MMM (4) (Courtesy 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 THE MILITARY SERVICE PUBLISHING COMPANY HARRISBURG, PENNSYLVANIA Copyright, 1942, By The Military Service Publishing Co. Harrisburg, Pa. 5th Edition, October, 1942 (4) ALL RIGHTS RESERVED 0^ The Military Service Publishing Co. 100 TELEGRAPH BUILDING HARRISBURG, PA, The Telegraph Press Harrisburg, Pa. PRINTED IN THE U.S.A. FOREWORD MAJOR GENERAL JAMES C. MAGEE The Surgeon General, U. S. Army Earlier editions of this book have been a great help to medical officers, particularly those of the National Guard and Reserve forces. 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 of the Medical Department of the Army of the United States. The sources of the subject matter are official publi- cations of the War Department and instructional material pub- lished 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 587 PART III MEDICAL TACTICS AND ADMINISTRATION I. Attached Medical Personnel With Units of the Infantry and Cavalry Divisions 601 II. The Medical the Medical Squadron, and the Medical Battalions 661 III. The Medical Service Within the Division 699 IV. The Medical Service Within the Corps and Field Army 747 V. The Medical Service of a Field Force 811 VI. Training of Medical Units 863 VII, Combat Orders and the Solution of Medical Problems 901 VIII. Administration 921 IX. Mess Management 961 X. Supply 983 Index 987 TYPICAL INSIGNIA UNITED STATES ARMY GENERAL HEADQUARTERS ARMIES HEADQUARTERS 1 ARMY GROUND FORCES AND ARMY GROUND FORCES OVERHEAD HEADQUARTERS ARMY GROUND FORCES ' RESERVE AIR FORCES COMMAND HEADQUARTERS SERVICES OF SUPPLY AND SERVICES OF SUPPLY OVERHEAD 1ST ARMY 2ND ARMY 3RD ARMY 4TH ARMY CORPS 1ST CORPS 2ND CORPS 3RD CORPS 4TH CORPS 5TH CORPS 6TH CORPS 7TH CORPS 8TH CORPS 9TH CORPS 13TH CORPS 14TH CORPS 1ST ARMORED CORPS DIVISIONS 1ST DIV 2ND DIV. 3RD DIV. 4TH DIV. 5TH DIV. 6TH DIV, 7TH DIV. 8TH DIV. 9TH DIV. 26TH DIV. 27TH DIV. 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 43RD DIV. 44TH DIV. 45TH DIV. 76TH DIV 77TH DIV. 78TH DIV. 79TH DIV. 80TH DIV 8IST 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. 95TH DIV. 96TH DIV. 99TH DIV. 101 ST DIV. OTHER ORGANIZATIONS ALASKA DEFENSE COMMAND 1ST CAVALRY DIV. 2ND CAVALRY DIV. ARMORED DIVS. NUMERAL CHANGES HAWAIIAN DEPT. HAWAIIAN DIV. PANAMA PHILIPPINE CANAL DEPT. DEPT. PHILIPPINE DIV. OFFICER CANDIDATE SCHOOL 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. INTRODUCTION 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, 1 2 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 die 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 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 >‘cet (c tl>« Commanding &vn*r«l Upon Rtquti Resources Office ol the Chief of Engineers •I Office of the Chief ol Chemical Warfare Plate 4. Organization of the Services of Supply, UNDER SECRETARY OF WAR Distribution Office ol the Chief of Odnance DIVISIONS ASSISTANT CHIEF OF STAFF FOR OPERATIONS COMMANDS Office ol the Quartermaster COMMANDING GENERAL SERVICES OF SUPPLY CHIEF OF STAFF Public Relations Plans SECRETARY OF WAR Adjutant. l£:?: STAFF SERVICE CHIEF OF STAFF Fiscal Office of the Marshal Office of the SERVICES Office ol the Chief ol Finance CHIEF OF ADMINISTRATIVE SERVICES Office ol the Chief ol Chaplains administrative ASSISTANT CHIEF OF STAFF FOR PERSONNEL Office ol the Eiecutive for Reserve and ROTC Affair, Mitt*,, National Guard Bureau 10 MILITARY MEDICAL MANUAL Mission. The Services of Supply 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 Services of Supply consolidates under the jurisdiction of the Commanding Gen- eral, Services of Supply, 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, Services of Supply, 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 Services of Supply; 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, Services of Supply. The staff of the Commanding General, Services of Supply, 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, Services of Supply. 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, Services of Supply. THE SERVICES OF SUPPLY 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 COMPONENTS OF THE ARMY OF THE UNITED STATES THE ARMY OF THE UNITED STATES TOTAL COMBINED STRENGTH 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 has been more rapid. Plate 5. 12 MILITARY MEDICAL MANUAL Plate 5. Strength of the Army of the United States, 1920-1940. THE ARMY OF THE UNITED STATES 13 Strength (approximate) Rank of Other names for Arms and services Units commander (normal) units of similar size composing the unit Squad 16 or less Sergeant or corporal. Section 2-136 4-177 Second or first lieutenant. Called “subflights” In the Air Forces. Company 12-700 Called “batteries” in the Field and Found in nearly all arms and serv- Coast Artillery: ices, composed “troops” in the only of troops Cavalry; “flights” from a single arm in the Air Forces. or service, except that chaplains and medical personnel form part of any regiment of any Battalion arm or service. 128-1250 Lieutenant col- onel or major. Called “squadrons” in the Cavalry and Regiment Air Corps. Called “groups” in the Air Forces. 800-3700 Brigade 3400-6900 Brigadier gen- eral. Called “wings” in the Air Forces. Infantry, Cavalry, Field Artillery and Coast Artillery. The triangular Infantry division contains no brl- Division. (There Triangular in- fantry division, Major general . gades. Comoosed of rpgl- are three main ments, and bat- types of divl- 15,500; cavalry talions from many sions — Infan- divisions, 10,000. different arms ana try, cavalry services. and armored.) In Infantry divisions, infan- try forms the basic fighting strength, and in cavalry divl- 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 65,000-90,000 Lieutenant Composed of infan- general. try divisions or of corps” to dis- cavalry divisions, tlnguish It from or armored divi- arms and serv- sions and of addi- ices which have tional brig ades. the word regiments, and “corps” as part battalions. from of their names, many different such as the corps of Engl- Composed of corps, neers and the and of additional Coast Artillery units from several Corps). arms and services. arms and services. Army (often called “field 200,000-400,000 .. Contains officers of all arms and serv- army” to dis- ices. tlnguish It from the whole Army of the United States, of which such a unit forms only a part). 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 battle. 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, sufficiently 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 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 (Sec. 58, N.D.A., as amended) 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. Service Commands Division States I 26th Division... Massachusetts. I 43d Division... Connecticut, Maine, Rhode Island, Vermont. II 27th Division... New York. II 44th Division, j. 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. NATIONAL GUARD INFANTRY DIVISIONS 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. 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. 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. Plate 7. Organized Reserves—Division Areas. THE ARMY OF THE UNITED STATES 17 The Organized Reserves, which form the smallest component of our peace time army, and consists mostly 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. 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, (PAR 6, AR 140-5) • 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 3 As a first lieutenant 4 As a captain 5 As a major 6 As a lieutenant colonel 7 Years 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 subcourscs 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 Academics, 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” arc required. Active Duty. In time of a national emergency expressly declared by Congress, the (PAR 33. 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 arc 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 Objects of the Reserve Officers’ Training Corps (ROTC). The general object of the THE RESERVE OFFICERS’ TRAINING CORPS (PAR 2. AR 143-10) 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 wcll- 1 The Officer's Guide, Military Service Publishing Company, contains complete and 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 ot 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 ot military training in educational institutions has proven itselt by its economy, its efficiency, and the excellence ot the very large number ot Reserve officers who have been commissioned into the Army ot the United States. Extent of Military Education. During the academic year 1940-41, the Army List and Directory records ill) 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 ot Butialo, Butlalo, 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 ot 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 arc 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 jeet arc 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 arc subordinates of the corps area commander and arc 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 arc not less than 14 years of age, and whose bodily condition is such as to meet the prescribed physical standaid. 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. Basic 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 To ORC 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 s8627 *8000 1 In secondary schools. 8 Approximate number. 8 In colleges, universities and essentially military schools. 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. 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. 1HE ARMY OF THE UNITED STATES M M M (4) CHAPTER H 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 arc 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 ivhat 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 he. 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 arc 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, fudge 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 arc 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 battle 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 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 bv 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 bv Number or Letter. The battalions are numbered. Companies are lettered or named. The units of the infantry regiment are designated as shown below; MILITARY MEDICAL MANUAL Regimental headquarters Headquarters company Service company Antitank company Cannon Company 1st battalion: Battalion headquarters and headquarters company Company A ('rifle) Company R (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 battle 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 Are (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 5O00 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 mtantry 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-Iettered 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 tire. 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 batde- 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 batde, 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 fires, and by flanking acdon. 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. 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 battle. Advance guards, jlan\ guards, rear guards, and outposts, as the situation may require, are provided 36 MILITARY MEDICAL MANUAL 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 torcc sent out to the front to precede and cover the main body on the march. It prevents the enemy from observing and tiring on the mam 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 Hanks 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. Flanlf 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% 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. 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 enemv be made, the advance guard is partially deployed, the entire area can be searched for hostile groups, and offensive action may be taken promptly. This procedure is similar to approach march in attack and the procedure obtains maximum security as well as great readiness for action. In general, flanl( 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. MILITARY MEDICAL MANUAL 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 quicklv 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 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 compan) 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. 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 MILITARY MEDICAL MANUAL 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 die lime ol attack., units arc moved iurwaru to the line ol departure. Here appropriate ■ urinations art taken to start the advance, final orders are issued, supporting weapons ait 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 mam 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 fiom a line of departure outside the area of contact: the approach march, the fire fight or conduct o/ the attack,', 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 attach 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 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 arc 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 arc 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 arc 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 arc 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?c 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. 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 arc 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 COMBAT CROUP LIGHT MACHINE CUN SOUAO HEAVY MACHINE GUNS ■ 37 MM ANTITANK CUN BO MM MORTAR SIMM MORTAR BOMM MORTAR OEfENSIVE CONCENTRATION SIMM MORTAR DCTENSIVE CONCENTRATION ARTILLERY NORMAL CONCENTRATION The Automatic Rifles are Located to Cover Gaps in the Fires of the Machine Guns. Plate 18. Defensive Fires. 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 wmch an intantry 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 8UU 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 33UU 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 5UUU 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 4U0-500 yards; it may be as deep as 12UU yards. The regimental reserve line (RRL) is placed ahead of the dominant observation of the locality, and is usually from 8UU-2UUU 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. It 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 tact. 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 bottlenecks 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 infsmtry 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 contr died h\ 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 docs 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 vehi.-les in which it moves and fights. Because of this mobilitv it can shift its verv 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 mav 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 rloselv 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 he greatly in- creased. Horse cavalry in the United States Armv has marched over too miles in a period of 24 hours. Under forced march conditions, infantry units require approxi- mately too 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 mav be feasible under favorable conditions, horse cavalry units habitually dismount to engage in combat, conceal their horses, and fight as infantry. Cavalry Missions. Cavalrv. 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 mav be performed by other available troops should usually be avoided as a means of conserving cavalrv for the time when other forces will not serve so well. The two types of cavalry mav operate in conjunction with one another nr independently of one another. Horse cavalrv 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.! 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 gready 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 will seek to withdraw from contact, retire to a place ot security, and reorganize for further action. At this stage they arc 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 arc 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. Accuracy of artillery 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 by 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 Plate 21. Trajectories of Guns, Howitzers, and Mortars, 50 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. MILITARY MEDICAL MANUAL 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 arc 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. TACTICAL FUNCTIONS OF THE ARMS 51 High explosive shell may be set to burst on impact, or at a slighi 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. i'laie £A. 155-mm Ouii, Heavy HelU Aruiiery. Chemical shell is filled with toxic chemical agents which are liberated on impact. 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 reallottcd 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 arc 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 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 arc 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. MILITARY MEDICAL MANUAL 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 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. TACTICAL FUNCTIONS OF THE ARMS 53 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 tor 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 batde. ENGINEERS 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 arc trained to operate as infantry, particularly as mtantry rifle companies. Specific Missions of Combat Engineers. Combat engineers arc able to facilitate the advance ot 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 ot 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 held. The organization of a position requires the use of large numbers of tools, picks and shovels particularly, which arc 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 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 ot an advanced landing field. Watei tor 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 arc regularly performed by engineer units. A cursory examination of terrain structure indicates the importance of rivers in military operations. Destruction ot bridges by a retreating enemy creates a difficult obstacle. River crossing operations arc 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 tor the headquarters ot divisions and higher echelons. The com- munication means include wire circuits and radio nets, the wire being used tor 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 arc 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 ot the division arc 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- nels 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 arc vital to success in battle. Since communications arc 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 55 Plate 25. An Infantry Regimental Command Post. M M M (4) 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 direedy 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 staff 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. This 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 (foot 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 for 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 arc divided into the following classification: urgent, priority, and routine. Messages arc considered routine by transmitting agencies unless the writer specifically classifies them as urgent or priority by writing the appropriate word on the face of 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 “cast,” “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 •dVz 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 any 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 off 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 file or reference. The original and the first copy arc 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 correcdy 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” arc 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 cither 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.” COAST ARTILLERY CORPS 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 augmented1 in time of war. These harbor defenses are highly 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. It 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^j 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. TACTICAL FUNCTIONS OF THE ARMS 59 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. Photo by U. S. Army Signal Corps. Plate 27. Coast Artillery 16-Inch Harbor Defense Gun. 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-Inch Coast Artillery Antiaircraft Gun. TACTICAL FUNCTIONS OF THE ARMS 61 control of antiaircraft units. In some situations, however, such as during an advance, it may be necessary to decentralize control of part of the antiiaircraft 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. 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 214 tons. The caliber .50 machine gun has an effective range of 1760 yards and delivers fire at a rate of 250 shots per minute. Detection of approaching aircraft, obtaining and computing firing data In 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-flying airplanes. Automatic weapons 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. ARMY AIR FORCES 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. Photo by U. S. Army Signal Corps Plate 30. Caliber .50 Antiaircraft Machine Gun. 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. Types of Air Operations. In general, air operations involve three fundamental tactical functions: TACTICAL FUNCTIONS OF THE ARMS 63 Air attac\, 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. Ottlcial Photograph, U. S. Army Air Corps. 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 particularly 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 are 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. OtHcial Photograph, U. S. Army Air Corps.. Plate 33. 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 arc 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 arc, 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, TACTICAL FUNCTIONS OF THE ARMS 65 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. Umcul i'luuugrapii, u. a. Aiiuy Air toi 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. Plate 33. Bell XFM-1 Pursuit Airplane (Multiplace). 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 reserv- 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 MILITARY MEDICAL MANUAL 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, it ever, operate tactically as a unit in the air. GHQ Aviation. GHQ aviation, under command of the Commanding General, Army Air Forces, comprises; Striking 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 of 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 67 furtherance of the strategical plan of the commander of the field forces. These operations are discussed in FM 100-15. TACTICAL FUNCTIONS OF THE ARMS 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 effectively 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 dement, reconnaissance element, striding 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 68 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 MILITARY MEDICAL MANUAL 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. 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. TANK DESTROYER FORCE 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 tahks, 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. 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. AIR BORNE TROOPS 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. 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 as 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 arc: 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, a! though the object itself is not visible. Fig. 2 CONTINUOUS TRACKS If the tracks are carried past the locality to which they really lead (0) they do not betray its importance. But a junction is suspicious, hence O-C should be suppressed and a cfrunmy path D-Y, put in. Fig. 3 CONCEALING A TRENCH FROM GROUND OBSERVATION A-B*C*D should appear as a continuous line -p. 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 visinet 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 MILITARY MEDICAL MANUAL 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. 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 frequendy close 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, 28th Infantry, commanded by Major Theodore Eoosevelt, Jr- on June 29, 1918, Is 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 source 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 are 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 arc 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 arc used for the following (See Infantry Drill Regulations, Chapter 11): Forward, By the right [left) flan\; To the rear; Hah; Ue 78 MILITARY MEDICAL MANUAL down (or Ta\e cover); Double time (or Rush); Change direction; Assemble; As skir- mishers; Are you ready (1 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 III 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 components 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. They may be said to stretch from the factories of the middle 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 troo_ps, 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: I Corps, II Corps, etc. Not First Corps, or 1st Corps. The expression “EYE” Corps for 1 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. Injantry Division Cavalry Division Armored Division Mountain Division Motorized Division Air-horne 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 7 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 not 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 corps 82 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. MILITARY MEDICAL MANUAL 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 •• 'plies, and enemy action. It is natural to expect that each constitutes a specially 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 maizes them win the day; It ain’t the individual, nor the army as a whole, But the everlastin team war\ of every bloomin’ soul. —J. Mason Knox in Cooperation INTRODUCTION 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 arc 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 batdc 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, attac\ and defense of river lines and Standing Operating Procedures, 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 the 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. MARCHES 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 of dirt roads, serious strains arc imposed upon their endurance. With all the hardships, except for 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 of commanders and staffs. When a command marches in several columns, by different 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 of 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 arc 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 of transport. Average Rates of March (mph) Unit On Roads Across Country Lengths of March Day Night Day Night Foot troops 2% 2 1 12 for a division 15 for smaller units Tanks, truck-drawn light artillery, cavalry com- bat cars, trucks, ambulances, motorized units .. 26 261 8 6 160-176 Horse-drawn artillery 103 S 3 2 80 Cavalry, animal elements 6s 6 6 4 35 Cars, armored or scout 35 35l 10 5 200 103 1 With lights. 3 Without lights. 3 May exceed this rate for short distances or limited periods. Troop Movement by Motor Transport Few units within the infantry division arc 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%-ton vehicle, the following numbers of additional trucks are neces- sary to haul representative war-strength units: Infantry battalion 35 21 Infantry regiment 121 74 Infantry brigade 244 150 Infantry division 544 334 1^4-ton 2^4-ton 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 arc 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 shutding 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 are 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 are 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 are 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, are 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. M M M (4) 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 facilitate effective entry into combat. These arc 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 series 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 (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 arc usually somewhat scattered and, when consolidated for a march, must be gathered together with the least practicable loss of time and effort (sec Plate 1). Companies, troops, and batteries arc usually first consoli- dated into their respective battalions or squadrons, and these arc 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 Plate 1. Battalion in Bivouac Prior to a March. the unit will pass that point cn 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 arc 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 be avoided. Whenever it is possible to do so, reconnaissance of routes should be made prior to the beginning of the march. Guides 90 MILITARY MEDICAL MANUAL may be stationed at points of change of direction or markers placed to indicate the way. The need for guides is increased during a night 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 units. 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. If 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 be encouraged to drink copiously before the beginning of the march, should be required to start the march with full canteens, and should be cautioned-*o 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 die 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 strictly prohibited. Men arc 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 ( ) Each unit is kept closed up to the prescribed distance from the unit in front. If proper march discipline is maintained no elongation of 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 before the unit halts. This naturally results in curtailing the rest periods and should be avoided whenever practicable, theytve Swing iwT “ °f Specifkall>' mcntioned Previously (1) Enforce all march regulations mentioned in this paragraph (2) Examine or cause to be examined the backs, shoulders, and hoofs of animals, it any, at intervals during the march, (3) Correct improper adjustment of equipment of the men. (4) At the end of the day’s march examine the feet 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 ot its march subdivisions may facilitate the entry into bivouac or assembly areas by pre- hmmary instruction of guides. He may direct that guides from subordinate units, such as infantry battalions, proceed rapidly in advance of the column to a point in or near c point of terminating the march. After being shown the area each unit is to occupy 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 after units have arrived. Unit signs to guide organizations off roads help to prevent confusion and loss of 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 dayligi : as a means of reducing confusion. 6 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 formation used may employ columns moving abreast, columns echeloned to the right (left) 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 MILITARY MEDICAL MANUAL 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. The ultimate case will include protection against action by enemy ground forces as well as mechanized and air threats. 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 that 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 take 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” by 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 envolvc combat. If the hostile force is small, units on security missions may 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. They may 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 by 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 be cleared unless the hostile force is attacked at once and destroyed or driven back. 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 body will be delayed. Of course, the enemy force may be too strong for successful attack by the small force used in the advance guard. But it attacks, nevertheless, and by this action forces the enemy 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. If an enemy force makes contact with a flank guard, the action is essentially 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 scries of delaying actions on successive positions. This action envolves deployment on a strong defensive position overlooking the route of advance of the enemy toward the 94 MILITARY MEDICAL MANUAL rear of the protected main body. Upon his approach long range fires are 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 gam 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 arc constituted from a force of the combined arms arc 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. By 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 counterrcconnaissance to prevent the ground agencies of the enemy from observing the main body. Motorized infantry. Infantry units may be furnished with motor transportation, or they may have it as organic equipment, so that they may perform missions as described above for cavalry. In fact, they may operate in conjunction with the cavalry or relieve the cavalry on a part of the perimeter of the zone of security. When these detachments are 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. It 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 gready 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 component 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 ot security to provide tor collection and evacuation ot 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 battle formation. Hence, this form of bivouac is unsuited to the conditions which arc to be expected when contact with an enemy is possible. 