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Chapter XVI

Contents

CHAPTER XVI

THE DIVISION OF HOSPITALIZATION (Continued)

HOSPITALIZATION OF SICK AND WOUNDED

Though the hospitalization division of the chief surgeon's office, A. E. F., was charged with the supervision of all hospitals of the American Expeditionary Forces, this volume gives but brief consideration to the mobile hospitals which served armies, corps, or divisions in battle or in training areas. These mobile hospitals are discussed in Volume VIII of this history, which considers field operations of the Medical Department. Though they were a part of the entire hospital provision of the American Expeditionary Forces, their procurement did not form a part of the hospitalization program as that term was technically understood. The hospitalization program referred essentially to the provision of fixed formations-i. e., base and camp hospitals and convalescent camps-and only when qualified by some explanatory phrase was the term "hospital program" made to include the field hospitalization of the American Expeditionary Forces. One reason for this was the fact that most of these field units were authorized by Tables of Organization in certain numbers for each body of troops and were supposed to accompany them automatically except as this provision was modified by priority of the shipping schedule. Certain units-e. g., mobile hospitals and mobile surgical units-were not originally prescribed by organization tables but were authorized by general orders and were provided according to tactical needs and resources. Thus, mobile hospitals were authorized1 but not supplied2 in the proportion of one per division. But the prime reason why the field units were not included in the hospitalization program proper was the fact that they were expected to give only very temporary accommodation to casualties. They had to clear as rapidly as possible in order to receive new arrivals from the front and to be prepared to clear and move on very short notice in order to accompany the troops they served. Therefore their bed capacity could not be considered a part of the total that should be available at a given moment. Nor did this program technically include infirmaries established by the American Red Cross along the line of communications, nor the infirmaries with capacities of from 10 to 50 beds which the military forces established and staffed with local personnel for care of the slightly sick and injured belonging to regiments in camps, small groups serving in towns, or other detached commands. These latter infirmaries were established where neither the number nor the severity of the cases required the establishment of a camp hospital and were under the administrative control of the local commander. All of these services though not included in the hospitalization program proper were nevertheless under the general supervision of the hospitalization division of the chief surgeon's office.


284

Therefore, though the term "hospitalization," as technically understood and as utilized in the following text, was applied to only fixed formations, and among these essentially to base and camp hospitals, including militarized American Red Cross hospitals and naval base hospitals receiving Army casualties, and to convalescent camps, it was used also in another and more general sense, being applied to the entire hospital system of the American Expeditionary Forces from the battle areas to the sea. This general system is here briefly described, before a discussion of hospitalization in its more technical sense is undertaken, in order that there may be given a coherent view of the subject in its entirety, and that the position therein of the fixed hospitalization may be defined.
 

HOSPITAL FACILITIES AT THE FRONT

The following units, which are discussed at some length in Volume VIII, comprised, during the World War, the sanitary train of divisions, corps, and armies:3 3 field hospitals, motorized; 1 field hospital, animal-drawn; 3 ambulance companies, motorized; 1 ambulance company, animal-drawn; 8 camp infirmaries; 1 medical supply unit; 1 mobile laboratory (added later). The normal capacity of the field hospital was 216 patients.4

When we entered the World War field hospitals were equipped similarly throughout and in accordance with existent tables of organization, but the unlooked for conditions it was necessary for them to meet in France necessitated additions to this equipment.5 Thus to one of the four divisional field hospitals additional surgical equipment was issued in order that it might function on a larger scale as a surgical hospital. To one of the other hospitals was added the equipment for the treatment of gassed patients.

Field hospitals were utilized according to current needs, their service and disposition differing considerably in the several divisions under changing circumstances. Often two hospitals were combined and here patients were sorted, distributed if need be to the other field hospitals with the division, or sent to the rear.

Usually one of the divisional field hospitals was used to sort patients and to care for the wounded, one received sick, and another gassed, while the fourth hospital was held in reserve or was used to supplement one of the others.5 Sometimes one of these hospitals was used for the nontransportable surgical cases only. When facilities permitted, this last-mentioned unit was reenforced by a mobile surgical unit, extra bedding and equipment and, rarely, by surgical teams. The hospitals carried their own tentage, but when opportunity offered occupied buildings in suitable locations.

As stated above, mobile hospitals were authorized in the proportion of one per division in action1 but were not provided in that number.2 Only 12 were actually utilized.2 These units were devised to care for the serious surgical cases and therefore were provided with appropriate equipment and with 120 beds for nontransportable wounded. The equipment to a large degree was surgical, and included X-ray apparatus, sterilizing apparatus, operating room supplies, electric lighting plant and mobile laundry. They cared for the seriously wounded who could not be transported to the rear without grave


285

danger. They were distributed by the army surgeon to augment the service of field or evacuation hospitals. One was used for a time for the treatment, in the army zone, of cranial cases only.6 These units, though small, were complete, required but a few hours for their establishment or packing, were readily transportable.

