Battle of the Bulge: German Medical Care

My main source is the German Infantry Handbook 1939-1945 by Alex Buchner (cheaper options available on Ebay, or at the Barnes and Noble marketplace).

The Handbook lacks Battle of the Bulge specific information but the Back-Line Services chapter has sections on medical and veterinary services. This chapter is very interesting as I have never thought about the need for a divisional butcher company ("capable of slaughtering 15 cattle, 120 hogs or 240 sheep and making up to 3000 kilograms of sausage daily").

Organization

Medical units were divided into troop and divisional services. Troop medical services began with a trained medic assigned to each platoon, and a medical NCO and soldier assigned to the company HQ. The company medics usually worked with the battalion surgeon during a battle and along with auxiliary stretcher bearers were responsible for taking the wounded from the battlefield.

In combat, the hope was that a wounded soldier could be taken off the battle field to a "nest" or collection point, immediately behind the front line. There first aid would be given and transportation to a troop dressing station (TVP) where the battalion surgeon provided "the first professional care" to include bone-setting, stopping of heavy bleeding, serums and other medicines, etc but not surgery.

Transition to divisional care took place at "wagon stops" where troops would be transported from TVPs to a main dressing station (HV-Platz), usually located three kilometers behind the front here.
Here we get our first insight into the difference between U.S. and German medical care.  The Americans relied on jeeps to transport the wounded off the battle field while the designation of "wagon stop" evokes a slower method.

Each division had a medical company, organized in three platoons and other units. All specifics on equipment and number of personnel have to be view as taken from the standard organizational chart and was probably the "best case" for actual medical support resources available:

• 1st Platoon - Stretcher-bearer platoon. Led by a specialist. Collect troops from the battlefield and set up the wagon stops.
• 2nd Platoon - Main dressing station platoon. Commanded by a surgeon. Responsible for setting up the HV-Platz. They had "a complete operating facility packed in portable containers, with full lighting and a light field X-ray machine". 
• 3rd Platoon - Replacement platoon. Commanded by a surgeon (when possible). Helped the other two platoons and set up collecting stations for slightly wounded or sick men.
• Field Pharmacy (transported in 3.5 ton truck). 
• Dental Station (dentist and assistant)..
• At least one cook capable of preparing special rations for patients.
• Two ambulance columns. Each column had three platoons (40 men and 12 ambulances, two cars and 8 sidecar motorcycles). These columns were used to transport wounded from the Hv-Platzs to field hospitals or other medical facilities.

In addition, the motorized divisional field hospital was manned by five surgeons, assisted by 66 men. Transport included 6 cars, 11 trucks and two motorcycles with sidecars. This level of resources allowed for the care and treatment of up to 200 to 300 patients. The book describes how the field hospitals were usually insufficiently manned and could be ineffective in their mission due to the frequents moves required to stay out of danger. Under a reorganization for infantry divisions in 1943 section the book lists divisional medical services as:

• 1 medical company, horse-drawn
• 1 medical company, motorized
• 1 ambulance company

Long term care and care for the severely wounded would be dependent on local medical infrastructure in the general vicinity or transport back to Germany. 

Veterinary Services

For an army dependent on horse drawn transport (each division had over 5000 saddle and draft horses), veterinary services were as vital to the mission as regular medical services for the humans. 

The veterinary organization consisted of regimental and battalion vets subordinate to the divisional staff. The regimental, battalion and unit vets were located "on the spot where the horses were" so they performed their duties in dangerous locations. .  

Each division had "about thirty" veterinary officers of different skill levels with a strong contingent of reservists called up from rural areas. 

The book doesn't make clear how a veterinary company related to the regimental and battalion veterinarians so I'm guessing it was a divisional asset.  The Veterinary Company consisted of:

• Six vet officers
• 24 NCOs
• 203 enlisted
• 88 horses
• 21 wagons
• 1 car 
• 9 trucks
• 1 solo and 2 sidecar motorcycles.

The Veterinary Company was responsible for setting up a collecting centers where wounded and sick animals would receive their "first adequate treatment", a small field hospital along with an area to quarantine horses suspected of contagious diseases and a supply section where healed horses were returned to service or new horses from army remount stations were cared for then distributed.

Hiwis (Soviet prisoners that volunteered to help the Germans) contributed greatly to the veterinarian services. Readers may remember this post in which a Hiwi reenactor is caring for a horse.

After years of reading military history, years of wargaming and knowledge of the vital role horse transport was to the German Army I never gave thought to the fact that:

"Normally every company, battery or unit had a blacksmith or blacksmith NCO.  In the battalions and similar units, and in the veterinary companies, there were master blacksmiths..". The blacksmiths often helped as veterinary assistant giving first aid and care of sick and wounded animals.

Impact of Allied Air Superiority

Foreign Military Studies  MS # B-048's titled Mission of the Chief Army Medical Officer of the Fifth Panzer Army reveals the impact of Allied air superiority towards German medical care:


- Throughout 5th Panzer Army's area of operations a significant portion of casualties, military and civilian, were caused by strafing airplanes, requiring an increased number of surgeons.

- River crossings for medical ferries were located away from troop ferries and marked by "appropriate flags".  River crossings and their associated traffic jams were prime targets for Allied aircraft.

- There were shortages of ambulances and gasoline and sometimes the shortages were exacerbated by air attacks on the ambulances ("frequent enemy air attacks, even on vehicles bearing the Red Cross emblem"). It seems that Allied aircraft attacks on medical installations were "probably unintentional" and "Generally, stations marked with Red Cross emblems were spared by the enemy" but the report states there were many cases aircraft attacking ambulances in broad daylight.

- Air attacks on transportation infrastructure (highways, ferries, overpasses, railways and rail stations) effected the evacuation of wounded to the rear and medical supplies to the front. 

