 416 Approach march, 40 Areas defense of, 42 visibility of, 219 Arm, upper, fracture of, 542 See also Fracture Armored Force characteristics, 69 effect on motor marches, 322 missions, 70 organization, 67 medical service, 738-744 See also Antimechanized measures Armored medical battalion, 689, 739 Armored units, attached personnel, 646 Arms and services AEF casualties, 367 conduct of encircling maneuver, 107, 108 in attack, 105 missions in bivouac and bivouac areas, 97 missions in offensive combat, 105 missions in security measures, 94, 97 missions of in defense, 112 missions of in marches, 94 tactical functions of, 25 Army Air Forces, 7, 400 air fighting, 65 air operations, types of, 63 air reconnaissance, 65 airbases, 66 aircraft, fire power of, 64 aircraft, types of, 63 basic combat structure, 79 battle employment, 66 characteristics, 62 equipment, care and maintenance of, 65 mission, 62 organization, 6 Army and Congress, 2 Army and Navy General Hospital, 378 Army Corps, See Corps Army Dental School, 422 established, 394 Army Dispensary, The, 419 Army, field, See field army Army Ground Forces, 7, 400 basic combat structure, 79 organization, 8 Army headquarters, medical section, 761 Army hinged halfring thigh and leg splint, 512 arrangement for group performance of in- struction, 517 equipment required, 513 procedure for application, 513 steps in application of, 515 troops required for demonstration, 512 Army internes, 393 Army Medical Bulletin, 397 Army Medical Center, 395, 419, 420, 421 Army Medical Library, 375, 377, 379, 398, 408, 420, 427 History, 427 Index-catalogue, 427 Index-medicus, 428 Location, 427 Army Medical Library Centenary, 397, 428 Army Medical Museum, 377, 378, 386, 398, 429 Contents, 428 History and origin, 428 Organization and location, 428 Purpose, 428 Army , medical regiments, 761-762 Army Medical School, 379, 395, 396, 398, 422 Army medical service, 759-762 Army Meteorological Register, 376 Army Nurse Corps, 388 appointment and promotion, 416 rights and privileges, 416 See also Nurse Corps Army Nurse Corps of the U. S. Army, 388 Army of the United States basic combat structure, 79 components, 10 Congress and the Army, 2 National Guard, 14 organization, 3 organization, units of, 13 Organized Reserves, 16 Regular Army, 11 Strength, 1929-1940, 12 organized, 373 reorganized as “Legion,” 373 Army Printing Plant, Carlisle Barracks, Pa., 397 Army Regulations control of venereal diseases, 488, 489 first, 373 Army School of Nursing, 386, 388 discontinuance of, 395 Army Service School, 384 Army Shoe Board, 384 Army surgeon, 759 Army Vaccine, 402 Army Veterinary School, 398, 422 ARP, 718 Arsine, 170, 174, 583 Artificial respiration, 558 Shafer method, 558, 559 Artillery, See Coast Artillery; Field Artillery; Antiaircraft Artillery; Armored Force; Tank Destroyer Force Artillery ammunition, characteristics, 50 calibers, 48 direct support in attack, 41 fire, effect of, 367 firing positions, 52 gas shell attacks, 175 heavy artillery, 50 infantry-artillery team, 52 gas attack, use of shell in, 175 trajectories of guns, howitzers and mortars, 362 Artillery-Infantry Combat team, 52 Artillery officer, duties of, 142 Ashburn, P. M., 384, 395 Ashford, Bailey K., 404 Asphyxiation, 556 Assembly position for attack, 40 Assignment of drivers, 251 Assistant Chiefs of Staff, 4 Assistant regimental surgeon, 618 Assistant Secretary of War, 4 1000 INDEX Assistant Secretary of War for Air, 4 “Association of Military Surgeons” Eligibility for membership, 379 Organized, 378 Attack, air, See Air attack Attack, chemical, See also Chemical Warfare acting during and after, 187 attack from aircraft, 176 chemical mortar, use of, 175 from the air, 186 mines, use of, 179 mortar and artillery shell, 175 objects of chemical attack, 174 plans of protection, 186 Attack, infantry, See also Offensive assembly position, 40 attack against deployed enemy, 99 attack against organized position, 99 attack by envelopment, 98 attack by penetration, 98 commander’s presence, 106 conduct of attack, 105 coordinated attack, 97, 104 frontages in, 41 holding attack, 102 infantry in attack, 38 main attack, 104 main effort, 40 meeting engagement, 99 missions of arms and services, 105 river lines, 118 piecemeal attack, 98 plan of attack, 102 reserves, use of, 105 separate arms in, 105 Attached medical personnel, 603-663, 759 Authentication of orders, 925 Authorization of medical attendance, 935 Automatic supply, 862 Auxiliary surgical group, 821 Aviation, See Classification of type combat aviation, 63 fighter pursuit, 64 interceptor pursuit, 64 liaison aviation, 63 light bombardment, 63 Aviation Medical Examiners, 399 Aviation Medicine, 567 Closed, 396 Research Laboratory, 388, 597 School for, moved, 395 The School of, 394, 399, 400, 594 Evolution of, 1783-1942, 587-592 flight surgeon, 592 duties and qualifications, 593 how to become, 594 Axles of motor vehicles, 253 Azimuth azimuth circle, 207 aerial photos, 239, 243 back azimuth, 210 determining azimuth, 207 direction and azimuth, 207 grid-magnetic azimuth adjustment, 212 measuring map azimuth, 210 measuring with compass, 226 map azimuths, 207 plotting on map, 210 Back azimuth, 210 Backing motor vehicles, 301 Baffle traps, 452 Ballistics, 361 Balloons, 64 Bandages, 530, 531 Velpeau’s, 543 Bandaging, 530 purpose of, 530 rules for, 533 Bandsman, training program, 907 Barnes, Joseph K., 371, 377 Basic relay post, 722 Bathing facilities, 462, 463, 496 Battalion aid stations, 391 Battalion headquarters section, medical regi- ment, 669 Battalion section, medical detachment, 603, 605 Battery, storage, care of, 322 Batde of Gettysburg, 75th Anniversary of, 398 Baxter, Jedediah Hyde, 371, 378 Bearer section, medical squadron, 678 Beaten zone of rifle fire, 364 Beaumont, William, 375, 408 Bed allowance, 839 Bed bugs, 478 Bed credits, 855 Bed requirements for combat, 850 Bell, Bessie S., 388 “Benzine Board,” 377 Beriberi, 405 Bibliographia Medica, 428 Biological Laboratories, The, 422 Billings, Frank, 387 Billings, John S., 377 Bivouac, 91 Antiaircraft defense of, 124 arms and services, missions of, 97 areas, evacuation of, 336 outpost, action when attacked, 96 security in bivouac, 95, 96 Blisters, care of, 501 Bodies, motor vehicle, 272 Body groups, motor vehicle, 253 Bombardment aviation, 63 Book Shop, Medical Field Service School, 395, 427 Botulism, 459 Bradley, A. E., 388 Brain, concussion of, 555 Brakes, motor vehicle, use of, 300 Braking systems of motor vehicles, 256 Bridges, crossing, 316 Brown, William, 373 B R P, 722 Bubonic plague, 407 Buildings for hospitalization, 840 Bureau of Public Relations, WDGS, 7 Burns, treatment of, 559 electric shock and burns, 559 Butter, inspection of, 462 Cacolet, transport of patients by, 550 Cadence drill, 889 > Caduceus for all Medical Departments, 382 ornament on collar and cap, 378 yellow silk for hospital stewards, 376 Calcium hypochlorite, 440, 441, 442 Caliber, classification light artillery, 48 INDEX 1001 medium artillery, 50 heavy artillery, 50 Calls of courtesy, 357 Camouflage discipline, 75 examples, 76 expedients, 74 general, 72 materials, 75 Camp Barkeley, Texas, 400 Camp, detention, 482 Camps and camp sites, 434 breaking, 435 interior arrangement of, 435 kinds of, 434 sanitary survey of, 434 undesirable, 435 Candle, chemical use of in gas attack, 179 Carcasses, disposal of, 453 Cargo carriers, See Motor vehicles, 251 Carlisle Barracks, Pennsylvania, 384 military reservation, 389 Carlisle Indian Industrial School, 424 Carroll, James, 382 Carrier, 472 diseases transmitted by, 472 Carrier, wheeled, litter, 551 Cars, See Motor vehicles, 251 Casualties abandonment of, 640-641 animals, 932 in AEF, by arm and service, 367 classification of death producing agents, 368 evacuation procedure, 160, 7x2 estimates of expected, 624, 649, 850, 915, 929> 93i; table, 931 gas casualties, first aid for, 586 march casualties, 434, 622 types, 623, 929-930 Cavalry characteristics, 45 horse regiment organization, 47 missions, 45 Cavalry, attached medical personnel, 644 Cavalry division, medical service, 751-754 Central control, medical department, 866 Central dental laboratories established, 397 Central hospital fund, 380 Chain of evacuation, medical service, 758 Chamberlain, W. P., 387 Chancroid, 484 Chaplain, medical regiment, 667 duties, 145 Chassis groups, 253 Chauffeurs, See Drivers Check list of sick and wounded, 734 Chemical officer, duties of, 143 Chemical Warfare acting during and after attack, 187 characteristics, 171 classification of agents, 168, 170 air, attack from, 186 aircraft, attacks from, 176, 186 alarms, 182 animals, protection of, 184 artillery shell in gas attack, 175 candles, chemical, use of, 179 chemicals, bulk, use