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 flanks, and provides conceal- ment from 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 arc 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 for a period of several hours may have no appreciable bearing on the action of these forces since they operate 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 envolvcs the use of a fraction of the combat strength of a command for the protection 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 arc 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 flanks. Areas between these small groups are 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. Bv this method a force protects itself during the periods when it is halted in bivouac. While the main force should be reasonably free from attack, if the hazard is great the position may be organized for defense and tbe 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 tbe 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 of 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 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 ot attack should be definitely established in orders. It may be to detend the OPLR, in which ease units should be quickly reinforced; they withdraw only on orders of the outpost commander. It may be to fall 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. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 97 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 countcrrcconnaissancc, and engages hostile forces which are advancing toward the main force. Motorized infantry. Motorized infantry units, reinforced as the situation may require, may perform covering force missions in the same manner as cavalry. Infantry. 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 ease 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 batdcficld. 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). 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). Attack in a Meeting Engagement. A meeting engagement is a collision between two opposing forces, each of which is more or less unprepared for batde. 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 clement of speed is present on the part of 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). TACTICAL EMPLOYMENT OF THE COMBINED ARMS 99 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 continue 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 batdc 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 MILITARY MEDICAL MANUAL 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. 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, cnvolvcs 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 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 direction from which the attack must be made may be included in the requirements of the mission. MILITARY MEDICAL MANUAL 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 arc 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 arc 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 attac\, 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. 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. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 103 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 be 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 attac\ 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. It 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 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. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 105 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 cnvolvcs 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 exaedy 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 mam 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 be 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 MILITARY MEDICAL MANUAL 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 and his subordinate commanders. But he is responsible for the decision and the super- vision of its execution. TACTICAL EMPLOYMENT OF THE COMBINED ARMS PURSUIT 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 are 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. 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. True 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 be 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. It 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 may strike a decisive blow with strong forces, secure in the knowledge that other parts of the area of contact, perhaps lightly 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 arc as follows: (1) To gain 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 for a main offensive effort at another place and time. (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 lie with the defense. The defender may often choose the ground on which he will meet the enemy. He may then,organize his position by selecting the most suitable areas, by field 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 defense may lower the morale of the troops. They may lose confidence in their own offensive powers. They 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. On the battlefield decisive results arc to be obtained only by the offensive. Types of Defense. There arc but two types of defensive operations. They are 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, after the enemy has developed his force for attack and partially fixed his dispositions, the counteroffensive 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 for defense, to strike the decisive blow. The overly aggressive commander who is prone to minimize or fail 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 of his mission and the size of the force available to him. Never an easy task, he will make his decision after consideration of the possibilities of protection of his flanks and front by natural obstacles; of fields of fire for his infantry; of observa- tion for his artillery to provide for the adjustment of 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 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 mile. 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 exposed, requires TACTICAL EMPLOYMENT OF THE COMBINED ARMS 111 strong reserves to meet and block any hostile threat which may arise. As a basis for further study 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 be used to block the hostile main attack or to launch a decisive counterattack. Its use in driblets to strengthen hard-pressed units on the batdc position would be exceptional. Each subordinate unit assigned to the batde 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 posidon with exposed flanks. It shows the batde position, sectors assigned to subordinate units, place- ment of reserves, artillery battalion position areas, and the location of the command post. It is schemadc only and without reference to any terrain or type of terrain. Each defensive position must be developed after analysis of the mission, the situation, and the actual terrain available for organization. Organizadon 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 arc 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 many 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 may be unoccupied except for personnel in observation. Units which are not held within the battle 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 by 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 battle position are satisfied, organization of positions ex- tending the flanks will be 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 be 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 be engaged by long range artillery fires; for this fire, positions may be occupied in advance of the battle position. These may be followed by fires from infantry weapons. Therefore, when the approach of an enemy can be 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 MILITARY MEDICAL MANUAL 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 batde 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 batde 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 vital 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 enemy separates his attacking forces widely the counterblow may be directed against one of his 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 infantry units may be employed in advance of the batde position as a covering force. Small infantry detachments may be placed in advance of the batde position to constitute the outpost. Within the battle posidon infantry units will be as- signed sectors for defense or hold positions on the regimental reserve line. Infantry units which are not utilized on the battle position or in the covering forces arc held in rear of the batde position as a mobile reserve. Field artillery. The artillery is held “in readiness” or it supports the defense of the batde position by performing direct support missions for designated infantry units or gen- eral support missions for the force as a whole. No artillery is held 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 it will be prepared to move on call to occupy 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 enemy 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 TACTICAL EMPLOYMENT OF THE COMBINED ARMS 113 approach. Firing data will be computed so that fire may be massed in specified areas, par- ticularly in the protection of exposed flanks. Depth is provided by 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 fire to assist artillery units on its Hanks. 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 key points, 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 attac\. Terrain 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 subiect 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 of the batde 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 for 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 batde 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 from a desperate situation, or to break off an engagement which has already accomplished its purpose or which appears to offer no further chance of success. It seeks to put space between the opposing forces. After 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 arc classified as night withdrawals or day withdrawals, depending upon the time at which they arc 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 nightfall 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 of serious enemy pressure. An aggressive enemy upon discovering the rearward movement will seek to convert an orderly withdrawal into a rout, bending his every effort to block its execution. Cavalry, however, may employ this maneuver with greater safety than a force which includes a large infantry component, especially a cavalry force withdrawing before 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 of 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 fraction of each unit in contact, such as units from infantry and artillery battalions, remains in 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 arc 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 arc 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. In 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 arc 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. Its 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. Purpose. Delaying action is an operation executed in order to prevent the uninterrupted advance of a hostile force. It seeks to gain time without fighting decisive engagements. The extent of the delay which must be obtained is often definitely announced by prescribing that the enemy must be 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 DELAYING ACTION 116 MILITARY MEDICAL MANUAL portion of a front, in preference to defense of a single position, in order to mass a strong force 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 are 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 be 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 be reconnoitered prior to movement. The necessary arrangements for control and coordination having been made, the actual execution of the withdrawal is properly 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 be 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 prompdy 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. Definition and Purpose. A retirement is a movement away from an enemy, a retrograde movement, in which a force seeks to regain freedom of action. Such a movement, to be a true retirement, must be part of a well-defined plan which has for 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 mo/ement 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. RETIREMENT 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 artillery 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 force will require covering forces and flank guards. Covering forces, if employed, must intercept and delay hostile units which seek to strike the flanks or block the retirement by encircling action. They 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. 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 after 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 after 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. MOUNTAIN OPERATIONS 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 greatly 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 MMM (4) 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 arc 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 arc concerned with the execution of security measures to counteract the effects of hostile attack from 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 arc 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 arc 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 1000 yards or more, then fly over the target to drop their bombs. The speed of flight 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 arc trained to engage promptly hostile aircraft within range. Rifles, automatic rifles, and caliber .30 and caliber .50 machine guns arc 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 unrcmunerativc. 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 are 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 are examples of dispersion while in movement. The effectiveness of air attack is reduced by separating individuals and units so that compact targets arc not presented. Security includes the measures which are 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 limited 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 off 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. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 123 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 arc present, the animals arc 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 machinergun fire and the detonation of the bombs. When bombs arc released, all men 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 arc 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 MILITARY MEDICAL MANUAL 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) arc 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. Individual fox holes, trenches or small depressions afford protection against the flat trajec- tory of the fragments of bombs, and machine-gun fire. Plate II. 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. It 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 arc capable of mutually supporting defensive fires. This applies particularly to the establish- ment of a ring of mutually supporting mochinc-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 spraying 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 be biv- ouacked so as to receive incidental protection from the fires of other units. Antiaircraft Defense in Combat. Defense of assembly areas. Assembly areas arc 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 enemy 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 enemy 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. In some cases, it may be necessary to designate certain weapons for antiaircraft fire. Troops should not fire on enemy 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 lire 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 hre. When so authorized, the opening of antiaircraft hre then becomes the responsibility of local commanders of small units. Reserves in defense will ordinarily be more vul- Plate 12. Infantry Battalion in Bivouac with Area Defense Against Air Attack. nerable to air attack for the following reasons: they are usually held more concentrated; they are vulnerable during movement to places of 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 hre. In the attack,\ 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, for protection against enemy aircraft. 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 unremunerative 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. Thev will seek natural obstacles to guard their front, flanks, and rear. Time permitting, thev will increase the difficulty of tank operation hy improvement of natural obstacles, bv the use of barbed wire, bv mine fields and other measures. Those areas which cannot be fully protected bv 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 arc used in combination. A barrier or obstacle loses its defensive value unless protected hy 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 enemv should be denied favorable routes of approach, or his advance should be materiallv 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 anv 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 thev can be effectively covered by small arms fire. Antitan\ 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 protection 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) Antitank mines. Antitank mines are usually of the contact type. They arc 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 objetives, 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 penetrative 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. EACTICAL EMPLOYMENT OF THE COMBINED ARMS 129 Our 37-mm antiun\ gun is a powerful and effective weapon. It is lew siiknuettcd, 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 arc: 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 grain 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. STANDING OPERATING PROCEDURES 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. 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. 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. TACTICAL EMPLOYMENT OF THE COMBINED ARMS 131 COMMAND AND STAFF PROCEDURE CHAPTER V The staff which serves the troops best, serves the commander best. Medical officers arc 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 cnvolved 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. He 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. (Sec 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 COMMANDER CHIEF OF STAFF AIDES DEPUTY CHIEF OF STAFF* SECRETARY OF THE GENERAL STAFF » LIAISON OFFICERS (FROM '0TH£R UNITS) (TO : SPECIAL STAFF [ANTIAIRCRAFT OFFICER}: ARTILLERY OFFICER CHEMICAL OFFICER ORDNANCE OFFICER PROVOST MARSHAL SIGNAL OFFICER COMMANDERS OF ATTACHED TROOPS ADJUTANT GENERAL FINANCE OFFICER INSPECTOR GENERAL] JUDGE ADVOCATE I OFFICER IN CHARGE |OF CIVIL AFFAIRS * QUARTERMASTER AIR OFFICER ENGINEER I HEADQUARTERS | COMMANDANT CHAPLAIN SURGEON TROOPS (COM BAT & SERVICE) * IN CERTAIN UNITS WHEN NOT REPRESENTED ON SPECIAL STAFF. COMMAND CHANNEL (DOWN) ROUTINE CHANNEL FOR - ADVICE AND RECOMMENDATIONS (UR) 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. COMMAND AND STAFF PROCEDURE 135 (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 frcm 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. 1 Reproduced wiii permission of Major General Frank S. Cocheu, U. S. A., Retired. 136 MILITARY MEDICAL MANUAL 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. i. 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. 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 are 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 (4) Operations and training section—the plans and trailing officer (S-3). (5) Supply and evacuation section—the supply oflker (S-4). Forward and rear echelons. The forward echelon of the headquarters of a unit usually includes all of the officers whose duties arc 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 frequendy 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 arc 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 o£ 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; planc 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-x for morale matters.) 3. 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. THE SPECIAL STAFF 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: COMMAND AND STAFF PROCEDURE 141 (1) Technical and tactical advice and recommendations to the commander and his jcneral staff. (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 officers 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 direcdy 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 officer. (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 are 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, reeiments, and battalions, corresponding to the special staffs of larger units, include such or the following 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 frequently combined with those of 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 junctions 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 tor 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 I 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 MILITARY MEDICAL MANUAL 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. COMMAND AND STAFF PROCEDURE 145 (3) Location and operation of hospitals and other medical establishments and pf 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 record (AR 345-105). The refinement of the system 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 (See Plate 2). A journal is a chronological record of events affecting the unit or staff section. 1 he 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 i i ct3 .2 o o c 1/2 c Time 2 Incidents, messages, orders, etc. Action taken 4 In Out Plate 2. Form for Unit Journal. 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. NOTES 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 his 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 II, III, 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 are 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 aflect 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 effect 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 MMM (4) 151 152 MILITARY MEDICAL MANUAL infantry regiments, artillery battalions, and other organic or attached units are furnished with their requirements. Thus the impetus ot the movement ot 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 battle 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 arc made in the basic plan to meet changing situations. Finally, the G-4 of a command is responsible to the commander that needs arc foreseen and provided for and that the system “works.” Classification of Supplies. For purposes of convenient reference, supplies required by troops in the field arc 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 I. Those items such as rations, forage, and illuminants which arc 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 II. Those authorized articles of equipment which, though consumed at an approxi- mately constant rate, arc for the personal use of the individual and necessitate special arrange- ments to meet individual requirements; examples are clothing and gas masks. These item:1 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 arc fillet! 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 arc 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 III. 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 arc con- ducted. It is divided for the purposes of combat and for decentralization of administration into a communications zone and a combat zone (sec 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 arc dispatched daily to an organization. Rations arc 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 man per day, the estimated average expenditure of the various items of supply, per day, in campaign.1 The amounts arc 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 Prance at the begin- ning of World War II, it was necessary to move te-ton per man per day across the channel to serve the expected requirements of the expedition. 154 MILITARY MEDICAL MANUAL 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 are 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 are similar terms. Daily train. The railway train arriving daily at the railhead with Class I and other supplies for the troops whom the 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 MILITARY MEDICAL MANUAL 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, frequently 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 wi1' 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 obset- 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 arc established in groups of two or more behind each corps at from 10-16 miles in rear of the battle front 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-transportablc 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 stockagc of depots for future needs and the level of supplies of all categories to be maintained are important questions of decision. These supplies arc 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 arc often accumulated in anticipation of a particular operation. If these supplies arc left on freight cars so as to be quickly moved they arc 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. 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 arc 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 arc 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 cn route at some convenient gasoline supply point established by the army. Vehicles remaining in the forward areas arc resupplied by exchanging empty containers for full ones brought forward by regimental or divisional transportation. Procedure to Obtain Class I Supplies (Rations, Forage, and Ilhiminants). The fol- lowing rations arc prescribed for field service (Circular 88, War Department, November 7. 1939). 158 MILITARY MEDICAL MANUAL 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-ounce 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 battle, 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 I 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 cn route to its final destination. At the regulating station cars arc 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 I 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 of the enemy to interrupt the 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 has 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 stockage 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 are important for large units. These figures are subject to constant revision to accord with experience. Procedure to Obtain Other Supplies. Other supplies arc obtained on approved requi- sition through unit supply officers. Heads of supply services of the division cither 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 arc filled. Reinforcing units to the division arc 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 arc 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 arc 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 arc 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 accents 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 disciplnc 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 batdc 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 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. 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. 162 MILITARY MEDICAL MANUAL 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 batde. 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 are 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 remembbr 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 litde 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, LEADERSHIP 163 comradeship among men, and pride in self, organziation, and country. The establish- ment and maintenance of good morale are 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 tor 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: First, 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, 164 MILITARY MEDICAL MANUAL THE LOGICAL BASIS OF THE COMMANDER’S ESTIMATE OF THE SITUATION Par. 1 With the OBJECT as the guiding consideration MISSION CALCULATION Par. 2 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 to all reasonable and practic- To all physical capabilities of able lines of action open to the enemy to hinder the ac- you to accomplish your mis- complishment of your mission, sion. (1, 2, etc.) (1, 2, 3, etc.) YOUR FORCE ENEMY FORCE VISUALIZATION Par. 3 of the lines of action and capabilities of the ANALYSIS VARIABLES (WHAT WILL HAPPEN IF) OWN LINES OF OPPOSED ENEMY ACTION BY CAPABILITIES etc. Leads to determination of the ADVANTAGES & DISADVANTAGES of your own lines of action Par. 4 COMPARISON SELECTION 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 arc 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. LEADERSHIP 165 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 arc 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 this 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 sec 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. CHAPTER VIII 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 are 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 nc 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 bv 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 types 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-fourth 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 of artillery for 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 forces 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 effect 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.”—Basic Field Manual, Vol. 1, Chapter 8, Defense Against Chemi- cal Attac\, War Department, 1938. 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 DEFENSE AGAINST CHEMICAL WARFARE 169 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. 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 smokje is a chemical agent whose principal effect 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 arc used in burning-type munitions. c. General types of 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, nonpersistent and persistent. (a) A nonpersistent 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 arc 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 severe heat burns. 170 MILITARY MEDICAL MANUAL e. Tactical use. Chemical agents are further classified according to their tactical use, as: GENERAL TYPE PERSISTENCY PHYSIOLOGI- CAL ACTION TACTICAL EXAMPLE USE (Name and Symbol) NORMAL PHYSICAL STATE 'Nonpersistent Lung Irritant Casualty < Phosgene (CG) Chlorine (CL) Gas Gas r Toxic < -Persistent Vesicant Casualty Mustard Gas (HS) Lewisite (Ml) Ethyldichlorarsine (ED) Liquid Liquid Liquid GAS - Xung Irritant Casualty Chlorpicrin (PS) Liquid Mrritant Depends on means of dissemination rSternutator Xacrimator Harassing Harassing Adamsite (DM) Sneeze Gas (DA) Chloracetophenone (CN) Tear Gas Solution (CNS) Tear Gas Solution (CNB) Solid Solid Solid Liquid Liquid SMOKE Burning or functioning time of the munition Negligible Screening 'White Phosphorus (WP) HC Mixture (HC) Sulphur Trioxide „ Solution (FS) Solid Solid Liquid INCENDIARY Burning time Heat Burns [Thermite (TH) Incendiary -} Solid Oils (White Phosphorus (WP) Solid Solid Solid CLASSIFICATIONS OF CHEMICAL AGENTS Name and Symbol Chloracetophenone Tear Gas Solution ' (CN) (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: 1 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- Contaminates. In some cases able odor. may be removed by ventilation Action on metals and heating. Tarnishes steel slightly. Tarnishes steel slightly. How used For harassing effect, in gren- For harassing effect, in artillery ades. 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 Not definite, slightly like coal smoke. Color and state in field A yellow smoke cloud. Grayish smoke cloud. Effects on body Immediate sneezing followed by headache, nausea, and vomiting. Temporary physical debility. Ef- Sneezing and burning sensation of the nose and throat. Slight lacrimation followed by occa- fectlve in low concentrations slonal nausea, headache, and but is delayed about 5 to 10 temporary debility. Immediately minutes. effective. First-aid care and emergency Remove to pure air, aspirin for Same as for Adamsite. treatment headache, rest, withhold fluids keep warm, by mouth, in- hale from bleach bottle. Irri- gate nose and throat with 2% sodium bicarbonate solution. Clean and reapply mask after Persistency vomiting. While burning, drifts with the While burning, drifts with the wind, will remain in low and wind will remain in low and protected places for some time. protected places for some time. General, 5 minutes in open. General, 10 minutes in open. Action on food and water Poisons unprotected food and Poisons unprotected food and « water; cannot be made safe for water; cannot be made safe for use. use. Action on metals Very slight. Vigorous corrosion on steel. How used For harassing effect. In candles For harassing effect, in candles Protection required or generators. or shell. Gas mask with a good filter. Gas mask with a good filter. SCREENING SMOKES Name and Symbol Sulphur Trioxide Solu- tion (FS) HC Mixture White Phosphorus (WP) Odor Acid or acrid. Acrid, suffocating. Like phosphorus matches. Color and state in Dispersed as liquid which White smoke pro- Dispersed as solid which field changes to white smoke duced by burning rapidly changes to flame upon contact with air. munitions only. and white smoke on con- tact with air. Effects on body Mild prickling sensation None. Smoke, none; particles to skin; non-injurious. produce severe fire burns First-aid care and which heal very slowly. Wash with copious None needed. Keep part under water, use saturated wet cloth. emergency treat- amounts of water, then ment with sodium bicarbonate Apply 2 to 5 percent cop- and treal as for ordinary per sulfate solution to burns. form a coat over the particles and prevent oxi- dation. Pick out solid particles and treat like Smoke gives dls- ordinary burn. Action on food and Liquid renders food and Smoke gives disagreeable water water unfit for use; smoke gives disagreeable agreeable odor. odor; solid is poisonous. odor. Action on metal Vigorous presence corrosion in of moisture. None, if dry. Non*. How used Screening smoke. In air- Screening smoke. In Screening smoke and in- plane spray for screening; smoke pots o r cendiary. In artillery in artillery shell, mortar candles, for train- shell and mortar shell. shell, and cylinders for ing only. primarily for smoke ef- training to simulate cloud feet; also used in same gas. munitions and airplane bombs for casualty effect None. and incendiary action. Protection required None. For smoke, none; for burning particles, none provided. VESICANTS Name and Symbol Lewisite (Ml) Mustard (HS) Odor Color and state in field Effects on body First-aid care and emergency treatment Persistency Action on food and water Action on metal How used Protection required Like geraniums, then biting. Dark brown liquid changing slowly into a colorless gas. Vesicant, blisters skin. Skin shows slight irritation in 15 minutes, followed by grayish discoloration and blisters in 30 minutes to 1 hour. Systemic poisoning; vomiting. If breathed, powerful lung irritant effects within \'i hour. If unprotected, immediate Irritation of eyes. Approximately six times as toxic as phosgene. When possible remove from contaminated area. 1. Apply protective ointment (M4) immediately. Repeat 2 or 3 times and remove, 2. Remove excess with dry cloth. Use solvent alcohol, ether, benzene, gasoline. Use soap and water. Use 8% Hydrogen perox- ide 2 or 3 times, saturate cloth and leave on wound. Open blisters at once. Eyes 2 or 3 drops of (Ml), Eye solution in each eye. Do not repeat. Do not use Hydrogen peroxide in eyes, rub or bandage eyes. Dispersed as liquid which slowly changes to gas. Rate of vapor- ization depends on temperature, vegetation, and method of dis- persion. Rapidly destroyed by water. Summer: 24 hours in open; 2 or 3 days in woods. Winter: 1 week or more. Pood which has come in contact with these gases, whether vapor or liquid, should not be eaten because of the great danger of arsenical poisoning. The salvag- ing of foods exposed to this gas depends on the degree of con- tamination and the suitability of such food for consumption should be passed on only by qualified experts after a thor- ough chemical examination. Very slight. For casualty effect or to deny ground through threat of cas- ualties. in artillery shell, mor- tar shell, airplane bombs, air- plane spray, and land mines. Gas mask and protective cloth- ing. Like garlic or horseradish. Dark brown liquid, changing slowly into a colorless gas. Vesicant, blisters skin. Symp- toms delayed 2 to 4 hours. If exposed, eyes burn and inflame. Skin in contact with gas or liquid, discolors, followed by blisters and sores. If breathed, hoarse cough develops, followed by severe pain in chest and in- flammation of lungs. Approxi- mately four times as toxic as phosgene. When possible remove from area and remove contaminated cloth- ing, otherwise, leave clothing on. Small area of clothing con- taminated, cut it away and cover the skin with protective ointment. 