U.S. Army Medical Department, Office of Medical History
Skip Navigation, go to content

HISTORY OF THE OFFICE OF MEDICAL HISTORY

AMEDD BIOGRAPHIES

AMEDD CORPS HISTORY

BOOKS AND DOCUMENTS

HISTORICAL ART WORK & IMAGES

MEDICAL MEMOIRS

AMEDD MEDAL OF HONOR RECIPIENTS External Link, Opens in New Window

ORGANIZATIONAL HISTORIES

THE SURGEONS GENERAL

ANNUAL REPORTS OF THE SURGEON GENERAL

AMEDD UNIT PATCHES AND LINEAGE

THE AMEDD HISTORIAN NEWSLETTER

Chapter XV

Contents

CHAPTER XV

THE DIVISION OF HOSPITALIZATION (Continued)

HOSPITAL CONSTRUCTION; PROCUREMENT

CONSTRUCTION

Despite the possibility of procuring from the French certain buildings that could be adapted to hospital purposes, it was apparent to the Medical Department, A. E. F., from the outset that these would have to be supplemented by new construction.1 Even before the arrival of headquarters, A. E. F., the erection of a barrack hospital was commenced in the debarkation camp at St. Nazaire.1

An important factor in expediting the development of our needs in this matter was the fact that the French did not have in the training areas which they were to turn over to our troops sufficient hospitalization to meet our needs, and it quickly became essential that we then construct buildings of our own.2 A set of plans for a large hospital of barrack type had been sent to France when the staff of the American Expeditionary Forces went overseas, but these were found to be wholly impracticable.2 The ground plan of the unit as defined by the War Department called for three times as large an area as did the plans eventually adopted for a unit with the same number of beds in the American Expeditionary Forces. Also, it prescribed porches, a sewerage system, extensive plumbing and heating appliances and other features which could not have been realized with the limited resources available in France. Neither lumber nor the labor necessary for their construction were procurable overseas.2 Accordingly, as soon as it was ascertained that the plans prepared by the War Department could not be utilized, an assistant to the chief surgeon, A. E. F., after collecting suggestions from various medical officers commanding base hospitals of the American Expeditionary Forces, formulated plans for construction and layout which were more compatible with our resources.1 Many of the good features that had been developed by our Allies were incorporated in the plans which he developed, but he also considered in their formulation the general layout of the Letterman General Hospital in San Francisco. The plans now formulated were made the basis of hospital construction in the American Expeditionary Forces. PLANS FOR A BASE HOSPITAL, TYPE A

The plan for the layout and for the buildings to be erected for each base hospital, whether located separately or in conjunction with others, was designated that of a type A unit.3

To conserve wear and tear on personnel and to facilitate administrative control, the area to be covered by these hospital units was reduced to a minimum, consistent with safety from fire.2 To economize in heating, lighting, structural material, etc., and to centralize and standardize the units, only 20


242

feet of space was allowed between most of the buildings. From an administrative and clinical standpoint this concentration proved preferable, and, though it increased the fire risk, not a single serious fire occurred in any of these units.2

The type A unit required a frontage of 850 feet and a similar depth, its normal layout comprising 3 rows of buildings, divided by suitable intercommunicating roadways and walks.4 The central row of buildings included those pertaining to general service such as administration, reception of patients, baths, operating and X-ray section, clinic, and dining room. On each side of this central row of buildings was a block of 5 or 10 wards, dependent upon their size, and in rear of these sufficient space for the erection of tents, the crisis expansion, which in prolongation of the several wards would provide additional bed capacity in emergencies.

FIG. 21.-General layout of hospital unit, type A (base hospital), with wards 20 feet wide. Demountable buildings. In a hospital center one recreation hall and one disinfector were provided for each two hospital units; the nurses' recreation club was omitted when a central nurses' recreation club was provided


243

In the type A unit the ward buildings were of two sizes;4 the scarcity of building material, and the different contracts made it necessary to have in one part of France buildings entirely different from those in another part.5 Thus the dimensions of one ward used was 20 by 164 feet; of another, 36 by 156 feet. The number of patients per ward varied, of course, with its size, normally being about 50 for the narrower ward and double that number for the wider one. In addition, the wards provided space for the necessary administrative, culinary and toilet facilities. Twenty of these buildings (10 when the wider wards were used), half being on each side of the central administrative or clinical group, provided accommodations for 1,000 patients, the normal capacity of these units. Extension of each ward by tentage, the crisis expansion, doubled this capacity, and gave accommodations for 1,000 emergency beds. In the corners of the general plan were located the quarters of the officers, nurses, enlisted men and accommodations for the isolated or psychiatric cases.3

FIG. 22.-General layout of hospital unit, type A, with wards 20 feet wide. Permanent buildings. In a hospital center one recreation hall and one disinfector were provided for each two hospital units; the nurses' recreation club was omitted when a central nurses' recreation club was provided


