The German Medical Corps
Mike Kaskalavich, Contributor to the website.
One can compare the life as a medic to that of memoirs of US medics serving in battle during WWII. German medic or säni carried out their duties under sometimes treacherous conditions either in the rear or on the front lines. Their self-sacrifice to help their comrades should never be forgotten.
According to Alex Buchner’s book Der Sanitatsdienst des Heeres 1939-1945 (1999) German Säni’s were not a troop or service arm, but had a cornflower-blue piping on their uniform and had typical army organization, structure and designations. All of the medical corpsmen wore the same field-gray uniform and equipment as all the other German soldiers, but added a Red Cross armband on the left sleeve of their uniform. All members of the medical corps were under the protection of the Geneva Convention of 1929. The German säni must wear the Red Cross arm band at all times and be clearly visible on the uniform. The Red Cross must be visible from a distance on buildings, tents, vehicles etc. These marked areas were to be used only for medical purposes and not serve as any other military function. This rule would not be followed in the eastern front due to Russian soldiers firing on medical personnel and would seek out the Red Cross as a target. This would also include the discontinued use of the white helmet with Red Cross or any helmet with markings. Soldiers in the western front would continue to follow the rules of the Geneva Convention due to the professionalism of the American soldiers. Side arms were also less equipped on the German säni on this front, but photographs indicate that side arms were still worn by the säni. In interviews with surviving German medic personnel it was merely a matter of choice what equipment that would be carried. Some would use issued medical gear, others would rather pick up an American or British medical satchel or rucksack because of its easier access and storage capabilities.
According to the directive from the Army High Command of May 23, 1939, according to which all Wehrmacht personnel were combatants, the members of the medical corps were also armed, with pistols as well as 98k rifles. According to the Geneva Convention they had the right, in case of and for the duration of urgent danger, to defend themselves and persons in their care with those weapons. The 98k rifle issue is not hard to believe, all men were soldiers first, specialty second. However the 98k would not be carried on the front line, only the sidearm for immediate protection. The bayonet would most likely be worn and is usually common to see in original photos to assist in providing medical care, such as making a tourniquet. This was because of the different approach to medical care compared to that of the USA and Britain. The German medical soldier on the front lines was, according to standard procedure, stationed at a triage area to the rear of the front called “Verwundetennest” or Wounded Nest. Here the wounded would get their triage type treatment and first aid, immediate transport, or ID Plate collected (death) from the Sanitätsunteroffizier – Medical NCO. The regular Heer soldiers that took additional medical first aid treatments were used and they would have a red cross that would be worn only when in medical duties. This soldier would be known as a Krankenträger (Stretcher Bearer). There were usually more than one in a company and would be responsible for stretcher duty and removing wounded from the battlefield to the Verwundetennest.
The ranks of the German Army Medical Corps:
Hilfskrankenträger – auxiliary stretcher bearers – were normal members of a company with a little bit advanced first aid training. In case a combat situation made it necessary they “dropped” their weapon, got an armband (either “Hilfskrankenträger” or a red cross armband), a basic first aid pouch and mainly recovered wounded comrades from the field plus providing basic aid (bandages etc.). There were usually 8 such men preselected for this.
Krankenträger – Stretcher bearers – were constantly with the company, constantly marked with a red cross armband, had two medic pouches and a pistol. There were usually four in a 1941 infantry company. They were better trained in first aid (2months medical training). These Krankenträger’s had the same color of arms on their uniform as the company type.
Sanitätsunteroffizier – Medical NCO – There was one in each company size formation. He was responsible for the professional medical treatment and organization in the company during garrison and in the field. He was specially trained in a medical school (training about 6 months) plus special courses. They always were marked with a red cross armband and a caduceus emblem on the left respectively right lower arm and showed the cornflower blue color of arms of the medical branch. If necessary the medical NCO´s of the companies gathered and built the Truppenverbandplatz of the battalion.
Sanitätsoffiziere – Medical Officers (Junior Medical Doctor/Officer- Battalion MO) were the first level doctor’s the wounded/ill soldiers would see at battalion headquarters. This was usually a young doctor who provided first professional life support at the troop bandaging station of the battalion. In mobile situations this was performed directly at the patient in the field. Sanitatsofficer wore blue waffenfarbe and in charge of the Unteroffiziere’s and direct advanced care (short of big surgery) in the battalion aid station (Truppenverbandplatz of the battalion).