1. Apply protective ointment immediately. Repeat 2 or 3 times and remove. 2. Remove excess HS with dry cloth. Use solvent, alcohol, ether, gasoline. Wash soap and water. Apply Dichloramine “T” in Trlacetin Inhale from wide mouthed bleach bottle. Eyes irrigate with water, bland oil (castor oil), 2% butyn or pontocaine compound ointment. Do not use Ml Eye Solution, bandage eyes, or rub eyes. Do not use cocaine in eyes. Dispersed as liquid which slowly changes to gas. Rate of vapor- ization depends on temperature, vegetation, and method of dis- persion. Summer: 4 to 5 days in open; i week in woods. Winter; Several weeks. All foods contaminated with the liquid form must be viewed with suspicion. Fatty foods (milk, cream, butter, cheese, fatty meats, eggs, etc.) con- taminated either by vapor or by liquid will almost certainly be highly dangerous and should be destroyed. Slight contamina- tion with mustard gas vapor may affect palatabllity but, ex- cept for fatty foods, the ma- terials should be edible after 48 hours’ airing and cooking. Very slight. For casualty effect or to deny ground through threat of cas- ualties. In artillery shell, mor- tar shell, airplane bombs, air- plane spray, and land mines, « Gas mask and protective cloth- ing. LACRIMATORS Name and Symbol Chloracetophenone (CN) Tear Gas Solution (CNS) Odor Color and state in field Effects on body First-aid care and emergency treatment Like apple blossoms. Bluish gray smoke from burning type munition; colorless from shell. Piercing irritation of eyes caus- ing profuse tears. Effective in extremely low concentrations. 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. Like fly paper. A colorless liquid, changing to colorless gas. Piercing irritation of the eyes, profuse tears, followed by nausea and vomiting. Same as Chloracetophenone. Name and Symbol Chloracetophenone Tear Gas Solution ■ (CN) (CNS) Persistency Cloud from burning mixture Summer: 1 hour in open; 2 drifts with wind. Will remain in low and protected places for some time. Shell or solid CN may remain several weeks. 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- Contaminates. In some cases able odor. may and be removed by ventilation heating. Action on metals Tarnishes steel slightly. Tarnishes steel slightly. How used For harassing effect. In gren- For harassing effect. In artillery ades. shell. mortar shell, airplane Protection required bombs, and airplane spray. Gas mask. Gas mask. IRRITANT SMOKES (STERNUTATORS) Name and Symbol Adamsite (DM) Sneeze Gas (DA) Odor Not definite, slightly like coal smoke. Color and state in field A yellow smoke cloud. Grayish smoke cloud. Effects on body Immediate sneezing followed by Sneezing and burning sensation headache, nausea, and vomiting. Temporary physical debility. Ef- of the hose and throat. Slight lacrimatlon followed by occa- fective in low concentrations sional nausea, headache, and but is delayed about 5 to 10 temporary debility. Immediately minutes. effective. First-aid care and emergency Remove to pure air. aspirin for Same as for Adamsite. treatment headache, rest, withhold fluids keep warm, by mouth, in- hale from bleach bottle. Irrl- gate nose and throat with 2% sodium bicarbonate solution. Clean and reapply mask after vomiting. Persistency While burning. drifts with the While burning, drifts with the wind, will remain in low and wind. will remain in low and protected places for some time. protected places for some time. General, 5 minutes in open. General, 10 minutes in open. Action on food and water Poisons unprotected food and Poisons unprotected food and water; cannot be made safe for water; cannot be made safe for use. use. Action on metals Very slight. Vigorous corrosion on steel. How used For harassing effect. In candles For harassing effect. In candles or generators. or shell. Protection required Gas mask with i good filter. Gas mask with a good filter. SCREENING SMOKES Name and Symbol Sulphur Trioxide Solu- tion (FS) HC Mixture White Phosphorus (WP) Odor Acid or acrid. Acrid, suffocating. Like phosphorus matches. Color and state in Dispersed as liquid which White smoke pro- Dispersed as solid which field changes to white smoke duced by burning rapidly changes to flame upon contact with air. munitions only. and white smoke on con- tact with air. Effects on body Mild prickling sensation None. Smoke, none; particles to skin; non-injurious. produce severe fire burns which heal very slowly. First-aid care and Wash with copious None needed. Keep part under water, use saturated wet cloth. emergency treat- amounts of water, then ment with sodium bicarbonate and treat as for ordinary Apply 2 to 5 percent cop- per sulfate solution to burns. form a coat over the particles and prevent oxi- dation. Pick out solid particles and treat like dis- ordinary burn. Action on food and Liquid renders food and Smoke gives Smoke gives disagreeable water water unfit for use; smoke gives disagreeable agreeable odor. odor; solid is poisonous. odor. Action on metal Vigorous presence corrosion in of moisture. None, if dry. Non*. How used Screening smoke. In air- Screening smoke. In Screening smoke and in- plane spray for screening; smoke pots o r cendiary. In artillery in artillery shell, mortar candles, for train- shell and mortar shell. shell, and cylinders for ing only. primarily for smoke ef- training to simulate cloud feet; also used in same gas. munitions and airplane bombs for casualty effect None. and incendiary action. Protection required None. For smoke, none; for burning particles, none provided. 174 MILITARY MEDICAL MANUAL SYSTEMIC POISONS Name and Symbol Hydracyonic Acid (HCN) Arsine (Aslfc) Odor Bitter almonds. Garlic-like odor. Color and state in field Colorless and volatile liquid, forming a colorless gas when released from container. Colorless, inflammable gas. Effects on body Giddiness, headache, convul- sions, unconsciousness, and death. Shivering, weakness, giddiness, nausea, vomiting, headache, ar- remia, anuria, uremia. First-aid care and emergency Inhale armyl nitrate, artificial Absolute rest, evacuate in prone treatment respiration, sodium nitrate, so- dium thiosulfate, or methylene blue intravenously. position, force fluids, carbohy- drates, blood transfusion, pro- mote diuresis. Action on food and water Liquid renders food and water unfit for use. Arsenic makes food and water unfit for use. With large stores, degree of contamination to be determined by analysis. Action on metal Slight. None. How used Casualty producing agent when used in a confined space. Casualty producing agent when used in a confined space. Protection Gas mask if worn at time gas is laid down. Gas mask if worn at the time gas is laid down. g. Symbols. Brief lettered symbols arc 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 for 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 arc 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 these of some one of the known types. Hence, the practical information about representative agents, contained in the accompanying table, should be of considerable value 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 of 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, arc 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. Smo\e. 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% 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 put 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. 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, arc 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. Plate 2. Livens Projector Attack—Diagrammatic Illustration, 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 nonpersistent 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. PULL SUPPPCE SET UP Plate 3. Livens Projector MKI At the beginning of World War No. II 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. Plate {?. Portable Cylinder with Nozzle and Firing Device, 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. Consequently, upon warning of the approach of hostile aircraft, particularly low-flying airplanes, gas masks should be adjusted. DEFENSE AGAINST CHEMICAL WARFARE 179 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 arc such as to carry the chemical cloud from his position to that of the target. Such weapons arc 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. 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. 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. PROTECTIVE EQUIPMENT AND PROCEDURE 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 OP GPS A7PSKS /// HS£ DC/P/A/G WOPLD WPP BRITISH FIRST BLACK VEIL BRITISH HYPO. P.crPH HEL MET /? uoe. ok/r! buRoncU unc/or tunro. FRENCH M-Z MASK ITALIAN MASK GERMAN MASK BRITISH HYPO. P. or PH HEL MET o//cd. BRITISH SMALL BOX RESPIRATOR FRENCH T/SSOT -RUSSIAN /HASH AMERICAN TISSUE Plate 7. World War Gas Masks. h. 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. 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; up®n 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 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 eat, sleep, and rest. They are desirable especially for command posts, telephone exchanges, and aid stations. Non-ventilated shelters arc 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 arc 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 arc readily absorbed by ordinary paint, hence arc difficult to remove from painted articles, unless they arc treated at once. DEFENSE AGAINST CHEMICAL WARFARE 183 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. /. 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 MMM (4) 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, are 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 dirccdy concerned with gas defensive training of troops, inspection and maintenance of protective equipment, gas reconnaissance in batde, 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 are 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. FASTEN BLANKET TO TOP OF FRAME WITH A STRIP OF WOOD. WEIGHTS- -PROTECTIVE COVER BLANKET OVERLAPS FRAME IN CASE OF — PROJECTING ENTRANCE. WEIGHTS - HORIZONTAL GALLERY -SHELF Plate 9. Gas-Proofing Dugouts. BLANKET EXACT WIDTH OF EN- - TRANCE FRAME - -BLANKET WHEN ROLLED UP MAY jX BE KEPT IN PLACE BY A STRING /XX AND LOOP ATTACHED TO A HOOK OR 7/XBY 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 X*- JOINTS ARE CLOS- ED AND THAT THERE ARE NO OPENINGS. 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 arc 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, arc 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-flying airplanes, gas masks should be ad- justed promptly. In 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 very 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 DEFENSE AGAINST CHEMICAL WARFARE 187 case its original position is rendered untenable with persistent gas. The plans must insure against selection of 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 relaxation 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 arc required arc undertaken. CHAPTER IX MAP READING 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. INTRODUCTION A knowledge of map reading is necessary in order to understand orders which arc 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 aiso 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 arc 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 military 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: «. 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 minut« 190 MILITARY MEDICAL MANUAL of longitude, or about 20 miles on a side, by the U. S. Geological Survey. Such sheets arc 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 arc called Conventional Signs. 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. Pence, smooth wire. 6. Trlangulatlon 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. Lone trees. 13. Buildings In general. 14. Orchard. 15. Railroad crossings, railroad beneath. 16. Pence 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. Equestrian 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. Bench mark 52 Bridge, foot .!!!!!!!!!!!!" 42 Bridge, highway, general 32 Bridge, highway, made of steel (S) 28 Bridge, truss, or girder 30 Bridge, suspension 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 church ;;;;;;; 22 Accentuated (every fifth) contour’..*."."."...’! 35 Cultivated field, com 7 Cultivated field, sugar cane ! 18 Cut 29 Dam 20 Demolitions (ruins) ! 39 Electric power transmission line 21 Pence of any kind (or board fence) 16 Fence, barbed wire 8 Fence, smooth wire 5 Fence, stone 46 Pence, worm 45 Pill 27 Ford, equestrian 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 general 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 11 Stream or creek. Intermittent 44 Stream or creek, perennial (blue on a four- color map) 4 Stream, head of 51 Tank trap 47 Telephone or telegraph line 2 Trail or foot path 41 Trees, lone 12 Trees, deciduous 11 Trenches (dotted when proposed) 38 Trlangulatlon point or primary traverse station 6 Wire entanglement 36 Wire entanglement (low or portable) 37 Woodland (deciduous trees) 11 Plate 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. Blacky 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 forms of relief portrayal. Marginal Information. The following items of marginal information usually appeal 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. t. 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. The 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 Basic symbol Airport (landing field) (a) Smaller unit Superior unit Airport (landing field advanced) Example: 1st Battalion, 2d In- fantry Autoglro Symbol indicating size Ammunition Arsenal Symbol of arm or service Arsenal (gas generating) (b) Company, troop, battery, flight Weapon Division. brigade. regiment, separate battalion. separate company. Balloon, ascension point Balloon bed Example: Battery E, 62d Coast Balloon barrage ascension point Artillery. Antiaircraft. Machine Barrage Blue (size indicating the extent, and notation indicating type) Gun Symbol indicating s’lze Demolitions Depot (supply point) Army or corps Example: Second Army LIST OF BASIC SYMBOLS.—To indicate pur- pose or character of activity. (Temporary depot in combat zone) Debarkation or embarkation point.. Military post or station; command post or headquarters (lower end; of staff terminates at location of establishment repre- sented) Dugout; Isolated In trench system 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 lacing: Gas-proof Entanglement Wire Concealed Line Gas: Area to be avoided Column Area blanketed by smoke (time effective) ( Airdrome Area probably affected by gas cyl- inder cloud Airship hangar Area to be gassed, nonpersistent Point, any located (suitable descrip tlon) General hospital Laboratory, experimental station. Or proving ground Point, distributing; For class I supplies Leader gear (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.) Ammunition Artillery ammunition Message center Small-arms ammunition Mines; Individual (layout shown if prac- ticable or area included) .. q or Water Prisoners of war Chemical land mine .. • Contact mines (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 Road block Water Bridge out Trains (supply, motor): Post: Observation Animal-drawn Pack Fixed underwater listening Visual signal Railway Searchlight Cavalry: Horse Sound locator Horse and mechanized Signal: Mechanized Radio station Chemical Warfare Service Direction-finder compass) Coast Artillery Antiaircraft Harbor Defense Intercept station Railway Switching central Tractor-drawn Switching central (located at com- mand post) Engineers Test station or cable terminal Infantry .. Wire on ground Motorized Traffic: One-way Parachute Medical Corps Two-way Military Police Tank: Barrier Ordnance Department 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.— rhese symbols are placed within the symbols shown above when appropriate, except when otherwise noted. Remount Service Signal Corps Signal Corps (aviation) Air Corps Tank Destroyer Airship Transportation Corps . 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, battery, or Air Corps flight | Battalion, Cavalry squadron, or Air Corps squadron Division Regiment or group Corps Brigade or Air Corps wing Army Division or air force Corps area, department, or section of communications zone Communications zone - Corps Rear boundary of theater of op- erations — Army 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 Main line of resistance Assistant leader, or second in com- mand Regimental reserve line Leader Limiting point Squad leader Line of communication To indicate boundaries and lines. Bombardment aviation, light (limit of radius of action) Line of departure Straggler line GHQ reconnaissance aviation (limit of zone of reconnaissance) prisoner of War Inclosure, IV Corps. Observation aviation (limit of zone of reconnaissance): Weapons. Automatic rifle (Dotted when emplacement is not occupied, thus) Bear limit, army aviation 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 Caliber .50 Brigade 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 Gun battery Howitzer or mortar .. Air Corps. 3d Air Force Open when em placement is unoccupied, thus Howitzer or mortar battery 701st Air Base Group 4.2-in. chemical 901st Transport Squadron mortar 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 532d Pursuit Group (Interceptor) Cultivated land Stream Second Army Aviation 203 d 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. Armored Force. Headquarters Company, 1st Armored Division Military Police Platoon, Headquar- ters Company, 1st Armored Divi- slon 'M F iHard surface Transportation Platoon, Headquar- ters Company, 1st Armored Divi- si°n THq Graded and improved Graded, not improved 1st Reconnaissance Battalion poor road ... Rifle Company, 1st Reconnaissance Battalion 0 (Trail Weapons Platoon, 1st Reconnais- sance Battalion .... Wpn 0 Motorcycle Platoon, 1st Reconnais- sance Battalion Mtcl A 1st Reconnaissance Squadron Armored Company (Light), 1st Re- connaissance Battalion C I 1st Cavalry Division Command Post. 5th Cavalry — 1st Armored Brigade Observation Post, 9th Cavalry Communication Platoon, Headquar- ters Company, 1st Armored Brl- gade Com Hq \ 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 Serv [ Chemical Warfare Service. 2d Platoon, 1st Chemical Company, Service Aviation — 2 [ G Reconnaissance Company, 1st Ar- mored Regiment (Light) Ren 10th Chemical Company, Mainte- nance . / Machine Gun Company, 1st Ar- mored Regiment (Light) Company B. 2d Separate Chemical Battalion rh 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 A 1st Platoon, Troop E, 8th Cavalry Machine-gun Platoon, Battery E, , 102d Coast Artillery E | 1st Platoon, Special Weapons Troop, 14th Cavalry ( Sp W 37-mm Platoon, Battery F, 202d Coast Artillery p 1st Platoon, Antitank Troop, 1st Cavalry Division I 2d Battalion, 2d Coast Artillery, Harbor Defense 7 Mortar Platoon, Weapon Troop, 2d Cavalry Brigade Wpn 1st Platoon. Troop A, 4th Cavalry Horse and Mechanized 912 Coast Artillery (Railway) .. 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) .. Headquarters Troop, 3d Cavalry Brigade H r 4th Battalion, 241st Coast Artillery, Harbor Defense, Type C 4 Troop A (Scout Car), 1st Reconnais- sance Squadron £ Command Post. Battery E, 248th Coast Artillery, Harbor Defense, Type B 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) pivision Ren 8th. Engineer Squadron (Cavalry Division) Battery B, 1st Field Artillery Obser- vation Battalion 3023 Engineer Battalion (Separate) Headquarters Battery, 1st Division Artillery (Triangular) 301st Engineer Battalion (General Service) Tank Destroyer Battalion 905th Engineer Battalion (Heavy Ponton, Motorized) ... Infantry. One squad, 2d Platoon, Company G 117th Infantry ' 3d 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 Headquarters Company, 3d Infantry Bridge Company, 16th Engineer Bat- talion 3d Machine-gun Platoon, Caliber .50, Company M, 120th Infantry 2d Platoon, 391st Engineer Company (Depot) r 1st Antitank Squad (Antitank. Com- pany), 1st Infantry Service Platoon, Company C, 801st Engineers (Water Supply) Command Post, 2d Battalion, 323d Infantry ' Automatic Rifle Squad. 2d Platoon, Company A, 1st Infantry 3d Platoon, Company B, 28th Engl neers (Aviation) Factory Platoon, Shop Company fi4th Engineers (Camouflage) Intelligence Platoon, Headquarters Company, 22d Infantry (nt i Field Artillery. Symbol may also be used to show artillery position area 1st Light Machine-gun Squad, Com- pany F, 309th Infantry Battery F, 2d Field Artillery Mortar. Section, Company C, 18th Infantry Ammunition Train, 2d Battalion, - 3d Field Artillery (Horse) . Service platoon. Headquarters Com- pany, 105th Antitank Battalion . • Weapons Platoon, Company E, 6th Infantry (Armored) Wpn Headquarters Battery, 3d Battalion. 4th Field Artillery (Pack) ... Gasoline Section, Service Battery, 54th Field Artillery Regiment (105-mm Howitzer, Armored) ▼ Str 3d Platoon. 205th Military Police Company 501st Infantry Battalion (Parachute) 1st Battalion, 8th Field Artillery 8th Infantry (Motorized) Headquarters and Headquarters Bat- tery , 11th Field Artillery Brigade 1st infantry Train 2d Battalion, 18th Field Artillery ■ ((Composite) (Sen-ice and Ammunition Battery, ;i 1st Battalion, 79th Field Artillery (240-mm Howitzer, Motorized) .. Kitchen Train, 2d Battalion, 3d Infantry Observation Post, 81-mm Mortar Platoon, Company D, 30th In- fantry 2d Section, Battery B, 71st Field Artillery Battalion, Horse-drawn Medical Detachment, 5th Infantry . 'Maintenance Section, Battery C, 98tn Field Artillery Battalion (75-mm Howitzer, Pack) Mslntcj 1st Battalion Section, Medical De-. tachment, 175th Infantry Medical Department. Veterinary troops Company B, 19th Ordnance Battal- ion (Armored) Headquarters and Service Company 1st Medical Regiment Headquarters and Supply Section 105th Ordnance Company (Medium Maintenance) Clearing company D, 8th Medical Battalion Service Platoon, 73d Ordnance Com- pany (Depot) r 1st Platoon, Company E (Ambu- lance). 105th Medical Regiment 462d Ordnance Company (Aviation, Bombardment) Station Platoon, Company G (Clear, ing 105th Medical Regiment 694th. Ordnance Company (Aviation Pursuit) 3d Platoon, Collecting Company. 47th Medical Battalion Armored 721st Ordnance company (Aviation Air Base) Clearing Platoon, Veterinary Troop. 1st Medical Squadron Quartermaster Corps. Light Maintenance and Car Battal- ion, 119th Quartermaster Regi- ment First Army Medical Depot Battalion Aid Station, 1st Battalion, 4th Infantry Company c, Truck Battalion, 105th Quartermaster Regiment Ambulance Loading post Company A (Truck). 13th Quarter- master Battalion (Armored) Shop Headquarters and Supply Pla- toon, Company C, 56th Quarter- master Regiment (Heavy Mainte- nance) Collecting Station, 1st Division Hth Evacuation Hospital 2d Platoon, company K, 48t,h Quar- termaster Regiment (Truck) Clearing Station, I Corps Pack Troop, 16th Quartermaster Squadrons, 1st Cavalry Division Hospital Train 681st Quartermaster Battalion (Steri- lization and Bath) Veterinary Clearing Station, First Army Service Platoon, Company A, 203d Battalion (Gasoline Supply) 5th Platoon, 12th Veterinary Com- pany Company D, 94th Quartermaster Battalion (Bakery) 901st Veterinary Evacuation Hospi- tal Transportation Platoon, 252d Quar- termaster Company (Air Base Ordnance. 1st Ordnance Company, Medium, Maintenance Second Army Quartermaster Depot No. 1 (Gasoline and Oil) Third Army Quartermaster Depot No. 2 (Motor Transport) .... 2d Ordnance Company, Heavy Main- tenance (Army) Railhead for Class I Supply, 2d Divi- sion 3d Ordnance Company, Heavy Main tenance (Tank) Service Section, 28th Ordnance Com- pany (Medium Maintenance) Ill Corps Quartermaster Park Truckhead Class I Supply, 2d Divi- sion Magazine Platoon, 51st Ordnance Company (Ammunition) Signal Corps. 59th Signal Maintenance Company (Aviation) 3d Platoon, 95th. Ordnance Com- pany, Maintenance Railway Artil- lery MAP READING 201 Intercept Section Headquarters Pla- toon, 3d Radio Intelligence Com- pany 5th Signal Battalion, Construction 317th Signal Company, Air Wing 1st Signal Company, Photographic . Signal Company, Operation (Radio), 59th Signal Battalion, Armored Corps Operating Platoon, 1st Signal Troop, 1st Cavalry Division Headquarters Platoon, 701st Pigeon Company Signal Company, Operation (Wire) 59th Signal Battalion, Armored Corps Operation Company, 62d Signal Bat- talion 1st Signal Company, Depot Construction Platoon, 30th Signal Company 2d Signal Company, Repair 7th Aircraft Warning Section, 2d Aircraft Warning Company 7 1st Signal Company, Construction, Separate 21st Signal Company, Operation, Separate ' Telephone and Telegraph Section. 313th Signal Company (Aviation) 3d Radio Intelligence Company 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 arc 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 *-grids) and vertical lines (known as the y-grids) spaced 1000 yards apart. These lines arc numbered in one series 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 are numbered at the top and are 40 to 42, inclusive; the horizontal grids are 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. Using: the “L” Shaped Coordinate Card. The coordinates of 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 are 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). 7 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 are 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 arc 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 Plate 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 are 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 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 of the map, as a ruler would be tor 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 tic\s 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 Plate 6. A Graphic Scale for Measurements in Yards. the number of 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 414 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. 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 either 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 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= 1,580 yards on the ground (Reduce to common terms) 2.82 inches on the map= 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 arc 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 arc 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- MAP READING 207 tativc 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 shouH 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/z 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 arc located on the map, and the road distance measured. It is found to be 11.4 miles. The rate of march is 2J4 mph, 11.4-i-2.5=4.56 The march will therefore require 4.56 hours. March time is always expressed in hours and minutes. 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 minutes travel time. Converting March Time to Distance. The distance that troops can move during a known elapsed time is an item that must frequendy 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 254 mph, and the troops have been marching for 3 hours and 15 minutes. 3 hours 15 minutes = 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 (214 miles per hour) could be constructed as follows. From the miles graphic scale of the map draw a line to represent 214 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. DIRECTION AND AZIMUTHS Direction, General. The established geographic terms, north, south, east, 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 Plate 9. The Azimuth Circle. The azimuths of A, B, C, D, and E are 22*, 78°, 135*, 240°, and 313°, respectively Plate 10. Map Reading Protractors. A—Semi-circular Protractor. B—Rectangular Protractor. LINE EXTENDED TO CUT PROTRACTOR SCALE TO FACILITATE READING. Plate 11. Measuring Map Azimuths. The azimuth of the line A — B Is 83*; of C — D, 286*. BASE LINE CONSTRUCTED ■THROUGH P PARALLEL TO VERTICAL GRIDS. INITIAL POINT FROM WHICH AN AZIMUTH OF 115° IS TO BE\ PLOTTED. c POINT PLOTTED FROM PROTRACTOR SCALE LINE DRAWN FROM P THROUGH P/ Plate 13. 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 gri'd. (Sec 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 bac{-azimuth. 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, (See 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. 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. h. 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 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. Plate 15. The Mil Azimuth Circle. The azimuth of A is 2140 mils. 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 arc 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 CHANCE 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. 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 must be able to secure this information from his map. Since the map itself is flat, special devices are necessary to show relief. One system is to color the high ground with various shadings of color to indicate different layers of elevation. ELEVATION AND RELIEF 5° ADJUSTMENT 11° ADJUSTMENT 2° .MAGNETIC AZIMUTH GRID AZ.s X° MAG. AZ.= X+ II GRID AZ. = X° MAG. AZ. = X— 5 GRID AZ.= X MAG. AZ.» X 4- 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 the 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 be 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 level 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.) MMM (4) 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 DRAW 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 he 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 shown 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 .tseii -nnot be as great as 620 feet (or the 620 contour would appear), and the point ‘‘C obviously not at the top of the hill, its elevation would be estimated as roughly between 605 and 610 feet. 6 1 Terrain Structure. The relief of the ground is, with rare exceptions, 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 therefor e 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 Erection 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 closed 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 b> 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 the 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 1:1U,000, the relief in the profile has a vertical exaggeration of about ten to one. To construct a profile, q working space (sec Plate .23) is first constructed consisting of equally spaced horizontal lines, each line to represent the devation of a contour, and the spaces between the lines representing the difference in devation between two contours. The number of spaces must be sufficient to accommodate he total number of contour intervals between the lowest and the highest point involved a the profile. Lines are numbered in sequence to conform to the contour lines involved. MMM (4) 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) /2 (at O), 1/3, 2/3, 1/3 and % 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. Reliable knowledge of the visibility, or lack of visibility of joints or areas is very essential to commanders. It greatly affects the location of ob- ervation posts, the siting of weapons, selection of targets, and may determine the suit- ibility of combat positions. The profile is the most reliable and useful means of determin- ng visibility, because it gives accurate information of what points are and are not visible, he location and the extent of invisible (defiladed or dead) areas, and from it the 220 MILITARY MEDICAL MANUAL actual amount of vertical defilade cat. be computed for any point. On Plate .4 assume an observer to be standing at O, eyes five leet above the ground, looking toward . 