244

Originally the plans for type A units provided for a recreation hall in the central row of buildings, and a space had been designed for such a structure. The American Red Cross undertook to install, equip, and operate these buildings, and in the fall of 1917 sent to France 5,000,000 feet of lumber for this and other purposes.2 Building material, however, was so scarce that the general staff, A. E. F., requested the American Red Cross to transfer this material to the American Expeditionary Forces, engaging itself to construct these buildings from material that would be obtained later.2 This created a regretable situation, because at no time did sufficient material become available for the American Expeditionary Forces to fulfill this obligation.2 Accordingly when the American Red Cross realized that fact, it again undertook the provision of recreation buildings, construction being effected by the engineers, but, when hostilities ceased many hospital units lacked their authorized recreation huts.2 FIG. 23.-General layout of hospital unit, type A, with wards 36 feet wide, 156 feet long. In a hospital center one recreation hall and one disinfector were provided for each two hospital units; the nurses' recreation club was omitted when a central nurses' recreation club was provided


245

FIG. 24.-Ward building (20 feet wide), hospital unit, type A. Demountable

FIG. 25.-Ward building (36 by 156 feet), hospital unit, type A

FIG. 26.-Administration building, hospital unit, type A


246

FIG. 27.-Nurses' quarters, hospital unit, type A

FIG. 28.-Nurses' dining room and kitchen, hospital unit, type A; for use with demountable buildings


247

FIG. 29.-Officers' quarters and dining room, hospital unit, type A; for use with demountable buildings


248

FIG. 30.-Officers' quarters, hospital unit, type A; for use with permanent type of buildings


249

This was a graver matter than might at first appear, for, in the absence of legitimate diversions otherwise obtainable, the facilities of the recreation buildings had a noteworthy influence in promoting the morale of the hospital.

FIG. 31.-Receiving and evacuating hall, hospital unit, type A; for use with demountable buildings

FIG. 32.-Receiving and evacuating hall and patients' bath, hospital unit, type A. Permanent type

FIG. 33.-Patients' bath, hospital unit, type A; for use with demountable buildings. Permanent type is shown in Figure 32

In order to standardize and simplify construction, each hospital was designed on the principle of using only portable wooden huts with floor dimensions of 20 by 100 feet, or any huts built of other materials but approximating these dimensions and obtainable in Europe.2 These standard units as designed were complete in every particular.1 Most of the type A hospitals were built of wood. Some, where local resources permitted, were superior, and, especially


250

FIG. 34.-Recreation hall, hospital unit, type A; permanent building type

in those units constructed by English or French contractors, tile, brick, sheet steel, and concrete were frequently used.2 The buildings that were made of wood or sheet steel (Adrian barracks) were composed of unit mill-fabricated sections 10 feet high and 81/3 feet wide, each side of the average buildings which had a length of 100 feet comprising 12 sections. These sections consisted of side frames and roof trusses to which, when set up, the walls and roof panels were bolted. They were bolted together while flat on the ground, then raised to a vertical position and temporarily secured until the side and roof panels had been bolted. The wall panels, 10 feet long and 41/6 feet wide, were provided with exterior and interior board walls, the latter having a smooth finish. Roofs consisted of boards covered with tar paper; floors and ceilings, of planks. The windows, though adequate, were comparatively small, for glass was scarce and substitutes frequently were necessary. Among these substitutes for glass were plain or oiled cotton fabrics, and an isinglass preparation on thin wire mesh. The isinglass preparation proved unsatisfactory in the damp climate of France.2 The first type A hospital, which was at Bazoilles, was reported as one-third completed in December, 1917.2

The component parts of the huts were interchangeable and were so divided that it was possible by adding sections to erect a building of any length desired; for example, ward buildings in the type A unit measuring 20 by 164 feet.2,4 Changes in width were made with more difficulty but could be effected by an adjustment of paneling or by doubling up buildings. Considerable latitude was thus possible in the dimensions of buildings.


251

Erection of these huts was relatively simple and, if the military situation so required, they could be taken down (no nails having been used in the assemblage of the component parts), shipped and reerected on another site in a minimum space of time.2 They left much to be desired, when compared with permanent structures, but met requirements, though the great scarcity of lumber frequently necessitated the use of green timber which resulted in some warping of the walls.2 The great advantages which structures of this type presented were availability, mobility, quickness of erecting, and low initial cost. The average price paid for them was $2,000. These huts, frequently called barracks, had been in use among the armies in France and had proven satisfactory.2 They became the backbone of our hospitalization program. FIG. 35.-Nurses' recreation club, hospital unit, type A; demountable

In order to preserve symmetry and to facilitate assembly it was prescribed that as far as possible huts should all be of similar design and of the same dimensions in any one unit. The demand for these structures gradually became so great that it was necessary to comb every available European market for building materials for them, and, as a result, a half dozen different materials for hospital huts eventually came into use.2 Of whatever material they were built the huts had the same design and dimensions as those prescribed for the portable wooden huts. FIG. 36.-Laboratory and morgue, hospital unit, type A; for use with demountable buildings