of, 179 clothing, protective, 180 commanders, responsibility for training, 168 cylinders, chemical, use of, 179 defense against gas, 167 definition of chemical warfare, 167 degassing and decontamination, 182 development since World War, 168 development in World War, 167 discipline, gas, 181 dugouts, gasproof, 185 first aid, 181 gas mask, army, 180 gases, types of, 169 indications of gas, 185 landmines, use of, 179 medical officer and chemical warfare, 167 mortar and artillery shell attacks, 175 objects of chemical attack, 174 objects of gas defense training, 168 ointment, protective, 180 origin of chemical warfare, 167 plans of protection, 186 projector shell attacks, 175, 186 protective equipment, 179 reconnaissance, chemical, 186 shell, chemical, 367 shelters, gasproof, 182 sentries, gas, 184 tactical uses of gas, 174 weather and terrain influences, 175 Chemical Warfare, Medical Aspects of, 565 Chemical Warfare Service, 168 Chief of Staff, 4 duties of, 137 Chief surgeon’s office, 820 Chief Surgeon’s Office, American Expeditionary Force, 387 Chiefs of Staff, Assistant, 4 Chiggers, 477 Chloracetophenone, 170, 172, 580 Chlorination of water, 440 See also Water Supply Chlorine, 170, 171, 570 Chlorine, effects of, 440, 441 Chlorine and orthotolidine, reaction between, 441 _ Chlorpicrin, 170, 171, 569 Choking, first aid treatment of, 558 Cholera, 405 Church, Benjamin, 371 Citizens’ Military Training Camps, 403 Civil affairs officer, duties of, 146 Civil medical practice, 936 Civilian Conservation Corps, 396, 403 civilian nurses for, 396 control of typhoid fever in, 402 entrance and discharge, 398 prevention of pneumonia in, 404 strength, 397 Civilian medical attendance, 935 Civilian Personnel Subdivision, SGO, 414 Claims Subdivision, SGO, 414 Classification of chemical agents, 168, 170 Classification of supplies, 996-997 Clavicle, fracture of, 542 See also Fracture Cleaning and disinfesting devices, See Devices Cleaning or policing, 476 Clearing company, 728-735 Army medical regiment, 762 medical battalion, 689 1002 INDEX medical regiment, 672 mountain medical battalion, 699 Clearing platoon, 673 Clearing station, 728-732 Clearing station tag, 733 Clearing troop, cavalry division, 753 Clearing troop, medical squadron, 679 Clerk, training program, 908 Cleveland, Grover, 379 Clinical record, 949 Clinical record form, 958 Close column motor march, 326, 329 Clothing, 497 cold weather, 502 jungle operation, 502 rainy season, 503 Clothing, antigas protective, 180 Clutch, use of, 299 Coach-and-pupil training, 889 Coagulation, 440 Coast Artillery Antiaircraft artillery, 59 materiel, 61 mission, 58 seacoast artillery, 58 Coast Guard officers insignia of rank, 342 relative rank with army, 357 Cochran, John, 371 Cold weather, mess precautions, 991 Collecting company medical battalion, 670-671, 685, 698 Army medical regiments, 762 duties in battle, 708-728 Collecting station, 713-720 cavalry division, 753 Collecting platoon, 672, 721 Collecting troop, medical squadron, 677 Color, national, salute to, 349 Columbia University Medical School, 398 Column combat team, 88 Column movement, mechanics of, 327 Combat aircraft, battle employment of, 66 antiaircraft defense in, 125 arms, tactical functions of, 25 aviation, combat, 63 Combat teams, 45 infantry combat teams, 45 SOP for, 129 column combat team, 88 infantry-artillery team, 52 Combat zone of, 39 Command and staff procedure, 133 Command post, infantry, 55 message center, 56, 718 messengers and messenger service, 56 Commander decision of, 163 orders of, 163 estimate of situation, 164 supervision of execution, 165 presence among troops, 106 plan of commander, 163 responsibility for gas training, 168 Commander, company, medical regiment, 667 Commander in Chief, 2 Commissaries, 985 Commissioned Subdivision, SGO, 413 Common emergencies, first aid in, 554 See also First aid Communicable diseases, 469 biological sources, 471 classification of, 469 definition of, 469 early recognition of, 482 factors in the control of, 472 factors influencing, 472 geographical sources, 471 methods of transmission of, 472 statistical report, 953 Communication axis of signal communication, 56 field message book, 57 infantry communications, 33 medical unit, facilities of, 56 messages, 56 messages, field, 57 motor march, 335 message center, 56 Communications zone, medical establishments, 832 Commutation of ration allowance, 992-993 Company aid group, 626 Company Aid Station establishment of, 390 Compass marching by, 226 measuring azimuth with, 226 use of in map reading, 223 Concentration of medical department units, 859 Condensed milk, inspection of, 461 Conditioning of troops, 507, 509 Also see Troops, conditioning of Conferences, training, 886 Congress and the Army, 2 and the War Department, 2 Constipation, 493 Contact, 472 carrier, 472 direct, 472 indirect, 472 infected person, 472 Also see communicable disease Contours, 215 on maps, 215 Contract surgeons, 380, 411, 417 See also Surgeon Control measures for diseases, 470, 482, 486 prophylaxis, specific, 474, 481 prophylaxis, venereal, 383, 385, 487 Contused wounds, 534 See also Wounds Convalescent camps, 841 Convalescent hospital, 795-800 Conventional signs, 190, 206 See also Symbols, Abbreviations Convoys, See Marches, motor vehicle Convulsions, epileptic, 555 Cooking, 988-990 Cooling system, motor vehicle engine, 264 Coordinate card, 203 use with maps, 203 use of in aerial photos, 237 Coordinated attack, 97 Coordinates, map grid, location by, 202 map coordinates, 201 on 2000-yard grid maps, 203 Coordination of attack, 104 Coordination of sanitation activities, 873 Corps medical battalion, 757 Corps organization, 80 Correspondence, military, 968-971 Correspondence book, 970 Cost Accounting Subdivision, SGO, 415 Counteroffensive, 109 conduct of, 112 Courtesy, military, 339, 343 See also Customs and discipline, 339 personal courtesy, 353 courtesy calls, 357 Craig, Charles F., 407 Craik, James, 371, 373 Crane, Charles Henry, 371 Credits for supplies, 867 Cross country driving, 307 Cross country march, 87 Curves, driving on, 317 Customs calls of courtesy, 357 general rules, 358 messes, 358 social functions, 358 titles of officers, 357 Cylinders, chemical use of in gas attack, 179 Daily sick report, 936, 964 Dairy products, inspection of, 461 See also Milk and diary products Danger space of rifle fire, 364 Darnall, C. R., 384, 401 Daylight withdrawal, 114 Death-producing agents, classification of, 368 Deaths occurring in hospitals, 949, 954-956 Decision of commander, 163 effect of mission on, 101 effect of terrain on, 102 Declination, map reading, 212 Decontamination, 182 Deductions for dependents, 966 Defense against gas, See Chemical Warfare; Antigas Defense against chemical warfare, See Medical Aspects of Chemical Warfare Defense, antitank, See Antimechanized meas- ures Defense, infantry in, 42 areas, 42 arms and services, missions of, 112 chemical warfare, defense against, 167 counteroffensive, conduct of, 112 object of, 113 passive defense, conduct of, m position, selection of, 109 river lines, 118 types of defense, 108 Definitions evacuation terms, 156 march terms, 87 militia, 15 motor marches, 323 Degassing, 182 See also Chemical Warfare; Antigas Delaying action, 115 conduct of, 116 INDEX Delousing, See disinfesting Dengue fever, 405 Demonstrations, training, 887 Dental Corps, 408, 411, 416 established, 384 reorganization, 385 training of candidates for, 398 Dental Division, SGO, 415 Dental hygiene, 494-495 Dental Officers, attached personnel, 619 Dental School, 395, 416 Dental service, administration, 934, 956 Dental technician, training program, 904 Department of Medicine and Surgery in For- ward Areas, 399 Dependents, pay deductions, 966 Deployed enemy, attack against, 99 Deputy Chief of Staff, 4 duties of, 137 Detachments, Infantry division, 602 Detention Section, convalescent hospital, 797- 798 Desert warfare, 120 Designation, numerical, of units, 80 Devices, cleaning and disinfesting, 462 bathing, 462 laundry, 462 shower bath, improvised, 463 Diary, company, 972 Dictated orders, 922 Diet, 493 adequate, 493 rules for regulation and control of, 493-494 vitamins, 492 Diet cards, 949 Dieticians, hospital, 991 Diets, hospital, 992 Differentials, motor vehicles, 270 Direction on map, 207 on aerial photos, 243 Disability, discharge, 951 Discipline, 339, 343 camouflage discipline, 75 gas discipline, 181 importance of, 162 march discipline, 322 military courtesy, 339 Discipline, water, 432 Diseases food or water borne, 469, 470 insect borne, 470 others requiring control measures, 470 requiring notification to public health au- thorities, 470, 471 respiratory, 470 transmitted by carriers, 470 venereal, 