Slightly different rules apply for the training of potential officers in specialist careers who, in addition to their military education, require a certain type of professional training. These are the careers of medical officer, veterinary officer, ordnance officer, and officer of the motor maintenance troops. In addition, the administrative officer and judge advocate careers in the Special Troop Service require special rules regarding the replacement of their officers. Training of the German Säni was very intensive, and the requirements were very high. The certificate of completed training was the Dv. 59 manual. This manual consisted of 431 pages covering topics such as first aid, the care of sick and injured and supporting medical officers and maintaining medical supplies and equipment. After completion of this course and passing the exam, the trainee was allowed to wear a round emblem with the staff of Aesculapius on his lower right arm. (Buchner, 1999)
Potential medical officers (Sanitäts-Offizier-Nachwuchs) active medical officer applicants are selected from secondary school graduate volunteers by the Wehrkreis surgeon in connection with the recruiting sub-area commander. They take part in the officer applicant training conducted for potential infantry officers, and after its conclusion and a short assignment to a field unit are appointed officer candidates. At that time, they are assigned to the Medical Officer Academy and begin taking medical courses at the university. After a certain period of time they are promoted to medical technical sergeant (Feldunterarzt). Upon passing their medical examination, they become officers. Soldiers of the Field and Replacement Army may be accepted for this career if they fulfill the requirements. Doctors and medical students may become reserve medical officers. While taking medical courses at universities, the reserve medical officer candidates are assigned to medical officer feeder battalions (Sanitätsoffizier-Ergänzungs-Abteilungen). Potential veterinary officers (Veterinär-Offizier-Nachwuchs) like the medical officer applicants, the active veterinary officer applicants are selected from young civilian volunteers and from soldiers of the Field and Replacement Armies. Their officer applicant training takes place in a mounted replacement and training unit. After their promotion to officer candidates they are assigned to the Army Veterinary Academy. They become active officers upon passing their veterinarian examinations. Veterinarians and veterinary students may become reserve veterinary officers.
Sänitater medical pouch contents:
1 anatomical tweezers, 1 clinical thermoneter, 1 wood-spatula, 1 nail-cleaner, 1 scissor 14cm – 16cm long, 3 band aids 5m x7cm , 6 band aid packs, 1 ligature-bind, 1 leather case with 20 safety-pins, 1 piece waterproof band aid 50 x 45cm
1 paper-box with 2 iodine bottles 4ccm Tinctura Jodi, 1 artificial resine soapbox with 50g soap, 1 paperbox with 1 roll Collemplastrum Zinci 5m x 2,5cm, 5 band aid packs 8cm x 9,5cm in paper, 1 grey aluminium box with 1 one tube 10ccm Unguentum saliicylici 2%ig, 2 tubes 10ccm Unguentum Formaldehydi 8%ig, 1 tube 10ccm alcalic eye-ointment. 5 aluminium tablet-tubes with 20 tablets Acidum acetylosalicylicum 0,5g, 20 tablets Opium 0,03g, 15 tablets Rhizoma Rei 0.5g, 20 tablets Cardiazol 0,1g, 10 tablets Natrium bicarbonic 1,0g.
Weight: 1,6kg, dimensions: 17x8x10,5cm, Packordnung: H.Dv.208/4
Krankenträger Pouch Contents
Equipment of the German Säni
Wounded tag used to identify the wounded. Applied by the Säni
Medical certification kept with Soldbuch. Made out of resistant cloth.
In an unknown memoir, Wehrmacht veteran Dr. Haen wrote: ‘The “Aesculapius” (snake on a stick) that was issued to me after a mere two months training (in between regular training) as a ‘hilfskrankenträger” was worn by me on the RIGHT sleeve, just like the picture shows. There were others who wore theirs on the left sleeve, so I am not sure what was the norm. If I am not mistaken the color of the aesculapius was blue, but I may confuse it with the one I wore much later with the Netherlands Red Cross Corps, looking identical, but on a rectangular piece of cloth. I never wore the red cross armband, as (according to seasoned vets of the time) it served ill willed opponents as a target.’
‘Also I was issued a “bag” rather than the Koppeltaschen; and at Arnhem I used a British medic bag when mine ran out of supplies. There also were a whole group of guys trained as “krankenträgers” or “hilfskrankenträgers’. (Wounded carriers and assistant wounded carriers) They got a few weeks or up to two months field first aid and hygiene” training, and were returned to their own units, with just a little sleeve patch. Sometimes (as in my case) they served in double capacity, for example I was a Kradmelder (motorcycle dispatch runner) as well as a “krankenträger’, Due to lack of gasoline the “krad” melder in the end became “rad fuss oder bauch” melder. ( bike, walk or crawl runner).’
