Office of the Surgeon
APO 443 XXXXXXX U. S. Army

Declassified Authority NND795145 by LW NARA Date 7/29/08
This office contemplates publishing monthly, a summary of the medical activities which affect the officers and the men of this division.  The initial medical record will begin with the 12th of December 1944, at which time this division took over the sector in the vicinity of St. Vith, and will conclude on 31 December 1944, which time the division is re-organizing and re-equipping in the vicinity of Anthisnes, Belgium.  This record will reflect the result of many days of hard fighting as well as days of rest and re-organization.

This record will not give a true picture of the entire division's medical activity because of the large number of troops still missing in action.  Records of the 422d Infantry, 423d Infantry, 589th Field Artillery Battalion, 590th Field Artillery Battalion, Medical and Engineer Battalions will be incomplete.  The records of the 591st and 592d Field Artillery Battalions, which for a period of time had been attached to other units for medical services, will not be complete.  The Engineer and Medical Battalions also have large components of their total strength missing in action.

More than 7,500 patients were treated in the division medical installations form the 12th of December 1944 until the year's end.  Of this number, 1,781 cases wee treated in the Division Clearing Station, and 1,288 are personnel of this division.  On analyzing the charts made available from studies of the A & D sheets of the Division Clearing station, the following figures strike home with forceful effect.

Trench foot and allied conditions 529 41%
Battle casualties 396 31&
Combat exhaustion cases 118 9.2%
Upper respiratory infections 62 4.5%
All other cases 184 14.3%

It is relatively easy to try to explain the high incidence of trench foot.  From the time the men got off the ship after crossing the channel, they splattered and splashed across France without overshoes, sleep or a change of clothing.  Immediately on arrival at St. Vith, large numbers of cases of trench foot became manifest.  At this time, all the front line troops were issued overshoes.  At the start of the German offensive, on the 16th of December, much equipment and individual clothing was lost.  The greater proportion of men lost all clothing excepting that in which they stood.  It was most difficult to conduct the proper foot hygiene at this time.  However, it is felt that if the men were properly oriented and realized that activity in itself, i.e., walking and moving their toes within their shoes, will act to prevent the occurrence of trench foot, a much smaller proportion would be admitted to the clearing station.  Constant and continual effort and training must be carried on to further orient the troops of the inherent danger of trench foot, not only to themselves, but the entire division's effort.

The 396 battle casualties was a smaller number than expected.  But in the view of the fact we supported for the most part one regiment of the division, its losses were moderate.  In analyzing our statistics on wounds in the chest, which means that men are not hitting the ground in the face of artillery fire.  Wounds of the chest and of the abdomen are among the most serious types.  Compound and comminuted fractures and gunshot wounds of the extremities were found in the normal proportion.

In view of the fact that only 118 cases (9.2%) of combat exhaustion were admitted to the clearing station, it is felt that we have suffered a markedly low number of casualties due to this source.  This percentage is abnormally low for troops for the first time to enemy fire.

Upper respiratory infections.  It has been proven to us repeatedly on maneuvers and on "D" series that when men live out in the open the number of cases of upper respiratory infections immediately decreases.  This is again borne out here.  For the same period, while at Fort Jackson, the number of men in the hospital with upper respiratory infections, totaled 800.  In the period of this report, only 62 cases were hospitalized.

On analyzing the A & D sheets of aid stations and collecting stations, we find a high percentage of common diarrhea throughout the command.  It must again be emphasized that unless the offices who command companies and platoons make proper mess sanitation S. O. P., the total number of personnel lost to combat because of diarrhea, will become prohibitively large.  A common violation exemplifying lack of supervision, is the use of water from unauthorized sources.  Diarrhea is almost 100% preventable when proper field sanitation is practiced.  All officers and men must make this subject a matter of primary concern.

Published herein are charts showing the incidence of trench foot, battle casualties, disease rates, total admission rates and the types of missiles which caused the largest proportion of wounds.  It will be noted on analyzing these charts, that the proportion of battle casualties and non-battle casualties is 1 to 4; that enemy artillery is still the greatest factor causing battle casualties among our troops' and that 27% of the T/O strength of the 424th Regiment had been cleared through the Division Clearing Station.

Records of 58 P. O. W. admitted to this station, showed that over 60% of the casualties were due to small arms fire, a tribute to the effectiveness of the average infantry man's weapon.

On perusing these charts, if the paper will be turned horizontally, it will be noticed that the X's from a graphic representation of the subject.  Also that percentage used on these charts are based on full T/O strength.  Mush information not elaborated herein can be obtained by a careful scrutiny of material made available here.