470, 482 Diseases, communicable, See Communicable diseases Disinfection, 462, 476 Disinfesting, 462, 477, 478 Dislocations and Sprains, 546 Distance on maps, 204, 223 determining, 223 measuring on map, 204 measuring by road, 205 Distribution of orders, 925 1003 1004 Dispensaries, 943 Dispensary, regimental, 622 Ditches, driving across, 316 Division in supply system, 157 National Guard, 15 organizations of, 80 Organized Reserve, 16 types of, 80 Division surgeon, 703 armored division, 738-739 cavalry division, 752 Division of Physical Reconstruction, 387 Division of Vital Statistics, SGO, 412 “Dodge Commission”, 381 Dog bites, 536 Dressings, Army first aid, 531, 533 Dressing Station, 391 Drivers, ambulance, 722-724 Drivers, assignment of, 251, 294 Drowning accidents, prevention of, 558 Drowning, treatment for, 557 Dugouts, gasproof, 185 Dunham, George C., 395 Duty roster, 964 Dysentery, 407 Ears, care of, 504 Echelon system of motor vehicle maintenance, 277 Echelonment of medical depots, 864 Eggs construction candling apparatus for, 460 inspection of, 459, 460 Electrical systems motor vehicle, 253, 272 Elevation, map reading, 213 determining, 216 Embarkation camp, 838-839 Emergency medical tag, 626-628 Emergency veterinary tag, 643 Encircling maneuver conduct of, 108 separate arms in, 107 Engine, motor vehicle, 260 fuel system, 264 exhaust system, 264 cooling system, 264 engine lubrication, 265 starting and warming up, 298 Engineer amphibian brigade, medical support, 751 Engineer officer, duties of, 143 Engineers, Corps of components of large forces, 53 missions, 53 Enlisted Subdivision, SGO, 413 Envelopment, attack by, 98 Epidemics, 469 Epileptic convulsions, first aid for, 555 Equipment aircraft, care and mainteilance of, 65 antigas protective, 179 motor vehicle equipment, 321 training, 883-884 Estimate of the situation, 164, poy effect of mission on decision, 101 effect of terrain o«t decision, 102 Estimate of supply requirements, 860-861 Estimates of casualties, 624, 649, 850, 915, 929, 931, table, 931 INDEX Estimating medical personnel, 858-859 Ethyldichlorarsine, 170, 172, 579 Evacuation See also Supply and Evacuation bivouac areas, evacuation of, 336 casualty evacuation procedure, 160, 703, 850 communications zone, 856 infantry, 33 terminology, 156 of gas patients, 585 time and vehicle requirements, 928-929 Evacuation hospital, 773-794 motorized, 794-797 Examples of correspondence, 969-971 Examples of field orders, 924-926 Examinations, physical, 938-942 Examinations, training, 885 Examining team, 938-939 Excreta, 442 Executive officer, medical regiment, 666 Executive Officer, SGO, 412 Exercise, physical, 505 Exhaust system, motor vehicle engine, 264 Eyes, care of, 504 Fainting, 554 Fairbank, Leigh C., 397 Feet, care of, 498 care of blisters, 501 shoe fitting, 498, 500 Field army organization, 80 Field Artillery characteristics, 48 classification by assignment, 51 classification by caliber light artillery, 48 medium artillery, 50 heavy artillery, 50 firing positions, 52 infantry-artillery team, 52 in direct support, 42 missions, 48, 52 Field expedients, motor vehicles, 308 Field Hospital, 391 Field medical card, 771 Field messages, 57 Field message book, 57 Field orders, 918, 921-927 form, 928 Field rations, 983 Field rations system, 985-987 “Field Service and Correspondence School of Medical Officers”, 384 Fighter pursuit aviation, 64 Figures on maps, 206 File of correspondence, 970 Films, training, 887, 890 Filtration, 440 Finance officer, duties of, 146 Finance Subdivision, SGO, 414 Finley, Clement Alexander, 371 Fire and movement, 33 Fire precautions and fighting, motor vehicles, 295 Fireman’s carry, 548 Firing effect of artillery fire, 367 defensive fires, 43 INDEX 1005 fire power of aircraft, 64 rifle fire danger space and beaten zone, 364 effect of, 367 positions, artillery firing, 52 First Aid, 511 definition of, 511 dressings, Army, 531 for foreign bodies, removal of, 562, 563 in common emergencies, 554 methods of controlling hemorrhage, 538 packet, 532 purpose of, 511 sprains and dislocations, 546 Standard rules of, 528 training in, 511 treatment for poisoning, 560 treatment of wounds, 536 treatment of fractures, 541 First Aid in common emergencies, 554 alcoholic intoxication, 558 apoplexy, 555 asphyxiation, 556 choking, 558 concussion of the brain, 555 drowning, 557 epilepsy, 555 fainting, 554 pain in the abdomen, 554 poisoning, 560 removal of foreign bodies, 562 shock, 554 thermal injuries, 548 unconsciousness, 555 Also see first aid First aid antigas, 181 Fiscal Division, SGO, 414 Fish, See seafoods Fitzsimons, William T., 387 Fitzsimons General Hospital, 943 Fixed hospitals, 942 Flag See also Color how to display, 359, 360 Flank guards, 37 action in marches, 92 Fleas, 480 Flies, 477 diseases transmitted by, 477 See also Fly control Flight Surgeon, 399, 592 duties and qualifications, 593 how to become, 594 Flikke, Julia O., 400 Fly control, 454, 456, 477 Fly traps, 454, 456 Flood relief of the Ohio Valley, 397 Food, 403, 481 handlers, 455 inspection of, 456, 987, 988 storage of, 458 Food Division, 388 Foot rest, Army leg splint, 545 Forced march, 87 Fore arm, fracture of, 543 Foreign bodies, removal of, eye, ear, nose and throat, 562 Forms for orders, 924-926 Forms of correspondence, 968-971 Formulae for calculating evacuation time, 929 Forwarding department, 718 For wood, William Henry, 371 Foster, George P., 385 Fox Leon, 407 Fractures, 541-545 first aid treatment of, 541 principles of splinting, 542 of skull, 555 symptoms of, 541 treatment of compound, 545 types of, 541 Fragmentary field orders, 922 Freezing, injuries from, treatment of, 560 Frontages in attack, 41 Fuel system, motor vehicle engine, 264 Fumigation, 477 Funeral, military, salutes at, 350 G-i, duties of, 137 G-2, duties of, 138 G'3, duties of, 138 G-4, duties of, 140 Garbage, disposal of, 449 garbage stands, 450 garbage strainer and soakage trench, 451 greese trap, 451, 452 labelling garbage can, 450 stack and cross-trench incinerator, 450 Garrison, William Lloyd, 376 Garrison ration system, 978-983 Gas, See Medical Aspects of Chemical Warfare Gas alarms, 182 Gas attack See Chemical Warfare; Attack, gas Gas discipline, 181 Gas indications, 185 Gas patient, evacuation of, 585 Segregation of, 585 Gas sentries, 184 Gas treatment section, 728, 750 Gases, types of, 169 See also Agents, chemical warfare tactical uses of, 174 Gasmask, army, 180 Gasproof dugouts, 185 Gasproof shelters, 182 Gasoline and oil supply, 157 Gear shifting, 299 General Hospitals established, first, 381 names of first, 381 organization and administration, 943-946 General medical supply section, medical regi- ment, 669 Genito-urinary system, hygiene of, 506 Geographical distribution of beds, 849 Gilchrist, Harry L., 395 Glenn an, James D., 387 Gonorrhea, 484 Gorgas, William Crawford, 371, 382, 383, 384, 385. 389. 401 Grant, Camp Illinois, 400 Graph, march, 337 Graphic scale constructing, 206 of maps, 204 Grease traps, 452 Grid coordinates location by, 202 on 2000 yard maps, 203 1006 INDEX Grid square, locadon by, 201 Grid-magnetic azimuth adjustment, 212 Ground forces See Army Ground Forces Group performance, training, 888 Guns, artillery, See Field Artillery; Coast Ar- tillery; Antiaircraft artillery Hair, care of, 496 Halts on motor marches, 338 Hammond, William A., 371, 376 Hand, fracture of, 545 See also Fracture Hawley, Paul R., 398 HC mixture, 170, 173 Headquarters, evacuation hospital, 773 Headquarters, surgical hospital, 764 Headquarters Company, armored medical bat- talion, 691 Headquarters commandant, duties of, 143 Headquarters corps medical service, 755*757 Headquarters detachment medical battalion, 683, 735 mountain medical battalion, 696 Headquarters section, medical detachment, 603 Headquarters and service company, medical regiment, 667-669 Health and weight, 506 Health warnings, 481 weight and health, 506 Heat exhaustion, first aid for, 559 Heating, 476 Heavy artillery, 50 Hemorrhage, 537 checking, 539 effects of, 537 methods of controlling, 539 severity of, 537 symptoms of, 538 tourniquet, use of, 540 types of, 537 High explosive shell, 366 History of the Medical Department of the United States Army, 395 History, medico-military era of central organization, 374 era prior to central organization, 372 evolution of Medical Department, U. S. Army, 371 “with due respects to Army medicine,” 400 History of service, 971-972 Hoff, John Van R., 406 Hoff Hall, 399 Holding attack, 102 Horner, J. W., 381 Horse cavalry organization of regiment, 47 Horseback, transport of patients by, 551 Hospital allowances, 839 Hospital corps classification of enlisted personnel, 382 established, 377, 378 in Spanish-American