Early War 1939
The Organization of the Medical Service of the German Army and its Employment in the Campaign Against Poland (An article by Lieut. Colonel H. Hartleben, Medical Corps, German Army. Military Review, Sep 1940).
The medical service, as well as other branches of the Army, finds itself faced with new missions, new tasks and new problems as a result of the changes brought about in modern warfare by motorization and mechanization. The Campaign in Poland offered the first opportunity to test the organization of the medical services of the German Army in this new warfare.
The two main problems that must be solved by a military medical service are:
- The problem of providing the best medical supply system that is possible under warfare conditions.
- The problem of transportation, especially in a war of movement. A simplification of these problems will result if the organization of the medical service is so elastic as to meet the various requirements of war under all conditions and if it is founded on the simplest and most uniform basic elements possible in order to measure up to the requirements of the various types of combat elements.
The medical service of the German Army, as in any army, emanates from the combat units. Every soldier carries one large and one small first aid packet and is trained in the application of these dressings. The medical personnel of the combat units include litter bearers with special training in first aid and the transportation of the wounded. In addition, a medical noncommissioned officer or private with thorough and careful training in medical service is assigned to each unit. All of the medical personnel, including the litter bearers, carry on their belt a medical kit for first aid. The litters consist of two equal-sized collapsible halves; they are so constructed that the bearers can easily carry and assemble them with few manipulations. Conditions permitting, the litters may be transported on two-wheeled carriers.
The infantry battalion is accompanied by two medical officers-the battalion medical officer and his assistant. Their equipment contains quantities of medicine and dressings sufficient to meet the demands of major operations. Included are tetanus antitoxin and a “pack filter apparatus” for the purification of water derived from any source. This equipment, packed in chests, is carried on a special medical equipment car. Small units may carry enough of this equipment to meet their own demands. In combat, the equipment of the battalion medical officer, together with his personal equipment which he carries with him in a leather case, serves for the establishment of the battalion aid station. This aid station is located as near to the actual front as possible. As a rule, the wounded receive their first aid by a medical officer at this station, unless such aid has been rendered in battle. Aid by a surgeon-specialist usually cannot be given at the battalion aid station, and no provisions are made for it.
The medical service within the infantry battalion is, thus, conducted independently by its own medical officers and their assistants-the medical NCO’S and privates. The medical service of the other arms is carried out in a similar manner, though with less personnel and equipment. Provisions are made for support by medical companies which go into action when casualties are heavy and serve mainly for the purpose of collecting the wounded in the zone of action.
From the battalion medical detachment, the medical service passes to the medical elements of the division. They comprise normally of two medical companies, one motorized field hospital (accommodations for 200 patients), and two motor ambulance trains (15 motor ambulances each). These elements are under the command of the division medical officer. Depending upon the type of division, the medical companies are either horse-drawn, motorized, or one company may be motorized and the other horse-drawn. In the case of very highly mobile units, the field hospital is omitted and replaced by a third motor ambulance train, in order to meet the constant transportation requirements.
Both on the march and in combat, the medical companies constitute the main factor of the division medical service. Each company consists of three platoons, each of which has a separate function. The first platoon is made up entirely of litter bearers who collect the wounded in the field and evacuate them from the battalion aid stations. The second platoon organizes the division aid station; it includes at least one surgeon-specialist. The third platoon may be used in support of the other two platoons or for independent missions. Near the division aid station elements of the medical company may be used to establish the collecting station for slightly wounded.
The employment of two medical companies in the division makes for great mobility of the medical service. It permits the medical service to keep up with the advance of the combat units and, in cases where the two companies are employed separately or in relief, to carry out the surgical work and to evacuate the casualties in a normal manner. It permits the establishment of two medical centers behind the combat troops where the operations cover a wide front. Besides, both companies may be employed jointly under favorable conditions. Thus the medical service of the division is elastic enough to conform to any number of changes in the situation.
The equipment of a medical company includes canvas for the erection of the division aid station (where buildings are not available) and modern surgical equipment. Like the battalion medical equipment, the equipment of the medical company is suitably packed in individual chests. Four horse-drawn or motor ambulances are assigned to the company.