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 wo. king 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. (Sec Plate 25.) b. By hasty profile. When speed is essential, and »he visibility of specific points, only, is at issue, the necessary information can be quickly determined by plotting on the work- ing space or ly 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 of points A and B, only, are at issue, the plotting shown is sufficient to determine that A i: visible and that B is not visible from O. c. By computation. The visibility of any single point can be determinedly 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 MAP READING 221 Plate 25. Visibility ol 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. The line of theoretical sight, being a straight line, will drop (or rise) one-half the total drop (or rise) in half the distance, one-third 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 doubtjul. The visibility of the doubtjul cases must be determined by one of the methods described above. Plate 28 shows a case of a mask approximately Plate 26. Visibility by Hasty Profile. Plate 27. Visibility by Computation. MAP READING 223 onc-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 arc 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 i map, scale off two miles, study the map and select some recognizable feature in that , /icinity. He would then march until he reached the feature. On the other hand, if no nap were available, he might calculate that the two miles would require forty minutes )f marching. He would march forty minutes and then take position. The Compass. Direction in the field is measured with the compass. There arc wo types of hand compass issued in the service, known as the prismatic compass and he lensatic compass. They are shown in Plate 30 and are similar in design, construc- ion, and employment. Each compass consists of a case containing a magnetic dial bal , need on a jeweled pivot, a hinged cover with a glass window, an eye piece containing prism or a lens for reading the finer graduations of the dial, and a holding ring. The lass cover has an etched line which is used like a front sight, and the eye piece has a slot 'hich can be used as a rear sight. The dial is fixed to a magnetized needle, rotates with ic needle, and is graduated for a full azimuth circle. Compasses are provided graduated MESA STEEP SLOPE i ROAO JUNCTION BLurr I SADDLE I KNOLL SKYLINE MILITARY CREST I ARROYO OR CULLY TOPOGRAPHICAL CREST _PIate 29. Military Features of the Terrain. ROAO CENTER EVERGREENS PAVED ROAD PASS OR CAP —Culvert VALLEY SMALL VALUEV OR DRAW CONCAVE SLOPE I NOSE -OP SPUR 'CROSSROADS PEAK CONVEX SLOPE CLEARING MAP READING 225 The Prismatic Compass Legend. The Lensatic Compass 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 reading.- 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 thr terrain (distant hill, house, etc.) proceed as follows; Raise the cover and the eyepiece anc. unlock the dial. Hold the compass to the eye and sight the compass at the object. HoL LUMINOUS MARK SET BY THE NIGHT MARCHING SCALE — COMPASS SO HELD THAT LUMINOUS ARROW ON DIAL POINTS TO LUMINOUS MARK. the compass steady until the dial comes to rest. Read the azimuth figure on the dial at th< index point. This will be the magnetic azimuth of the line from the observer to th 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 th compass to the eye and watch the dial, facing the entire body about until the dcsire< azimuth figure on the dial is at the index point. Holding the compass in this position Plate 33. Compass Set for Night Marching. 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 are 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. Plate 36. Orienting Map by Ground Feature, 230 MILITARY MEDICAL MANUAL POSITION OF OBSERVER—' Plate 37. Locating Position on the Map by Inspection. CHURCH POSITION OF OBSERVER Plate 38. Locating Position on the Map by Single Point. MAP READING 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. 231 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 see 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. b. 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-edge 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. c. 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-Argonne 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 enemv 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 clues. Important enemy areas are re photographed 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, mav 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. h. 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 “aerocartograph”) which work on the stereoscopic principle and by which contours may be plotted directly from overlapping aerial photographs. This use of the aerial photogiaph is a spccialistic 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 are not available. Even when maps arc 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 arc cut down, and fields formerly cultivated arc 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 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, Plate 2 shows the characteristic shape of a five-lens composite. MILITARY MEDICAL MANUAL VERTICAL I : 10,000 OBLIQUE 5000 FEET 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 sc desired. Also, a mosaic may be rephotographed either as a whole or in sections and repro duced in sheets 20" x 24" in size. The multi-lens cameras take pictures of other sizes They are used primarily for mapping projects and it is seldom that the line officer wil encounter them in their original print form. The amount of ground area shown in am individual print depends on the type of camera used (focal length) and the altitude frorr which the picture was taken. Plates I, II, and III are vertical photographs of the same arc: made from different altitudes and over a period of years. (Note. Plates referred to in Romai numerals, numbered serially from I to XII, arc photographic plates and arc to be found ix 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 ease, and also the relation of the altitude upon the amount and clarity of the minor detail recorded. Plate 2. Five-lens Composite (rectified). 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 be disregarded as having no effect upon the tactical use of the photograph. The plotting of Plate I 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 arc 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 tilt 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 236 MILITARY MEDICAL MANUAL show the top of the cylinder to be relatively larger than its base (because it is closer to the lens), 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 (.U34 inches) and represents the relative height of ACTUAL LOCATION AND SIZE OF CYLINDER TOP RECORDED LOCATION AND SIZE OF CYLINDER TOP. 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 the 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 arc entered on this basis. Photo- graphs, on the other hand, arc 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 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 on 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 f laie -k. tisuig Hie Paolo Cooidmale (Jard. (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 objects 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 arc 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 be 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 74QC 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 scries, 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 arc easy. One secs familiar things, and secs 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 be 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 be apparent direedy 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 are known or suspected to be 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, but 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. But 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 arc usually darker, and narrower than highways, with long straight tangents and INTERPRETATION OF AERIAL PHOTOGRAPHS 239 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 appear as dark patches, not only because they arc 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 difference of color and the shadows themselves may escape notice. The camera is so sensitive to light that it records the difference 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 III. A realization that the camera records all detail in terms of light reflecting properties greatly facilitates understanding aerial photographs. Plate VII, 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 of 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 oaring through grass land, probably a pasture; in the right center are wooded stream lines passing through a lightly wooded area; at the upper right arc artificial drainage ditches in a cultivated stream bottom. Incidentally, the upper left corner of this particular photograph shows with unusual clarity the terracing of cultivated slopes. Such terraces arc 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 arc 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. SCALES AND AZIMUTH Scales. The aerial photograph 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 be 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 ccale 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 focal 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 I 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. truike o. ueiermumig llie scale (K*) oi a Vertical Fdotograpli by Means ol 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 are 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 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 be 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-f- 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 Vz 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. (Sec 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-visihle features are selected 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 nort line of the photograph can then be determined from this data in the same manner as de- scribed above. . , , c. Making 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, cither by drawing it parallel to the original line, or by re-basing it on the datum line. It is not neewsary tha there be a zero line in order to make azimuth readings. Whenever a line intersects another JPlaie 8. Determining Magnetic Worth. (Diagram Oriented to the Photograph.) 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. Phue a. Measuring Plioio Azimuths. (Uagiam mvciicu iu Approximate XNoilh Orientation.) i*lale 10. moiling Fliolo Azmiutlis. 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 (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-degrec mark on the datum line, V* 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-dcgrcc 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. 6 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 olacing 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 arc 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 arc irn- proved or abandoned, and new roads put in. Woods are 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, arc 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 docs 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 arc 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 crctc 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. It 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 primary 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 arc still bare earth and not yet grown over with grass or weeds. It is probably a very recendy 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. It is also desirable to know the nature of the woods. Woods consisting of mature trees so closely spaced that the branches interlock (Plate III, right center) have vastly different military value from woods whose trees are so spaced that much of the ground is clearly visible (Plate III, 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 directly, as is the case with the finger drainage on Plate III, and also in portions of Plate IV. 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 be seen in photographs as in Plates VIII, IX, and XI. To all intents and purposes they can be considered as form contours and serve as such for indicating relief. Bends in the routes of unimproved roads where they pass around ridges, spurs, and draws, are likewise valuable clues to relief. The most valuable source of information regarding relief, however, is the drainage net, which can be 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 be 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 typical drainage pattern. Plate XI shows various types of minor drainage and their characteristic patterns in various types of background terrain. In both cases the patterns of the drainage lines are clearly marked by the more luxuriant vegetation along their courses. They 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 ridge 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 s;en 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 secs 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 arc 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 wi c 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 the 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 see 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 abihty 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 MILITARY MEDICAL MANUAL 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 basic terrain structure. 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. o © ©^ oo £ ft u b* O O £ 13 *- ;> NN NN NN 0> -M C$ ft Photo by Air Corps, U. S. Army Plate IV. Vertical Photograph. Photo l»y Air C rj>s, U. S. Army Plate V. Oblique Photograph. 3000 feet. Photo by Air Corps, U. S. Army Plate VI. Oblique Photograph. 5000 feet. Photo by Air Corps, U. S. Army Plate VII Photo by Air Corps, U. S. Army Photo by Air Corps, U. S. Army Plate IX. Photo by Air Corps, U. S- Army Plate X. Typical Drainage System. Photo by Air Corps, U. S. Army Plate XI. Types of Minor Drainage. Photo by Air Corps, U. S. Army Plate XII. Stereoscopic Pair, 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. I 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, j 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 II 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 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 jspeeds 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: M M M (4) 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 vdoped 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. ENGINE CAB BODY COMPART- MENT 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. 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 t,he weight of the vehicle and forms a housing for the driving axle shaft and the AXLES 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 hearings, the gaskets, 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. Axle 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. _ I 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 she ft, 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. 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 spind es y means of two or more flat or coiled springs and transverse linkages. 256 MILITARY MEDICAL MANUAL 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. 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. WHEELS, TIRES, BRAKES AND STEERING 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 CARE AND OPERATION OF MOTOR VEHICLES 257 wheels and in some cases on the transmission main shaft. 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. Mechanical Brake System with Single Cross Shaft. 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 I 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 brakes 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 brakes 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 Plate 8. Lockheed Hydraulic Brake System, (Bragg-Kiesrath). Air brakes 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 Plate 9. Diagrammatic Arrangement of an Air-operated Braking System. Plate 10. Diagram and Nomenclature of Complete Steering Mechanism. (Society of Automotive Engineers Nomenclature). 260 MILITARY MEDICAL MANUAL Electrical brakes 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 either 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 stroke 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 stroke 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. 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- standy 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 dead 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. INTAKE STROKE COMPRESSION STROKE EXHAUST STROKE Plate 13. Events of one complete cycle of a four-stroke Otto cycle engine. POWER STROKE 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 i 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. WATER JACKET AROUND COMBUSTION CHAMBERS, VALVES AND CYLINDERS. RADIATOR UPPER TANK 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. OIL PRESSURE GAGE 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 total 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. Plate 17. Clutch. 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. 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 propeller 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 uore universal joints. A universal joint is substantially a double hinged joint with die pins of the hinges set at right angles. Several different methods are used to achieve ihis, 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. PROPELLER SHAFT 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 :ontact, 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 ile must take short steps, almost marking time, while the man in the outside file nust 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 md travel a greater distance than the wheels on the inside. This causes no difficulty vith 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. 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. Plate 24. One Cell of Lead Acid Storage Battery Showing Relationship or Plates, Insulators, and Terminals. Plate 25. A Typical Battery Ignition Circuit. CARE AND OPERATION OF MOTOR VEHICLES 275 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. Plate 26. Typical Magneto Circuit. Plate 27. Bendix Drive. 276 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. MILITARY MEDICAL MANUAL 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 COMMANDER MOTOR OFFICER Instruction Operation Maintenance Inspection Records Reports Supply CHIEF OF SECTION Supervision Inspection Operation Reports MOTOR SERGEANT Shop Foreman Maintenance Inspection Records SUPPLY SERGEANT Surveys Property records Nonexpendable supplies DRIVERS Operation Caretaking Inspection Lubrication Y Trip ticket Accident report MECHANICS Caretaking Repairs Maintenance operations Lubrication CLERK Dispatcher Forms Records Supply Memo receipts 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 dr 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. CARE AND OPERATION OF MOTOR VEHICLES 277 278 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 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 tp 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. MILITARY MEDICAL MANUAL MAINTENANCE OPERATIONS 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- 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. *Remove 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. U nit Defect 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 i 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 ignition wiring, generator servicing, starter servicing, M M M (4) 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 off front-drive axle, and lubrication. Front end to include spring hold-down bolts, rebound clips, shackles, shock absorbers,i 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 anv column for towing disabled vehicles will depend upon the type of vehicle, road conditions, tvpe 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 purnose 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 be 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. LUBRICATION 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 dualifled 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. 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 lubriqation 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 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. INSPECTIONS 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 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. Weekly 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 Lights Appearance Lubrication Battery Mats Body bolts and screws Rear-view mirror Bows Running boards Brakes Running gear Broken metal Seat brackets Bumper and tow hooks Servicing Canvas Special mountings Chains Springs Condition of motor Steering Curtain fasteners Straps Doors Tail gate Driver’s permit Tires: Extinguisher Cuts Fender bolts Inflation Fenders Unusual wear Floor boards Tool brackets Glass Tools Handle and latches Traction devices Hood fasteners Upholstering Horn Wheel lugs Insulating material Windshield wiper Keys Defects to be corrected: Leaks on ground 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 RECORDS AND REPORTS 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 PAGE 4 IT. Was an Investigation made by n policeman (civil or mili- tary) ? y f t ... H so, state Name No. Ik Precinct or station Fk.Ml\X £i±y IS. Name* and addresses of i»-rsons oilier than driver In Gov- ......$f G.atSJi. 19. Name*-and addresses of other witnesses: AAOM.- . of drlvir) I certify that the above report was delivered to me on the ...... day of .— — — —, 10.—.. at * o’clock (Signature of officer in charge) (bfflciai'tltie) " (Government department or establishment) NOTE.—'This report should be slushed to report of Inrestlgsllnr Officer. 10—18J0 « g mt PACE I Standard Form No. 26 Approved by the President June 10,1927 DRIVER’S REPORT—ACCIDENT MOTOR TRANSPORTATION INSTRUCTIONS TO DRIVERS la case oi injury to person or damage to property: A Stop car and render such assistance as may be needed. B. Fill out this form, ON THE SPOT, so far as possible. C Deliver this report promptly to your immediate superior. Failure to observe these instructions will result in disciplinary action. 1. Name of Government driver: PittfATT^_Optve5 2. Stationed at -Pg3jLJ?.RL'1fL!n..V..>vq . ».y. V.eA».£../.«...../>.«..t. 14. State conditlon’of light, weather, and roadway: zjSjijuLj. wuU'tf- C 15. Explain bow accident happened: of traffic regulation violated, if any. 4. Attach photographs of scene of accident and of damaged cars, if any taken. 6. Attach Findings and Recommendations of Investigating Officer. ‘■nss#"*" If the above diagram is not applicable, attach substitute diagram. zsssaie*d=r SfanHar — Time interval allowed to reduce chance of conflict between serials TIME LENGTH 1st FA 193 motor vehicles at 600 per hour (Par. 74 b) = 19.3 or 20 minutes 3d FA 237 motor vehicles = 23.7 or 25 minutes Indicates remark in Match Order 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 lively 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 surrounaings. 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 MILITARY MEDICAL MANUAL 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 100-3). GENERAL (SILVER) LT. GENERAL (SILVER) MAJ. GENERAL (SILVER) BRIG. GENERAL (SILVER) COLONEL (SILVER) LT COLONEL (SILVER) MAJOR (GOLD) CAPTAIN (SILVER) 1ST 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 100-3). 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. j 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 /ery heart of a unit’s power. ADMIRAL VICE ADMIRAL REAR ADMIRAL CAPTAIN COMMANDER I I1TTTT 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 demarcation 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 COMMANDER REAR ADMIRAL CAPTAIN LIEUT. COMMANDER LIEUTENANT LIEUTENANT (J. G.) Plate 3. Sleeve Ornamentation, Coast Guard Officers. ENSIGN 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. 103, FM 100-3). 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 pays 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, M1921, 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 Anns (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 hot so- 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 |l I. 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, is designated by Act of Congress dated March 3, 1931, as the National Anthem. It should be played as written without flourishes or repeUtlons. It should not be played as part of a medley. MMM (4) 348 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. MILITARY MEDICAL MANUAL 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, 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. MILITARY COURTESY AND DISCIPLINE 349 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 Fart 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 q. At a military funeral, all persons in the military service in uniform or in 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 i MILITARY MEDICAL MANUAL 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 5.) 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 18, In Civilian Clothes, With No Headdress. Plate 17. In Civilian Clothes, With 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 officer 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. /. 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 Plate 24. A Civilian Saluting the Color the Colors (Standards). (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 frequently 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 bv 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 arc 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 to 357 358 MILITARY MEDICAL MANUAL the commander of the post, camp, or station. (See 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 arc usually made between 7:30 and 9:00 p.m. d. Dress when calling. Proper uniform or civilian dress is worn. (Sec 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- Plate 1. Proper Use and Display of Flag. 360 MILITARY MEDICAL MANUAL ment employ receiving a less salary than themselves.” (Sec 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 off and the Plate 1. Trajectory for 1000 Yards, Model 1906 Ammunition. Figure 1. —Trajectory diagram for the cartridge, ball, caliber .30, M190G (vertical scale is 20 times the horizontal scale). Figure 2.-Trajectory diagram for the cartridge, ball, caliber .HO, Ml (vertical scale is 20 times horizontal scale). Plate 2. Trajectory Diagrams. 361 362 MILITARY MEDICAL MANUAL Plate 3. Trajectories of Guns, Howitzers, and Mortars. BALLISTICS AND PROJECTILES 363 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 ease of artillery ammunition, or of the relatively soft metal of a rifle bullet, the projectile moves forward, sealing 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 force 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 arc 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 arc not distributed evenly over the entire pattern but are much closer together near the center. Vertical shot groups arc 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.) Fig.1 Continuous danger space At short range the height of the trajectory never exceeds that of a man Fig.2 Short danger space and long safety space in long range fire Between A and B the bullet is always higher than a moms heed Fig.3 Danger, spaces of trajectory and ricochet At A occurs the’Tirst cotch" by lowest part of cone 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.duc to ricochet depending on the direction and remainingvclocity of the ricochet bullets 6 HEAF5 OF Fi RE. 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 o£ 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 tone is comprised of all the danger spaces mentioned above. (Sec Plate 4) 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 arc 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 Plate 7. Effect of Ground Slopes on Beaten Zone. 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 arc designed to penetrate protective armor, such as tank armor, in order to cause casualties within the vehicle. (See Plates 8, 9, and 10.) 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. Legend: 1. Bullet: 2. Propelling charge; 3. Cartridge case. 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. Plate 9. An Assembled Round of 75-mm High Explosive Ammunition. Legend: 1. Fuze, point detonating Mk. Ill; 2. Adapter and Booster, Mk. ni-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; 13i Rotating band; 74. 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 arc driven out in the form of a cone. In effect, shrapnel is a flying BALLISTICS AND PROJECTILES 367 shotgun. The ease itself docs not undergo much fragmentation, but each individual bullet, as well as the time fuse and the casing, becomes a separate projectile. Shrapnel is •specially 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 arc 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 arc 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 arc 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 1 Medical Department of the United State* In the World War, Vol. XV, Statistic*, Part 1. 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 ‘f. S.- 4.38% Other gases f. 4.47% Others 2.60% Part II 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 arc, 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 Shippcn, 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. Torncy, Brigadier General, Surgeon General. 1914-1918—William Crawford Gorgas, Brigadier General and Major General, Surgeon General. 1918-1931—Merrittc 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 MILITARY MEDICAL MANUAL 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. 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. 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 arc unknown. 1778 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. June. All troops were discharged except 700. One surgeon and four surgeon’s mates were retained to provide medical care for the Army. 1784 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. 1788 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. An Act of Congress reorganized the Army as a “Legion” under command of a major genera! 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. 1792 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. 1790-1798 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 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 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. 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. 1813 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. 1814 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 Lc Baron continued as Apothecary General until April 18, 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.” Other Events during the Period 1812-1818 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. November 1. Surgeon General Lovell submitted the first quarterly report of the Medical Department to the Secretary of War. MEDICO-MILITARY HISTORY 375 The first meteorological report issued by the Army was dated 1826 and entitled, Meteorological Register for the Years 1822-23 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. 1826 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. The “Library of the Surgeon General’s Office” was founded. (This is the origin of the present Army Medical Library in Washington, D. C.) 1836 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. There was a marked reduction of the Army and the Medical Department following the Florida Seminole War. 1842 A general hospital and several regimental hospitals were established in anticipation of war with Mexico. 1845 376 MILITARY MEDICAL MANUAL 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.” 1846 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. Congress authorized the appointment of hospital stewards as had been previously recommended by Surgeon General Thomas Lawson in 1847. 1856 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 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 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. 1861 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 1862 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 “Lettcrman 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 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. 1865-1898 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 A descriptive catalogue of the Army Medical Museum, Washington, D. C., was pub- lished. 1867 1875 Colonel Jedcdiah 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 hospit'' 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 a id 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 follrwing 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 arc, 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 membeis 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’* 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 arc instructed. It is a medical theater of scientific study, research, and instruction. The modified Maltese cross was adopted in place of the shield as a collar device for medical officers. 1894 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 arc 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 di«eascs, the most common of which was typhoid fever. MMM (4) 380 MILITARY MEDICAL MANUAL Diphtheria 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. 1898-1899. The Spanish-American War Period 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-Amcrican 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- 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, Triplet, 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-Amcrican 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 Philippines 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 thctc. 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, for 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 Ouemados, near Havana, Cuba a month later. This board demonstrated positively that yellow fever is transmitted by the bite of the mosquito Aedes aegypti. 1900 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. 1901 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. 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. 1904 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-Amcrican 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. 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. 1908 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. 1909 384 MILITARY MEDICAL MANUAL 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 of 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. 1910 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 San Francisco, California, to be named Lettcrman 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 border. 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. Torncy as head of the Medical Department. General Torncy 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 measure-s 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. 