Soon after the Medical Department began its construction program general headquarters, A. E. F., was confronted by a severe shortage in the building material necessary for its many construction projects.2 Accordingly, in an effort to retrench, it reexamined the plans for hospitals and other buildings and ordered a reduction in the space allowed for living quarters of officers, nurses, and enlisted men.6 The chief surgeon's office acceded to this reduction except in so far as it affected nurses.2 Though it strenuously opposed diminution of the modest allowance that had been made for them, this reduction in their quarters was enforced until April, 1918,7 when one room, 10 by 14 feet, was allowed for each 2 nurses. Covered passageways connecting wards, clinical buildings and dining rooms were eliminated as mentioned above, but


252

the plans successfully resisted further pruning except where the units were grouped in centers. Certain further reduction was then possible; for example, some of the psychiatric or isolation buildings were eliminated and the general staff strongly advocated elimination also of unit administration buildings and storehouses.2 Fortunately it receded from this position, otherwise it would have been impossible promptly to equip the frequent drafts of outgoing patients.2

As discussed below, under procurement, the French were primarily charged with coordination of construction, several agencies often seeking the same site.2 After the approval of the French had been received for the construction of a project, the chief surgeon recommended to the assistant chief of staff, G-4, general headquarters that such construction be effected. The latter then directed the commanding general, Services of Supply, to proceed with construction of a designated number of hospital units at a certain place. The Engineer Corps then proceeded with the construction, much of this being effected, under engineer control by civilian contractors. Even when buildings were taken over from the French it was almost always necessary to have extensive additions, repairs or alterations made before they were suitable for our hospital use.2

FIG. 37.-Operating and X-ray building, hospital unit, type A. This plan was adopted December 15, 1917, and was to be used only when demountable buildings were to be used. The permanent type is shown in Figure 38

During the early period of our hospital construction it was necessary to secure from the French a promise that their Engineer Corps would construct the necessary railroad sidings and loading quais.2 In view of their shortage of man power and matériel, such promises were difficult to obtain. On the whole, however, without the assistance at this time of the French, who took


253

immediate and actively helpful interest in the prosecution of our program, we would have experienced great difficulty in having ready sufficient hospitals to shelter the large number of wounded of the following summer and fall.2 As it was, very few of our barrack hospitals were ever entirely finished.2 It was necessary to occupy them long before the construction work was completed and wounded were moved into the wards when these furnished little more than protection from the elements.1 During the warm weather this situation was not serious, but after cold weather came on it was only the early termination of hostilities that prevented very great suffering: Thousands of casualties were sheltered in unfloored and unheated tents.1 The personnel of base and camp hospitals frequently assisted in the building or modification of the structures which their respective units utilized and continued to perform this work even after patients were admitted. Convalescent patients and, later, labor troops also assisted and were an important factor in the efforts to overcome the shortage of civilian labor.2 The situation was fraught with great anxiety to those charged with the provision of hospital accommodations for the rapidly increasing numbers of casualties, but in view of the difficulties encountered it was not surprising that the construction program was never fully realized.1

PLANS FOR HOSPITAL CENTERS

The necessity for doubling, or in emergencies quadrupling, the size of a base hospital with relatively small increase in the number of the personnel serving the unit, suggested that further economies might be made by grouping these organizations into hospital centers.2 Though the expedient offered many advantages the FIG. 38.-Operating, X-ray, and clinic building, hospital unit, type A. This plan, adopted August 12, 1918, superseded the plan of December 15, 1917, shown in Figure 37. When one type A unit only was constructed, this plan was used; however, when two or more units were constructed at a hospital center, this plan and the plan shown in Figure 40 were alternated


254

FIG. 39.-Dispensary and clinic building, hospital unit, type A; to be used for demountable building only

FIG. 40.-Clinic and surgical dressings building, hospital unit, type A. This building was to alternate with the operating X-ray, and clinic building shown in Figure 38; that is, when there were more than one type A unit in a hospital center, half were to have buildings according to this plan, and half according to the plan shown in Figure 38

FIG. 41.-Patients' kitchen, hospital unit, type A. Temporary type


255

FIG. 42.-Patients' kitchen and dining halls, hospital unit, type A. Permanent type


256

FIG. 43.-Patients' dining hall, hospital unit, type A, for use only when demountable buildings were furnished

FIG. 44.-Quartermaster's storehouse, hospital unit, type A, for use only when demountable buildings were furnished


257

FIG. 45.-Quartermaster's and medical storehouse, hospital unit, type A. Permanent type

dominant consideration causing its adoption was the need to compensate as far as possible for the shortage in personnel, by reducing staff and overhead demands to a minimum. It was planned as early as September, 1917, to group from 2 to 20 hospitals and a convalescent camp at each of these formations and that the largest of them should have from 30,000 to 36,000 beds.2

The geometrical layout of the individual unit admirably fitted in with any grouping scheme. When a site capable of accommodating a number of the type A units was selected, an initial survey, with particular reference to contours, was made by the Engineer Corps, A. E. F., and the grouping eventually adopted with reference to the most adaptable conformation to these contour lines.2 By doing this and by bearing in mind that the majority of the buildings were but 20 feet wide, a considerable saving in piering matériel or excavation work was effected. The location of the units, moreover, was made with a view of harmonizing the administration of the center.