War, 381 training, 378 transfer to, 380 uniform, 378 Hospital fund, 993 Hospital messes, 991-993 Hospital rations, 787 Hospital Ship “relief”, 380 Hospital stewards caduceus, 376 organization, 380 Hospital Subdivision, SGO, 414 Hospital trains, 850, 851 Hospital units, communications zone, 841 Hospitals, classification and administration, 942- 956 Hospitals in theatre of operations, 841 Hospitals, surgical, 762-764 Hospitalization and evacuation, 839-857 Hospitalization unit, 765 Hour of arrival at Initial Point, 88 Hour of clearance at Initial Point, 88 Housing sanitation, 475 Howitzers, artillery, See Field & Coast Artillery Hume, Edgar Erskine, 392 Huntington, George S., 398 Hydrocyanic acid, 170, 173, 174, 583 Hygiene, dental, 494-495 Hygiene, military, 491 definition of, 491 responsibility for, 491 responsibility of the medical officer, 491 Hygiene of the Genito-urinary system, 506 Also see Sex hygiene and venereal diseases Hygiene of the respiratory apparatus, 503 Hygiene, personal, 491-510 Hygiene, sex education in, 486, 489, 506, 507 venereal disease, 507 Immunization artificial, 473 by repeated exposure, 473 encephalomyelitis vaccine, 398 pneumonia, 397 recruits, 939 typhoid, 473, 423 Incendiary agents, 170, 584 white phosphorus, 170, 584 thermite, 170 See also Medical Aspects of Chemical War- fare Independent corps, medical service, 758 Index Catalogue Subdivision, SGO, 413 Index Medicus, originated, 378, 394, 395 Also see Army Medical Library Infantry-Artillery team, 52 Infantry combat advance guard, 36 andmechanized defense, 44 approach march, 40 assembly position, 40 combat teams, 45 command post, 55 communications, supply, evacuation, 33 defense areas, 42 defensive fires, 43 direct support of artillery, 41 fire and movement, 33 Infantry combat flank guards, 37 frontages in attack, 41 in defense, 42 in security, 35 infantry-artillery team, 52 main effort in attack, 40 main line of resistance, 44 mission of infantry, 26 INDEX 1007 outpost and march outpost, 38 rear guards, 37 regimental reserve line, 44 units, designation of, 28 Infantry combat units, organization of, 27 weapons, 29 characteristics of, 33 zone of action, 39 Infantry division, general staff section, 707 Medical section, 705-706 Infected wounds, 535 Infiltration, motor march, 325, 328 Influenza epidemic, 385 deaths during 1917 and 1918, 386 Initial point of marches, 88 Insane, disposition of, 951 Insect control, 477 Insignia army and navy, 357 Coast Guard officers, 342 officers rank, 340 Inspection of motor vehicles, 288 after operation, 299 at halt, 299 before operation, 297 during operation, 298 Inspection, food and food handling, 455-460, 974-975, 987-988 Inspector Generals Department, WDGS, 7 Installation, evacuation hospital, 783 medical supply depot, 803 Instruction, training program, 881-896 Interceptor pursuit aviation, 64 Interior economy, attached personnel, 6x7 Intersection & resection, on maps, 211 Intoxication, alcoholic, treatment of, 558 Inventory of food stock, 982 Ireland, Merritte Weber, 371, 388, 389, 392, 393, 395, 4i9 Irritant gases and smokes, See Medical Aspects of Chemical Warfare Irritants, smokes, 170, 173, 581 adamsite, 170, 173, 581 sneeze gas, 170, 173, 582 See also Medical Aspects of Chemical War- fare Isolation, 481 See also communicable diseases Jeeps See Motor vehicles, 251 Jones, John, 372 Journal, unit, 147 Judge advocate, duties of, 146 Jungle warfare, 120 Kelser, Raymond A., 394, 406 Kitchen, collecting station, 715 Kitchen police, 974, 975-976 Laboratories army or communications zone, 806, 836, 872 theatre of operations, 871 Lacerated wounds, 534 Lacrimators, 170, 172, 580 chloracetophenone, 170, 172, 580 See also Medical Aspects of Chemical War- fare Language of orders, 920-921 Lantern slides, 891 Larynx, removal of foreign body from, 562 Latrine box, standard, 445 pit, 444, 445 straddle trench, 444 urine troughs for, 446 Laundry facilities, 462 Laveran, Alphonse, 407 Lawson, Thomas, 371, 375 Lazear, Jesse W., Dr., 382 Leadership commander’s estimate of situation, 164 decision, 163 importance of discipline, 162 morale and unity, 162 orders of commander, 163 plan of commander, 163 principles of leadership, 161 troop leading, 161 troop leading, essentials of, 162 Lebaron, Franci:, 374 Lectures, training, 886 Lee, Camp, Virginia, 400 Leg, lower, fracture of, 545 See also Fracture Leg splint, application of, 542 Legislative and Liaison Division, WDGS, 5 Letterman, Jonathan, 384 Letterman General Hospital, 384 “Letterman Plan”, 377 Letters of instruction, 918 Lewisite, 170, 172, 577 Liaison and Liaison officers, 149 Liaison aviation, 63 Liaison section, 720 Library Division, SGO, 413 Library of The Surgeon General’s Office, 375, 377. 425 Library Service Subdivision, SGO, 415 Lice, 478 See also Disinfesting Light, 476 Light artillery, 48 Light bombardment aviation, 63 Liquid chlorine water purifier, 401 Liquid waste, disposal of, 451 soakage trench, 452 Litter, dressed, 516, 519 Litter, transport by, 549 adjuncts to the litter, 551 improvised litters, 549 Litter, wheeled, carrier, 551 Litter bearer group, 606 attached personnel, 630-631 Litter bearer section, 721 Litter bearers, evacuation hospital, 778 Litter platoon, 741 Litter wounded, 716-717 Loads of motor vehicles, 318 Location of collecting station, 714-715 Logistics, 86 Lovell, Joseph, 371, 374, 408, 427 Lubricants for motor vehicles, 287 Lubrication of motor vehicles, 286, 320 Lubrication of motor vehicle engine, 265 Lung irritants, See Medical Aspects of Chemical Warfare 1008 INDEX Lung irritants, 170, 171, 567 phosgene, 170, 171, 567 chlorpicrin, 170, 171, 569 chlorine, 170, 171, 570 See also Medical Aspects of Chemical War- fare Lymphogranuloma inguinale, 484 Lyster, Theodore C., 387 Lyster, bag, 439, 440 Magee, James Carre, 371, 396, 399 Main attack, 104 Main effort by Infantry, 40 Main line of resistance, 44 Malaria, 407 Maltese cross, 379 Malingerers, 717 Manure, disposal of, See waste, disposal of Map, operation, 926 Map reading areas, visibility of, 219 azimuth circle, 207 azimuth, measuring, 210 azimuth, plotting on map, 210 back azimuth, 210 compass, marching by, 228 compass, measuring azimuth with, 226 compass, use of in map reading, 223 contours, 215 conventional signs, 190, 206 coordinate card for map reading, 203 coordinates, map, 201 coordinates, grid, location by, 202 coordinates, grid, on 2000 yard grid map, 203 declination of maps, 212 direction and azimuth, 207 distance, 223 distance and time, 204 distance, measuring by road, 205 distance on map, 223 distance, measuring on map, 204 elevation, determining, 2x6 elevation and relief, 213 figures on maps, 206 graphic scale, 204 graphic scale, constructing, 206 grid coordinates, location by, 202 grid square, location by, 201 grid magnetic azimuth adjustment, 212 identifying features in the field, 231 map reading in the field, 223 intersection and resection, 211 marginal information, 192 medical officer and map reading, 189 military maps strategic map, 189 tactical map, 189 terrain map, 190 mil in map reading, 212 orienting map in the field, 228 profiles, 217 protractor, use of, 210 representative fraction, 205 representative fraction, determining, 206 resection, 211 scales, words and figures, 206 situation, maps, 148 staff maps, 146 map symbols, 193, 206 special symbols, 192 terrain contours, 215 terrain elevation, 213 terrain elevation, determining, 216 terrain structure, 217 time and distance, 204 Maps, training, 891 Marches, foot and motor action of advance, flank and rear guards, 93 advance guard, 36 air and mechanized forces, influence of, 322 Antiaircraft defense, 122, 124 approach march, 40 arms, missions of, 94 bivouacs, 91 bivouac areas, evacuation of, 336 characteristics of motor march, 322 close column, 326, 329 column combat team, 88 column movement, mechanics of, 327 command and communication, 335 command and staff, 331 compass, marching by, 226, 228 conduct of march, 90 cross country march, 87 definitions of march terms, 87 definition of motor march, 323 discipline and training, 322 flank guards, 37 forced march, 87 halts, 338 infiltration, 325, 328 initial point, 88 hour of arrival at, 88 hour of clearance, 88 logistics, 86 motor vehicle maintenance, 284 march graph, 337 march unit, 87 marches for training and concentration, 87 motor marches, 304 motor transport, movement by, 86 night march, 87 open column, 326, 329 order of march, 88 organization and command, 331 outpost and march outpost, 38 pioneer work, 332 pools, motor, 251 preparation for march, 88 principal elements, 323 quartering party, 335 rates and lengths, 86 rear guards, 37 reconnaissance party, 332 reinforcing units, 81 road space, 87 route marking, 334 route