Unit No. Cases % Rate 5 10 15
HQ & HQ SP Troops 31 1.6 XXX    
81st Engineer Bn 9 1.4 XXX    
331st Medical Bn 0 0.0      
422d Inf Regt 38 1.1 XX    
423d Inf Regt 36 1.1 XX    
424th Inf Regt 380 11.6 XXXXXXXXX XXXXXXXXXX X
Div Arty 34 1.6 XXX    
Total 106th Div 528 3.36 XXXXXXX    

Unit No. Cases % Rate 5 10 15
HQ & HQ SP Troops 13 0.7 X    
81st Engineer Bn 15 2.6 XXXXX    
331st Medical Bn 5 1.6 XXX    
422d Inf Regt 14 2.4 X    
423d Inf Regt 22 2.7 X    
424th Inf Regt 275 9.4 XXXXXXXXXX XXXXXXX  
Div Arty 45 2.2 XXX    
Total 106th Div 395 2.5 XXXXX    

Unit No. Cases % Rate 5 10 15
HQ & HQ SP Troops 14 2.5 XXX    
81st Engineer Bn 15 2.1 XXXXXXXX    
331st Medical Bn 12 2.7 XXXXXXXXXX XX  
422d Inf Regt 25 3.2 XXX    
423d Inf Regt 23 3.7 XXX    
Div Arty 32 1.5 XXXXXX    
Total 106th Div 323 5.24 XXXXXXX    


A review of casualties of XXXXXXXXXXXXXXXXXXXXXXXXXXX is herein charted.  This chart will not include Co "B" of Medical Battalion missing in action or other medical troops missing in action, with the infantry regiments, artillery battalions and the Reconnaissance troops.


Unit EXH NBC Shell Frag Rifle Mortar MO Robot Mine Total
422d Med Det - 1 - - - - - - 1
423d Med Det - 3 - - - - - - 3
424th Med Det 4 5 3 - - 1 - - 13
Div Arty Med Det - - - - - - - - -
81st Engr Med Det 1 8 1 2 1 - 4 - 17
Total 5 17 6 2 1 1 4 - 36


The 106th Division left the United States for foreign service early in November 1944.  From December 1943 until this time, with the cooperation of the General Staff, Special Staff, the Artillery, Regimental and Medical Officers, the personnel of the entire Division was constantly screened bur men who might be considered mal-adapted to combat duty.  By the time this organization had reached the Staging Area, it was quite evident that its personnel was prepared for combat and that morale was high.  This was determined by the attitude of the men as well as the reports from those who censored the outgoing mail from the individual units.  In the Staging Area the dispensaries reported a minimum number of soldiers with functional symptoms, and no men admitted to the neuropsychiatric section of the Station Hospital there.  Aiding the morale at this station was the abundance of athletics during the training days as well as the free use of passes by the commanding officers.

In England, morale continued high and the presence of neuropsychiatric disorders among the troops were minimum.  Here again the censors of the mail reported the high morale among the men.

The Division crossed the Channel, splashed across France and arrived in Belgium where it replaced the Second Division in the line.  The Clearing Station was set up at St. Vith, Belgium and two wards were assigned for the cases diagnosed as Exhaustion.  Here very few men were admitted to the Clearing Station with diagnosis of Exhaustion, and it is interesting to note that those who were admitted were recent additions to the Division.  Most of these men gave histories of previous civilian or military care of their "nerves".  A contributing factor to the low neuropsychiatric admissions to the Clearing Station was the fact that men with mild functional complaints were treated at the Regimental Train Areas, not in the front lines.  In those areas they were sedated and boarded for no more than 48 hours and then returned to front line duty.  This policy could not be continued because of the great fluidity of the situation.  Those who were not improved after this regime were evacuated to the clearing station.  Another contributing factor was the very satisfactory billeting of the men in the forward areas as well as the "erroneous" belief that the area was being utilized as an indoctrination site "before sending troops into full battle."

On the whole, the mental attitude of this Division was at its highest peak.  It was prepared for combat both mentally and physically.

On 16 December 1944, this Division received the full impact of the German offensive.  The element of surprise and the fury with which the Germans attacked certainly had its effect on each man in the Division, particularly the men in the front lines, who were considered the most stable because of the XXXXXXXXXXXXXXXX.  XX a very few days most of these men became thoroughly frightened, clinging, trembling, exhausted men who, though expressing a desire to return to their organizations, did not have the strength to stand on their feet.  The look of terror in their eyes was significant.  Each man evacuated to the clearing station had received for the most part adequate sedative medication in the Battalion Aid Station.  It was interesting to note that many of these men did not want assistance from any of the corps men.  Most of these men who came through the station had not been neuropsychiatric problems in the past.  The patients were of all ranks and s surprising percentage of non-commissioned officers came through.