In consultation with those in charge of construction, representatives of the chief surgeon's office worked out and adopted an appropriate layout for each center.2 The primary requisite was the decision as to the location and adequacy of railroad sidings, all of which had to be newly installed, and the frontage of units on these sidings. The requirements for the administration and supply of these centers were made by providing suitable extra buildings for that purpose. Central water, sewerage and lighting systems, garages, storehouses, etc., also had to be installed. In fact, the larger centers, in some of which we had projected a capacity of 20,000 beds, approximated the creation of a veritable city with all its accessory requirements. PLANS FOR CAMP HOSPITALS, TYPE B UNITS

The layouts of the type A and type B units were highly similar, differences between the two consisting chiefly in the size and completeness of the buildings employed.8


258

Type B hospitals were much less elaborate than those of type A, for it was intended that they would provide only the barest hospital necessities.2 Though each of these was a fairly complete working plant with operating room, X-ray laboratory, etc., they were not designed to give definitive treatment. Each type B unit required an area 600 feet square and consisted of a central block of service buildings and two lateral rows of five wards each.2 Each of the wards was 100 feet long by 20 feet broad and accommodated 30 patients. In each of these units also, space was reserved, in prolongation of the wards, for crisis expansion by tentage, or where permanent expansion was desired, by huts.8 The normal capacity of the units was 300 beds but with the crisis expansion a total capacity of 1,000 beds was provided.

Type B hospitals were never grouped, but were scattered throughout France, to meet needs arising in isolated commands and in training areas.2

FIG. 46.-Barrack building, hospital unit, type A. Demountable

FIG. 47.-Personnel dining hall, hospital unit, type A. Demountable

They were a very important element of American Expeditionary Forces hospitalization and proved to be quite indispensable. On the day the armistice was signed 66 of these units were in operation.2

QUALITY OF CONSTRUCTION WORK

The quality of the construction work performed in our various individual hospitals and hospital centers varied from good to bad, seemingly conforming to the individual experience and efforts of the officer locally in charge of construction.2 Many of the projects were turned over to French or English contractors who secured the best results. The work performed on some of the hospital projects, particularly those in the advance section, was highly unsatisfactory, being of a makeshift character with apparently no attention to detail or desire to make the best of the material at hand.2 It was early pointed out and particularly emphasized by the chief surgeon's office that the first requisite


259

in any construction program was the building of good roads, and the development of the water and sewer systems. In many of the projects these desiderata were overlooked, construction of buildings being started before any work had been done upon roads. Hospital sites, when this procedure was followed, soon became small seas of mud, and progress was materially handicapped. As late as December, 1918, many of the essential roadways in these units were in inexcusably bad condition.2

In those parts of France where our base hospitals were erected, cloudy days prevailed for the major part of the year and for this reason north-south orientation with east-west exposure to sunlight was not as important a factor as it would have been in more sunny localities, nevertheless, wherever practicable, this orientation was practiced.

To avoid excessive piering, all buildings were arranged on parallel lines with the general layout conforming as far as possible to contour lines.

Recognizing the shortage in material, and the great difficulty of obtaining in adequate quantities many of the essential articles required in a great construction project of this nature, every conceivable refinement was eliminated from these type A and type B hospital units.2 For example, porches were not included. Because of the prevalence of inclement weather in France, particularly in the territory in which we were required to hospitalize, it was believed that overhead protection in the form of covered passageways along the front of the ward entrance and connecting up the central group of clinical and mess buildings should be provided. These were prescribed in the plans as finally adopted, but were never installed in any of the units, owing to scarcity of lumber. Because of the fact that plumbing material could be procured in very limited amounts only, plumbing fixtures were reduced to a minimum. Buildings were heated by stoves; fecal matter was disposed of by the pail method and incineration.

FIG. 48.-Medical storehouse, hospital unit, type A. This building was to be used only when demountable barracks were used. 
The permanent type is shown in Figure 45

CONVALESCENT CAMPS

With the speeding up of troop movements early in the summer of 1918, it was soon realized that fixed hospitalization, as its acquisition was then progressing, could not keep pace with the arrival of troops. To meet this situation it was decided to provide convalescent camps in the vicinity of and as part of large


260

hospital centers to which men not yet fit for duty, but who no longer required careful hospital treatment, could be sent pending their fitness for return to duty.9 In these camps the men were provided with shelter. The bed space was limited but the food was good, and the men were given a certain amount of work and exercise to fit them for their forthcoming duty. The assistant chief of staff, G-4, general headquarters, on June 1, 1918, authorized the construction or establishment by tentage of these convalescent camps, on the ratio of 20 per cent of our total bed capacity.10 Many of these camps were in operation upon the conclusion of hostilities on November 11, 1918, and it was through their operation only that we were able to provide accommodations for the battle casualties occurring during the summer and fall of 1918.2

