The book formed part of the basis of the material covered by Ken Burns' PBS documentary The War (2007), as well as the HBO miniseries The Pacific (2010), in which Sledge was portrayed by Joseph Mazzello.

By his own account, Sledge began writing the memoir in 1944, "immediately after Peleliu while we were in rest camp on Pavuvu Island" and continued working on it "as soon as I returned to civilian life" in 1946.

It brings the reader into the island hopping, the jungle heat and rain, the filth and malaise, the fear of potential banzai attacks, and the hopelessness and loss of humanity that characterized the campaign in the Pacific.

Sledge describes in detail the physical struggle of living in a combat zone and the debilitating effects of constant fear, fatigue, and filth.

"[2] New York Times writer and editor Dwight Garner describes the book's depiction of war as "surpassingly vivid," adding, "What puts With the Old Breed across is, oddly enough, Sledge's sensitivity.