The division aid station is the first place at which surgical aid is rendered. Here the wounded are examined as their fitness for removal, their condition is improved and emergency operations are performed. The duties of the division aid station are limited to these functions because of the necessity of maintaining the mobility of the medical companies and of their remaining as near to the combat units as possible—three or four miles behind the front line.
Surgical activity within the division is centered further back in the surgical hospital, where the routine should be similar to that of a regular hospital in the zone of the interior. Its equipment is somewhat larger and heavier than that of the division aid station. The surgical hospital is motorized and can follow the division quickly upon being relieved by other medical units. If necessary, a second surgical hospital may be moved up to support the division surgical hospital, until relief arrives.
The division evacuates its sick and wounded mainly by means of its motor ambulance trains, part of which may be used for the evacuation of patients from the aid stations to the rear or to the division surgical hospital. The motor ambulance trains serve also for the transportation of wounded to collecting stations or hospitals in the communications zone. The motor ambulance of the German Army accommodates four lying, or two lying and four sitting, or eight sitting patients. A number of motor ambulances are equipped for cross-country travel.
The division medical service as outlined above may be reinforced temporarily, if necessary, by additional medical elements. Besides, surgical hospitals of the army unit may be employed in all zones if circumstances call for such reinforcements, as, for instance, in the case of epidemics.
A corps medical officer is designated to supervise the execution of the directives from the army medical service, to supervise the progress of the division medical service and to take such corrective action as he may find necessary. He is authorized to shift the medical elements within the division for the purpose of balancing their strength. He also has at his disposal special medical elements which he may employ whenever the divisions call for help. He may also call upon the army chief medical officer for additional medical units if required.
The purpose of the organization of the medical service above the division is to regulate and execute the evacuation of patients to the rear, and to sort the sick and wounded according to medical requirements. All of this belongs to the functions of the army chief medical officer. Depending upon the size of the army, he has at his disposal a varying number of medical units, especially motorized surgical hospitals designed for local support of the division medical services. For evacuation purposes, he has under his command a number of motor ambulance trains organized like those of the divisions. These medical units are combined into an army medical detachment.
Each army has two evacuation battalions. They are organized into three companies of three platoons each. Each platoon is equipped to set up a separate collecting station. The collecting stations serve merely as transfer stations where the patients receive simple medical attention and are afforded rest and food for brief periods. These stations are placed at points where the situation indicates a concentration of wounded and also at points where the sick and wounded must be distributed among the various hospitals in the communications zone or loaded on hospital trains.
The hospitals in the communications zone are divided into hospitals for the slightly wounded and hospitals for the seriously wounded; each numbers up to 500 beds. They are equipped as much like regular hospitals as possible and contain special wards under the direction of surgeon-specialists. Where local hospitals are available, they are, of course, put into service. Other large buildings may also be used to house the hospitals. The mobile hospital equipment includes as standard equipment capable X-ray apparatus and dark room equipment, all suitably packed in chests.
In order to keep the medical services with combat units properly supplied at all times a medical supply depot is allocated to each army. This army depot may establish branch depots where and when it deems such stations necessary. The officers of the medical service are picked for their professional ability as well as for their qualities as leaders. Assigned to the chief medical officers of the armies as consultants are carefully selected and recognized specialists in their profession—generally university professors. The latter assist the medical officers of the various medical establishments either with advice or, when necessary, actual help. In addition, the army chief medical officer has at his disposal special groups of auxiliary surgeons. These surgeons, carrying their own sets of surgical instruments, go into action where their assistance is most urgent, be it at the division surgical hospital or the division aid stations. It was demonstrated in the Polish campaign that it is not advisable to send these surgeons any further forward than the division aid station.
The German Army entered the war against Poland with a medical service organized along the lines described above, and found that no material changes were necessary in that organization—that it could solve all the problems with which it was confronted. Chief among the problems encountered was that of transportation, for not only did the military operations proceed at an extraordinary pace but the road conditions in Poland were decidedly poor. Nevertheless the elasticity and the simplicity of the organization enabled the medical service to keep itself and its supplies moving forward with the combat units while casualties were being evacuated with a maximum of efficiency and speed. The motorized medical units bore the brunt of the burden, the horse-drawn medical companies being unable to keep up with the swiftness of the military operations. The motor ambulance trains performed tremendous feats. Thanks to the motorization of the division surgical hospitals, they were able to follow the combat units at a relatively fast pace. In many instances, the hospital units established themselves quickly in local hospitals, schools or other public buildings, even though the primitive conditions in certain parts of Poland made it necessary frequently to resort to auxiliary measures.