FIG. 49.-Disinfector building, hospital unit, type A, for use only when demountable barracks were used

TENTAGE

The intended use of tents in connection with fixed hospitals in the American Expeditionary Forces was to permit a rapid expansion of the bed capacity of a hospital during stress3 and to shelter patients in convalescent camps.9 As stated above, in the plans of both type A and type B hospitals the permanent wards were so situated as to leave space at their outer ends for ward tents. Thus patients in the permanent wards so far improved as to be no longer in need of close supervision by ward surgeons and nurses could with safety be removed to the contiguous tent wards, leaving space for the more seriously sick or wounded. FIG. 50.-Ablution building, hospital unit, type A. Demountable

The kinds of tents used were two European models, the marquee and the Bessonneau and our own Medical Department ward tent.11 Contracts were made with three companies in France for 10,000 Bessonneau tents.11 This is a double-wall tent, capacity 26 beds normal, 30 beds emergency. It is well lighted with windows, and since stoves may easily be installed, this tent is quite warm. If supplied with electricity, suitable walks and roads, this tent makes an admirable ward as it is warmer than the barrack ward. The Bessonneau tents did not begin to arrive until about the 1st of October, and there were only 800 of them in use on November 11.11 Three thousand marquee tents had been delivered by the British, and deliveries were coming in at the rate of 50 per day at the time of the signing of the armistice.11


261

FIG. 51.-General layout, hospital center, Bazoilles


262

FIG. 52.


263

Because of the inability to obtain an adequate number of either the marquee or Bessonneau tents, practically all hospitals with crisis expansion made use of all three of the kinds of tents referred to. However, the greatest use was made of the United States Army ward tent in connection with the convalescent camps, since the patients therein had convalesced to a point where they needed little or no strict hospital treatment.11

It was necessary to employ approximately 2,500 American ward tents in convalescent camps in the fall of 1918, and when the armistice was signed the chief surgeon's office had placed in use practically all its resources in tentage.11

The question might logically be asked why type A units were not constructed on a 2,000-bed capacity basis from the start, and thus eliminate the necessity for tentage. The reasons for this were obvious. There was not sufficient building material on hand in France to permit of this action; and even had there been, it would have been unnecessary and expensive installation.2 In providing for this expansion by the use of tentage we divided our sources of supply and retained a mobility in crisis matériel that was essential in expanding at places requiring it, and, as the name implies, these crises occurred only in certain phases of our combat activities. By expanding only during them, overhead and upkeep expenses were reduced materially.

FIG. 53.-General layout, hospital unit, type B (camp hospital)

In this connection, the chief surgeon, A. E. F., expressed the opinion in March, 1919, that a crisis expansion of 1,000 beds made a hospital too unwieldy, and that it should be no greater than 500 beds.5


264

FIG. 54.-Ward, hospital unit, type B

FIG. 55.-Administration building and officers' quarters, hospital unit, type B


265

FIG. 56.-Patients' mess, hospital unit, type B

FIG. 57.-Bath and disinfector, hospital unit, type B


266

FIG. 58.-Operating and clinic building, hospital unit, type B

PROCUREMENT

Prior to the approval, on August 13, 1917, of a program authorizing 73,000 beds,12 the chief surgeons' office, A. E. F., had steadily been acquiring existing hospitals from the French, for it was impossible to construct buildings in time to meet the immediate needs of our troops who had begun to arrive in June, 1917.2 But when the program authorized June 1 became effective a progressive system of hospital procurement was adopted.2 As it was evident that any attempt to administer our base hospitals under canvas would prove impracticable, it was essential that the chief surgeon find buildings in which base hospital units could operate, and during many months he took over the most suitable available structures that could be found. These accommodations could be provided by (1) taking over military hospitals from the French Army; (2) leasing the most suitable buildings available. Buildings in the first category were transferred by the French to the limit of their capacity. No reasonable request was ever refused, and among the hospitals thus transferred were some of the very best in France, but evidently it was neither expedient nor possible that that country deplete its own resources of this character unduly in order to meet our needs.2 From our own point of view, too, there were definite objections to taking over French military hospitals, despite the willingness of France to help us to the utmost. One objection was the fact that most of these hospitals were small institutions of from 25 to 300 beds, and that the limited personnel authorized for our service could be used much more economically in operating much larger units.13 Moreover, these hospitals, widely scattered, were served largely by French residents of the communities where they were located. When we took over such a formation it was necessary either to lease neighboring quarters for our personnel or to diminish its bed capacity by quartering them in a part of the hospital itself. As explained more fully in Chapter XVI, the bed capacity of our base hospital


267

in order to compensate to a degree for the low percentage of Medical Department personnel authorized on the priority schedule by the general staff, had been increased to 1,000 and made capable of expansion in emergencies to double that size.14 It was recognized from the outset that only under unusual circumstances could French hospitals be used to advantage, except to meet transient needs or to form a nucleus around which barrack extensions could be constructed. Practically all of those which were transferred to our service were much increased shortly after they came under our control.13 FIG. 59.-General layout, hospital unit, type C (convalescent camp), 2,000 beds