reconnaissance, 89 security measures, 91, 94 shuttling, 330 SOP for movements, 120 state of march, 88 tactical march, 87 task forces, 82 conduct of, 431 distance, 432 duties of medical officer during, 434 physical inspection during, 432 preparation for, 431 rate of, 432 soldier’s load during, 430 water discipline, 432 time distance, 88 time length, 87 traffic control, 334 training and concentration, 87 Marginal information on maps, 192 Marine Corps officers insignia of rank, 340 relative rank, army and navy, 357 Maroon color, adoption of, 382 Master schedules, training, 878 Maus, Louis M., 406 Mayo, William J., 387 McCaw, Walter D., 389 McHenry, James, 373 McKinley, William, 381 Measures to maintain health and vitality, 480 Meat canned, 459 color, odor and consistency, 459 cured, 459 disease, transmission by, 458 poisoning, botulism, 459 preservation of, 458 refrigeration, 458 spoilage of, 458 storage in temporary camps, 458 Mechanic, auto, training program, 911 Medical Administrative Corps, 386, 397, 411, 416 candidates for, 399 new school started, 400 Medical aspects of chemical warfare, 565 physiological classification, 566 classification by persistency, 566 classification by tactical use, 566 Medical aspects of chemical warfare, research on, 398 Medical battalion, medical regiment, 669-672 Medical battalion, infantry division, 708 triangular, 672 Medical battalion, mountain division, 695 Medical company, armored medical battalion, 693> 740 “Medical Corps of the U. S. Army”, 383, 41L 415 promotion, Regular Army, 416 Medical Department components and distribution of, 4x1 organization and activities, 411 professional service schools, 420 purpose of, 411 Reserve Officers’ Training Corps, 418 Surgeon General’s Office, 412 Medical Department concentration center, 821 Medical Department regulations, first, 374, 375 Medical Department Equipment Laboratory es- tablished, 393 Medical Department Research Coordinating Board, 399, 403 Medical Department Reserve Corps, 399, 417 Medical Department Reserve Officers’ Training Corps, 396 Medical detachment, artillery, 607 Medical depots, Medical estimate of situation, 914-917 INDEX Medical Field Service School, 423 book shop, 395, 426 coat of arms for, 393 command and organization, 424 Department of Field Medicine and Sur gery, 426 established, 393 Hoff Hall, 399 location and history, 423 Medical Department Equipment Laboratory, 426 new building authorized, 398 organization, 422-423 school departments, 424 special courses instituted in 1940-41, 426 training courses, 425 Medical headquarters, 820 Medical Instructors Bulletin, 396, 397 Medical mission, 913 Medical officer of the day, 944 Medical officer, See also Surgeon chemical warfare and medical officer, 166 map reading for, 189 Medical reference data, 927-932 Medical regiment, 664-681 Medical Regiment 1st, Carlisle Barracks, Pa., 397, 398 Medical regulator, 855 Medical Replacement Training Centers, 400, 418 Camp Barkeley, Texas, 400, 418 Camp Grant, Illinois, 400, 418 Camp Pickett, Virginia, 400, 418 Camp Joseph T. Robinson, Arkansas, 400, 418 Officer-Candidate Schools, 419 “Medical Research Laboratory and School for Flight Surgeons”, 392, 393 Medical Reserve Corps created, 383 during 1917, 385 officers on active duty, 392 Medical sanitary company, 861 Medical service of army, 759-762 Medical service within corps, 755-818 Medical service of the division, 703-754 Medical service, evacuation hospital, 781 Medical service of field force, 819-874 Medical Service in Campaign, 384 Medical squadron, cavalry division, 675, 752 Medical Statistics, U. S. Army, 1857 to 1859, 37.6 Medical Statistics of the Provost Marshal Gen- eral’s Bureau, 378 Medical supply, service of field force, 860-868 Medical supply depot, 800-802 Medical and Surgical History of the War of the Rebellion, 377 Medical units communication facilities, 56 ROTC medical units, 21 SOP for medical units, 130 Medicine and Surgery Subdivisions, SGO, 412 Medicine, aviation Medicine, Its Contribution to Civilization, 395 Medico-military history; See History Medico-Military Man, 409 Medium artillery, 50 Meeting engagement, attack in, 99 Mess accounting in field, 983-985 Mess kits, cleaning of, 455 1009 1010 INDEX Mess Management, 973-993 Mess sergeant, training program, 910 Mess supplies, 996 Message book, field, 57 Message center, 718 Messes, field, 454-456 Messes, officers, 3158, 985-986 Messages, 56 field messages, 57 Meteorological report, first, 375 Register, 376 Mil in map reading, 212 Military courtesy, See Courtesy, military Military hospitals, 942-956 Military Intelligence Division, G-2, 5 Military intelligence section of staff, See G-2 Military Intelligence Service, WDGS, 7 Military Preventive Medicine, 395 Military Preventive Medicine, 395, 469 definition of, 469 historical background of, 469 Military Surgeon, 378 Military symbols, 192 See also abbreviations Militia defined, 15 Milk and dairy products, 461-462 Mines, land, use in gas attack, 179 Mission, tactical effect of on decision, 101 medical mission, 913 Mobile hospitals, 942 Mobile surgical unit, 764 Mobilization Training Program 8-5, 400, 419, 896-912 Modern health measures, 401 Monthly mess account, 980 Morning reports, 960-963 Moore, John, 371 Morale and unity, 162 Morgan, John, 371, 372 Mc'rison, John S., 384 Moitat', artillery, See Field Artillery; Coast Ar- tillery Mortar, chemical use of in gas attack, 175 Mortar shell, chemical, attack by, 175 Mosquitoes Destruction and prevention of, 382, 477 diseases transmitted by, 477 Motor ambulance first, 383 Motor transport of sick and wounded, 547, 553, 554 See also Marches; Motor vehicle Motor vehicles, operation and maintenance abandoning, 285 abuse of vehicles, 251, 294 accident prevention, 295 axles, 253 battery, care of, 322 bivouac, evacuation by motor vehicle, 336 bodies, 272 brakes, use of, 300 braking systems, 256 bridges, crossing, 316 care and operation, 251 chains and traction devices, 305 cleaning, 321 controls, 296 cross country driving, 307 curves, driving on, 317 differentials, 270 ditches and ravines, crossing, 316 drivers, assignment o£, 251 echelon system of maintenance, 277 electrical systems, 272 engine, 260 fuel system, 264 exhaust system, 264 cooling system, 264 engine lubrication, 265 equipment and tools, 321 field expedients, 308 fire precautions and fighting, 295 gear shifting and use of clutch, 299 inspections, 288 before operation, 297 during operation, 298 at halt, 299 after operation, 299 loads and loading, 318 lubricants, 287 lubrication, 286, 320 maintenance, 276 maintenance operations, 280 march maintenance, 284 motor marches, characteristics of, 322 marching, 304 muddy roads, driving on, 314 night driving, 317 operation, factors affecting, 251 operation, requirements for, 251 pools, motor transport, 251 power transmission system, 266 records and reports, 290 repair procedure, 285 road rules and traffic regulations, 303 safety precautions, 295 sand, passing through, 315 servicing, 320 signals, 303 speed limits, 251, 296 starting and warming up engine, 298 steering mechanism, 260 stream crossings, 316 swampy or boggy ground, driving on, 315 tightening, 321 tires, care of, 321 tools and equipment, 321 towing methods, 308, 285 transmissions, use of, 300 turning, backing, parking, 301 vehicle units and assemblies chassis groups, 252 body group, 253 accessories, 253 electrical systems, 253 wheels and tires, 256 See also Transportation Motorized division, medical support, 745 Mountain divisions, medical support, 747 Mountain medical battalion, 695 Mountain operations, 119 Mouth, care of, 494 Movement of company to collecting station, 715 Movement by motor transport, 86 Movements, SOP for, 120 Muddy roads, driving on, 314 Munson, Edward L., 384 Muujn, John L., 388 Murray, Robert, 371 Mustard gas, 170, 172, 572 Myer, Albert J., 377 Nails, care of, 498 Narcotic drugs control in hospitals, 956 National Anthem, courtesy to, 347 National Defense Act, 385 National Guard organization, 14 Divisions, 15 National Guard Bureau, 16 National Red Cross, See Red Cross Naval officers insignia of rank, 341 relative rank, army and navy, 357 Naval vessels, visits to, 355 Night driving of motor vehicles, 317 Night marches, 87 antiaircraft defense, 123 Night withdrawal, 114 Noble, Robert E., 387 Noncommissioned officers of the Medical De- partment, 399 Nontactical march, 87 Numerical designation of units, 80 Nurse Corps, 417 Army Nurse Corps of the U. S. Army, 388 established (female), 382 increased, 386 organized, 381 Nursing Division, SGO, 415 Nutrition, 491 diet, 493 rules for regulation and control of, 493. 