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 1917 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 docs 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-defense 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 tc 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. Glcnnan 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 Mincola, 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 Camicrs, 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, this 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 forces. 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 statistics 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 few 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 bottles, 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 tor each wound treatment: Water and gloves were not always available, or the supply was limited. However, instruments could be sterilized suffi- ciently 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 scries 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 depicted by hemorrhage or suffering from shock could be retained longer and consequently evacuated in belter 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 staff 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 Hazclhurst 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 Mcrrittc 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. 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 die 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. 1921 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 Uric Patterson recommended its transfer to the Panama 1922 394 MILITARY MEDICAL MANUAL 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 arc 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 arc also invited to attend. These meetings are held at eight o’clock at the Auditorium (center wing of the School Ruilding), 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 are 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 Mitchcl 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. MEDICO-MILITARY HISTORY 395 1929 A medical officer, Colonel Harry L. Gilchrist, Medical Corps, was appointed Chief of the Chemical Warfare Service with rank of 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, pub- 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 leadershio 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. 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 1932-1942. The Period from General Ireland’s Administation to 1942 396 MILITARY MEDICAL MANUAL 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 193 a. January 13. The Surgeon General’s Office was reorganized into 10 divisions and 30 subdivisions. (Sec 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 15. The Medical Reserve Officers’ Training Corps was reestablished and, in the fall of the same year, instruction was started in several medical schools. MEDICO-MILITARY HISTORY 397 June 4. An Act of Congress provided changes in the requirements for 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. Intcrneships 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. 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. 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 arc six months, many physical examinations for entrance and discharge from the Civilian Conservation Corps arc 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 15. 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 15. 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 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 direedy 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 of 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. 1940 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 Geneial 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. 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. 1941 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. Flikk'e, Major in the Army Nurse Corps, was promoted to the grade of Colonel, the first Army Nurse to attain this rank. 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. 1942 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 are 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 the 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 arc 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. It was an Army doctor, assisted by members of his medical board, who made the out- standing investigation about yellow jever, 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 Army Conquers Yellow Fever 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 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 Aimy 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 continuedv 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. The Army Pioneers American Bacteriology 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 Rcccndy 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. 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.” The Army Encounters Dengue Fever 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 eases 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 buffalo 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. *Hofl! Hall, the school building of the Medical Field Service icheol, was «amed i» his house. MEDICO-MILITARY HISTORY 407 made toward cpmbatting it was taken in the tropics by the natives, who drank a bitter fluid with the taste of 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. Recenffy 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. 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. Army Hygiene Controls Dysentery 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 The Army Shuts Out the Bubonic Plague 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 unreplaceable 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. 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- S 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 j war, and these duties contain many variations and increases from the normal. Herein j lies the necessity for continuous military training of the Medical Department Reserve Officer, so he will be able to adapt himself readily, to the military plan. The Medico-Military Man 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 are 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. 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 Silent Success 410 MILITARY MEDICAL MANUAL 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? CHAPTER II ORGANIZATION AND ACTIVITIES OF THE MEDICAL DEPARTMENT THE PURPOSE 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. 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 arc 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, are 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 arc 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 M M M (4) 412 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, 1 he Surgeon General is able to establish a unified policy of medical service for the Army Ground Forces, the Army Air Forces, the Services of Supply, the Task Forces, the Defense Commands, and the Theatres of Operation. MILITARY MEDICAL MANUAL 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. ”1 he 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. 6 ORGANIZATION AND ACTIVITIES 413 [INTERNATIONAL I DIVISION I V.» tit CHIEE OE SUPPLY SERVICE DISTRIBUTION I DIVISION Slot* Conl-oJ E.eU Eq^.pmant NURSING PURCHASES DIVISION Control Eaped-t-nq DIVISION I M»«i t 04-'» REQUIREMENTS I DIVISION I S-PplT CHIEE OE PROEESSIONAL SERVICES PROOUCTION Plate 1. Office of the Surgeon General, a Staff Division of the Services of Supply. DENTAL DIVISION Dental Banct. e-anc*. PREVENTIVE MEDICINE IVlSlQN Sanitation V«»«-ra! Conl>o< Hyq.en* Branch Su'9«ry CONSTRUCTION A- Corps Lril MEDICAL PRACTICE DIVISION Ad|ul«nt PUBLIC RELATIONS DIVISION CHIEE OE OPERATIONS HO&PIIAUZATION 4 evacuation Division THE SURGEON GENERAL DEPUTY SURGEON GENERAL EXECUTIVE OFFICER DIVISION E.eld Equipment EISCAL DIVISION Budqtti MEDICAL BRANCH DEPOTS TRAINING E.scal IS-p* CHIEE OE ADMINISTRATIVE SERVICES MEDICAL PROCUREMENT DISTRICTS HISTORICAL DIVISION MEDICAL MUSEUM Civilian PERSONNEL DIVISION Pan c*t Clan:* cation RESEARCH s DEVELOPMENT DIVISION CH,£E OE PERSONNEL SERVICE MEDICAL RECORDS DIVISION Stjt.it.cjl MILITARY PERSONNEL DIVISION GENERAL DISPENSARY WASH.. D. C OEPlCE ADMINISTRATION DIVISION loHlt* Co»n & CONTROL DIVISION S«'»icc MEDICAL CENTER 414 MILITARY MEDICAL MANUAL The Dental Division supervises matters relating to the Profession of , dentistry in the army and its subdivisions are: Deiital 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 MisceU 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 Stocf{ Control Branch, Station Branch, Field Equipment Branch, Overseas Branch and Cargo Branch. The International Division’s sub-divisions are: 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 sujpervising 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 Denartment activities. Its sub-divisions arc: 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 medicine, 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 AR 605-20. All members of the Medical Corps of the Regular Army arc 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 derailed 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 Field Service School, Carlisle Barracks, Pennsylvania, or 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. ORGANIZATION AND ACTIVITIES 417 registered female nurses who are citizens of the United States, between 22 and 30 years of age, unmarried, and graduates 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 with the exception that their pay and allowances and mileage are on a different scale. 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 School.” 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- 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 an 8-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 two 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 six 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 two officer-candidate schools for the Medical Ad- ministrative Corps: one at the Medical Field Service School, Carlisle Barracks, Penn- sylvania; the other 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 arc 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 arc 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. 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 arc 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 close 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 VOLUNTEER RED CROSS WORKERS TRAINING MED DEPT ENLISTED MEN School for Medico' Department Technicians Post Exchange Officer MEDICAL DEPARTMENT SCHOOLS TRAINING OF INTERNES Johns HupVias Un.v Physiotherapy! Cav l HuSp lor Insane U. S P.H $ Fite Marshal hospital TRAINING COURSES Dietetics Occupational Therapy Recreation Officer Assistant Commandant Secretary ARMY SCHOOL OF NURSING I Du«t6f J Supervisors Surgical Nursing Medical Ob.tetfVal Nutting Dietetics Affiliated Summary Court ARMY VET SCHOOL d„„h lA... Secretary] I Preventive Medicine Meat and Dairy Hygiene Veterinary Medicine Surgery Forage Inspection I Roentgenology] ARMY DENTAL SCHOOL [Ait'i Secretary] iRoenlgenologyJ Plate 3. Organization of the Army Medical Center. Chaplain Director [Preventive I Medicine Oral Surgery Denial Proathfia ARMY MEDICAL SCHOOL [A** I Secretary! Preventive Medicine Cl>n veal Surgery Clinical Medicine Oto-Rh.no [Laryngology] Roentgenology] Director Commanding Officer Anaesthesia and Operating Executive Officer Surgseal Service Septic Surgery] Maiutlo* Facial Surgery Urology | Denial Service Generali Surgery] Chest Orthopedic Surgery Obstetrics and Gynecology Eye. Ear. Nose and Throat Adjutant THE WALTER REED GENERAL HOSPITAL O'diO'Rmil Oumici I Mclabolicj Respiratory! Electro* cardiography Neuro- I Physchlatry' I Physiotherapy] Personnel Adjutant Adjutant j Mcdtc.il Service NkdirtiJ Iniet'inal Jjuberculoni*] Isolation Occupational Therapy X Ray Surgeon Laboratory Service ; Commanding Officer Executive Officer fetal |Mrlaboli«mj [Serology jBoctrr.ologyj ] Pathology Chemistry Signal Officer Detachment Medical Department Profesuonol S*r»K( Ort»CC Information Office Medical Supply Officer Hospital Inspector Registrar Bureau Office Del acKmenl <* pMitnu I Receiving and! Dupociiion J Pharmacy Finance Officer Octet* Depjfiment Hovpual Fund I Quartermaster NwiJ-n* Serv** Red Grots MILITARY MEDICAL MANUAL and the Army Veterinary School. These schools are conducted solely for the special train- ing of Medical Department officers and enlisted men. Regular courses are given for physicians, dentists, and veterinarians recently com- missioned and advanced courses are given for officers of longer service. Individual training is available for those specializing in various branches of medicine, surgery, and public health. Courses for Medical Department enlisted men include X-Ray and laboratory technic, oral hygiene, dental mechanics, and food and forage inspection. Under direction of the schools, but conducted in the hospital itself, there are courses in dietetics and physical therapy. Selected Army Nurses are trained in the field of anesthesia. COMMANDANT ASSISTANT COMMANDANT Secretary Department of Administration Department ot Military Sanitation Department of Military' Art Department of Trainina Doctrine Book Shop Department of Training Department of Dental Field Service Library Department of Logistic! Department of Veterinary Field Service Art Department Liaison Officers Department of Field Medicine and Surgery Plate 5. Organization of the Medical Field Service School. The organization and command of the Medical Department Professional Service Schools are so established that separate faculties are provided for the Medical, Dental and Veterinary Schools. These schools are coordinated by the Assistant Commandant. Many of the officers on duty at the Walter Reed General Hospital are members of the faculty. The facilities of the hospital are available for the instruction of students of the school. An average of 75 officers during peace-time graduate yearly from the Medical Department Professional Service Schools. These Professional Service Schools also graduate annually approximately 50 enlisted men in roetgenology technic, 40 in clinical laboratory technic, 30 in dental mechanics and oral hygiene, and 10 in veterinary technic and food and forage inspection. All schools have increased in capacity during this emergency. The Biological Laboratories. The biological laboratories, in addition to furnishing a valuable accessory to teaching for the Professional Service Schools, do routine laboratory work for the hospital, for the Third Service Command, and special work for the entire Army. They manufacture various biological products and supply typhoid vaccine for all ORGANIZATION AND ACTIVITIES 423 the federal medical services. The major research work of the Medical Department is con- ducted in these laboratories. They are equipped with the most modern sterilizers, in- cubators, and refrigerators to insure sterility and the preservation of biologicals which are essential to the military service. The biological production laboratory is prepared to meet the requirements of a maximum mobilization. The capacity of production is such that over 1,500,000 doses of typhoid vaccine can be made in one week. The laboratories collaborate with civilian and other federal laboratories in the field of research. MEDICAL FIELD SERVICE SCHOOL Purposes of the School. The purposes of the Medical Field Service School are: To instruct and train Medical Department officers of the Regular Army, National Guard, and of the Officers’ Reserve Corps in the principles and methods of medical field service so as to increase their ability as instructors and to enhance their proficiency in the performance of their command and staff duties. During periods of emergency, to instruct and train selected enlisted personnel of the Army of the United States for commission as officers of the Medical Administrative Corps, Army of the United States, and in the duties pertaining to the training and operation of Medical Department units of the components of the Army of the United States. Plate 6. The Medical Field Service School, Carlisle Barracks, Pa. To act as an agency of the Commanding General, Services of Supply, in the develop- ment and perfection of the principles and methods of medical field service. To assist in the development of medical field sanitary equipment and the modification and development of field equipment pertinent to the needs of Medical Department troops and installations; to assist in the preparation and revision of Medical Department train- ing publications, instruction manuals, and other publications; to make research in matters pertaining to the field duties of the Medical Department; to disseminate to the service information pertaining to instruction and training used and developed at the Medical Field Service School. Location and History. In 1920, the War Department authorized the establishment of the Medical Field Service School at Carlisle Barracks Military Reservation as a means of providing field training for Medical Department officers and enlisted men. The school was established in 1921. Carlisle Barracks is just northeast of the city limits of Carlisle, Pennsylvania. One of the oldest American military posts, it was established by the British Army in 1754. It has been the scene of important events in wars fought by the United States from the American Revolution, during which it was a depot and munitions works, to the World War, when, during 1918-1919, it was used as General Hospital Number 31. From 1879 to 1918 it was occupied by the Carlisle Indian Industrial School. Since World 424 War I, Carlisle Barracks has remained under the control of the War Department. It is a Medical Department post with a medical officer in command. Many of the buildings used for housing the school facilities until October 1941 were formerly used by the Carlisle Indian Industrial School. Some were constructed during the period of the Revolutionary War and other immediately following the Civil War. A new school building was opened to classes in October 1941 (see Plate 7). Additional buildings and facilities of the temporary type have been provided for the operation of an increased quota of Medical Department officers and Medical Administrative Corps officer candidates. MILITARY MEDICAL MANUAL Command and Organization. The school has the same organization as the special service schools of the arms and other services. The Commandant commands the post and all of its troops and installations. The Assistant Commandant, a medical officer of the grade of colonel, supervises the conduct of the various courses and the admin- istration of the school departments. In addition to the instructors of the school, the post overhead includes a number of officers and enlisted men of the Medical Department, Quartermaster Corps, Signal Corps and the Finance Department. A protestant and a catholic chaplain are present for duty. Commissioned personnel of the Infantry, the Corps of Engineers and the Judge Advocate General’s Department are on duty at the post. The 32d Medical Battalion is the demonstration unit for the school. School Departments. The Medical Field Service School has the following instructional departments: Administration, Military Sanitation, Field Medicine and Surgery, Military Art, Training, Logistics, Training Doctrines, Dental Field Service and Veterinary Field Service. Each instructional department is headed by a Director, In addition to the Medical Department officers of the faculty there is an Infantry officer, an Armored Force officer and a Chemical Warfare officer assigned as liaison officer and instructor. The faculty consists of especially trained officers, many of whom are graduates of the Com- mand and General Staff School and of the Army War College. The school has three activities which facilitate the instruction. The school Library where military and medical publications are available for instructors and students; the Art Department which prepares overlays, charts, diagrams, and allied instructional materials; and the Book Shop. These activities are under the supervision of the Assistant Commandant. The instructional departments have specific objectives in reference to training and instruction: Military Art (Medical Tactics and Technique), To instruct students in: The practical application of map reading including aerial photographs and photomaps. The principles of war, and the characteristics of the various combat arms. The organization and employment of the combat arms. The organization, equipment, tactics and technique of Medical Department units. The technique of combat orders. The principles of chemical warfare. Military Sanitation. To instruct students in; The established measures for the preservation of the health and prevention of disease among troops in all climates and under all conditions. Responsibilities of the Medical Department in health matters and control measures against all diseases of military importance. The construction and use of field sanitary devices. Methods of conducting sanitary inspections. Training. To instruct students in; The more basic aspects of military training. The methods of conducting military training for groups of enlisted men. Dismounted drill and calisthenics for both physical fitness and knowledge of the manner of instructing in these subjects. Military courtesy and discipline. Training management, including programs and schedules. Logistics. To instruct students in: ORGANIZATION AND ACTIVITIES 425 The principles and methods of supply of troops in the field. The principles and methods of movement of troops of smaller units. Administration. To instruct students in; General administration of the military service. Administration of the medical service. General knowledge of military law and the administration of military justice. Training Doctrine. (Extension Courses), To prepare instructional material for use in the training of officers and enlisted men, particularly those of the Medical Department. The preparation and revision of Field Manuals, Technical Manuals, Army Ex- tension Courses, Army Regulations, Training Films and Film Strips. The distribution of instructional material to troop schools of the various posts and stations of the Army. Dental Field Service. To instruct students in; The principles and technique of dental administration in post, camp and in the field. The principles and technique of dental service in the field. The proper treatment of maxillo-facial injuries in the field, and in the post or camp. The role of the dental surgeon as assistant to the medical officer in the field. Veterinary Field Service. To instruct students in: Provisions made for the protection of troops against the use of unsound food products of animal origin. Preparation and rendition of field veterinary reports and returns. The principles of sanitation, preservation of animal health, prevention and con- trol of diseases of animals. The organization, technical and tactical employment of veterinary organizations with various arms. The organization, installation and operation of veterinary field hospitalization. Veterinary aspects of chemical warfare. Training Courses. In time of peace there are several courses of instruction normally conducted by the school. These courses are so arranged that field training will be made available to the maximum number of Medical Department officers and enlisted men and for the specific needs of those who attend the school. The Basic Course is designed for newly commissioned Regular officers of the Medical, Dental, Veterinary, and Administrative Corps of the Medical Department. This period of training is normally conducted each year for five months, commencing about January 15 and ending in June. It includes basic principles of field service, field sanitation, training management, and Medical Department administration. The Advanced Course is for selected field officers of the Medical Department who re- ceive three months of training in medical tactics and related subjects of large army units. This course normally begins about September 15 each year and ends in December. Many of the officers who complete this course are then assigned as instructors with the National Guard and Organized Reserve units. The National Guard and Organized Reserve Officers’ Course is a two-months Course, usually beginning about September 15 of each year and ending in November, for selected officers of the Medical Department from the National Guard and Organized Reserves. The Noncommissioned Officers’ Course begins about September 15 of each year and ends November 15. This two-months’ course is designed for noncommissioned officers of the Medical Department of the Regular Army and the National Guard, to instruct them in their field duties and Medical Department administration. Army Extension Courses are offered by the school to certain Regular and Reserve officers and enlisted men of the Medical Department whose duties will not permit them to attend the School. A Medical Reserve Officers’ Training Corps camp is conducted for a period of six weeks during the months of June and July each summer at Carlisle Barracks. The Officers’ Reserve Corps of the Medical Department has two 14 day training 426 MILITARY MEDICAL MANUAL periods, one during the month of June and the other during the month of July of each year. Attendance at Courses. The average attendance at these various periods of instruction is as follows: The Basic Course 60 to 80 The Advanced Course 15 to 25 The National Guard and Organized Reserve Course 10 to 20 The Noncommissioned Officers’ Course 75 to 100 The Enlisted Sanitary Technicians’ Course 15 to 25 The Reserve Officers’ Training Corps Camp 250 to 500 The Officers’ Reserve Corps Camps 500 to 600 The average total of the above indicates that about 1000 officers and enlisted men of the Medical Department, including the National Guard and the Organized Reserves, are actively trained in medical field service annually. Special Courses Instituted in 1940-41. The emergency conditions of 1940-41 resulted in the prompt expansion of the facilities of the Medical Field Service School to meet the enormously expanded responsibilities of the Medical Department. A course of one month was instituted for the training of officers of each component of the Medical Department of the Army of the United States. Similarly a one-month’s course for Sanitary Technicians was instituted. An officer-candidate course for prospective ap- pointees in the Medical Administrative Corps was started. Students are provided living quarters in newly-constructed frame barracks. The first officers’ class of one month which started April 1, 1941, was drawn from units of the field forces, for the most part, and subsequent classes have been from the same source. Demonstration Troops. Troops of Medical Department personnel are stationed at Carlisle Barracks to conduct demonstrations and assist in teaching the tactics of medical field service. The presence of these troops provides an excellent opportunity for the students to assume command during school maneuvers and field exercises. The Medical Department Equipment Laboratory. The Medical Department Equipment Laboratory was established on October 1, 1920, for the purpose of providing an experi- mental laboratory for producing, testing, and determining the serviceability of medical equipment, especially the equipment used by field units. It has developed many of the appliances and apparatus used by the Medical Department of the Army, and new models of equipment, transportation, and other devices are being studied constantly. This activity functions under a Director, who is a Medical officer. The Department of Field Medicine and Surgery. The Primary purpose of this depart- ment is to improve upon the methods of handling the wounded, particularly at the time and place the casualty occurs. It also makes studies in the advancement of in- dustrial medicine, such as cause of accidents and the necessary treatment. The Medical Department Board. The Medical Department Board is stationed at Car- lisle Barracks and operates under the direction of the Surgeon General. It consists of the Commandant and Assistant Commandant of the Medical Field Service School and from three to seven officers recommended by the Surgeon General and designated by War Department order. The Board considers and reports on such subjects as may be referred to it. It originates and submits to the Surgeon General recommendations for the improvement of the Medical Department, especially policies relating to service in the field. The Medical Field Service School Library. The library at the Medical Field Service School possesses a noteworthy collection of books, magazines, and documents for the use of faculty members, students, and members of the garrison. The Medical Field Service School Book Shop. The Book Shop is one of the essential activities of the Medical Field Service School. It is an agency through which all Army personnel may purchase text books, and instructional matter as needed in their training activities. A list of publications available will be furnished upon request. ORGANIZATION AND ACTIVITIES 427 THE ARMY MEDICAL LIBRARY The Army Medical Library is a treasure house of classified medical information avail- able to students of medicine throughout the world. It is the most precious possession of the Medical Department of the United States Army, and as expressed by Professor William H, Welch of Johns Hopkins School of Medicine “America’s greatest gift to Medicine.” It contains more than a million items and is the largest medical library in the world. History. Until 1922 the Army Medical Library was called the Library of the Surgeon General’s Office. It was originally a small collection of reference books for the use of Surgeon General Joseph Lovell (1818-1836) and was kept in his office in Washington. In 1840 a manuscript catalogue listed 228 volumes; at the outbreak of the Civil War in 1861 the number of volumes was between three and four hundred; on May 10, 1864, a printed catalogue showed a total of 1,365 volumes; and in another printed catalogue of October, 1865, the number had increased to 2,258. Colonel John Shaw Billings, Medical Corps, is given credit for being the creator of the library. He was placed on duty in the Surgeon General’s Office in 1865, and he took a deep personal interest in the establish- ment of a source of medical information for Medical Department officers. He was the librarian from 1868-1895. In 1868, $80,000 was made available from funds left over from the Civil War hospitals, and Colonel Billings was given authority to expand the library. On June 12, 1868, a printed catalogue showed 6,066 volumes; in 1871 the number had doubled to 13,380; in 1873, 25,000 volumes and 15,000 separate pamphlets; in 1876, 40,000 volumes and 40,000 pamphlets; and in 1895, when Colonel Billings retired, the number had increased to 308,445. At the present time the Army Medical Library contains over a million books, pamphlets, theses and manuscripts. Many rare books are in the collection, including 450 of the existing 600 medical incunabula or books published before a. d, 1500. Besides books, pamphlets, and these valuable collections, the library has five thousand portraits of medical men, and a collection of medical autographs. Location. The Army Medical Museum, which housed the Army Medical Library from 1865 to 1887, occupied the Old Ford’s Theatre, Washington, D. C., in which Abraham Lincoln was assassinated. In 1887, the Army Medical Library and the Army Medical Museum were moved to larger quarters at the corner of Seventh Street and “B” Street (now Independence Avenue), S. W., Washington, D. C. It still remains at this site. A bill was passed by Congress and approved by the President June 15, 1938 authorizing $3,750,000 for the construction of a building to replace the present Army Medical Library and Museum. Funds for this appropriation were never made available. However, during 1941 Congress passed a bill (H. R. 5146) authorizing an appropriation of $4,750,000 for construction of a new Army Medical Museum and Library and for purchase of the site in the District of Columbia. It will be a building approximately 212 feet square, con- taining 4,002,000 cubic feet of space. It is expected that the site will be near the Capitol. The Index-Catalogue. The Index-Catalogue began in the mind of Colonel John Shaw Billings when from his experience in 1860 he realized the need for such a bibliography. The catalogues published in 1872 and 1873 led to definite proposals in 1876, when a catalogue was submitted to universities, libraries, and medical men for criticism and suggestions. The catalogue was received with high favor. It was arranged under both authors and subjects, practically the same style as adopted later in the Index-Catalogue. The first series of the Index-Catologue was published in 1880, when Congress made the first appropriation for this purpose. It indexed 85.663 author titles, 151,504 titles of pam- phlets, subject titles of 168,587 bonks, and 511,112 journal titles. Sixteen volumes came out yearly from 1860 through 1895. The second series consisting of 21 volumes was issued between 1896 and 1916. The third series consisting of ten volumes and indexed medical literature to include the year 1925, was compiled between the years of 1918 and 1932. The fourth series is now under compilation, the first volume of which was Issued in June, 1936. The abbreviations are shortened; the volume numbers are in Arabic instead of Roman; and the use of eponymous titles in nomenclature of diseases is avoided as much as possible. 