Therefore, in attempting to meet hospitalization requirements, medical officers charged with the procurement of buildings quickly turned to the adap-


268

FIG. 60.-Administration and clinic building, hospital unit, type C

tation of suitable buildings. These, however, were comparatively few, most of them having been preempted by the French or by her allies, Belgium, Italy, and Portugal, and were being utilized either for hospital purposes or as habitations for French and Belgian refugees.13 Many were occupied by Red Cross and other volunteer aid societies from all parts of the world. Under these circumstances, when the United States entered the field it was found that the majority of possible hospitals discovered or offered were lacking essential and rudimentary hospital facilities or potentialities.13 Common defects were inaccessibility, poor state of repair, lack of sanitary plumbing, small size and wide dispersion of buildings. Nevertheless, anticipating the arrival of large bodies of troops from the United States necessitated the procurement of existing buildings. This was pushed to the utmost, though most buildings taken over required alterations, additions, and repairs in order to make them suitable for hospital use.13 On September 27, 1917, the chief surgeon, A. E. F., reported in some detail the difficulties which would be encountered in adapting existing buildings to hospital needs. On the 17th of the following month he wrote the Chief of Staff as follows:15

It is recognized that in the present emergency anything that offers shelter for patients must be used. However, the use of such buildings as the French have offered can be considered only as an emergency measure and in no wise meets, from our point of view, the demands for adequate hospital facilities.

Among the buildings taken over were school buildings, hotels, chateaux, barracks, factories, and even stables. School buildings, as a rule, were among the earliest buildings utilized.13 Almost invariably they were unsatisfactory; few had running water, sewer connections, or toilet facilities. Under the French law, when schools were requisitioned for military purposes the teaching personnel, which were furnished living quarters in the building, had to be allowed to


269

FIG. 61.-Officers' quarters and mess hall, hospital unit, type C


270

FIG. 62.-Standard barrack, hospital unit, type C

retain them.2 The result was that in the same buildings there would be wards for patients, quarters for personnel, and living quarters for French civilians-arrangements that were inevitably unsatisfactory to all concerned.

Objections to the use of hotels as hospitals rested on other grounds.13 As practically all the best and most suitably located buildings of this class had been taken over by the allied governments, those available were very largely summer hotels without heating facilities. Usually, they had insufficient water and very limited plumbing, and they required many alterations before they were suitable for hospital purposes. Also the rate of rentals was very high. In addition, when a private building was taken over for military purposes the owner was allowed by law to reserve certain parts of the building; also the law required that a building should be returned to the owner in the same condition as when taken out of his control.2 The latter provision necessitated refurnishing these structures at high cost and removing all improvements or additions which might have been installed. Furthermore, they were difficult to administer and extravagant in their requirement of personnel.

With many differences in detail, the difficulties incident to the use of other buildings were comparable to those pertaining to hotels. Barracks, because of their large ward space, were more easily administered, generally speaking, than the hospital established in other preexisting structures.13

When we desired an existing French hospital, or buildings being utilized by the French as a hospital, a representative of the chief surgeon inspected it and if it was deemed suitable, a request by letter was made upon the French for its transfer to the American Expeditionary Forces, through the chief of the mission attached to headquarters of the American Expeditionary Forces.2 The date of transfer was decided upon and the French thereupon notified us when we could take control. As a rule, the Medical Department of the American Expeditionary


271

Forces usually took over in these buildings all the hospital property that was still serviceable.2

Careful inventories, which included the conditions of buildings and lists of the property contained therein, were prepared by representatives of the American and French Armies, acting jointly.2 These inventories were prepared in quadruplicate and each interested party was furnished a copy. Record of these transactions was maintained in the chief surgeon's office, A. E. F. From this beginning gradually developed the service later known as "rents, requisitions, and claims," which later took charge of all such transactions and became the custodian of these records.2 The personnel of the chief surgeon's office which had been gathered together for this purpose was transferred to that service when it was officially put into operation. FIG. 63.-Kitchen, hospital unit, type C

The acquisition of schools, hotels, and other buildings not previously occupied as hospitals was accomplished through leases obtained generally through a local representative of the French Army.2 Rarely was it necessary to resort to military requisition, although in a few isolated cases this proved necessary.2

Securing private buildings was not unattended with great difficulty; on the contrary, much opposition was encountered even after they became available to us. Endless bickerings with proprietors and directors led to almost endless correspondence which could result only in the greatest amount of delay in making the buildings over into hospitals.16

In July, 1918, when our hospitals in France provided beds for but 5.7 per cent of our troops there, the French were asked for buildings sufficient for 45,000 beds, because of the difficulties in the way of construction.16 The beds requested were to be in buildings located either on our line of communications or, if not there obtainable, then in the more remote parts of France. The central bureau, Franco-American relations, which controlled all such requests, unofficially