Mobile surgical units were smaller organizations transportable on three trucks each provided with an operating room, sterilizing, X-ray and electric light equipment. They also were assigned by the army surgeon to supplement the hospitals of division, corps, or army.2

The sanitary train of a corps consisted of four field hospitals, four ambulance companies (all motorized) withdrawn from the replacement divisions.7 These units cared for and evacuated patients from the divisional hospitals in front of them to the army units in their rear and cared for the disabled while en route.

The sanitary train prescribed for an army was the same as that of an Infantry division.8 It was supplemented by the mobile hospitals and mobile surgical units above mentioned, and by evacuation hospitals which were authorized in the proportion of the two per division.9 However, that number of evacuation hospitals was never reached, though equipment for 16 of them was sent overseas early in the war.2 Each evacuation hospital originally provided for 432 patients but in the summer of 1918 their capacity was increased to 1,000 beds and the equipment of these units already in France expanded accordingly.2 In emergencies their capacity was further increased. These units under control of the army surgeon were located at railheads, where they received from the front all patients that were to be sent to base hospitals on the line of communications. They were supplemented by other army hospitals which cared for gassed patients by three neuropsychiatric hospitals and by certain militarized units furnished by the American Red Cross.2
 

HOSPITAL FACILITIES IN THE SERVICES OF SUPPLY

The hospital facilities provided in the interior, in France, England and Italy, but by far to the greatest degree in France, were base hospitals (including one pertaining to the Navy), hospital centers, convalescent camps, camp hospitals, American Red Cross military hospitals, American Red Cross hospitals, and American Red Cross convalescent homes.2

BASE HOSPITALS

Prior to the World War, base hospitals were the Medical Department units of the line of communications designed to receive patients from field and evacuation hospitals, as well as cases originating on the line of communications, and to give them definitive treatment.10 It was intended that base hospitals would be well equipped for such treatment and that there would be sent to the home territory only patients requiring special treatment or whose condition might be such as to warrant the opinion that they were either disabled permanently or not likely to recover within a reasonable length of time.

Base hospitals had been organized originally with a staff of 20 officers, 46 nurses, and 153 enlisted men.10 This staff was increased in the latter part


286

of 1917, then consisting of 35 officers, 100 nurses, 200 enlisted men and a valuable but limited number of civilian employees, viz, dietitians, technicians, and stenographers.11

Base hospital units were allowed in the shipping schedule in the proportion of four to a division, but were displaced to a considerable degree by combat troops, with the result that from the time our forces began to conduct operations on a large scale, in the summer of 1918, their number was inadequate and remained so until after the armistice was signed.2 In many instances their equipment was not received for many months after having arriving overseas.

HOSPITAL CENTERS

In the American Expeditionary Forces the controlling factor in the preparation of plans for base hospitals was economy in personnel and material. But there was every necessity for further economy in personnel, administration, and supply; consequently, these hospitals were grouped, in so far as local conditions permitted, into "centers of hospitalization,"12 or hospital centers, as they came to be called.
 

CONVALESCENT CAMPS

Before headquarters, A. E. F., authorized the establishment of convalescent camps, on June 1, 1918,13 there were in nearly all our military hospitals in France many patients whose medical or surgical treatment had been completed, but whose physical condition was such that their attending surgeons could not return them to their commands for full duty.14 Since there was every necessity for keeping as many base hospital beds as possible ready for the reception of patients from the front, the substandard men referred to above frequently had to be evacuated long distances to other hospitals where the demand for beds was not so insistent. Particularly was this necessity for a clearance true of the base hospitals located nearer to the front. To relieve this condition and, at the same time, to increase hospital facilities generally, the chief surgeon, A. E. F., recommended on May 17, 1918,15 that convalescent camps be authorized and constructed, one in the vicinity of each hospital group. Its size in point of bed capacity was to be rated at one-fifth that of the hospital group it was to serve.

The cases to be sent to a convalescent camp were those for whom medical and surgical treatment, beyond dispensary care was no longer necessary, but who needed a more or less brief period of graded physical training and rehabilitation suited to their condition. This physical rehabilitation was to be under an experienced medical officer; but line officers assisted by noncommissioned officers, temporarily or permanently disabled for further duty, were to be used for commanding and drilling provisional companies. Thus over-hospitalization and loss of discipline would tend to be obviated.

