XXXXXXXXXXX

XXXXXXXXXX

(TABLES CANNOT BE ACCURATELY READ - Two not shown here)

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.

MEDICAL DEPARTMENT

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

EVALUATION OF THE MENTAL HEALTH OF THIS COMMAND

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. C	13	XXXXXXXXXXXXX
Co. D	4	XXXX
HQ, 2nd BN	0
Co. E	3	XXX
Co. F	5	XXXXX
Co. G	13	XXXXXXXXXXXXX
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

NO OF EXHAUSTION CASES ADMITTED TO THE 106th CLEARING STATION FOR EACH 24 HOUR PERIOD FROM 9 DECEMBER TO 31 DECEMBER 1944 (inclusive)

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
17	8	XXXXXXXX
18	28	XXXXXXXXXXXXXXXXXXXXXXXXXXXX
19	8	XXXXXXXX
20	16	XXXXXXXXXXXXXXXX
21	45	XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22	16	XXXXXXXXXXXXXXXX
23	20	XXXXXXXXXXXXXXXXXXXX
24	0
25	1	X
26	8	XXXXXXXX
27	3	XXX
28	3	XXX
29	0
30	1	X
31	2	XX

SUMMARY OF ADDMISSIONS & DISPOSITIONS
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


MARTIN M. FISCHBEIN
Major, Medical Corps
Neuropsychiatist