272

FIG. 64.-Quartermaster building, hospital unit, type C

FIG. 65.-Shops and disinfector building, hospital unit, type C


273

FIG. 66.-Laundry building, hospital unit, type C

FIG. 67.-Dining hall, hospital unit, type C


274

FIG. 68.-Bathhouse, hospital unit, type C

FIG. 69.-Venereal and skin clinic, hospital unit, type C


275

FIG. 70.-Perspective of a Bessonneau tent in a two-tent unit

FIG. 71.-Perspective of a Bessonneau tent, showing framing and double walls

FIG. 72.-Plan of a two-tent (Bessonneau) ward


276

FIG. 73.-Showing heating arrangements in a Bessonneau tent


277

FIG. 74.-Perspective of a marquee tent, showing a unit of three tents


278

FIG. 75.-Plan of a marquee tent ward of three tents

FIG. 76.-Showing heating arrangements in a marquee tent ward


279

FIG. 77.-Perspective of closet in a marquee tent ward, showing construction

FIG. 78.-Plan of a two-tent ward, United States hospital ward tent


280

answered all the requests made by furnishing lists of buildings that were quite different from those desired, thus necessitating our rejecting many buildings as being unpractical for our purposes.17 Because of the urgency of the situation, General Pershing addressed the Premier of France as follows

GENERAL HEADQUARTERS,
AMERICAN EXPEDITIONARY FORCES,
   France, August 16, 1918.

Monsieur GEORGES CLEMENCEAU,
  President du Conseil, Paris.

MY DEAR MR. PRESIDENT: General Ireland, the chief of our Army Medical Service, has brought to my attention the vital need of extra hospital facilities, which we must have as soon as possible. At present we have at the most but 6 per cent of beds for our troops in France, and it is agreed that 10 per cent is the lowest safe margin. In view of the increased program of troop arrivals, it will be impossible for our hospital construction to keep pace with the influx of troops, so that it is necessary to call on your people for an increasingly large amount of hospital space in buildings already constructed. On July 13 a request was made for 45,000 beds in buildings either on our line of communications or, if this were impossible, in the more remote parts of France, and a specific request has been made for various hotels, schools, and military barracks which have been inspected by our medical officers. A copy of this list is herewith attached, with the addition that we have made a request for and need the École de Legion d'Honneur at St. Denis.

In accordance with instructions No. 9 of February 12, from the office of the Undersecretary of State, these questions have been handled entirely with the central office of the Franco-American relations in Paris. General Ireland informs me, however, that he fears that it will be impossible to get the quick action needed. Experience has shown that any specific request for buildings which have been inspected by our medical officers are usually met by a counterproposition which, after a certain length of time, has been made to the American officers in charge of this work. May I not suggest that the central bureau of Franco-American relations hasten to make inspections of a number of buildings suitable for hospitals with a view of meeting, without delay, the increasing necessity for largely increased accommodations for our sick and wounded? Just now, time is the all-important factor, and anything you may be able to do to enable us to meet our early requirements will be most highly appreciated.

I regret having to bother you with this matter, but in view of its importance I bring it to your attention, knowing well that with your powerful assistance we will achieve the results that we desire in the quickest possible time.

Permit me to express my thanks for the splendid efforts made by your officials to aid us in every way.

With highest personal and official regards, believe me,

Very sincerely yours,

                      (Signed)  JOHN J. PERSHING.

At the instance of the Premier, the French mission now submitted a list of public buildings which, it was stated, had been reserved for the American Medical Service.18 The French Government wished to divide equally the burden of hospitalization among the territorial departments and among the different classes of buildings in the departments. Long lists of buildings were sent at intervals to the chief surgeon through the French mission, but for various reasons (such as the delapidated condition of some of the buildings, their small size, their remote location) many buildings included in these lists had to be rejected.13 Buildings thus offered fell, in the main, into four classes: Military casernes, public or private hotels, schools, and miscellaneous buildings which comprised factories, storehouses, etc. The amount of buildings thus


281

offered potentially represented beds to the number of 155,422.13 Possible accommodations for many more had been taken over by us, but these were found unnecessary after the armistice had been signed.

After the signing of the armistice the buildings which had been accepted from the French on November 11 were returned with the exception of one at Lucon,19 but procurement of buildings continued for several weeks in order to provide hospital facilities in new locations conformable to the new conditions which arose by the armistice.15

On November 27, in reply to a request for a conference concerning relinquishment of buildings used for hospital purposes, the commanding general, Services of Supply, wrote the commissioner general for Franco-American war affairs as follows:20 * * * * * * *

2. Owing to the indefinite information regarding the military situation at present, it is not believed that a conference on this subject should be undertaken at this time, but this can be undertaken as soon as a definite plan of demobilization of the American Expeditionary Forces has been made.

3. Although a reduction of the necessity for hospitalization has been made from 15 per cent to 7½ per cent, since November 11, yet this reduction comes at a time when there are approximately 190,000 patients in hospitals, and we can not operate upon the lesser figure until these cases are returned to duty with their units or evacuated to States.