Though it was proposed to use barracks for convalescent camps, no objection was held to the use of tents, the stipulation being, however, that there should be an increase in floor space over that for ordinary barracks and that there should be no double bunks.


287

As mentioned above, this proposal of the chief surgeon was approved by headquarters, A. E. F., June 1, 1918. The bed capacity of convalescent camps was included in the normal capacity of the hospitals with which they were connected.

CAMP HOSPITALS

It is neither necessary nor advisable to place all cases originating on the lines of communications in base hospitals; all such cases do not require the more extensive or definitive treatment for which base hospitals are intended; furthermore, it is axiomatic that sick and injured soldiers should receive hospital care just as near their commands as is compatible with the condition of the patients and with the exigencies of the military situation. Therefore, in the American Expeditionary Forces for each divisional training area and camp, a camp hospital was provided,16 where all local cases could be admitted, only the severely sick and injured requiring a better quality of treatment being transferred to base hospitals.

As early as July, 1917, the chief surgeon, A. E. F., attempted to secure authorization for personnel for these important units but his recommendation was disapproved, on the ground that personnel from the divisional sanitary trains would be available to fill this need.2 Experience proved that such a view is based on a misconception of the problem presented. To employ the sanitary train personnel in this way prevents the training in preparation for combat, which is just as essential for sanitary units as for those of the line. Moreover, divisions were constantly changing from one area to another and to have followed the plan proposed by the general staff, A. E. F., would have resulted in abandoning these excellently-equipped sanitary formations until the next division chanced into the same area.2 The necessity for providing and authorizing sanitary personnel for the camp hospitals is one of the outstanding lessons of the experience gained in this war.2

CAPACITY OF HOSPITALS

BASE HOSPITALS

The pre-war bed capacity of a base hospital was 500.10 This was based upon the fact that in a war of motion it frequently would become necessary with the progression or recession of the battle front to change the locations of base hospitals along lines of communications. Thus mobility was a factor which had to be borne in mind in connection with the equipment of a base hospital. However, in France, there was every indication that the location of a given base hospital would be relatively fixed; consequently, in his study of hospitalization for the American Expeditionary Forces, the chief surgeon, A. E. F., on August 2, 1917, stated that the personnel of a base hospital, with proper material, could reasonably well care for 1,000 patients, and that it was his intention to increase the equipment of these units and to operate them with a capacity of 1,000 beds each.16 This increased capacity was effected in General Pershing's project of the rear which he sent by cable to the War Department during the following month.


288

Fig 79. Outline map of France showing the location of the various fixed hospitals of the American Expeditionary Forces

In addition to the increase in capacity of base hospitals from 500 to 1,000 beds, a crisis expansion of 1,000 beds was provided for by the use of tents.17 Thus there came to be two kinds of bed capacity: normal and crisis expansion. It was only upon the normal bed capacity, however, that the ratio of hospital beds to troops was based.13

HOSPITAL CENTERS

Since hospital centers comprised an aggregation of base hospitals, their separate bed capacities were not fixed. They possessed an elasticity, in so far as hospital beds were concerned, that was limited, on the one hand, by available ground where buildings constructed in situ were to be used, and, on the other hand, by available buildings where these were to be used, for example, at Vichy.

At a number of points several-i. e., from 2 to 11-base hospitals were grouped physically in hospital centers, and accommodations for much larger formations were under construction when the armistice was signed.

The largest of these hospital centers were at Mesves, Mars, Savenay, Bordeaux, Bazoilles, Rimaucourt, Beaune, Allerey, Nantes, Brest, and Limoges, whereas in Paris the hospitals were grouped administratively as one center. The principal hospital centers in existing buildings were Vichy (hotels), Toul (casernes), Clermont-Ferrand, Vittel-Contrexeville, and Cannes.
 

CAMP HOSPITALS

Camp hospitals had an authorized capacity of 300 beds and crisis capacity in emergencies,16 but some were much larger; e. g., No. 26, which served the first replacement depot at St. Aignan, and had a capacity of 2,200 beds,19 and Camp Hospital No. 52 at Le Mans, which had a capacity of 2,300.20
 

AMERICAN RED CROSS HOSPITALS

American Red Cross military hospitals and convalescent homes were a valuable asset to the American Expeditionary Forces, particularly in Paris, where up to the time of the Chateau-Thierry operation the Medical Department was not allowed to establish hospitals.2 Their bed capacity was variable. After July 1 the Medical Department did establish many hospitals in and around Paris and on November 11 arrangements were under way by which we would have had 20,000 beds in that city.21 Other notable Red Cross hospitals were at Beauvais, Juilly, Jouy-sur-Marne, Toul, Froidos, and Glorieux, as well as convalescent homes for officers, nurses, and men.