494 importance of, 492 vitamins, 442 Obesity, 506 Observation aviation, 63 Offensive combat coordinated attack, 97 piecemeal attack, 98 attack by penetration, 98 attack by envelopment, 98 attack in meeting engagement, 99 attack against enemy deployed for defense, 99 attack against organized position, 99 plan of attack, 102 holding attack, 102 main attack, 104 coordination among staff, 104 Offensive combat conduct of attack, 105 use of reserves, 105 mission of arms and services, 105 presence of commander, 106 Office of The Surgeon General, 412, 413 Officer-Candidate School, 418 accepted applicants, 418 selected applicants, 418 Officers calls of courtesy, 357 conduct, general rules, 358 insignia of rank, 340 relative rank, army and navy, 340-342, 357 INDEX social functions, 358 titles, 357 Officers’ mess, 985-986 Officers’ Refresher Course for Medical Depart- ment pool officers, 4x9 Officers, Reserve See Reserve officers See Medical Department Officers Reserve Corps Official History of War, Medical Service, Diseases of the War, see Medical Aspects of Chemical Warfare Ohio Flood Relief, 403 Oil and gasoline supply, 157 Ointment, antigas protective, 180 Operating tent, evacuation hospital, 788 Operation map, 926 Operations Division, SGO, 4x4 Operations Division, WDGS Open column motor march, 326, 329 Operations and train section of staff, See G-3 Operators of Motor Vehicles, See Drivers Optical repair section, 802 Order of march, 88 Orders commander’s orders, 163, 164 supervision of execution, 165 Orders, plans for, 917-927 forms, 924-927 company, 971 oral, 922 Ordnance officer, duties of, 144 O’Reilly, Robert Maitland, 371 Organization, See also headings by branch Organization Armored Force, 66 Army Ground Forces, 7, 8 basic combat structure, 79 Army Air Forces, 6 basic combat structure, 79 Army of the United States, 1, 3, components of, 10 basic combat structure, 79 Regular Army, 11 units of, 13 National Guard, 14 Organized Reserves, 16 Services of Supply, 9 War Department, 2 corps, 80 divisional, 80 types of divisions, 80 field army, 80 General Staff, 136 horse cavalry regiment, 47 motor march, 331 Supply in theatre of operations, 154 infantry units, 28 numerical designation of units, 80 reinforcing units, 81 task forces, 82 large units, 80 School of Aviation Medicine, 394, 399, 400, 594 Organization and Training Division, WDGS, 5 Organized Reserves, 418 division areas, 16 branches, 17 active duty in emergency, 17, 19 officers, appointment of, 17 1011 1012 INDEX officers, promotion of, 18 organization, 16 Orientation by map, in the field, 228 identifying features in the field, 231 by aerial photos, 236 Orthotolidine test, 441 Outpost, Action of, when attacked, 96 Outpost and march outpost, 38 Overlay, 927 Packets, first aid, 532, 533 Panama Canal, 401 Papers and rubbish, disposal of, 453 Parachute troops See Airborne troops Park, corps medical, 865 Parking motor vehicles, 301 Passive defense, 109 Pasteurization of molk, 461 Patient detached from organization, 949-950 Patients, effects and pay, 949-950 Patrolling, See Scouting and Patrolling Patterson, Robert Urie, 371, 393, 396 Pay allotments, 965-966 Pay of hospital patients, 949 Pay reservations, 966 Pay roll, preparation and form, 966-968 Pediculus, corporis, and capitis, 476 Pelvis, fracture of, 545 See also Fracture Penalty envelopes, 970 Penetration, attack by, 98 Pershing, John J., 387, 388 Personnel Division, SGO, 414 Personnel Division, WDGS, 4 Personnel, medical service of field force, 857-860 Personnel section, evacuation hospital, 777-782, 7% Personnel section, medical regiment, 669 Personnel section of Staff, See G-i Pharmacopeia, earliest, 373 Regulations, Army, first, 373 Pharmacy management, military hospital, 956 Phosgene, 170, 171, 567 Phosphorus, white, See white phosphorus Photos, aerial scales and azimuth, 239 direction and azimuth, 243 military terrain features, 245 stereoscopic relief, 247 uses of aerial photos, 233 classification, 233 sizes of aerial photos, 234 distortion, 235 orientation by, 236 coordinate card, use of, 237 legends on photos, 238 recognition of terrain features, 238 Physical examinations, 937-942 Physical examination, annual, instituted, 383, 400 Physical exercise, 505 posture, 506 purpose of, 505 Physiological research labortary, 397 Physiology of digestion, 408 Pickett, Camp, Virginia, 418 Piecemeal attack, 98 Pioneer work for motor march, 332 Plan for army medical service, 760-761 Plan of attack, 102 Plan of commander, 163 Planning Subdivision, SGO, 414 Planning and Training Division, SGO, 414 Plans and orders, medical problem, 913-932 Plans and training officer, medical regiment, 666 Plotting azimuth on map, 210 Pneumonia pre\ rntion, 404 Poisoning, treatment of, 560 Policy of evacuation, 850 Polish Typhus Relief Expedition, 392 Polk, James K., 376 Pools, motor transport, 251 Positions assembly position for attack, 40 selection of, 109 attack against, 99 Postage, free, 970 Posture, 506 Poultry, inspection of, 459 Power transmission system, 266 Precautions Transportation of sick and wounded, 552 Use of tourniquet, 540 Preparation for combat, orders, 918-921 President of the United States, 2 Preventive maintenance, motor vehicle, See Motor vehicles Preventive Medicine Subdivision, SGO, 412 Procurement Planning Subdivision, SGO, 413, 415 Procurement Section, SGO, 414 Professional examination, 400 Professional Services Division, SGO, 412 Professional service, evacuation hospital, 780 Professor of military science and tactics, duti«-i of, 23 Profiles of terrain, 217 Program, mobilization training, 896-912 Program of training, 877, 881 Projectiles, 361 artillery projectiles, trajectories, 49 danger space, beaten zone, 364, 365 Projector, chemical use or in gas attack, 176 Promotion Medical Department Officers, 416 Property of patients, hospital, 949 Prophylaxis, 474 Army Regulations, venereal, 489 specific, 474, ,481 stations, 489 venereal, 383, 385 Prostitution, 486 May Act, 486 military control of, 486 Protractor, use of, 210 Protection against air attack, 90 Protective clothing, antigas, 180 Provost marshal, duties of, 144 Pulmonary edema cases, 585 Punctured wounds, 534 Purchase of rations, 979-983 Purification of water, See Water purification Pursuit aviation, 64 Pursuit, tactical method of executing, 107 separate arms in encircling maneuver, 107 conduct of encirclement, 108 Pyorrhea alveolaris, 495 INDEX 1013 Quarantine, 481, 482 camp, 482 detention camp, 482 working, 482 Quartering party for motor march, 335 Quarterly Cumulative Index of the American Medical Association, 394 Quartermaster, duties of, 146 Radio net, medical battalion, 743 Rank, insignia of Army and Marine Corps, 340 Navy, 341 Coast Guard, 342 Rank, relative Army and Navy, 357 Ration account, morning report, 962 Ration return form, 982 Rations, for field use, 983 Rations, mess management, 977-978 Ravines, crossing, 316 Rear guards, 37 action of, 93 Receiving department, collecting station, 715 convalescent hospital, 798 evacuation hospital, 777, 785 Surgical hospital, 769 Receptacles, meat, improvised, 455 Reconnaissance, air, 65 by aviation, 63 Reconnaissance, chemical, 186 Reconnaissance, ground in motor vehicle march, 332 route reconnaissance, 89 Reconnaissance, medical officers, 620 Record and Mail Subdivision, SGO, 413 Records, clearing station, 732 Records of motor vehicles, 290 Records, physical examination, 939-942 Records, staff, 146 Records, surgical hospital, 771-773 Records of wounded, 626-630 Recruiting, physical examinations, 938-942 Red Cross American Red Cross, 385 National Red Cross recognized, 384 Reserve, 386 “Yacht”, 380 “Reed-Vaughn-Shakespeare Typhoid Board”, 402 Reed, Walter, 381, 382, 401, 420 Reference data, medical, 927-932 Regimental aid station, 634 Regimental medical detachment, 604 cavalry regiment, 613 Regimental reserve line, 44 Regimental surgeon, 617 Registrar, 944-945 Registrar’s office, surgical hospital, 769 Regular Army, See Army of the United States Regulating stations, 851, 865 Reinforcing units, 81 Release of information on patients, 936 Relief of collecting company, 726 “Relief,” Hospital Ship, 380 Relief, map reading, 213 Relief, stereoscopic on aerial photos, 247 Relief, terrain, on maps, 213 Repair procedure for motor vehicles, 285 Replacement Center, See Medical Replacement Training Centers Replacement of personnel, 859 Report blank, physical examinations, 940-941 Report sheet, hospital, 947 Reports on motor vehicles, 290 Reports, physical examinations, 939-942 Reports, staff, 146, 148 Representative fraction of maps, 205 determining, 206 Requisitions, 867 Research Laboratory for Aviation Medicine, 388 Resection and intersection on maps, 211 Reports Subdivision, SGO, 413 Reserve line, regimental, 44 Reserve officers Appointment of ROTC graduates, 23 