4. All offers of buildings made on the various lists have been definitely accepted or rejected. Since August 1 these have amounted to approximately 125,000 beds, of which approximately 51,000 have been accepted and approximately 74,000 rejected. Since this time many buildings that have been accepted have been returned through the French mission as being necessary for hospitalization, and from time to time many others will be returned when it is definitely ascertained that they will not be needed and that no troops will be located in the localities concerned.

5. Your attention is called to the fact that every consideration has been given to disturbing schools as little as possible, that wherever possible schools have been evacuated and returned, and this plan will be continued. Attention is also called to the fact that it will be only necessary to requisition buildings in those localities where troops may hereafter be stationed and where no buildings exist. This number will be reduced to a minimum.

6. Regarding the matter of deoccupation of the older establishments obtained during the early part of the American occupation, attention is called to the fact that considerable construction in barracks, or water supply, electric lighting, sewers, roads, drainage, etc., has been done, and it is believed that on this account these should be retained until the last to be evacuated.

7. It will not be necessary to requisition buildings not already in process of organization, but it is desired to occupy many hotels on the Mediterranean and in the Pyrenees, in which it is expected to treat convalescents. These properties were obtained through amicable lease in the main. But few requisitions were made, and their retention is in the main agreeable to the owners. In other localities no buildings have been taken or will be taken where hospitals have not been organized and operated. REFERENCES

(1) Wadhams, S. H., Col., M. C., and Tuttle, A. D., Col., M. C.: Some of the early problems of the Medical Department, A. E. F. The Military Surgeon, 1919, Washington, D. C., xlv, No. 6, 636.

(2) Report of activities of G-4-B, medical group, general staff, G. H. Q., A. E. F., December 31, 1918, by Wadhams, S. H., Col., M. C. On file, Historical Division, S. G. O.


282

(3) Letter from the chief surgeon, A. E. F., to the chief engineer, A. E. F., September 17, 1917. Subject: Design for a 1,000-bed crisis expansion, A. E. F., Army Hospital, Type A. Copy on file, A. G. O., World War Division, chief surgeon's files (322.32911).

(4) Plans on file, Record Room, S. G. O., 632 (A. E. F., France).

(5) Letter from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, March 28, 1919. Subject: Plans for hospitalization. On file, Record Room, S. G. O., 632 (A. E. F., France).

(6) G. O. No. 46, H. A. E. F., October 10, 1917.

(7) G. O. No. 58, G. H. Q., A. E. F., April 18, 1918.

(8) Letter from the chief surgeon, A. E. F., to the chief engineer, A. E. F., September 30, 1918. Subject: Plan of type B (300-bed) camp hospital unit. Copy on file, A. G. O., World War Division, chief surgeon's files (329.32914).

(9) Memorandum for the assistant chief of staff, G-4, G. H. Q., A. E. F., from Col. S. H. Wadhams, G. S., May 24, 1918. Subject: Hospitalization. Copy on file, Historical Division, S. G. O.

(10) Memorandum for the commanding general, Services of Supply, A. E. F., from the assistant chief of staff, G-4, G. H. Q., A. E. F., June 1, 1918. Copy on file, Historical Division, S. G. O.

(11) Report on hospitalization and evacuation of sick and wounded, for the military board of Allied supply, April 10, 1919, by Brig. Gen. J. R. Kean, M. D. Copy on file, A. G. O., World War Division, chief surgeon's files (314.7).

(12) Memorandum for the chief of staff from the chief of operations section, General Staff, G. H. Q., A. E. F., August 11, 1917. Subject: Hospitalization. On file, A. G. O., World War Division (632).

(13) Report of the activities of the chief surgeon's office, A. E. F., from the arrival of the American Expeditionary Forces in Europe to the armistice, by the chief surgeon, A. E. F., March 20, 1919. On file, Historical Division, S. G. O.

(14) Memorandum for the chief engineer, A. E. F., from the chief surgeon, A. E. F., September 20, 1917. Copy on file, Historical Division, S. G. O.

(15) War diary, chief surgeon, A. E. F.

(16) Letter from the commander in chief, A. E. F., to the chief of French Mission, Tours, July 13, 1918. Subject: Hospitalization. On file, A. G. O., World War Division, chief surgeon's files (322.32911).

(17) Letter to M. Georges Clemenceau, President du Conseil, Paris, from General Pershing, August 16, 1918. Subject: Hospitalization. On file, A. G. O., World War Division, chief surgeon's files (322.3291).

(18) Memorandum for the assistant chief of staff, G-4, S. O. S., from the chief surgeon, A. E. F., August 13, 1918. Subject: Hospital program, A. E. F. On file, A. G. O., World War Division, chief surgeon's files (322.32911).

(19) Letter from the chief surgeon, A. E. F., to the chief, French Military mission, S. O. S., November 23, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief surgeon's files (329.32911).

(20) Letter from the commanding general, S. O. S., A. E. F., to the commissioner general, Franco-American war affairs, November 27, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief surgeon's files (329.32911).

RETURN TO TABLE OF CONTENTS