All the men with functional disorders complained bitterly of the severity of the continuous German artillery barrage - particularly the noise.  Many complained of the screaming "Mimmies".  Most of the men complained severely of the German 88's and of the latter's effectiveness.  Men entered the station clasping their hands tightly against their ears, stating that they could still hear the thunderous barrage. Even following a 24 hour period of adequate sedation some of the men still held their ears.  But after some persuasion this practice ceased.  Occasional gunfire in the distance would bring on a renewal of the symptoms but with continued reassurance became symptomless.  Some of the men cried bitterly over the loss of "buddies" and of whole companies.  Many men could not be adequately treated in this echelon of medical care.  Very few men at this station complained of "the sight of so much blood".  The predominant picture throughout was severe anxiety.  Not one malingerer was noted among the patients at this station.  Very few men were evacuated to this clearing station in restraints.  Of these, all were reassured and the restraints were removed within a very few hours after admission to the ward.  During this period no patient revealed any evidence of a psychosis.  A very common symptom among all the patients was the "startle reaction".  The dropping of a utensil or the slamming of a door could easily induce trembling or apprehensiveness.  The sleep of many of the patients was disturbed by "battle dreams", but these were no different than those reported before by other observers.

Because of the great number of patients in the clearing station, the necessity for frequent movements, the uncertainty of evacuation by army, and the severity of the symptomlogy of the patients necessitating extended sedation and psychotherapy, it was necessary to evacuate most of the patients.  The contemplated 3 day treatment plan could not be carried out.

The tables compiled on the Combat Exhaustion cases evacuated to the clearing station by no means presents the true picture of the situation.  Many men are still missing.  The tables are significant in that they reveal the height of the fury of the battle - and as the lines became more stabilized, the less were the admissions to the clearing station.  And during this latter period the few men that did come to the clearing station were not the type of patient seen during the height of the battle.  These patients were not those with old cardiac complaints.  G. I. complaints, as well as back and leg complaints, for which no organic disease could be determined.  Most of these men were returned to duty after 3 days stay at the clearing station where they were permitted to talk about their experiences, wash up thoroughly, ate three square meals a day and got plenty of rest.  One would expect a greater number of cases to appear in this Division among the troops during this latter period.  Neuropsychiatric disease has not been a problem in the Division.

With the above evidence in mind, it becomes obvious that any individual, regardless of his background, can succumb to excessive mental trauma and become a neuropsychiatric causality.  This fact is known to be true.  The personnel of this Division certainly were mentally qualified for combat.  There still remains the thought among some troops that the enemy cannot last much longer - that "he hasn't got much to fight with."  These thought certainly leave the individual more susceptible to overwhelming mental traumate when surprising enemy action does occur as it did this month.  Our troops are not "battle wise" after a surprising short period of active combat.  They learned the hard way.  The lesson has now been well learned and through there will continue to be neuropsychiatric casualties among our troops, it will not be because they are not prepared for any eventuality.

The following data of combat exhaustion in the 106th Infantry Division had been compiled for your information.  The period concerned in this report is from 9 December to 31 December 1944, inclusive.

The data obtained on the following organizations is incomplete due to the fact that the largest component of each is still missing in action.

422d Infantry 6
423d Infantry 6
589th FA Bn 2
590th FA Bn 0

The records of the 591st and 592d FA Bns are incomplete because  they had been attached to other units for a period of time.

The following organizations are for the most part intact and the data is submitted to reveal the incidence  of combat exhaustion in these units.

1 X = 1 case
Organization No. of cases  
424th Infantry 89          
     Hq. Co. 4 XXXX
     Service Co. 0          
    Med. Det.  4 XXXX
    Cannon Co.  3 XXX
    AT Co. 4 XXXX        
    HQ, 1st BN  2 XX        
    Co. A 6 XXXXXX
    Co. B 8 XXXXXXXX
    Co. D 4 XXXX        
    HQ, 2nd BN 0          
    Co. E  3 XXX        
    Co. F 5 XXXXX        
    CO. H 6 XXXXXX
    HQ, 3rd BN 1 X        
    Co. I 2 XX        
    Co. K  8 XXXXXXXX
    Co. L  2 XX        
    Co. M  1 X        

Other Units in 106th Division

81st Engr Bm 8 XXXXXXXX
331st Med. Bn 3 XXX
FA Hq & Hq Btry 0  
591st FA Bn 0  
592nd FA Bn 4 XXXX
Special Troops 0  


December No. Cases  
9 2 XX
10 2 XX
11 0  
12 1 X
13 2 XX
14 4 XXXX
15 2 XX
16 4 XXXX
24 0  
25 1 X
27 3 XXX
28 3 XXX
29 0  
30 1 X
31 2 XX

Division Troops
Total of combat exhaustion cases 118
Evacuated to Evacuation Hospital 91
Returned to duty 27
Percentage of combat exhaustion of all admissions 9.2%

Non-Division Troops (7th Armored; 9th Armored; Attached Units Cleared through 106th Clearing Station

Total of combat exhaustion cases 79
Evacuated to Evacuation Hospital 69
Returned to duty 10
Percentage of combat exhaustion of all admissions 12.3%

For the Surgeon

Major, Medical Corps

Contributed by John D. Bowen, National Archives Researcher
Page last revised 09/19/2016
James D. West