The great distances that the medical units were required to cover could have been fatal to wounded, whose condition called for special treatment in clinics located in the zone of the interior. The large number of demolished railroad bridges was quickly repaired, however, thus permitting the use of the specially equipped hospital trains for the evacuation of patients by rail to the zone of the interior. In very serious cases, such as gunshot wounds of the eye or skull and fractures of the femur, patients were evacuated by aircraft-either in ambulance planes or in the regular transport planes. Evacuation by air over great distances proved highly satisfactory, particularly since no major variances in altitude were involved.
In view of the prevalence of centers of communicable diseases in Poland, a certain number of losses due to various kinds of diseases were anticipated. However, every German soldier being inoculated against typhoid fever, the number of typhoid cases was extremely small. Dysentery cases occurred, for the troops had to march through many regions where that disease was common. Well trained in hygiene, the troops succeeded in keeping the disease down and prevented the spread of a regular dysentery epidemic. There was not a single case of smallpox among the soldiers. The inoculation of all wounded against tetanus proved a complete success. Lockjaw has lost its terror as a war disease.
The casualties were relatively small. Official figures have been released, placing the killed at 10,000 and the wounded at 30,000. Thus the ratio of killed and wounded is 1:3, a somewhat higher ratio than that of the war of 1914.
Medical Corps Operation Structure
The following information was derived from the “Medical history of the German medical corps, documented by the U.S. Army Medical Department, Office of Medical History” (1945).
WEHRMACHT HOSPITALIZATION AND EVACUATION
The chain of evacuation of German wounded was found to be very similar to that utilized by the US Army, but triage, that is sorting of patients for specialized hospitalization, differed in several important aspects. First aid to the wounded was rendered in a Verwundetennest by a medical non-commissioned officer, in an extreme forward position. This treatment can be said to compare in echelon to that given by a US company aid man on the field of battle. Here the first dressing, improvised splinting for transportation ease, traction splinting, pressure bandages and tourniquets were applied. The wounded were evacuated from the Verwundetennest to the Truppenverbandplatz, which corresponded to the American battalion aid station, and where the first medical officer, corresponding to the US battalion surgeon, practiced. Treatment given at this station included: checking of the dressing (unless there was some indication the dressing was not to be disturbed) ; tracheotomy; application of occlusive dressings to open chest wounds; relief of pain; preparation for further evacuation to the rear; shock therapy in the forms of peristone, physiological salt solution, coramine, and external heat by electric heaters; prevention of infection, by injection of tetanus antitoxin and gas gangrene antitoxin, administration of sulfapyridine by mouth, insufflation of sulfanilamide powder into wound at time of first dressing, pressure bandage, and arrest of hemorrhage by application of tourniquet (rarely by hemostat or ligature); and catheterization.
From the Truppenverbandplatz all the wounded were evacuated to the Hauptverbandplatz, which was established about four miles to the rear of the combat line by the Sanitaets Kompanie of the division. This unit was staffed to perform the functions of both clearing and hospitalization. Its Tables of Organization provided for two operating surgeons, but in times of stress six or eight more surgeons might be added. The unit was designed to hospitalize two hundred patients, but often expanded to three or four hundred. When the flow of casualties was not heavy, all those patients with abdominal wounds and other non-transportable cases were given primary surgery at this installation. In addition, primary surgery was performed on minor wound cases here as well. All cases with major compound fractures, brain wounds, and chest wounds were evacuated to the Feldlazarett or to a Kriegslazarett, where they were treated with more definitive care. In the German medical field manuals the functions of a Hauptverbandplatz are listed as: tracheotomy; closure of open chest wounds; aspiration of the pericardium in cardiac tamponade; emergency amputations; final arrest of hemorrhage; administration of blood and blood substitutes; surgery on the non-transportables; and suprapubic cystostomy.
The Feldlazarett was the next unit in the chain of evacuation. It was an Army unit designed to care for two hundred patients. Ordinarily patients with head wounds and transportable chest wounds, severe muscle wounds, buttock wounds, and major compound fractures received primary surgery in the Feldlazarett. While it was attempted to perform intra-abdominal surgery as far forward as possible, such cases were often evacuated to the Feldlazarett for surgery whenever the Hauptverbandplatz was too busy. The Feldlazarett was staffed with only two surgeons, but in periods of pressure, it was often augmented by surgeons from other units.