428 MILITARY MEDICAL MANUAL The Index-Medicus. The history of the Index-Medicus is herewith included because it has so often been confused with the Index-Catalogue with which it was closely related as an immediate supplement for a long period. It has never been an official government periodical and depended upon financial support from its sales. Starting in January, 1879, a year before the first volume of the Index-Catalogue appeared, it came out monthly until May 1899, when it met financial ruin. Three more volumes were published between 1900 and 1902 in Paris under the title Bibliographia Medica. In 1903 the Carnegie In- stitution of Washington with Colonel John Shaw Billings as vice-chairman of the Board of Trustees revived the Index-Medicus and it continued until 1927, when it was amal- gamated with the “Quarterly Cumulative Index Medicus” of the American Medical Association, both of which are continuing to give their support. Although the Army Medical Library continues to assist in the compilation of necessary literary facts, the Army gives no financial support to the publication. The Army Medical Library Centenary. On the 16th of November, 1936, the 100th anniversary of the founding of the Army Medical Library was commemorated at the Army Medical Library, Washington, D. C. Men whose names are known to every student of medicine came from distant parts of the world to celebrate an important advance in medical knowledge. Universities, scientific institutes, academies, ho'spitals, and libraries sent representatives. It was an important and significant occasion to com- mend the United States Army Medical Department for the most extensive collection of publications in the realm of medical science that mankind has ever known. The Army Medical Library and its Index-Catalogue is according to an editorial in the Journal of the American Medical Association, the “Pride of the Medical Profession of America.” THE ARMY MEDICAL MUSEUM History and Origin. The Army Medical Museum had its origin in 1862 during the Civil War. It was originally created for the purpose of preserving specimens which would be illustrative of war wounds and of war diseases which produced death and disability. Most of the early collections came from the battlefields of the Civil War. Gradually the collection was extended to include all forms of injuries and disease, and at the present time it is a general pathologic museum accessible to scientists and research workers for study. It also is an educational exhibit for the public. Organization and Location. The Army Medical Museum is a part of the Professional Service Division of the Surgeon General’s Office. It is housed in a large three-story build- ing with the Army Medical Library at Seventh Street and Independence Avenue, S. W., Washington, D. C. This building was completed in 1887 at a cost of $200,000. The Army Medical Library and the Army Medical Museum have made such a rapid growth that recent construction authorization has been granted for a new and adequate building. Purpose of the Army Medical Museum. It is the central laboratory of pathology for the Army and the national museum of the American Dental Association. Under the auspices of the National Research Council and the American Medical Association, it is the depository of the American Registry of Pathology. Contents of the Army Medical Museum. The total number of accessions is over 125,000 of which about 40,000 consist of medals, figures, photomicrographs, and actual tissue dissections of embryology, normal anatomy, histology, pathology, history of medicine, dentistry, and veterinary medicine. In May, 1939, one of the largest and most valuable collections of wax anatomical specimens in the world was added to the Army Medical Museum. (This was the George S. Huntington collection, presented to the Army Medical Department by Columbia University Medical School.) Some of the other outstanding exhibits are the medical medals, the section on ophthal- mic pathology, the section on fracture of bones, the famous microscope collection, and the world’s largest collection of war wounds, showing the effects of arrows, tomahawks, small arms, high explosive shells, and war cases. This museum is an important and valuable adjunct to the Army Medical Library and like the library is an educational treasure whose value is appreciated as much bv the professional public as by the Army Medical Department. CHAPTER UI FIELD SANITATION Definition. Sanitation is the art by which we adjust our living conditions in accordance with the laws of hygiene. Methods of application of sanitary art may change—the simplest effective methods are the best. Sanitation as applied to the military is shaped according to the environment in which the military situation occurs. In this chapter emphasis is placed on the sanitation of the forces in the field and in camps rather than in peacetime garrisons. Because of the advancement of preventive medicine and sanitary engineering, sanitation in garrisons has become similar to the public health control of large metropolitan communities. In the military force the art of sanitation is founded upon a knowledge of hygiene. Commanders of troops who have a clear understanding of the fundamental hygienic principles may intelligently select and apply the sanitary methods required to meet the needs of their troops under various conditions. Field sanitation employs all the sanitary methods used in civilian communities and, in addition, those special methods found necessary to preserve the health of troops living under conditions peculiar to military service. Sanitation is closely related and basic to preventive medicine. Preventive medi- cine as related to military forces is discussed in Chapter IV. There is necessarily some in- clusion and reference to disease in the discussion of sanitation—field sanitation has a large part in prevention of disease. Purpose. When troops take to the field they leave behind all the comforts and appliances of modern civilization, the shelter over their heads, beds to sleep in, safe drinking water from a handy faucet, cooking ranges, toilets and bath tubs, in a word all that is accepted so naturally without thought in our daily life at home. And yet these things are necessary and must be provided. (FM 8-40). Impure water cannot be used; human occreta, manure, and garbage must be disposed of in an efficient and sanitary manner; clothing infested with parasites must be sterilized; food must be preserved from flies and other insects; and bathing, laundry, and toilet facilities must be provided. Responsibility. Who shall be the judge as to what water is safe for human consumption and advise as to its method of sterilization? Who is called upon to recommend as to sani- tary requirements in the selection of a camp site? Who advises and instructs regarding the disposal of camp wastes? Who, in short, must know the right thing to do and how to do it? It is obviously not the duty of the line officer. He is skilled in warfare, and it is his duty to engage with the enemy in armed conflict. While he is responsible for the entire administration of his command he is forced to depend on his staff of trained officers for technical advice and assistance. Upon the medical officer then must fall the responsi- bility of advising as to these sanitary measures and appliances. And yet, the average doctor, trained though he be in the practice of medicine and sur- gery, is wholly incapable of advising on these important matters. It is obvious, therefore, that the exigencies of military life require a type of training that is not ordinarily ac- quired by medical practitioners. In other words, in warfare and field service, medical men are needed who are trained in military matters and military hygiene and sanitation. The average doctor, though he be in uniform and though he be skilled in the arts of medicine and surgery, may be of little assistance to his commanding officer and to the military service if he is ignorant of these other matters. Remember that in no war in history have deaths in battle equaled the number of deaths caused by disease. When to this is added the acknowledged fact that most diseases are preventable, the importance of military hygiene, sanitation, and preventive medicine may be appreciated. Historical Background. Camp sanitation plays no little part in the prevention of disease. During the Spanish-American War the importance of pure water, the danger from flies and other insect carriers, and the proper disposal of camp wastes were not sufficiently appreciated by all. As a consequence typhoid fever ran rampant, incapacitating thousands of men before they ever reached the battlefield. Human excrement was disposed of in pit 429 430 MILITARY MEDICAL MANUAL latrines and then covered with lime. It was not, however, adequately protected from flics nor was the food that the men ate. It was no unusual experience in those days for men to notice and to complain of particles of lime on their food that had been deposited there by flies directly from the latrines. Commanding officers and soldiers failed to appreciate the dangers of impure water, especially in the tropics, and were sometimes careless about what they drank, so that dysentery was widespread. In fairness, however, it must be said that this was not due wholly or even largely to indifference to the dangers, but rather to the difficulties encountered in campaign conditions and to a lack of knowledge of and facilities for the purification of water in the field by methods which we now have. Responsibility of Line Officers. From time immemorial, it has been held that the com- manding officer of any military organization, regardless of its strength or type, is respon- sible in all respects for that organization. He is, therefore, responsible for the health of the members of his command and, consequently, for the initiation and enforcement of suitable measures that will most effectively protect their health. To handle a mililtary force in battle is much less difficult than to bring it on to the field in good condition. The maintenance of the health of his soldiers, and, consequently, the military power of his organization, is one of the highest duties of a commander. Cooperation of Line with Medical Officers. The advice of the medical officer is invalu- able in the conservation of the health of troops, and the commanding officer will lean heavily upon his surgeon in all matters pertaining to the health of his men. The com- mander realizes that rigid sanitation is the tool by which health is maintained. Usually, the recommendations of the experienced medical officer are accepted without question and are carried out just as fully and as promptly as possible. All the reasonable recommenda- tions of a medical officer will be given the gravest consideration by the commander con- cerned. Experienced officers have long recognized that for the preservation of the health of their troops—and thereby their effective strength—sanitary requirements are exceeded only by military necessity, and that the military necessity which must disregard sanitary requirements exists very seldom and then only when in actual contact with an enemy. MARCHES The Soldier’s Load. When a soldier goes into the field he must carry on his own back the equipment and clothing that he requires. In the selection of the materials entering into this equipment, the weight of the load, and its distribution on the body of the soldier, the medical man plays an important advisory part. An overloaded soldier either arrives too late on the scene of the fighting, throws away excess equipment, or else arrives too exhausted to fight. The proper load for an infantryman is one that does not exceed y3 the body weight or about 50 pounds for the average man. The maximum load is 45 per cent of the body weight or 67 pounds for a 150 pound man. Above 45 per cent the average expenditure of energy increases three limes as rapidly as the load. The load should be so adjusted that it is as near as possible to the center of gravity of the body. The nearer it is to this point the less muscular exertion is required to maintain equilibrium. The center of gravity of the body in the erect position is 0.6 cm. in front of a line connecting the centers of the femoral heads and opposite the center of the body of the third lumbar vertebra. There should be no constriction of the chest. Pressure on the chest not only causes an increased expenditure in an effort to breathe, but also causes the heart severe embarrass- ment by the force required to expel the supplemental air against the increased intra- thoracic pressure. Constriction of the abdomen restricts its expansion and thus lessens the excursion of the diaphragm. This embarrasses respiration and further prevents the abdomen from serving as an expansible reservoir of blood, throwing an added strain on the heart. All load should be borne by the shoulders and back and should fall mainly on the trapezius muscles rather than on the clavicles or acromion processes. FIELD SANITATION 431 Marching. Marching constitutes the principal occupation of troops in campaign and is one of the heaviest causes of loss. The importance of the abililty to march and thus secure preponderance of numbers at the critical time and place for victory has always been recognized by the great strategists. And yet there is no secret in the ability to make suc- cessful marches beyond the secret of attention to detail and the observance of the rules of the game. In this the conscientious medical officer has an important part. Preparation for a March. Troops should be trained to march by a graduated scale of work, exactly as athletes must gradually develop their endurance and skill. Medical officers should insist that a regular program be followed, commencing with exercises and drill, followed by marching without packs and short marches with light packs, gradually increasing the size of the pack and length of the march until the men are able to march 15 miles a day under full pack without exhaustion. The success or failure of a campaign may depend on the attention to detail by medical and line officers. Except when provided with rail or motor transportation, the motive power of the soldier is in his legs and feet. No soldier can march with bad feet and no one can afford to neglect his feet. The attention to the feet begins with the selection and fitting of proper shoes, the kind and fit of socks, the proper cutting of toe nails and the care of the skin, and ends with the rigid inspection and care of the feet at the end of each day’s march. Only in this way will the feet be able to withstand the gruelling punishment of long marches on rough roads under a heavy pack. In Chapter V, shoe and sock fitting is discussed and rules are given for the care of the feet. It is desired here only to emphasize their importance. Plate 1. Full Equipment Adjusted to the Infantry Soldier. Before starting on a march the men should be inspected as to their general state of health and the obviously ill separated out. The adjustment of the pack is carefully noted. A detailed foot and foot-wear inspection is made, and all defects arc corrected before the march is begun. Conduct of the March. Marches should be conducted during the most temperate part of the day, in the cool of the morning or the afternoon, preferably the former. Morning marches should begin about one hour after daylight, thus affording ample opportunity after arising to eat breakfast, break camp, adjust packs, police camp, and attend to the calls of nature. Breakfast should be a light one and include fuel-supplying foods such as sugar and fat. 432 MILITARY MEDICAL MANUAL Night marches are more trying than day marches and generally should be shorter. They should begin soon after dark and end if possible by 1:00 a.m. or 2:00 p.m. to allow the troops to sleep during the early morning hours. Tactical considerations, however, often require the march to be so timed as to assure the arrival of the troops for assault at daybreak. It is very important that canteens be filled with potable water at the start. Frequently soldiers fail to do this and, becoming thirsty on the march, take whatever water is available from surface sources, which are usually unsafe. This is particularly true in hot tropical countries where unless water discipline is strict, soldiers are apt to drink from pools and streams, all of which are dangerously polluted. Water cans and trailers are filled and chlorinated at the commencement of the march. Troops should march at once after falling in. It is both tiring and injurious to morale to stand around under full pack waiting to move out. Experience is an important guide in all these matters. March technic that would be successful in a temperate climate utterly fails in arid deserts or in tropical jungles. This is one reason why all officers are required to have a broad experience and are sent to foreign duty in tropical lands. In jungle hiking the vegetation is so dense that, unless a column is kept compactly closed up and a responsible officer is stationed at the rear who keeps in constant touch with the leader, soldiers will stray and at once become hopelessly lost. More than one command has dissolved in the dense tangles of a tropical jungle, never to be reassembled. On account of the heavy rains, the sudden incidence of darkness when the sun sets, and the necessity to pitch camp in a wet and impenetrable forest, the march is usually terminated not later than 2:00 p.m., after a very early start, and tents pitched or fern shacks constructed in the early afternoon. Troops can then get under cover and change to dry clothing from waterproof bags; otherwise the command rapidly becomes exhausted from exposure and improper camp conditions. The rate of march is to miles per hour, including the hourly halts. The halts for rest are made at regular intervals. The first halt is for 15 minutes at the end of the first 45 minutes of marching for the purpose of allowing troops to relieve themselves and to adjust packs. Thereafter there are halts of 10 minutes after each 50 minutes of marching. A halt of from 30 minutes to an hour is usually made at the “noon halt,” during which a light meal may be eaten. During the halts the men should always take off their packs. If the ground is not wet they should lie down. If the ground is covered with snow, men must avoid sitting down on the snow and if nothing else is available to sit on they should remove their packs and sit on them. The distance averaged by foot troops per day is 12 miles for large commands and 15 for* small ones. Anything more than this is called a “forced march.” Greater distances are covered not by increasing the rate of march but by extending the time of the march. Physical inspection of the troops should be made by company officers and surgeons during the march to note men who give evidence of fatigue. If these men are cared for early they may be prevented from becoming march casualties and saved to the command. Special attention should be given to the- complaints about foot affections. The men march in a column of twos, threes or fours at route step. Advantage should be taken of paths and shade along the route. Hard pavements should be avoided when dry dirt roads are available and foot troops should, when practicable, be marched on separate roads from mounted troops, artillery, and transport. Men should be allowed to unbutton their collars and shirts. In summer the sleeves may be rolled up. Such simple precautions often save men from heat exhaustion. The order of march in the platoon should be alternated each day, giving the short men as well as the tall men an opportunity to lead the column. Troops should be halted well clear of their camp to come up slowly and be somewhat cooled off and rested when arriving in camp. Water Discipline. Water discipline is essential. Raw recruits are inclined to empty canteens soon after the start of a march and then drink surface water that may be highly polluted. Slow sipping economizes water and quenches thirst better than large gulps. FIELD SANITATION 433 Sucking a small pebble or chewing gum is valuable because the mouth is kept closed and the flow of saliva is increased. The desire for water is decreased. The normal needs of water average about one quart of water at the end of 7(4 miles marched under average conditions. This may be increased or decreased depending upon any factor that increases or decreases body heat. The amount of water evaporated during a given march with the effects if not re- placed are as follows: TABLE, WATER EVAPORATION ON THE MARCH Miles Marched Quarts Evaporated Effects if loss is not replaced 7/z 1 Thirst 15 2 Slight inefficiency 22 3 Marked inefficiency 30 4 Danger Water supply on the march is maintained in several ways. The normal routine of providing potable water consists of: Overnight sterilization. Fill canteens and trailers so that by morning the water is cold, or chlorinated water is free from taste. If water is sterilized by boiling, it is better made into weak tea. At start in morning. All canteens and carts should be full of cool, sterile water. At halj-way halt. Canteens should be refilled from water carts, strict care being taken to avoid waste. Water carts should be refilled at once, if possible, and contents chlorinated. At end of march. Advance arrangements should be made as to the water supply by the following officers; Medical officers are responsible for the purity of water from main sources. Engineers are responsible for the quantity and delivery of water. Unit commanders are responsible for water guards and distribution of water. Water supplies are rigidly protected, a responsibility that is shared by all officers. Streams are marked showing filling point for water for cooking and drinking, next down stream a place for watering animals, and, below this, places for bathing and for washing clothing, respectively. A patrol is put on the stream to enforce these regulations. Guards are placed over important springs and wells. The high temperature and humidity of the tropics cause a tremendous amount of sweating, and this sweating results in a loss of salt from the body. This may produce severe abdominal cramps called “heat cramps’' or by soldiers “salt cramps.” To prevent this condition salt must be added to the water. It also happens that many of the sources of water supply in the desert furnish water with a relatively high degree of salinity. Troops must become accustomed to drinking water with salt in it. Salt should be added to water supplies in the following amounts to be effective: (1) One lb. table salt to 100 gallons of water. (2) 0.3 lbs. table salt to 36 gallons of water (Lyster bag). (3) 54 teaspoonful to one quart of water (metal canteen). Prior to arrival at camp medical officers with some of their personnel should go forward with the advance party to supervise the sanitary arrangements which should be pre- pared for the troops on their arrival, such as latrines, urinals, water supply, kitchen waste disposal, infirmary, and similar medical matters. On arrival, units are assigned their company areas, packs unslung, tents pitched, orders read, inspection of feet made, and sick call held. Men are allowed to rest. When possible it is well to avoid making camp after dark. Troops should never be kept standing in ranks after arrival at the camp site but should be immediately sent to the areas assigned them. A substantial hot meal should be served promptly at the end of the march. Commanders must personally see that their men wash their feet as soon as possible after reaching camp and that their feet are treated as required. Details of the care of the feet are related in Chapter V. Material requirements necessary for change of socks and shoes must be provided the troops before the march. 434 MILITARY MEDICAL MANUAL Duties of the Medical Officer. The duties of a medical officer of a unit on the march are best accomplished if he will keep towards the rear where he can gauge the men’s fitness, observe the effects of the march on both the strong and the weak, and treat soldiers who have been referred to him by the unit commander. Sick men will be evacuated or placed at collecting points previously coordinated with the evacuation system. Toward the end of the march he should request to have the necessary sanitary personnel join the advance guard to supervise the water purificiation and other sanitary arrangements for the camp site before the main body arrives. During the longer halts the medical officer can make closer inspection of the individual men who have complaints, and by inquiry of several members of the unit can estimate the general physical condition of the force. The medical officer should keep himself acquainted with the policies and plans of the unit commander so that the medical and sanitary arrangements can be outlined and established to conform to and satisfy this plan. The ambitious medical officer who shows keen interest in the welfare of the troops will soon gain their confidence and do much to stimulate and maintain morale. CAMPS AND CAMP SITES The careful selection of a camp site is most important. The medical officer is fre- quently asked to advise as to the suitability of a camp, and it is incumbent on him to know how to survey sites available lor a camp and advise intelligently on its selection and preparation. Strategical and tactical requirements usually dictate the choice of camp sites, and under such circumstances sanitary considerations alone will not be the governing factor. Within these limitations, however, the most favorable site from a sanitary point of view should be selected. Kinds of Camps. Camps are of various kinds. Temporary camps are those that are used from one night to six months. They vary from the bivouac which is a one-night camp on the march or in active service confronting the enemy and in which the shelter or “puP” tent is used, to more durable camps with heavy tentage. Permanent or semi- permanent camps are used for a period longer than six months. They may consist of mobilization or training camps where troops are assembled and trained, embarkation or debarkation camps near sea ports for the embarkation or reception of troops, and segregation camps for the quarantining of troops for contagious diseases, including venereal diseases: Sanitary Survey of Proposed Camp Sites. A sanitary survey should be made of the pro- posed sites bearing in mind the following considerations; The character of the site and the surrounding territory, the natural drainage, and the nature of the subsoil should be noted. The methods of waste disposal should be studied. The water supply should be investigated as to its adequacy and potability. The types of habitation required should be borne in mind—usually this will be tentage supplied by the troops themselves. The presence of insects and the character of the vegetation are important. Have an eye for insect vectors of disease and poisonous plants dangerous to man and animals. The presence of communicable diseases in the surrounding territory may be of great importance and tend to forbid the establishment of a camp in that vicinity. A Suitable Camp Site. Following are the requirements of a suitable camp site: The available space should be large enough to accommodate the command without crowding, allowing ground for erection of all necessary tentage and depots with an area for exercise and training. Camp on a sloping ground is preferable to that on flat ground. This gives positive drainage and insures against stagnant surface water. It is not necessary to place it on the top of a hill. Firm, porous soil covered with grass is the most desirable. This insures against exces- sive mud in wet weather, and dust in dry weather. Ground water is usually lower in FIELD SANITATION 435 such soil, affording better opportunities for disposal of waste water by seepage. There is also less apt to be surface water in such soil. There should be no marshes, stagnant pools, or ponds in the neighborhood which might be the breeding sites for mosquitoes. Water supply should be sufficient in quantity and of such quality as will permit puri- fication with the available means. Wood, grass, and forage should be easily obtainable. The camp site should be accessible from the main routes of transportation but not necessarily astride of roads on account of the excessive dust and disturbance. In cold countries ground sloping to the south, with woods to shut off the north winds, should be chosen. In hot countries, the ground should be high, free from underbrush, and shaded with trees. Prevailing winds from one direction are desirable. Such winds aid in keeping insects away, especially flics, from the latrines and picket lines, and afford an opportunity of putting such establishments to the leeward. Violent winds are undesirable on account of the cold in the winter and the in the summer. Shelter from such winds is offered by leeward slopes and by woods. Woods frequently are chosen for camp sites since they offer concealment from the enemy. Open woods without underbrush are ideal, but very dense forest is poorly sunned and is usually very damp and poorly ventilated. Undesirable Camp Sites. The sites of old camps and the vicinities of cemeteries should be avoided. Marshy ground, ground near the foothills of a range with damp subsoil, plowed ground, depressions, closed ravines, dry beds of streams, thick forests, and insect-infested areas arc all undesirable. The presence of disease-bearing insects may be of utmost importance. The very ten- ability of a situation may rest on this factor alone, and it may become an important factor in the defense of a region. For instance, in the tropics, if a hostile and invading force could be held for some days in a heavily malarious region while the defending forces occupied higher, healthy ground, the entire campaign might be decided by this factor alone. Where disease-carrying insects prevail in great numbers all war plans have to take serious account of such a condition. Some of the most difficult problems that faced the defending forces in the Philippines had to do with the control of mosquitoes in dangerously malarious but strategically important areas. Interior Arrangement of Camp. The interior arrangement of the camp must conform to the site chosen. For most purpose the camp area will usually be approximately square. The kitchens should be on the windward flank (if there is one), the latrines being on the opposite flank with the company tents between. All tents should be individually ditched, especially if they are not provided with floors. Side walls should be rolled on all good days to allow sunlight and ventilation of the tent. Bedding should be aired and sunned frequently and systematically. In cold weather tents are heated with the conical Sibley stoves set in sand boxes. Breaking Camp. Upon breaking camp it should be well policed. This is the responsi- bility of the commanding officer, but medical officers hold an advisory responsibility. All latrines should be well filled in and marked with a sign post, if the military S’.uation permits, to warn future campers, refuse should be disposed of, and in general the ground left as nearly as possible in the condition in which it was found or better. There are many instances where subordinate units have been sent back to police a camp dte which was left in an insanitary condition. WATER SUPPLY AND FIELD PURIFICATION Importance of Pure Water. The importance of pure water cannot be over-emphasized. Until the method of spread of intestinal diseases was understood and the part that water played in the conveyance of these diseases recognized, they were the largest cause of morbidity and sickness in the armies of the world. Potable (Safe) Water. Pure water is, of course, the quality of water desired but seldom found. Pollution or contamination of water with human or animal wastes is common 436 MILITARY MEDICAL MANUAL in most sources of water found in the field. This means that disease producing bacteria or organisms which may be found in the water are the causative agents of the various intestinal diseases. Other bacteria found in polluted waters are tnose non-pathogenic bacteria common to the intestinal tract of animals and man. Contrary to popular impression, it is not possible to determine, by simply looking at it, whether or not a particular water supply is safe for drinking in its natural state. The cool, sparkling water from the clearest spring may be laden with disease producing germs. On the other hand the water from a muddy or discolored stream may be suitable to drink in its raw state. The only safe method of dealing with water from an un- known source is to assume it to be dangerous until it is proven otherwise. Even water from a community’s public water supply system cannot be taken for granted as being a safe water just because it happens to be from a public supply system. The safety of such a water can be quickly and easily ascertained, and such action should be taken before it is pronounced safe for troops. However, potable water does not merely mean water which is not polluted. There are other factors which render water unpleasant to sight and taste. Turbidity is that characteristic of water found in its natural state which gives it a muddy or cloudy appearance. This is due to suspended material in the water, silt, clay and organic matter. Color in water gives an objectionable appearance. From the standpoint of the individual soldier unpleasant tastes and odors in the water make it unfit for drinking. All these detrimental qualities and their removal must be considered in supplying water to troops. i Plate 2. The Clear, Sparkling Water of a Spring May be Polluted by Waste from a Privy. Sources of Water. The common sources of water are rivers and streams, lakes, wells, springs, tube borings, and distillation. Water from rivers and streams cannot be considered safe and is usually turbid. Lakes, if large, are usually clean in the center. The action of the sun and of oxygen purifies the water far from the shore. Shore water is never safe. Spring water is of two kinds, namely land and main springs. Land springs are formed by water that percolates through the ground and appears at lower levels. It may be heavily contaminated. Main springs are derived from underground reservoirs lying FIELD SANITATION 437 between two impermeable strata. Such water has usually been filtered through a con- siderable depth of soil and is usually, but not necessarily, free of disease-producing germs. All such water of course contains soil bacteria. It cannot be considered as safe for human consumption without proper treatment. Well water is subsurface water and not necessarily safe just because it is not on the surface. Shallow wells may drain the surface almost directly and deeper wells in the vicinity of privies and barnyards may, in porous soil, be heavily contaminated. No well water should be accepted as safe until it has been proven so bacteriologically. To be safe, wells should penetrate through an impermeable stratum, be lined so as to exclude surface drainage, covered to prevent surface contamination, and equipped with pumps, etc. so that nothing is introduced, such as buckets, from the outside. Artesian water obtained by tube borings is usually safe. Such water comes from under- ground supplies, formed by water draining from hills underneath impermeable strata of soil. It is best obtained in valleys and at the lowest points of plains. Distilled water is bacteriologically pure but is not obtainable in sufficient quantities. Responsibility for Water Supplies. In the Army, the Corps of Engineers is responsible for the quantity and quality of all water supplies not only in times of peace, but also in the Zone of the Interior and the Theatre of Operations in times of war. In the field all the general units and the water supply battalion of the Corps of Engineers have portable or mobile equipment for the purification of water and are responsible for supplying such water to the organizations to which they are attached. In certain in- stances it may be necessary for small units below the division to provide their own water supply. The Medical Department is responsible for determining the potabilty of, and advising as to the sanitary suitability of all water supplies for military personnel at all times and places. The unit commander is responsible for the water discipline of his organization and for the execution of standing orders pertaining to the purification of water by and within his own organization. Water Requirements. All living things require water. Experience has shown that the minimum amount of water that must be provided for troops under ordinary conditions of march or in bivouac is 1 gallon per man per day, \l/i quarts for drinking and 2/z quarts for cooking and drinking with meals, either as water, as coffee, or other beverage. However, climatic conditions and the effort of march may alter this minimum. Troops operating in hot climates may require from 14 to 40 percent more water. Let us suppose that the commanding officer of a body of troops desires to move camp to another location. He is anxious to know how much water will be required per man per day during the march and in the new location. The medical officer is asked to estimate these requirements and to advise on the plan. What then are the water re- quirements in the various situations, in permanent camps, in semipermanent camps, on the march, or in bivouac? The following will serve as a guide in this estimation. Permanent camps: One should estimate a per capita consumption of 100 to 150 gallons per day where there is a water-borne sewerage system and where there are numerous other water requiring devices such as continuously flushing urinals, increased laundry facilities, dishwashing machines and lawns. Temporary camps: One should estimate 5 gallons per person per day and 10 gallons per animal. This amount should not be greatly exceeded since waste water must be dis- posed of by improvised methods and an excess will collect as insanitary surface water. Bivouac and march: Three gallons per capita are necessary, except under unusual con- ditions when 1 gallon is the absolute minimum. This is based on H/2 gallons for drink- ing and cooking, % gallon for washing hands and face, /2 gallon for washing cooking utensils, and % gallon unavoidable wastage. The animals will each require 5 to 10 gallons depending on whether the weather is cold or hot. In combat: The amount necessary to retain efficiency should not be less than the mini- mum of 1 gallon per capita per day for a period of not more than three days. In ex- treme conditions animals can be limited to 5 gallons per animal per day. Determination of Water Yield. In estimating the requirements of the command it is also important to calculate the yields that may be expected from the sources of water 438 MILITARY MEDICAL MANUAL available. This estimation of a small stream should not be made immediately after a rainstorm, and if circumstances do not permit any other time consideration must be given thereto. This estimation can usually be done only by actual measurement. The water content in cubic feet of a well, pool, or other container of standing water is determined by multi- plying its surface area by its average depth, determined by the best measurements possible. Having found the contents in cubic feet, multiply by 7.48 to determine the number of gallons. The daily yield is usually also of importance. To determine the yield of a well or spring, lower the surface rapidly by pumping; measure or calculate the amount pumped out, and note the time required for the well to regain its normal level. Thus if the surface of a circular well 4 feet in diameter be lowered 2 feet by pumping, the amount pumped out is xX22X2 or 3.1416X4X2=25.13 cu. ft.