Active duty in emergency, 17, 19 oppointment of, 17 promotion, 18 Reserve Officers Training Corps, 20, 417 Medical units, 21 eligibility for enrollment, 21 courses of instruction, 22 PMS&T, duties of, 23 appointment as Reserve officers, 23 Reserve (tactical) use of in offensive combat, 105 Resistance, individual, 473 age, vitality, racial, 473 previous environment, 473 Resistance to diseases, 473 Respiration, artificial, 556 Respiratory diseases, control of, 475 Responsibility of commander, 703 Rest, 481 Retirement, 1x7 , Retreat, See Retirement; Withdrawal Retrograde movements, 640-641 Reynolds, Charles Ransom, 371, 398 Ribs, fracture of, 545 See also Fracture Rifle fire danger space, beaten zone, 364 effect of, 367 Rinderpest vaccine, 394, 406 River lines, operations at, 117 attack of river lines, 118 defense of river lines, 118 Roaches, 478 Road, measuring distance by, 205 Road rules, 303 Road space on march, 87 Robinson, Camp Joseph T., Arkansas, 400 Rodent control, 480 Roller bandage, 530 Rolleston, Humphry Davy, Sir, 397 Roosevelt, Theodore, 383 Ross, Ronald, 407 Roster for other duties, 965 Route marking for motor march, 334 Route reconnaissance, 89 Rubbish and papers, disposal of, 453 Rules, standard, of First Aid, 528 Rush, Benjamin, 372 Russeix, F. F., 383, 402 1014 INDEX Saddle-back carry, 550 Safety precautions, motor vehicles, 295 Saluting, 343 hand salute, 344 by men in formation, 347 mounted, 348, 351 in vehicle, 349, 352 by sentinels, 350 in civilian dress, 351 in athletic costume, 355 at military funerals, 350 to National color, 349 Sand, driving through, 315 Sanitary Corps, 411, 416 organized, 386 trained, 388 Sanitary order, 466 detailed outline of, 466, 467 Sanitary reports disposition of, 465 general, 465 military camp or post, 463 monthly, 378, 463, 465 special, 465 Sanitation cooperation of line with medical officers, 43p definition of, 429 field, 380, 429 historical background of, 429 proper sanitary layout for battalion camp, 464 purpose of, 429 report, 378, 463 responsibility for, 429 responsibility of line officers, 430 sanitary order, 466 survey, 463 Salvage material, disposal of, 453, 454 Sanitary technicians, training program, 906 Sanitation in theatre of operations, 868 Scalds, first aid for, 559 Scales graphic, constructing, 206 graphic, on maps, 204 on aerial photos, 239 of maps, 206 Sentries, gas, 184 Schools See Army Medical Center See Medical Field Service School See Medical Replacement Training Center See Schools, specialists See Aviation Medicine Schools, specialists Clerks’, 419 Chauffeurs’, 419 Mechanics’, 419 Bakers’ and Cooks’, 419 Officer-Candidates’ Preparatory, 419 See also Medical Replacement Training Centers Scouting and patrolling, importance to medical personnel, 76 missions of, 77 equipment for, 77 formations, 77 routes and movements of patrols, 77 control and signals, 77 Screening smokes, 170, 173 Sea foods canned, 461 inspection of, 460 Seacoast artillery, 58 Secondary evacuation, 857 Section surgeons, 838 Secretary of War, 4 Secretary of WDGS, 5 Security measures infantry in, 35 on the march, 91, 94 in bivouac, 95 of bivouac areas, 96 arms and services, missions of, 97 Security measures for march, 91, 94 Sedimentation, 440 Segregation, 482, 489, 585 Senn, Nicholas, 379 Serbian barrel, 479 Services of Supply, 10 basic combat structure, 79 organization, 9 Services, tactical functions of, 26 Serving food, 990 Sex hygiene education in, 486, 489, 506, 507 venereal disease, 507 Shakespeare, Edward O., 381 Shells, artillery, See Projectiles, Artillery Shell, artillery high explosive, 366 shrapnel, 366 chemical, 367 use of in gas attack, 175 Shelters, gasproof, 182 Shifting gears, 299 Shippen, William, Jr., 371, 372 Shock, 554 Shoe fitting, 498, 500 anatomical study of, 499 Shower bath, improvised, 462, 463, 496 Shuttle, ambulance, 722-724 Shuttling, in motor march, 330 Sick call, 936-938 Sick rates, 840 Sick report, 936, 964 Sick and wounded, report of, hospital, 945 Sick and wounded, transportation of, See Trans- portation of the sick and wounded Signal communications axis of, 56 Signal Corps mission, 54 message center, 56 axis of signal communication, 56 messengers and messenger service, 56 visual signals. 56 communication facilities of medical unit, 56 messages, 56 field messages, 57 field message book, 57 Signal officer, duties of, 144 Signals motor vehicle signals, 303 visual signals, 56 Signature of orders, 913 Signs, conventional, 190 Siler, Joseph F., 405 Situation, estimate of, 904-906 Situation maps, 148 INDEX 1015 Skin, care of, 495 Skull fracture, first aid treatment of, 555 Sleep, 481, 505 Smallpox vaccination, 406 Smokes, screening, See screening smokes Snake bites, 576 Sneeze gas, 170, 173, 582 Soakagc pit, 451 Social functions, 358 “SOP”, 708 Sources of venereal diseases, 485 Spanish-American War, 381 Spanish windlass and ankle hitch, 529 Special purpose aviation, 63 Specifications Subdivision, SGO, 415 Speed limits for motor vehicles, 251, 296 Spine, fracture of, 545 See also Fracture Splint, 542 for fractured arm or collar bone, 543 hinged, half-ring, Army, leg, 544 hinged traction, arm, 543 improvised for fractured leg, 545 improvised for fractured pelvis, 543 Sprains and dislocations, 546 Square, grid, location by, 201 St. Martin, Alexis, 375, 408 Staff, See also Commander coordination among staff, 104 presence among troops, 106 definition and functions, 133 organization, 133 general staff, 136 chief of staff, 137 deputy chief of staff, 137 G-i, 137 G-2, 138 G-3, 138 G-4, 140 Staff special staff, 140 relations with subordinate units, 141 composition of special staff, 141 air officer, 142 antiaircraft officer, 142 artillery officer, 142 chemical officer, 143 engineer officer, 143 headquarters commandant, 143 ordnance officer, 144 provost marshal, 144 signal officer, 144 surgeon, 144 adjutant general, 145 chaplain, 145 finance officer, 146 inspector general, 146 judge advocate, 146 officer in charge of civil affairs, 146 quartermaster, 146 Staff maps, 146 Staff medical officer, 934 Staff procedure, 133 Staff records, maps and reports, 146 Stage of march, 88 Standard, national, salute to, 349 Standing Operating Procedures, 129-915 For the combat team, 129 for movement, 120 for medical units, 130 Station hospitals, 841, 942, 943 Statistical Branch WDGS, 5 Statistical and Documents Subdivision, SGO, 415 Statistical report, hospital, 952-955 Statistics, vital, 467 by strength, 467 computing rates and ratios, 467 non-effective rate, 468 rate, 467 Steering mechanism of motor vehicles, 260 “Stegomyia Brigade”, 382 Stereoscopic relief on aerial photos, 247 Sternberg, George Miller, 371, 378, 379, 403, 404 Stermutators See Medical Aspects of Chemical Warfare See Sneeze gases Stimson, Julia, 392, 393 Stock record, food, 981 Storage of foods, 987-988 Storage and Issue Section, SGO, 414 Straddle-back carry, 547 Straddle trench latrines, 444 Strainer, garbage, 451 Strategic map, 189 Straub, Paul F., 384 Streams, crossing, 316 Study in Troop Leading and Management of the Sanitary Service in War, 384 Sulphur trioxide, 170, 173 Supply, general, 995-997 armored units, 743 battalion, 736-737 service of field force, 860-868 distribution, 866 Supply depot, 800 Supply Division, SGO, 414 Supply, Services of, See Services of Supply Supply Division, WDGS, 5 Supply officer, medical regiment, 666 Supply and evacuadon section of staff, See G-4 Supply and evacuation of large units, 151 operation of supply system, 152 classification of supplies, 152 definition of supply and evacuation terms, 173 diagram of organization for supply in theatre of operations, 154 division in supply system, 157 gasoline and oil, 157 Class I supplies, 157 reserve stocks, 158 casualty evacuation procedure, 160 supply of infantry, 33 Supply sergeant, training program, 909 Support artillery, 42 Supporting carry, 547 Surgeon Air, 412 contract, 380, 411, 417 corps, 380 dental, 382, 416 division and brigade, 380 hospital, 374 mates, 373 origin of title for, 374 regimental, 373 service command, 411 1016 INDEX Throat, removal of foreign body from, 562 Ticks, 479 Tilton, James, 371, 373, 374 Time and distance, map, 204 Time distance of march, 88 Time length of march, 87 Time requirements for evacuation, 928-929 Time systems, 919 Tires, care of, 256, 321 Titles, officers, 354 hospital personnel, 944 medical officers, 934 T/O 2-11, 612 T/O 2-71, 614 T/O 3-11, 657 T/O 4-11, 658 T/O 4-31, 658 T/O 4-41, 659 T/O 4-51, 659 T/O 4-61, 660 T/O 4-71, 660 T/O 4-81, 661 T/O 4-111, 661 T/O 4-151, 662 T/O 5-21, 652 T/O 5-35, 653 T/O 5-55, 653 T/O 5-65, 654 T/O 5-95, 654 T/O 5-115, 654 T/O 5-171, 655 T/O 5-185, 655 T/O 5-215, 650 T/O 5-235, 656 T/O 5-275, 656 T/O 5-411, 657 T/O 6-10, 