The Kriegslazarett, or General Hospital, was usually assigned to the German Army Group. In Italy most of these installations were grouped at Merano and Cortina d’Ampezzo. It was their function to hospitalize all patients who were not returned to duty from the more forward units. In addition, certain groups of the wounded received primary surgery at the Kriegslazarett, such as penetrating head wounds complicated by involvement of the eye or ear, and maxillofacial wounds. In very busy periods, all patients with major wounds might be evacuated to the Kriegslazarett for surgery while the more forward units confined their surgery to men with wounds of such a nature that they would be able to return to their units and full duty within reasonable short periods of time after surgery. Also, as frequently occurred during heavy attack periods, abdominal and head wound cases were given no surgical care.
In addition to those units already mentioned, there were hospitals for the lightly sick, lightly wounded, and convalescent patients. In each German division was the Ersatz company which served as a replacement depot and reconditioning unit for lightly wounded who had received primary surgery at the Hauptverbandplatz. The wounded sent to this Ersatz company were given light exercise under the direction of a doctor, and were ordinarily returned to duty after one week. There were usually between fifty and one hundred lightly wounded in the Ersatz company, in addition to the replacements sent from Germany, who only stayed long enough to be equipped before being sent into combat. The officers and the doctor of the Ersatz company were limited service personnel by nature of previous wounds or illness.
In the army areas and in the general hospital centers, hospitals for the lightly sick and wounded were established by elements of transport units (Krankentransportabteilungen). They received their patients from Feldlazaretten in the Army area and from Kriegslazaretten in the Army Group area or hospital centers. Most patients sent to these particular hospitals stayed for two or three weeks. One such hospital was located at Bolzano not far from the hospital center at Merano. At the time this hospital was visited on 6 May 1945 there were 1600 patients. The commanding officer reported that 500 would be able to return to duty in two weeks, 600 in one month, 300 in two months, 100 in three months and the remaining 100 in six months.
At the beginning of the war in Europe, all divisions had two Sanitaets Kompanies. At the end only the armored and mountain divisions had two each, but the Corps Surgeon had under his control one Sanitaets Kompanie for use where needed. When two Sanitaets Kompanies were available, two Hauptverbandplatzen were often established. In the beginning of an offensive, one Sanitaets Kompanie, horse-drawn, was placed only three or four kilometers behind the battle line to receive casualties. The other Kompanie, motorized, was held in reserve to be used after substantial gains had been made. Then, if further gains were made and the Hauptverbandplatz was required farther forward, the motorized Kompanie moved, leaving its patients to be taken over by the animal-drawn Kompanie. The patients of the animal-drawn Kompanie were left to be taken over by a Feldlazarett. Thus there were often two divisional units performing surgery ahead of the Army’s most forward Feldlazarett. With a large-scale offensive division, army, and army group hospitals might all perform primary surgery only on the less seriously wounded, putting aside the intra-abdominal and intra-cranial wounds in favor of those who were more likely to live and return to full duty.
There were no Auxiliary Surgical Groups, but the German Army Surgeon learned to use personnel from reserve or less active units to augment the staffs of heavily-pressed units. Most American observers felt that the German system of hospitalization and evacuation was certainly extremely flexible, but its very flexibility tended to favor the lightly wounded at the expense, and often the expense of death, of the more seriously wounded, the group which US surgical practice terms “first priority” wounded.
Lack of adequate supplies and equipment was also given by this German medical officer as a reason for the deterioration of the Wehrmacht’s medical service. Many patients died from exsanguination because neither blood nor a blood substitute was available at the field hospitals. Many patients with small wounds developed infection because of the precarious condition in which they arrived at the base hospital after a long journey, without proper dressings or immobilization of the wounds. There were no blood banks to furnish blood for the restoration of blood volume. With the decreasing number of medical personnel and the increasing hunger of the Wehrmacht for more manpower the obtaining of blood for transfusions became more and more difficult. Plasma was unobtainable. Penicillin was unknown. Sulfonamides were used but were felt by the Germans to be most useful only in acute infections, and to have no particular value in the treatment of patients from whose wounds flowed large amounts of purulent material. No new discoveries in chemotherapy had been made, and while patients received large amounts of drugs, ineffectiveness had been noted in patients who had had inadequate wound surgery.