= 188 gallons. If the well re- gains its level in one hour its daily yield is probably at least 188X24=4512 gallons, and may be more. Plate 3. Location of Water Sources (Stream). The volume of flow of a small stream is determined as follows: Select a fairly long reach in which the channel is straight, uniform in size (or nearly so), and free from eddies. Determine the cross-section area of the water at the center of the reach selected by measuring the width (w), and taking several soundings across the stream (d). Measure any convenient length (1), as 30 or 50 feet, on the bank and mark the ends. Now drop a chip of wood in the center of the channel upstream and note the number of seconds (t) it requires to travel the measured distance. Divide the distance in feet by the time in seconds,-—-, giving the surface velocity in feet per second. The mean velocity is about 0.8 of the surface velocity. Multiply the cross section area in square feet, w x d, by the mean velocity in feet per second and the result is the flow of the stream in cubic feet per second, (Q). This entire calculation can be set up in one FIELD SANITATION 439 formula. Q= x x x The number cf gallons per second is calculated by multiplying Q (cubic feet per second) by 7.48 (the number of gallons in a cubic foot of water). In very small streams it may be necessary to build a dam or insert a receptacle (such as a cask) in the bottom to conserve the flow. The flow from a weir in the dam may be caught and measured, or the time required to fill a cask in the bottom noted. A standard cask holds about 55 gallons. Protection of Water Supply Sources. Every source of water supply, civilian or military, should be carefully guarded against pollution. The principal and most dangerous pollu- tion is human and animal excrement or sewage; these wastes are often intentionally placed in water to dispose of them or are washed in from deposits of excrement on or near the surface of the ground. During droughts, surface and ground waters are more likely to be polluted than under average conditions. During floods high water reaches deposits of excrement and washes them into the watercourses. Such deposits would not ordinarily be dangerous. Plate 4. Water Sterlizing Bag, with Tripod. Water supply sources for military forces can be, and usually arc, carefully guarded so as to minimize the possibility of local pollution. Latrines arc placed so that surface or underground drainage from them cannot reach the water source. Great care must be taken that the watershed is not contaminated by careless individuals. When streams are used as a source of water, points along the stream are designated at which water for 440 MILITARY MEDICAL MANUAL various purposes may be drawn. Beginning upstream the following points are desig- nated: water for drinking and cooking, water for animals, and water for washing and bathing (Plate 3). It is often necessary to place a “water guard” to .enforce compliance with such instructions. Purification of Water. In the field just as in permanent stations it is necessary to purify water. This not only includes the destruction of bacteria, including possible pathogenic organisms resulting from the pollution of water, but also the removal of turbidity, color and obnoxious tastes and odors. Chlorination is one of the most effective measures of purifying water from pathogenic organisms. It is an accepted fact that one part of chlorine per million parts of water will kill most, if not all, of the bacteria contained in the water providing sufficient time is allowed for the action to take place. In practice, calcium hypochlorite or chloride of lime is used, preferably the Grade A calcium hypochlorite which contains about 70 per cent available chlorine. For field water supply the amount used should be such that the residual chlorine in the treated water will be 1.0 part per million. The use of sodium thiosulphate is not permitted to neutralize the excess chlorine. It is best to use a small amount of Grade A calcium hypochlorite initially, testing it with orthotolidine imme- diately after the addition of hypochlorite solution until sufficient residual chlorine re- mains. Sedimentation is the storage of water in some reservoir device so that the material in suspension in the water, causing turbidity, can settle to the bottom of the container. Filtration is the removal of turbidity from the water by allowing it to pass through a bed of sand. Coagulation is the addition of a chemical, usually alum or aluminum sulfate which reacts with the carbonates and bicarbonates of the water to produce an insoluble flake-like substance, aluminum hydroxide or “floe,” which entraps the bacteria and the finer particles in suspension in the water. Coagulation is used in conjunction with sedimenta- tion and filtration. Purification of Water in the Field. Within each general service unit of the Corps of Engineers there are portable purification units, easily transportable and capable of being set up and placed in operation in a relatively short period of time. As indicated by its name the purpose of the unit is to convert water of questionable purity and clarity to safe, clear drinking water To accomplish this the water is lifted from the stream, lake, pond, or well by a gasoline driven pump. It is then sterilized by chlorination, clarified by filtration in a rapid sand filter, and finally delivered to a 3000 gallon canvas reservoir for storage and distribution. One of these units can deliver approximately 600 gallons of purified filtered water in one hour. Assigned to each field army there is an Engineer Battalion, water supply, whose essen- tial equipment is the mobile purification units. One of these units accomplishes the purification of water in the same manner as the portable purification unit except it is on a larger scale. It is mounted and transported on a 2x/z ton truck and it is capable of de- livering approximately 4200 gallons of purified, filtered water in an hour. In certain situations it may be impossible to obtain purified water from the Corps of Engineers. The water may be purified in such an instance through the use of the water sterilizing bag (Lyster bag). The equipment consists of a water bag of canvas or rubberized cloth, an ampule con- taining Yz gram of Grade A calcium hypochlorite, and orthotolidine solution for testing residual chlorine. The bag and the chemical are obtained from the Quartermaster Corps, not from the Medical Department. The canvas bag weighs about pounds, holds about 36 gallons of water (20 inches in diameter and 28 inches in length), and is provided with a cover of the same material as the bag. It is solely a stationary receptacle in which water can be held while it is being sterilized and from which it can be distributed through faucets without dipping, these faucets being arranged around the bottom of the bag. This apparatus is issued to troops at the rate of one to each 100 men or fraction thereof.^ The procedure is as follows: (1) Suspend the bag on a tripod. Fill it with water to the mark four inches from the top, straining the water through cheesecloth. (2) Draw a small quantity of water through one of the faucets into a canteen cup. (3) Break a tube of calcium hypochlorite into the canteen cup, stir with a clean stick making a paste and then fill the cup two-thirds full of water. (4) Empty this solution into the water bag and stir thoroughly with a clean stick which is long enough to reach to the bottom of the bag. (5) Draw at least one-half canteen cup of water from each of the faucets and pour it back into the water bag. This serves to sterilize the faucets. (6) Wait 10 minutes, then wash out one of the faucets by allowing a small amount of water to run through onto the ground. Fill a clean canteen cup to a depth not to exceed /i inch, from the same faucet. Add one cc. (fifteen drops) of orthotolidine testing solution to the water in the cup. Wait five minutes and note the color produced. The following is a guide for reading the color reaction between the free chlorine and orthotoli- dine: No color. Insufficient chlorination. Add more calcium hypochlorite. Canary yellow. Insufficient chlorination. Add more calcium hypochlorite. Deep yellow. Satisfactory chlorination. This represents about one part per million (ppm) of chlorine. Orange red. Overchlorinated. Add more water and re-test. Bluish green. Alkaline or hard water. Add a few more drops of orthotolidine to get a correct color reading. (7) As a factor of safety, the water should be allowed to stand for thirty minutes after the addition of a satisfactory amount of calcium hypochlorite before being used for drinking purposes. Chlorinating Water for Small Detachments. Frequently small detachments are sepa- rated from the main body and from the supply of chlorinated water at the company messes. There are several good emergency methods for the sterilization of water. If /z gram (1 ampule) of grade A calcium hypochlorite is placed in a full canteen, this will be the sterilizing solution for the other canteens by using a canteen capful for each of the remaining canteens. Two to three drops of iodine in a canteen full of water will give considerable protection. The simple method of boiling for 10 minutes will destroy most pathogenic bacteria. Transportation of Water. Standard 5 gallon water cans are issued to a unit on the basis of supplying each man with a gallon of water. These cans have only a small open- ing and can not be used for the distribution of water to the individual without con- siderable waste and danger of contamination. Tank trailers with a capacity of 250 gallons of water are at present chiefly used by medical troops and certain Air Corps units. These trailers are for the storage, transpor- tation and distribution of water. Storage of Water in a Unit Area. If purified water is delivered to a unit from the Engineers or if it is necessary to chlorinate the water in the water sterilizing bag, this same bag is used for the storage of water within the unit area and for the distribution of water to the individual soldier. Procurement of Purified Water from the Corps of Engineers. As mentioned in a pre- vious paragraph the various units of the Corps of Engineers have portable or mobile equipment for the purification of water. The Engineer battalion, combat, within an infantry division has four portable purification units, each capable of operating at a separate water distributing point (W.D.P.) or several may operate at one water dis- tributing point. It is intended that one portable purification unit can supply water to an entire combat team. Plate 5a shows how the water would be delivered from such a water distributing point to the water sterilizing bag using trucks of the regimental or battalion train for the transportation of the 5 gallon water cans. It may be impossible to find suitable water sources within the divisional area. In such cases the services of the Engineer battalion, water supply, are utilized. A water dis- FIELD SANITATION 441 442 MILITARY MEDICAL MANUAL tributing point would be established to the rear where one or several mobile purification units would operate, supplying one or more divisions. The water would be transported from this water distributing point (Plate 5b) by the large tank trucks or tank trailers, equipment of the water supply battalion. They would carry the water to the divisional water distributing point where it would be stored in the large 3000 gallon reservoirs. Distribution from this point would be in the manner illustrated in the previous paragraph. In desert warfare or in operations over comparatively waterless terrain, great distances may be involved in delivering water from the source to the troops in the combat zone. It would be necessary to establish a water point or water depot (Plate 5c) in the com- munications zone. From this point the water would be brought forward by railroad tank cars or other similar means of transportation to the army railhead and thence for- ward in the usual manner (Plate 5c). An alternate method would be the delivery of water from the communication zone via the daily train to the divisional railhead. Distillation of Water. On establishing a beachhead or when operating in desert country bordering the ocean, sea water or water containing alkaline salts may be the only source available to troops. Distillation is the only way alkaline salts may be removed from water. When impure water is boiled and the steam condensed, a pure water free from dissolved mineral and organic matter and from bacteria is obtained. However, except on a large scale, distillation produces little water for the amount of fuel con- sumed In the modern army where mobility is paramount, efficiency in distillation apparatus must be sacrificed. Mobile equipment used in the Army will probably not produce more than 30 gallons of distilled water per hour. Small distillation apparatus may have to be improvised under special conditions. Gas Contaminated Water. Water sources that are contaminated with warfare gases should be avoided if other supplies are available. If not, contaminated water will be considered as potable if it meets certain requirements. There should be no odor of any chemical agent before the water is chlorinated, nor should there be excessive cloudiness or discoloration. The addition of five parts per million of chlorine (2 ampules of Grade A calcium hypochlorite per water sterilizing bag) must produce a chlorine residual of one part per million or more. The pH (acidity) of the water before chlorination should be above 5,0. These tests apply to all known warfare gases that may contaminate water supplies with the exception of chlorpicrin. However, the treatment of contaminated water should if possible be left in the hands of the water supply personnel of the en- gineer units or of the engineer water supply battalion. DISPOSAL OF WASTES The disposal of waste products in the field, in camp, or in cantonment is the most im- portant detail in field sanitation. Life in camp brings men in close contact with the soil under conditions where the usual sanitary devices of civilization are lacking, and unless great care is observed they will soon thoroughly contaminate the surroundings and disease will quickly spread. Field sanitary devices must be supplied to replace those of established communities, and various kinds of wastes must be disposed of in such a manner that pathogenic bacteria are eliminated. Waste must be changed so that it no longer promotes the breeding of flies and other disease-carrying pests, and nuisances must be prevented. The wastes to be disposed of are of two classes: solids consisting of human feces, kitchen garbage, stable refuses, general camp refuse, and carcasses; and liquids consisting of urine, kitchen sullagc, and ablution sullage. They may also be classified as human wastes, kitchen wastes, animal wastes, and rubbish. Excreta. On the march and in temporary camps there is no other method of dispos- ing of human excrement except in the earth. On the march soldiers should be instructed to dig a small pit into which they should void their excrement after which it should be covered with earth. It is not only unsanitary but creates a nuisance if this precaution is not observed. In temporary camps disposal of human excrement is done by means of shallow trenches (straddle trenches) or in pits of various depths. Since nitrifying bacteria WATER PURIFICATION BAG PORTABLE PURIFICATION UNIT I MOBILE PURIFICATION UNIT LEGEND Plate 5. Water Logistics. MMM (4) 444 MILITARY MEDICAL MANUAL are not found normally in the soil at depths greater than 18 to 24 inches the action of these bacteria does not take place on the fecal material in the pits. Organic matter derived from the intestinal tract decomposes very slowly requiring several months to a year to break down into stable compounds. This is one reason why old camp sites are not desirable. At temporary camps of less than one weel\, bivouacs, and on long halts, the method of disposal of fecal material is by the straddle trench. This is a trench about one foot wide, 18 to 24 inches deep, and long enough to provide for 8 per cent of the command at one time, allowing two feet per man (Plate 6). Instead of one long trench a number of parallel trenches or individual straddle trenches (2 ft. in length) may be constructed. The 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 la 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 seats 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. 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 wbieh th« 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. 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 are 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 freuently changed and the old ones burned. Oil should not be used in the fits as it dogs 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 arc 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 weekly. 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 only 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. If prepared incinerators are used they may be of the same kind used in the disposal of garbage, or more open ones may be employed. 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 tramp 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 vicinity 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 day, averaging 0.8 pound per man in large camps or about six to eight tons for an infantry 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 decomposition 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 sprayed on the garbage after unloading. At the noon-time halt on marches, waste food and drink may 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 ahould 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. I lowever, 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 hll. 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. 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 arc the best means of disposal of waste liquids. Pits for such purposes *rc 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 soa\age trenches are made. 452 MILITARY MEDICAL MANUAL The soa\age 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. 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 punched in the bottom. I he 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 m 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 docs 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 lead* 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 off 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. Plate 15. Washing Mess Kits in the Field. Papers and rubbish which can be readily burned should be burned. I hey 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 flics. 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 MILITARY MEDICAL MANUAL and fuel containers* truck bottoms* fcadoa* Or qtbqr articles which will 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. Plate 16. 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- . features in proper mess sanitation are inspection and supervision of food handlers* fPr0tCC?°? frTfldirt afd fllCS’ St°rage’ 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 mest 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 frmts. It is important that the rat.on be adequate, the menu varied, and -the food well 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 FIELD SANITATION 455 Suspended meat cage- Collapsible fly-proof meat safe Tin lined meat safe Plate 17. Improvised Meat Receptacles. kitchen police. Unit commanders are required to send the names of all permanent food handlers to the surgeon. These men are 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 are 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 arc then sent to their unit compander 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 /z 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. vipm:7rDfily. f,°ld supplied each man should gram, nf w 3000 Cf’ories. provide at least 100 grams of protein, and contain adequate vitamins. Food supplies: Meat and fish: Source. Quality. Freshness. Handling. FIELD SANITATION Kitchen utensils: Are pots and pans kept grease free? Are 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. Nonedible 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? Are they used? Have fly traps been provided and are 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 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? Are 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? Are 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 organizations? If not, what corrections are advisable? Police: Dishwashing: Does the method meet the requirements of Army Regulations? (W.D. Circular 76- I94I) Are trays, dishes, and utensils clean? Look between fork tines and around hilt of knife. Is there evidence that all dishes and uten- sils have been properly sterilized and air dried? 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 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. MILITARY MEDICAL MANUAL 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 grow 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, diarrheas, but food mav 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, deterioriatum, 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 arc 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. Smeller. A sweller is a can which contains gas in sufficient 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 sufficient 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 arc 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. 460 MILITARY MEDICAL MANUAL 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 characterized 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. Skin. 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 stalencss or adulteration. Oysters whether in the shell or shucked are highly perishable. They deteriorate rapidk when improperly handled and present a characteristic, disagreeable odor or a gassy or rm ky appear- FIELD SANITATION 461 ance. 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 arc generally regarded as undesirable for food and should not be used. Ordinarily, only canned crabs, clams, shrimps, and lobsters arc 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. Mill[ 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 500 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 strict6st 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 14314° 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 F. and held for 30 minutes, automatic deviceso for registration of the pasteurizing temperature, coolers wherein the milk may be rapidly cooled to 450 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 promptly transferred to the laboratory. If MILITARY MEDICAL MANUAL 462 laboratory facilities ire 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 bottle 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 setde out to form precipitates, however, this does 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. 7 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. Eytry opportunity should bo 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 (athletes foot). y 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”, Captcr 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 arc 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 Plate 19. Diagram of a Proper Sanitary Layout for a Battalion camp. 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 arc 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 within 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 or 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 f 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. His 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. 10, AR 40-205). ^g 610X5 Here the number of events (cases) is 12 and this is multiplied by 1000 and by 52. The figure 52 represents one year expressed in weeks. This result is divided by the strength multiplied by 5 (the number of weeks in which the 12 cases occurred). Suppose these cases had occurred in one calendar month, then 12X1000X12 /■ -— =236.0 610X1 In this case the year is expressed by 12, the number of months in one year, and the strength is multiplied by one, there being one month in the period. If these events occurred, in say x8 days, then the formula would be— 12X1000X365 .n 610X18 Most of the morbidity records prepared by camp or station surgeons cover a 4- or a 468 MILITARY MEDICAL MANUAL 5-weeks’ period so that the first example shown here would be the one to follow. For a more extended discussion see FM 8-55 or TM 8-255 (now published as Army Medical Bulletin No. 23). The noneffective rate is a daily rate and is the number of men sick in hospital or quarters per 1000 strength on the day for which it is calculated. The noneffective rate is employed to determine the number of troops in a given command that are physically fit for duty on a given day, or the average daily noneffectiveness caused by a disease during a selected period of time. The noneffective rate for a given day may be calculated as follows: ,T t Number of sick Xiooo Noneffective rate= Strength The following formula may be used to determine the average daily noneffective rate for a period of more than one day: .. ff . „ Sum of number sick daily X 1000 Noneffective rate= —— — Sum of daily strengths The following formula may also be used to determine the daily noneffective rate: .T a . _ Total days lost X iooo Noneffective rate= — — ;—- No. of days in period average daily strength Thus, if in a command of 500 troops, 10 men are sick on a given day, the noneffective rate is 20 per 1000 troops. It is calculated as follows: ,, _ 10X1000 Noneffective rate per 1000= 500 10,000 500 =20 If four cases of measles occur in a command of 500 troops during one month and these cases are sick for 10, 12, 14, and 14 days, respectively, the noneffective rate may be calculated as follows: xt rc .• . (10+12+14 + 14) X IOOO Noneffective rate iooo—- — 30X500 50,000 15,000 Or; =3-33 Noneffective rate =— X l000- 30 500 = I.666Xi22£_ 500 =1.666X2 =3-33 In 1928 the total United States Army, consisting of 134,380 troops, lost 73,144 days from duty because of influenza, or, as expressed by the noneffective rate, 1.49 men out of every 1000 troops, were incapacitated for duty each day of the year. This is determined by the following calculation: Noneffective rate per 1000—73A 44 X Iooo 365 i34>38o =200.39 X—I000— 134,380 =200.39X0.00744 = M9 In the report of venereal diseases the prophylactic rate is required. That is, the number of men per 1000 strength who have taken venereal prophylaxis during the month. This rate is obtained as follows: Number of prophylactics 1000 . administered Average daily strength Ratios are used to express relationships between frequencies of occurrence of related events Ratios are usually expressed in percent (per 100). A case fatality rate is the ratio of deaths from a specific disease to the number of cases of the disease. If during an epidemic of meningitis there were 120 cases and 30 of them died, the case fatality rate would be 25 calculated as follows: Case fatality rate=3-° I0°. 