Here is the final paragraph of the report:

"As a result of enemy air superiority, losses were particularly high, the performance of medical duties particularly difficult, and the conditions for adequate treatment of wounds and recovery particularly unfavorable. On the German side, there was no shortage of war-experienced medical officers, and to the end there generally was no lack of medical supplies, but circumstances beyond out control dealt the heaviest blows. Up to 500 casualties passed through collecting stations daily. The job done by the surgeons, who often kept on operating for 16-18 hours practically without pause, could not be surpassed". The same applies to the accomplishments of the medical officers and medical personnel, who worked day and night, and in particular to the performance of the courageous ambulance drivers".

Battle of the Bulge: U.S. Medical Care

Evacuation by 1/4-Ton Truck in deep snow in the vicinity of Monschau and illustrates Medical Detachment personnel of the 393d Infantry Regiment, during the Battle of the Bulge. Picture from 324th Medical Battalion Unit History

U.S. Medical Care

Battle of the Bulge Memories needs to be added as a permanent link to the index as this is the second time the site has come up in searches for relatively obscure information.

This article, Medics in the Bulge by Ralph Storm provides a great overview, not only of medical care during the battle, but also throughout the European Theater of Operations (ETO).

Storm's article goes beyond medical unit organization and front line procedures with extended sections on typical medical cases such as trench foot, cold injury and combat fatigue.

A quote from medic Keith Winston of the 100th Division (note: the 100th ID was not at the Bulge but held the line to the south as other divisions were rushed north)  on casualty evacuation under ideal conditions:

 "A boy gets hurt on the line.  Within a minute or less a telephone message is sent back to our forward aid station, a distance of 300 to 1000 yards from the front, where a Sergeant and four litter bearers are always on hand.  They rush right up to the line with a litter." First aid with an emphasis on stopping bleeding and hopefully by the time the patient was stabilized another litter team will have arrived to take the wounded to " where a jeep can travel... anywhere from 25 to 300 yards, depending on conditions."

The Medics definitely were earning their combat pay even when they were not entitled to it until early 1945!

Aid stations were located 1 to 3 miles behind the front line, did not have beds and only had the bare essentials. A physician would look at the patient who was then sent to a clearing station farther to the rear with a note from the physician on a card, attached to a button hole in the patient's coat.

Be sure to read the piece on litter carrying in the article.  It is in the aid station section and describes the exhausting work.  During emergencies it was not unknown for the battalion surgeons would act as litter bearers.

 The clearing stations would probably still be in artillery range of the enemy but this was the spot that any emergency operation would be performed. Finally, the wounded are taken by ambulance to an evacuation hospital, "where first class attention is administered".

During the Bulge many of the hospitals had to constantly move. The 130th General Hospital at Ciney, Belgium (northwest of Bastogne), was caught up in the fighting just as they were moving out.

Again, I highly recommend this article as it contains a wealth of information and interesting insights such as how penicillin could be extracted from the urine of patients and reused and despite the U.S. Army being segregated a decision was made not to set up segregated hospitals due to the impracticability and redundancy.

Summary of Winston's description:

Front line medics:

• stabilize until litter team can pick up and carry to where a jeep can pick up the wounded.

Aid Stations:

• fist look by a physician and initial diagnosis performed.

Clearing Stations:

• emergency operations performed.

Evacuation Hospital:

• "where first class attention is administered"
• If a patient needed more than six months of care he was sent back to the U.S.  Less than six months, he would be kept in theater for a quicker return to his unit.  During the Bulge this time was shorted to four months (to be sent back to the States) due to the surge of casualties. 

Warfarehistorynetwork.com has a good article on the U.S. Army Medical Corps in WW2 and mentions Portable Surgical Hospitals (PSH's). Originally, I thought PSH's were the clearing stations described by Keith Winston but they were a little more specialized.

 From the article:

"These spartan PSH tents were set up to accommodate major surgery, sometimes so close to the front that they were under fire from the enemy. They retreated or advanced rapidly with the fortunes of war. A staff of a fully equipped PSH could disassemble and load tents, equipment, and personnel onto waiting trucks within two hours"

The "ideal" process for treatment in the Warfarehistory's article summarized:


Front Line medics:

• Treat where the wounded man fell.  
• This usually consisted of a shot of morphine to prevent him from going into shock, some sulfa powder to keep his wounds from getting infected, and a rapid bandage to stop the bleeding.

Battalion Aid Station:

• "perhaps a kilometer behind the lines". 
• Thorough first aid, diagnosis, and serious injuries stabilized. 

Collecting Station:

• Further back from the aid station.
• Serious casualties sent to a PSH (if available) or sent the wounded to a clearing station that consisted of 12 doctors and 96 enlisted men.

Clearing Station:

• "major medical surgeries could be performed in sanitary conditions before the worst cases were sent to an evacuation hospital."

Portable Surgical Hospital:

•   Major surgery, probably allowing for more complicated cases than a clearing station.
•   Sometimes located in range of enemy artillery.

Evacuation Hospital

• 12-15 miles behind the lines.
• "Seriously wounded were shipped to a general hospital as near to the home of the individual soldier as possible."

Overview

Compared to conditions in WW1 the mortality rate for a wounded soldier fell from a little over 8% to 3%.  During the Civil War the mortality rate was as high as 25%.

I'll begin reading and try to find information allowing a comparison between medical care available to the Germans at the Bulge.  To help this comparison any suggestions and comments are welcome.

Related Links

Link to the Bulge series index.

324th Medical Battalion unit history, from training to deployment and their actions during the Bulge.

Recollections from nurse Dorothy Steinbis Davis who served in a field hospital in the European Theater of Operations with the 7th Army.