Finally, this medical officer felt that one of the greatest reasons for lack of immediate care was the general deterioration in German medical officers. The mental status of the average medical officer, and his morale, were low for many reasons, each resulting in deteriorating care for patients. Among these factors was the large number of infected wounds, leading doctors to feel that all wounds were automatically infected; the inadequate number of personnel; the lack of care possible because of constant evacuation; the lack of liaison, there being no uniform treatment plan throughout the German medical service; the entrance into the service of young, poorly-trained surgeons, “graduate wonders” who knew little or nothing of the principles of surgery; the class distinction favoring the Luftwaffe, SS and high-ranking officers; and the placement of medical officers in high positions by political rather than professional standards. All of these points weighed heavily on the mind of the conscientious surgeon and succeeded in wearing down professional morale.
This had been a discussion of wound infections, which, according to the German consultant, were just as frequent in this war in the German army as in World War I. As such, it has reported generally most of the negative aspects of German surgery and surgical practice. There are, however, many positive aspects, which somewhat redeem the German practices in the eyes of an American observer. Therefore, a brief description of certain German techniques, such as treatment for shock and hemorrhage, extremity wounds, head wounds, intrathoracic wounds, and abdominal wounds, is felt to be in order here.
MEDICAL CARE AND SURGICAL PRACTICES
Wounds received in shock were treated by the use of external heat, stimulants, infusion of peristone and direct blood transfusion. Peristone had not been available in all German installations. The medical units in the divisional area were given first priority on peristone, but it was frequently not available to them. German medical officers claimed that peristone was a good plasma substitute, and that its osmotic properties were such that it was retained in the vascular system from twelve to fourteen hours. It was furnished in 500 cc. units. Usually one and never more than two units were used in the treatment of one patient. All blood transfusions were accomplished by the direct method. Blood was transfused in amounts of 200 cc, 300 cc, 500 cc, 800 cc, and never more than 1000 cc. Hence the most a patient in shock might receive would be 1,000 cc of peristone and 1,000 cc of blood. The general German belief seemed to be that if the pulse volume did not approach normal, after such treatment no surgery was to be performed. Some German surgeons interviewed were opposed to using more than 200 to 300 cc of blood at one time. The extreme pallor of many and moderate pallor of most of the wounded seen in German hospitals were further evidence that little blood was administered.
This type management of shock and hemorrhage was in sharp contrast to American methods whereby plasma is made available and used in quantities sufficient for the needs in all forward medical units of a division; and whereby banked blood is available in adequate quantities in all army hospitals including field hospitals adjacent to division clearing stations.
The bulk of extremity wounds suffered in the Wehrmacht were given primary surgical treatment in the Hauptverbandplatz or the Feldlazarett. In rush periods this surgery consisted of no more than incision of skin and fascial planes, the removal of gross debris and devitalized tissue, and usually trimming of devitalized edges of the skin wound. The careful wound excision practiced by Allied surgeons was done in German hospitals only in rare instances. One German surgeon reported that he had performed only four or five such operations in as many years of war surgery. In these he had done a primary wound closure. It was evident in many of the patients seen that practically no wound excision had been accomplished, since much devitalized tissue was left behind, and frequently wounds were primarily drained after no more than a fasciotomy. Perforating wounds from small arms missiles or small high explosive shell fragments had no surgery performed. This applied to wounds of joints and wounds involving bone unless there was a large wound of exit. Splinting of extremities after surgery varied. In several hospitals visited, surgeons stated that temporary wooden or wire ladder splints were applied for three to five days, following which treatment the limbs were put in plaster if infection did not develop. Most of the other hospitals reported that plaster was applied immediately after surgery. In either instance, the plaster was always padded and windows were cut over the wounds to permit inspection and dressing.
Compound fractures of the femur were put up in skeletal traction in both field and general hospitals. Kirchner wires were used in applying skeletal traction. When infection developed, the limb was incorporated in plaster, but some traction was usually continued. An ingenious apparatus made of perforated metal pipes served as a substitute for the ordinary Balkan frame. It was capable of many combinations to secure, easily and simply, pulley wheels in the desired position for any sort of traction. In some instances a complete Balkan frame was fashioned. In most cases, however, one pipe, which clamped to the metal hospital bed, sufficed to support sufficient side arms to provide the necessary number of pulley wheels in the proper positions. Walking, unpadded plaster spicas, after the method of Boehler, were used in the management of some of the simple fractures of the femur, and in some compound fractures after the soft tissue wounds had healed. They were not used early in the management of fresh compound fractures from bullet or shell fragment wounds as Truetta used them in the Spanish Civil War. In badly damaged heels, one surgeon was practicing excision of the talus, calcaneus, and one half of the scaphoid and cuboid, then placing the foot in a drop position and anchoring it there with a Steinman pin. He said that one-quarter to one-third of the cases so treated got functional results, but the remainder required amputation. Those getting a “functional result” were fitted with a below the knee prosthesis.