120 =o.25X 100 =25 CHAPTER IV ESSENTIALS OF MILITARY PREVENTIVE MEDICINE Definition. Military preventive medicine includes the measures which are necessary for the prevention and control of diseases among the members of military forces. It is comparable to the activities of the public health service of civilian communities, as modified by military environmental conditions. It has a definite and important role in the mission of the Medical Department. The mission of the Medical Department is the conservation of man power—the pre- servation of the strength of the military forces. It accomplishes its mission by three methods; first, by accepting for the military service only those men who are physically fit; second, by keeping these men physically fit through the application of the principles of preventive medicine; and third, by restoring to physical fitness, as promptly as possible, through the application of curative medicine, those who become disabled. Soldiers are subject to the same diseases as people in civil life. In some respects they encounter greater health threats. Their life demands concentration in compact military communities, with a resulting exposure to large doses of mixed and crossed infectious material. Their exposure to hardships and hunger, which lower their natural resistance, and to sudden changes of environment tends to make them more susceptible to the communicable diseases than would be the case under normal civilian conditions. Therefore, the medical officer must fortify his knowledge of curative medicine with the principles of preventive medicine. Basically, sanitation and hygiene are factors in preventive medicine and are necessarily included in the study of that subject. Historical Background. In most wars the loss of military man power from disease has greatly exceeded the losses of men in battle. Even during the World War our losses from disease exceeded our battle casualties. History records many examples of important campaigns which have failed because of outbreaks of disease among the troops. The map of the world, as we now know it, undoubtedly would have been quite different if outbreaks of disease had not prevented military leaders from accomplishing their mis- sions. Much of this enormous loss was due to preventable disease, before mankind emerged from a state of relative medical ignorance. It is only in recent decades that we have come to know much about the basic causes of the diseases that wrought such havoc among men assembled in armies and have devised ways and means to prevent such losses. Definition. The designation “communicable diseases” is used to cover all those infec- tious or contagious diseases transmitted from person to person by direct contact, indirect contact, or through some special transmitting agent. They are all caused by “germs” of one kind or another; in some, the specific germ is known, while in others it is not known. They are the diseases which, under favoring conditions, may appear in epidemic form. Epidemics. An epidemic exists when a large number of persons in a community are affected simultaneously by a certain disease or suffer its effects within a short space of time. To have an epidemic outbreak of communicable disease three things are COMMUNICABLE DISEASES necessary: A focus, or source, of the disease. Susceptible individuals. Proper contact between the susceptible individuals and the source of the disease. Classification of Communicable Diseases. Communicable diseases which affect military personnel may be classed for the most part under five general headings: First. Diseases which are transmitted by the intestinal discharges and then acquired by ingestion of infected material. They are commonly called food or water-borne diseases. Included in this class are: 470 Amoebic dysentery (protozoal) Botulism Cholera Diarrhea (common) Dysentery (bacillary) MILITARY MEDICAL MANUAL Food infection Parasitic infestations (helminthic) Paratyphoid fever Typhoid fever Undulant fever Second. Diseases which are conveyed by the secretions of the mouth, nose, and throat of infected people and which gain entrance to the body of the uninfected through those portals. This method of transmission is commonly known as “droplet infection.” These are the respiratory diseases. Diseases which can be placed in this class are; Chicken pox Common colds Diphtheria Encephalitis (epidemic) Influenza Measles Measles (German) Meningitis (meningococcic) Mycotic diseases of the lungs Pneumonia (lobar and bronchial) Pneumonia (secondary) Pneumonia plague Poliomyelitis Psittacosis Scarlet fever Septic sore throat Smallpox Tuberculosis (pulmonary) Vincent’s infection Whooping cough Third. Dieases which are dependent upon exposure to insects, known as the insect borne diseases as they are usually transmitted by blood-sucking insects. The diseases in this class are: Bubonic plague Dengue Equine Encephalomyelitis Filariasis Leishmaniasis (oriental sore, es- pundia, and kala-azar) Malaria Pappataci fever Pseudotyphoid meningitis (Swine- herd’s disease) Relapsing fever Rocky Mountain spotted fever Trench fever Trypanosomiasis (African sleeping sick- ness and Chagas’ disease) Tularemia Typhus fever Yellow fever Fourth. The venereal diseases in which the infection is usually transmitted by direct contact during sexual intercourse. The diseases in this class are: Chancroid Gonorrhea Lymphogranuloma inguinale Syphilis Fifth. Diseases requiring control measures not included in the above headings and which might be listed in two or more of the above classes are as follows: Anthrax Beri-beri Infectious jaundice Leprosy Rabies Rat-bite fever Ringworm (tinea cruris) Scabies Scurvy Tetanus Trachoma Yaws The diseases for which notification to Public Health authorities is usually required in the states and cities of the United States are: Actinomycosis Ancylostomiasis (hookworm disease) Anthrax Chicken pox (varicella) Cholera Conjunctivitis (acute infectious) Dengue Diphtheria Dysentery (amebiasis) Dysentery (bacillary) Encephalitis (infectious, lethargic, and nonlethargic) Favus German measles (rubella) Glanders (farcy) Gonorrhea ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 471 Influenza Leprosy Malaria Measles (rubeola) Meningococcic meningitis Mumps (parotitis) Paratyphoid fever Plague (bubonic, septicemic, pneumonic) Pneumonia (acute lobar) Poliomyelitis Psittacosis Puerperal infection (puerperal septi- cemia) Rabies Rocky Mountain spotted (or tick) fever Scarlet fcvsr (scarlatina) Septic lore throat (streptococcic throat infection) Smallpox (variola) Syphilis Tetanus Trachoma Trichinosis Tuberculosis (pulmonary) Tuberculosis (other than pulmonary) Tularemia Typhoid fever Tyhus fever Undulant fever (brucellosis) Whooping cough (pertussis) Yellow fever Botulism, pellagra, food infections and poisonings, although not considered commun- icable, are also reported since they usually occur in groups or epidemics, and their pre- vention is practicable. Diseases or infestations for which notification of Public Health authorities is not everywhere required are as follows: Ascariasis Climatic bubo Coccidiodal granuloma Common cold Filariasis Icterohemorrhagic jaundice (Weil’s disease) Impetigo contagiosa Lymphogranuloma venereum (in- guinale) Pediculosis Yaws Rat-bite fever (sodoku) Relapsing fever Ringworm Scabies Schistosomiasis Vincent’s infection (angina, stomatitis) Biological Sources. Every case of communicable disease comes from some other case of that disease; air, water, food, utensils, insects, and all other such means are merely the agents which carry the germs from the infected person to well persons. Geographical Sources. The geographical source of the communicable diseases that play such an important part in the health of the soldier is the civil community from which he comes as a recruit or the civil community adjacent to the military community where he resides. Areas at large. In a concentration of military man power some men arrive at the rendezvous while in the earliest or incubation stage of measles, mumps, or other com- municable disease. In a few hours, or a few days, they will be sick. These men are unaware of their exposure, and until symptoms appear there is no way to foresee their impending sickness. In the meantime they are necessarily coming in more or less intimate contact with other men among whom will be a certain proportion who are susceptible to the disease in question. After a short time some of these susceptible contacts will become sick with this same disease; by that time an epidemic may have started and, unless vigorous measures are taken to stop it, it will continue until all the susceptible material has been exhausted. Such infections increase in virulence by being exchanged between individuals who have been unaccustomed to them. Local areas. Men in a military community will naturally come in contact with people of the adjacent community. Many of the communicable diseases are present at all times in civil communities, and susceptible soldiers will almost certainly be exposed to such diseases, acquire them and, of course, introduce them into the military com- munity with the results outlined above. 472 Methods of Transmission of Communicable Diseases. Communicable diseases arc transmitted in three ways: direct contact, indirect contact, or by a special agent. A “con- tact” is a person (or animal) known to have been sufficiently near a source of infection presumably to have been exposed to the transfer of infectious material, either directly qj- from articles freshly soiled with such material. As a contact the person is considered a potential carrier of the disease, although he may not display the symptoms of the disease in question. A direct contact transmission of disease occurs when a susceptible person comes in close or intimate physical relationship with a person sick with the disease in its infective stage. A few examples of diseases which may be transmitted by direct contact are: measles, mumps, smallpox, respiratory diseases, and the venereal diseases. Transmission by indirect contact occurs where the susceptible person uses some article which has recently been used by a person sick with the disease in its infective stage. Some common examples of indirect transmission are; using towels, dishes, eating utensils, pipes, lighted cigars, cigarettes, and the like, that were in recent intimate contact with, or soiled by, the sick person. Influenza, as an example, may be spread by unsterilized eating utensils. The majority of the diseases transmitted by direct contact are also trans- mitted by indirect contact. MILITARY MEDICAL MANUAL 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 Typhoid fever Vincent’s infection As distinguished from a “carrier,” the term “injected 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. PRINCIPAL TRANSMISSION AGENCIES CONTROL OF TRANSMISSION PROTECTION OF SUSCEPTIBLES SOURCE AGENCIES AIR VENTILATION OF BARRACKS. BED SPACING IN SQUAD ROOM. CUBICILED BEDS. PREVENTION OF CROWDING. ISOLATION OF CASE «. CARRIERS. QUARANTINE OF CONTACTS. WARM CLOTHING. PER- SONAL CLEANLINESS IMMUNIZATION. CONTACT BY AIR HANDS FOOD AND MESS EQUIPMENT CASE OR CARRIERS HANDS PERSONAL CLEANLINESS FOOD and MESS EQUIPMENT DISINFECTION OF DISHES i 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 direedy or indireedy. 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 are responsibilities of the Engineer Corps. The medical officer of the unit makes recommendations based upon inspections in order to insure the observance of proper 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 ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 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 efficiendy. 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 If If If (4) MILITARY MEDICAL MANUAL 476 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. “Delousing” 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 bv 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. 1 hey 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 bancrojti (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 Bedbugs arc 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. MILITARY MEDICAL MANUAL 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 protected 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 digging 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, body 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 disinfested, below, or in the lower part of which, there is a receptacle for water. This sits on an improvised furnace or firebox. The galvanized iron garbage can is the most practicable and no seperate containers for ESSENTIALS OF MILITARY PREVENTIVE MEDICINE water arc necessary (Plate 4). Water to a depth of about 4 inches is placed in the bottom of the can which is placed over the fire. A wooden grate supported on sticks about one foot in length is placed at the bottom of the can to separate the clothes from the water. Hooks on which to hang the clothes may be improvised from nails driven into the lid. Clothing is left in the can for 45 minutes after steam commences to escape. The clothing or blankets should be hung loosely. Two barrels working full time will be able to disinfest the clothing of approximately 200 men. It is best however, to have 3 or 4 barrels operating to do real effective work. While the clothes and effects of the soldiers are being disinfested they themselves must be scrubbed and cleaned. A kerosene soap should be used. Plate 4. The Serbian Barrel for Disinfestation of Clothing, If pubic lice are detected in the command, daily inspections should be carried on while control measures are in progress. The most effective control is to shave the pubic region; wash the parts with strong soap and follow this with an application of kerosene or alcohol and ether. Daily examinations are necessary to be sure that case is cured. Tic\s may be divided into two families: hard ticks and soft ticks. The hard ticks are responsible for Rocky Mountain Spotted fever, a typhus like disease transmitted in the west by the Dermacentor andersoni, a wood tick, and in the east by the Derma- centor variabilis, a dog tick; also Mediterranean eruptive fever spread by another type of dog tick. These hard ticks may cause a form of acute ascending paralysis which, especially in children, may end fatally. It appears to be an intoxication due to the injection of tick saliva during a period of several days’ attachment. Recovery is usually rapid if the tick is removed before the muscles of respiration are involved. Louping ill, an encephalomyelitis of sheep, common in certain parts of Scotland, is due to a virus said to be transmitted by a hard tick. Human infections may occur. One does not usually feel when a tick is biting. If a tick is removed forcibly the mouth parts will be left in the skin and may have to be removed surgically. A tick can be made to loosen its hold by touching it with a moistened cigarette, or by applying turpentine, kerosene or gasolene to it. A fairly effective vaccine for the prevention of Rocky Mountain spotted fever is available and it protects for one year. The soft tick is responsible for several forms of relapsing fever. The tick borne relapsing fevers are found chiefly in two large areas. The first is chiefly limited to districts bordering on the Mediterranean, and the second embraces the greater part of the Western Hemisphere including many of our southern states, Central America 480 MILITARY MEDICAL MANUAL and the northern part of South America. In the American form small rodents are the animal reservoirs of infection. Fleas are agents for the transmission of plague and typhus fever (endemic). They are eliminated by eradication of the animal host which infects them. Fleas will resort to man when the normal host is not available, and, if his former host was infected, the disease will be transmitted to the human host. As man may be closely associated with domestic animals he is apt to be bitten by fleas normally parasitic on such animals. If the fleas are traced to rats, then effective rat control measures must be employed. Pet animals may be freed by the use of various methods such as powdering with derris root powder, pyretheum powder, or bathing in a solution of 2 per cent cresol, or kerosene and soapy water. If a building or room is infested with fleas, fumigation with hydrocyanic acid gas or sulphur dioxide is effective. The room should then be swept and the sweepings burned. Rodent Control. Rodent control is important because rodents, especially rats are hosts for fleas which are capable of transmitting plague and typhus fever. In order to control the disease the original reservoir of infection, the rodent host on which the flea feeds, must be destroyed. Ground squirrels, rabbits, and rats are the most commonly infected rodents. The rodents and the more common diseases with which they may be infected respectively are: Rats; Bubonic plague, rat-bite fever, typhus fever (endemic). Ground squirrels, rabbits, woodchucks, muskrats, skunks: Turaremia. Ground squirrels, chipmunks, meadow mice: Rocky Mountain spotted fever. Rat control is most important because rats serve as hosts for the rat flea and are a source of plague and typhus fever (endemic). Plague has a very high mortality, and may be wide-spread among a colony of rats. Because rats tend to inhabit the same buildings as man, the diseases affecting the rat are apt to be transmitted to man. Measures of control are designed to prevent the migration of fats to a community. If they are already present measures are taken to destroy them or force them to leave. All buildings should be rat-proofed; all openings to buildings which permit entrance of rats should be closed; all drains leading from the building should be constructed to prevent the entrance of rats; building material used should be non-destructible by rats. The storage of food and food wastes should be such as to prevent access to them by rats. Food must be stored in metal containers and so placed as to be away from the walls and off the floor; garbage cans should be covered and the garbage should be disposed of promptly so as not to be accessible to rodents. Cement walls and floors and the storing of food products in refrigerators and metal containers has decreased the incidence of rat prevalence. Fumigation with hydrocyanic acid gas is the most effective means of exterminating rats and in addition destroys the fleas which are using the rats as hosts. Trapping rats has a disadvantage in that the fleas leave a dead rat, migrating to a living host as soon as one is available. In a suspected plague area control measures should be carefully planned, using the most suitable methods available. The routine autopsy examination of all rats killed should be continued until an infected rat is found. Measures may include the following; reducing the rat food supply to the minimum, rat proofing, rat poisoning (with rigid supervision), fumigation with hydrocyanic acid gas, and trapping as necessary to secure specimens for examination. Other rodents are eradicated by destruction of their habitat and by hunting, trapping, or poisoning. When such rodents are used as meat for human consumption (rabbits' and squirrels, principally), the meat should be thoroughly cooked. Rubber gloves should be used by persons engaged in dressing these animals or when performing necropsies on infected laboratory animals. Diseases harbored by these rodents are more prevalent in the spring and early summer during the appearance of early ticks. Measures to Maintain Health and Vitality. Measures designed to maintain the health and vitality of the individual include several factors, some of which are personal and ESSENTIALS OF MILITARY PREVENTIVE MEDICINE some are environmental. Watchfulness of the general health and strength is the best insurance against sickness. Proper food, proper clothing, activity (work and exercise), and rest and sleep are all important. Personal hygiene is of paramount importance; it is discussed in Chapter V. Food. Good food, nutritionally adequate, properly prepared and served, is vitally necessary to good health and discipline. Nothing contributes more to the contentment and morale of the soldier than a good mess. Few things contribute more to good health, buoyant vitality, and natural resistance to disease than adequate nutrition. Clothing. Proper and adequate clothing protects the soldier from undue exposure to adverse climatic conditions, maintaining his general resistance to many diseases, especially the respiratory diseases. Activity. Work and exercise must be tempered to suit the physical condition of the men and their environment. Activity improves the general health, especially outdoor work and exercise. Even during severe epidemics it is much better to keep the well men busy in the open air. Working or exercising men until they become slightly tired does no harm, but fatigue is to be scrupulously avoided, especially during an epidemic or a threatened epidemic. Rest. Rest, relaxation and sleep are next in importance to food in maintaining health. Work periods should be interspersed with short rest periods. In training troops, the type of work should be changed often enough to prevent monotony and provide relaxation. Sleep is a natural process in the maintenance of health, and loss of sleep lowers the vitality. The average person requires 7 to 8 hours of sleep in 24 hours, which should be taken at regular times; however, if needed, sleep at any time is beneficial. Sleep should always be had under the most favorable conditions; in a quiet place, with plenty of fresh, cool air, without drafts; in a comfortable bed with sufficient coverings. Night clothes should be worn whenever possible. Health warnings. Even though the sick men are not seen by him in person, the organi- zation commander can do much in the prevention and control of communicable disease. The company commander receives definite information every day as to the state of health of his command when he signs the Daily Sick Report. A sick rate of 1 to 2 per cent of the total strength of his command—varying according to the environment and the season- ing of his troops—may be regarded as normal. A sick rate of 3 to 4 per cent should be viewed with alarm and should call for prompt investigation of the general sanitary con- ditions. A sick rate of 4 to 5 per cent calls for drastic measures, with the closest super- vision of environmental conditions. A rate exceeding 5 per cent generally indicates an epidemic of one or more communicable diseases. An unusual number of injuries should cause the company commander as much concern as an excessive number of sick men. The rates mentioned are not the daily admissions to the hospital but are the total number of men absent from duty each day on account of sickness or injury. Specific Prophylaxis. Specific prophylaxis is limited to a very few diseases. At the present time the most important ones, from the military standpoint, are typhoid fever, paratyphoid fevers, tetanus, yellow fever and smallpox. In the military service protection of the individual against these diseases is a routine matter, required by higher authority. But the commander of a small unit, such as the company, has a very definite responsi- bility to contribute to this protective procedure by seeing to it that all of his men receive the necessary prophylactic treatment promptly in compliance with these orders. When circumstances require it, such as the prevalence of other communicable diseases for which passive immunity can be obtained by artificial means, the medical officer should make clear to unit commanders the need for specific prophylaxis. The unit commander will rely on his medical officer for information of the presence of such diseases in the com- mand or in adjacent communities. In peace time stations or during campaigns in coun- tries where typhus or cholera is prevalent, all troops are required to be vaccinated against the prevailing disease. Isolation and Quarantine. Isolation and quarantine are physical measures taken to separate and segregate contacts and infected individuals from those who are well. Isolation. By isolation is meant the detection and segregation of a person or persons 482 MILITARY MEDICAL MANUAL suffering from a communicable disease, or carriers of the infecting micro-organism, so as to prevent the direct or indirect conveyance of the infectious agent to unexposed, susceptible persons. Isolation is usually maintained in a separate ward of the hospital or in a building separate from other dwellings. The care of the isolated patient should be entrusted only to personnel that is well-trained and experienced in handling such cases and who will also enforce and practice strict personal hygiene. Quarantine. By quarantine is meant the limitation of the personal association and physical surroundings of persons (or animals) who have been exposed to communicable disease for a period of time equal to the longest usual incubation period of the disease to which they have been exposed. Wording quarantine is the segregation of a group of contacts to prevent the spread of the infection to the unexposed members of the command. This group then continues its training or duties as a separate unit until the period of quarantine is over. In this manner the occurrence of disease may be restricted to the members of the quarantined group. The quarantined group should be inspected by a medical officer once or twice daily in order to detect any new cases of disease in the early stages. Carriers are removed for individual isolation and treatment in a hospital. Camp quarantine may be established in camps or mobilization centers where there is a prevalent communicable disease. By this measure the entire camp is placed under re- striction, and the units therein are limited to the territory of the camp during the period of quarantine. A detention camp may be established within a mobilization center for the housing of recruits so that disease symptoms may appear, if present, without exposing the entire per- sonnel. If a case develops the period of quarantine is then prolonged until a continuous period passes, equivalent to the incubation period of the disease detected, without the de- velopment of any communicable disease within the group. Early Recognition of Disease. The early recognition of the fact that a man is sick is a very important factor in disease control. No special knowledge of medicine is required to recognize that a man is sick with some acute disease. Company officers are not expected to make diagnoses, but they are expected to recognize that a man is probably sick. The specific diagnosis is for the medical officer to determine. In a great many instances even the most experienced medical officers cannot make a definite diagnosis the first time they see a sick man, especially one in the initial stage of a communicable disease, because many such diseases, initially, present several of the same symptoms. The detection of sickness is not as difficult as commonly believed. Company and platoon commanders make frequent inspections of their men, with special reference to their clothing and equipment. Dirty clothes, an unshaven face, or a dirty rifle will seldom be overlooked. It is an equally simple matter to look at men with attention directed to their physical condition. In a short time the alert officer will do so unconsciously and, as in other in- spections, the man who is normal in appearance leaves no lasting impression, but the sick man stands out prominently. Sick men should be immediately removed from inti- mate contact with well men. Segregation of the sick and early, proper disposition of the sick or disabled men of an organization will save three-fourths of the time they would otherwise spend in hospital. Likewise, early recognition of the sick may prevent many unnecessary contacts and prevent the spread of a communicable disease if the ill person detected has such a disease. Historical Background. For hundreds of years armies have been decimated, and the civil communities in their theatres of operations have been scourged, by outbreaks of venereal diseases, often of epidemic proportions. Biblical history indicates that Moses recognized and took steps to eliminate the venereal disease hazard. The history of the venereal diseases in the United States Army is graphically represented in Plate 5. With very few exceptions, they have been the outstanding cause of noneffectiveness (loss of time from duty) among our troops. During the World War, although the venereal disease situation was unusually good as compared with that of other wars, the loss of time from duty on PREVENTION AND CONTROL OF VENEREAL DISEASES account of venereal diseases was exceeded only by that due to an unprecedented outbreak of influenza. During peace time, the venereal diseases ordinarily cause more loss of time from duty than all the other communicable diseases combined, although men with active venereal disease arc not accepted for military service. In war time, men with curable venereal disease are accepted, as any other policy would cause the rejection of many serviceable recruits and would also place a premium on the acquisition of venereal disease as a means of avoiding military service. ESSENTIALS OF MILITARY PREVENTIVE MEDICINE 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, the 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, arc 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 484 MILITARY MEDICAL MANUAL 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 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. 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 arc incfectivc. 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 by medical officers and by company commanders of the troops concerned. (Sec AR 40-235.) Standing orders require that every soldier, upon enlistment or recnlistmcnt, 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 arc 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 prophylactic 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 arc 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 prompdy 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 and 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. MILITARY MEDICAL MANUAL 488 This is done slowly. The solution is retained in the urethra for five minutes by the cloc\. The meatus should be held tight enough to retain the fluid while allowing an occasional drop of protargoi to escape. 6. After the time limit of 5 minutes has expired, the pressure on the meatus is re- leased and the protargoi solution is allowed to escape without pressure on the urethra to expel the last drop, which it is desired should remain, 7. About /2 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 offers 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. h. Instruction of officers. In all troop schools conducted under the provisions of AR 350-2600, and at the Air Corps Training Center 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); to 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. Bv 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. NUTRITION 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 492 MILITARY MEDICAL MANUAL scientific dogmatism. Wc 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; CALORIES REQUIRED BY A MARCHING SOLDIER. Normal Extra 10% for Load Road needs, work T otal waste o Level or un- 2064 900 2964 3260 dulating 50 lb. do. 2064 1172 3236 3560 50 lb. Ascending 2064 2x10 4174 4590 100 feet per mile 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 B1 (thiamin chloride), the antineuritic vitamin, is found in the outer layer of grains. A deficiency causes beriberi. Vitamin B2 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. Coffee, 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. MILITARY MEDICAL MANUAL Satisfy dietary requirements as to proteins, fats, carbohydrates, salts, water, and vitamins. Have the calory (fuel) intake adequate to the needs. Have enough bulk in the diet and secure 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 medical officer, as well as the dental officer, must fit watchful for diseases of the gums. The soldier who fails to practice dental hygiene is particularly susceptible to infections of the gums and carious (decayed) teeth. Pyorrhea alveolaris, 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. CARE OF THE SKIN 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 arc 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 ift 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 soaps arc 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 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 perforate: bottom Cartridge or kerosene tin with - perforated bottom tWooden floor 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- , 1 avoid most thc 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 of holding considerable air in its meshas is a poor conductor of heat and consequently feels warm. For this reason wool is especially valuable for clothing. Another advantage of wool is its capacity for absorb- ing moisture without feeling wet. Evaporation proceeds slowly from woolen clothing, and as a consequence chilling of the body is prevented. Flannel 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 for 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, stiff 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 free 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 of 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 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. MILITARY MEDICAL MANUAL 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 present 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 arc 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/z 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 oa 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 Fittin*. MILITARY HYGIENE 501 TABLE OF SOCK SIZES, WOOL SOCKS Shoe size Corre- sponding sock, size Shoe size Corre- sponding sock, s‘xe 5 1 9 io54 9 54 12 5 54 10 6 io 54 654 11 11 1254 7 1154 7 54 12 8 ix 54 12 54 13 854 13 J ' 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 Plate 5. Care of Blisters on Feet. 502 cases of so-called “athlete’s foot.” In this connection exposure of the feet to the air i 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. MILITARY MEDICAL MANUAL 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 arc 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 help# to save shoe leather during the dry season. During the “rainy reason” this is of no value, as the shoes arc continuously wet anyhow. Where the waters arc suspected of being infected with the ccrcariac 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. MILITARY HYGIENE 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 tht 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. MILITARY MEDICAL MANUAL 504 Deep breathing exercises are of value in preserving health. The best exercises, how- ever, arc 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. SLEEP 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. 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 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. The 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. 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: WEIGHT AND HEALTH Height (inches) Weight (pounds) Height (inches) Weight (pounds) 60 120 70 156 6x 122 7i 161 62 125 72 168 63 128 73 175 64 IS* 74 182 65 135 75 189 66 139 76 197 67 M3 77 205 68 69 M7 151 78 213 TABLE OF NORMAL HEIGHT AND WEIGHT FOR A YOUNG MAN 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. The genito-urinary 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. This 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 formaton. 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 HYGIENE OF THE GENITO URINARY SYSTEM MILITARY HYGIENE 507 type of operation. In some eases 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 UMM (4) 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. T.ones 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, milk, 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. I he 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 they 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. Efforts must therefore be concentrated on personal pro- tection. All the measures used in the jungles are apnlicable here except the chemical prophylaxis, since mosquitoes in the far north are only 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. TRAINING IN FIRST AID SUBJECTS 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; 511 512 MILITARY MEDICAL MANUAL explanation, demonstration, imitation (application), and correction of errors. Proficiency is accomnlished bv repeated instruction and application. .. . A demonstration o£*e group performance method of instruet.on m the appl.cat.on 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. IM 8-220: (when revised) Medical Department Soldier’s Handbook The application of the Army Hinged Half-Ring I high and Leg Splint shou d i 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 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 troops') mig ' S1VC thC Wr°ng impreS5i0n °f medical aid technique to newly-trained eqmpment required £or dei— — -» (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. 513 .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 Flate 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 ARMY LEG SPLINT lO STEPS I DREW LITTER 3. APPLY TRACTION STRAP INITIATE TRACTION 5. DRESS WOUND 4.APPLY SPLINT SECURE TRACTION s.Srlint Support & SUPPORT LEG 7. foot Pest 8. place patient on Utter 9. Fix Splint With Utter bar 10. COVER patient 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 battalioij 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 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 (or far) pole of the litter and its upper edge is even with the head of the canvas. he second blanket is placed lengthwise on the first so that one edge corresponds with the inner pole of the fitter and its upper edge is again even with the head end of the canvas. It is then tolded back upon itself once in the same manner as the first blanket. The tree 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 519 Plate 8. Step No. 2: Part II, Placing right hand through splint. half.rinfi at a right angle to the bars of the splint so that when applied the short bar of the splint wifi be on the inner side of the leg and the concavtty of the rmg w.U be directed upward In order effect ‘the thigh,°the'shorter terlgg direct/d 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 ■ Whl Vhe 2 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 No. 3 the No. 1 man applies the Army Leg Splint to the injured leg by ro 1 g under’the le