608 T/O 6-21, 611 T/O 6-31, 609 T/O 6-45, 615 T/O 6-50, 607 T/O 6-75, 612 T/O 6-110, 613-614 T/O 6-150, 616 T/O 6-165, 648 T/O 7-ix, 605 T/O 7-21, 646 T/O 7-31, 662 T/O 8-15, 684 T/O 8-16, 685 T/O 8-17, 687 T/O 8-18, 689 T/O 8-21, 664 T/O 8-22, 667 T/O 8-25, 669 T/O 8-28, 673 T/O 8-37, 828 T/O 8-55, 831 T/O 8-65, 744 T/O 8-66, 745 T/O 8-67, 670 T/O 8-68, 746 T/O 8-75, 691 T/O 8-76, 692 T/O 8-77, 694 T/O 8-85, 675 T/O 8-86, 678 T/O 8-87, 679 T/O 8-88, 680 T/O 8-89, 682 duties of, 144 Surgeon, army group, 837 Surgeon, communications zone, 826 Surgeon General, The, 371, 411 Office of The Surgeon General, 412, 413 Divisions of the office of The Surgeon General, 412 Surgeons General of the U. S. Army, 371 Surgery, traumatic, 409 Surgical hospital, 762, 773 Surgical service, surgical hospital, 769 Survey, sanitary, 463 Sutherland, Charles, 371, 378 Swampy ground, driving on, 315 Symbols, military, 192 map symbols, 193, 206 symbols on aerial photos, 238 Syphilis, 484 Systemic poisons, 170, 174, 583 hydrocyanic acid, 170, 174, 583 arsine, 170, 174, 583 See also Medical Aspects of Chemical War- fare Tabulating and Coding Subdivision, SGO, 413 Tactical Employment of Combined Arms, 25 Marches, 85 Logistics, 86 Marches, Rates and lengths of, 86 motor transport, movement by, 86 march terms, definitions, 87 march, preparation for, 88 route reconnaissance, 89 air attack, protection against, 90 march, conduct of, 90 bivouacs, 91 Tactical employment of medical detachments, 620 Tactical map, 189 Tactical march, 87 Tactical training, 895-896 Tank Destroyer Force Characteristics, 71 Tactical employment, 71 Tanks, See Armored Force Tanks, defense against, See Antimechanized measures Task Forces, 7, 82 Team, combat, See Combat Team Technical section, surgical hospital, 765, 766 Technicians, training program, 903-912 Tenth International Congress of Military Medicine and Pharmacy, 398 Terrain, 35 elevation and relief on maps, 213 contours on maps, 215 elevation, determining, 216 terrain structure, 217 profiles, 217 areas, visibility of, 219 decision, effect on, 102 terrain map, 190 gas attack, influences on, 175 aerial photos, recognition of features on, 238 aerial photos, features on, 245 Tests and examinations, 885 Tetanus toxoid, 537 Thermal injuries, treatment of, 558 Thompson, Dora E., 392, 393 INDEX 1017 T/O 8-99, 811 T/O 8-117, 873 T/O 8-125, 823 T/O 8-135, 696 T/O 8-136, 697 T/O 8-137, 698 T/O 8-138, 700 T/O 8-139, 701 T/O 8-141, 834 T/O 8-195, 748 T/O 8-196, 749 T/O 8-197, 750 T/O 8-237, 837 T/O 8-315, 825 T/O 8-455, 827 T/O 8-497, 829 T/O 8-500-1, 830 T/O 8-510, 824 T/O 8-520, 851 T/O 8-534, 853 T/O 8-537, 852 T/O 8-538, 854 T/O 8-540, 844-845 T/O 8-550, 842, 843 T/O 8-560, 846-848 T/O 8-570, 763 T/O 8-571, 821 T/O 8-580, 774-775 T/O 8-581, 790-791 T/O 8-590, 792-793 T/O 8-600-1, 822 T/O 8-610, 872 T/O 8-611, 807 T/O 8-650, 833 T/O 8-661, 801 T/O 8-697, 826 T/O 8-780, 835 T/O 9-65, 648 T/O 10-15, 65° T/O 10-35, 649 T/O 10-165, 651 T/O 10-175, 652 T/O 17-11, 647 T/O 17-35, 647 Tools and equipment, motor vehicle, 321 Torney, George H., 371, 385 Tourniquet, use of, 540 Towing motor vehicles, 285, 308 Traffic control, 334 regulations, 303 Trailers, tank, water, 441 Training marches, training for, 87 motor marches, training for, 322 first aid subjects, 511 Training, medical units, 875-912 mess personnel, 975 surgical hospital, 767 veterinary service, 816 Training aviation, 63 Training program, mobilization, 896-912 Training Subdivision, SGO, 414 Trajectories of artillery projectiles, 49, 361 Transfers, hospital, 953 Transmission of communicable diseases, 472 Transmission systems, motor vehicle, 266 uses of, 300 Transport aviation, 63 Transport manual, 547 arms carry, 549 fireman’s carry, 548 saddle-back carry, 549 Transportation of the sick and wounded, 547 ambulance, 553 cargo trucks, 554 improvised litters, 549 manual transport, 547 on horseback, 551 on travois, 551, 552 14-ton truck (jeep), 554 precautions in, 552 transport by litter, 549 transport of patients by cacolet, 550 See also Motor Vehicles Traumatic surgery, 409 Travel radon, 978 Travois, 552 Treatment platoon, 741 Triage, 717 Triangular bandage, 530 Troop carriers, See Motor Vehicles Troop leading, 161 essentials of, 162 Troops, conditioning of, 507 special problems of jungle, desert, and extreme cold, 508 “Tropical Disease Board”, control of dengue fever, 405 first, 382 second, 382 third, 393, 394 Tropical warfare, See Jungle Warfare Truck driver, training program, 912 Trucks, See Motor Vehicle Tugo, Oscar C., 387 Turning motor vehicles, 301 Typhoid, 402 “Typhoid Fever Board”, 381, 402 Typhoid vaccine, 423 preparation of, 383 strains of paratyphosus “A” and “B” added, 385 Unconsciousness, 555 Uncoordinated attack, See Piecemeal attack Under Secretary of War, 4 Unit journal, 147 Unit of march, 87 Unit plan, medical service, 9x7 • Unit staff, evacuation hospital, 776 Unit training program, 878 Units large units, supply and evacuation, 151 units, military symbols for, 192 numerical designation of, 80 Urine, disposal of, 446-447 Vaccination rinderpest, 406 smallpox, 406 tetanus toxoid, 399 typhoid, 423 yellow fever, 399 Vaughn, Victor C., 381 Vedder, Edward B., 395, 405 Vehicle requirements, 928-929 Vehicles, motor, See Motor vehicles Venereal disease, 404, 470, 482-489, 506-507 1018 INDEX Venereal prophylaxis compulsory, 385 started, 383 Venereal rate, 404 Ventilation, 475 Vesicant agents, 170, 172, 571 mustard, 170, 172, 572 lewisite, 170, 172, 577 ethyldichlorarsine, 170, 172, 579 See also Medical Aspects of Chemical War- fare “Veterans’ Bureau” created, 393 Veterinary administration, 959 Veterinary ambulance, 814 Veterinary company, mountain medical bat- talion, 701 Veterinary company, separate, 810 Veterinary convalescent hospital, 836 Veterinary Corps, 416 organization, 385 reorganization of, 396 Veterinary Division, SGO, 415 Veterinary evacuation hospital, 836 Veterinary hospitals, 943 Veterinary officers, attached personnel, 619 Veterinary School, 395 Veterinary section, attached personnel, 615, 042 Veterinary service, administration, 934'935 schematic diagram, 815 organized, 389 Veterinary technicians, training program, 905 Veterinary troop, cavalry division, 754 Veterinary troop, medical squadron, 681 Vincent’s Angina, 495 Visibility of areas, 219 Vitamins, 492 See also diet Walking wounded, 717-718 Walter Reed General Hospital, 383, 394, 395- 419, 420, 422 War Department and Congress, 2 organization, 2 War Department General Staff, 4 Secretary of, 5 Statistical Branch, 5 Legislative and Liaison Division, 5 Military Intelligence Service, 7 Bureau of Public Relations, 7 Inspector General’s Department, 7 Task Forces, 7 Ward management, hospital, 945"949 Wards, evacuation hospital, 787 Wards, surgical hospital, 769 Warren, Joseph, 400 Washington, George, 372, 373 Waste, disposal of, 442 disposal of urine, 446 excreta, 442 garbage, 449 liquid, 451 manure, 448 composting, *48 drying, 449 burning, 449 other waste, 453 pit latrine, 444, 445 soakage pit, urine, 447 standard latrine box, 445 straddle trench, 444 urine troughs, 446 Water discipline, 432 Water logistics, 443 Water purification, 435 chlorinating for small detachment. 441 chlorination (Lyster bag), 440 distillation of, 442 field purification, 435, 440 gas contaminated water, 442 importance of pure water, 435 liquid chlorine method, 384 water sterilizing bag, 439 Water supply, 435 determination of water yield, 437 importance of pure water, 435 potable, 435 procurement of, 441 protection of, 439 purification of, 440 responsibility for, 437 sources of, 436 storage of, 441 transportation of, 440 water requirements, 437, 438 permanent camps, temporary camps, bi- vouac and march and in combat, 437 Weapons carries, See Motor Vehicles, 251 Weapons, infantry, 29 characteristics, 33 Weather influence on chemical warfare, 175 Weight and health, 506 Wheels of motor vehicles, 256 White phosphorus, 170, 173, 584 “With Due Respects to Army Medicine”, 400 Withdrawal from action, 114 night withdrawal, 114 daylight withdrawal, 114 Women’s National Relief Association, 380 Wood, Leonard, 384, 401 World War I development of chemical warfare in, 167 development of chemical warfare since, 168 medical service of, 390 Wounds, 534 Abbreviations, 628 first aid treatment of, 536 dog bites, 536 snake bites, 536 types of and their treatment, 524 Wrist, fracture of, 543 Written field orders, 923-927 “Yellow Fever Brigade”, 382 Yerjk.es, Robert M., 388 Zone of combat, 39 SPECIAL MAP "A” THIS ENVELOPE CONTAINS 1 COPY OF SPECIAL MAP "A" 1 PROTRACTOR GRADUATED IN DEGREES 1 PROTRACTOR GRADUATED IN MILS THE MILITARY SERVICE PUBLISHING CO. 100 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