Two surgeons were found who had been using the Kuntscher nail in the treatment of certain fractures of the long bones. It was reported by two surgical consultants that for a time many surgeons attempted the use of this intramedullary nail with poor results, including osteomyelitis and death from shock. Following this experimentation, a few surgeons were designated who might use the method when they thought it indicated. The original work in Germany on this intramedullary nail was done by Kuntscher at the University at Kiel beginning in 1937. It was first tried on animals. Examination of the bones histologically at various periods after nailing led to the conclusion that approximately one-third of the marrow is destroyed and that small fat emboli are nearly always dislodged. One surgeon who participated in the original study at Kiel stated that he had records of 550 cases, not all his own, in which the Kuntscher nail had been used. Fat embolism had occurred in a few of these cases but in no instance did it lead to a fatality. This surgeon felt that its usefulness was chiefly in closed fractures of the middle third of the femur, in which the fracture line was transverse or nearly so. Such patients could walk without any splinting eight to fourteen days after the operation. This surgeon did not feel it an advisable procedure in tibia fractures and rarely used it in fractures of the humerus, radius, or ulna. It could be used in compound transverse fractures of the femoral shaft after the wound had healed or when infection was absent. One surgeon had used it in a few infected compound fractures of the humerus and femur when the desirability of fixation seemed to outweigh the danger of using it in the presence of infection.
In the field of head surgery, only a few intracranial wounds were found in the hospitals visited. One hospital at Merano and one at Gardone Riviera held the largest concentrations of head wounds. Of a sample of forty head cases, at least thirty needed further neurosurgery. There were also approximately twelve with wounds of the spinal cord, a similar proportion of which needed further surgery. Neurosurgical techniques in practice among the German hospitals visited were generally barely adequate, and often under the standards set in Allied armies.
The German medical establishment in Italy was almost completely self-sufficient, as it had to be, with the Brenner rail route to Germany under constant Allied air attack. On 4 May, two days after the German surrender, Fifth Army assumed control of the Base Medical Depot at Merano, along with a large factory equipped to manufacture many items such as cotton, bandages, drugs and narcotics. Included in the factory was a well-equipped laboratory capable of performing biochemical and physio-chemical procedures. The equipment was extremely modern in design, and apparently expensive and valuable. This factory employed approximately nine hundred German military workers. A few civilian men and women were employed by the Germans, hut for the most part this factory was run by German WACs and enlisted technicians.
The Merano medical depot, as apart from the factory, contained approximately 2000 tons of medical supplies when it was captured; with consolidation of other north Italy depots into this one, the stock levels were built up to 9000 tons within a few weeks. The depot did not employ civilians, and operated with a complement of three hundred enlisted men and forty WACs. This depot operated in similar fashion to a US base section depot, with the exception that platoons organized from its basic complement were attached to the various armies of Army Group “C”. Thus, each army had no depot unit solely its own, as is the case in the US army.
The medical supplies stocked at this depot were generally of an inferior quality. A certain cheapness, typical in many ways of the entire German medical service, was noticeable in almost all items of expendable supply. A paper material, somewhat like crepe, was used as a substitute for gauze in the dressing of wounds. Also, a still thinner paper was placed under casts as a substitute for cotton batting. Many of the medications found in this depot were of Italian manufacture, and not of a very high quality. The medical equipment generally was substantial and well-made, however, but more suited for a civilian general hospital than for issue to a field medical service. Surgical and dental instrument sets were far too elaborate to insure a rapid replacement. X-ray equipment, including dental X-ray sets, was good, and especially designed chests were provided to aid in proper handling. Chests of a standard size and design were provided for mobile medical supply platoons. These chests were an admirable item, hinged on opposite edges, top and bottom, so that the chest could be opened from the top or the front, and when set up one on top of the other, provided an efficient and orderly establishment. Liquid medicines were dispensed from large demijohns, and requisitioning units were required to furnish their own containers. When a sufficient supply of demijohns was lacking, bottles of all shapes and sizes were used. The general appearance of the pharmacy at the Merano depot was not one of orderly and neat management. Thus German medical supply and equipment seem to summarize actually the entire German medical establishment: a service of great potential ability and technique hampered by paucity of material and bogged down in the morass of politico-military interference over a long period of time.
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