RATIO OF BEDS

In the early summer of 1917 the hospitalization question concerning the American Expeditionary Forces naturally divided itself into two distinct problems: Hospital accommodations to meet the immediate needs of the sick of the American troops in France; the provision of hospitals for the care of the wounded to be expected when our troops became actively engaged in the front line.

As it obviously was impossible for us to construct hospitals in time to meet our immediate needs, the French were asked to relinquish to us accommodations of this character wherever they were needed.2 To these requests they willingly acceded.


289

After the French had met the initial needs of our service in the transfer of hospital facilities, they urged that we prepare a hospitalization program in which we would outline what we considered necessary to meet both present and future needs.22 They did not seek to influence the terms of the program, but sought chiefly to learn the number of beds that the American Army would require as well as their geographical distribution in order that they might promote our projects and coordinate a similar plan of their own with ours. Accordingly, on July 8, 1917, representatives of the chief surgeon's office, A. E. F., and of the French Medical Service held a conference whose purpose was the study of a project to provide 50,000 beds, which it was the intention of headquarters, A. E. F., to locate in France during 1917.23
 

FIG. 80.-American Red Cross Military Hospital No. 21, Paignton, Devon, England

This number of beds was considered by the chief surgeon as being too small to use in connection with a project, in view of the inevitable delay in securing sites and completing necessary construction work; therefore on August 2 he recommended in its stead that not less than 100,000 beds be provided, using 500,000 troops as a basis for his estimates.24 At this time the general staff was willing to agree to the chief surgeon's estimate in part only;25 that is to say, no fault was found with the proportion of the number of beds to be supplied, but, since it was believed that there had been an inadequate time for mutual research and study, there was a possibility of error which would be minimized


290

in a basic number smaller than 500,000 troops. Therefore, the application of the chief surgeon's percentages was made to a force of 300,000 men, thus providing for 73,000 beds.

Since there must be a correlation of the provision of beds and personnel with which to operate them, and further, since the bringing of personnel to France had been placed on a phase basis, it is not surprising that headquarters, A. E. F., should adopt a similar basis for hospitals. This was done in mid-October, 1917.2 Hospital beds were now allowed on the basis of 10 per cent of our total forces in Europe for a given phase, with an additional 10 per cent for troops in combat. It was anticipated by the general staff that not more than four of the five corps concerned would be engaged simultaneously, consequently the above allowance would approximate 15 per cent hospital beds for ordinary needs and 25 per cent for maximum needs, in addition to the beds of the divisional field hospitals.22

FIG. 81.-American Red Cross Convalescent Hospital No. 101, Lingfield, Surrey, England. (For officers)

The provision of base hospitals according to the successive increment of forces was tabulated as follows:


291

American Expeditionary Forces hospitalization program-estimated beds required

In forwarding this program to the chief surgeon, the adjutant general, A. E. F., stated that since the whole question of the strength of the American Expeditionary Forces was dependent upon the amount of tonnage that might be placed by our Government in the trans-Atlantic transport service, and that accurate information on this particular subject would not be available for some time, the commander in chief, A. E. F., was not prepared to take any definite action beyond such authorization for providing hospitals as had already been given.26 The study was believed to be complete enough to warrant consideration by the chief surgeon with a view of making such recommendations as he desired.

In his analysis of this program, the chief surgeon pointed out that there were two factors which must be taken into consideration as having a possible modifying influence on the result arrived at:27 First, the basic principle on which the program was founded was that the personnel of each base hospital unit could care for 1,000 patients; second that a base hospital unit in an emergency, could increase its capacity from 1,000 beds to 2,000 beds by the use of tentage. As to the first, the base hospital unit obviously could not care for 1,000 patients if it became necessary to divide the units into small detachments in order to fit them into small existing buildings which might be taken over from the French. As to the second factor, the emergency expansion could not be considered as being possible were existing buildings such as schools and hotels to be taken over and used as hospitals, in view of the fact that in connection with most of these buildings there was inadequate ground space for expansion. Even if there were the necessary ground space, the lack of usual hospital facilities, by additionally burdening the personnel, would almost make expansion out of the question.


292

On December 15, 1917, the chief surgeon reported to the commander in chief, A. E. F., that in so far as the Medical Department was concerned, the project of 73,000 hospital beds along the line of communications had been accomplished.28 In this accomplishment, he had found that adherence to a fixed numerical fractional program had caused much confusion and delay in the acquisition of sites and labor and in the placing of material. It was thus obvious that hospital construction on a definitely prescribed percentage basis could not keep pace with the arrival of troops. In the absence of authorization to perfect plans for a progressive hospitalization program looking far into the future, it was impossible to provide in time the necessary hospital facilities eventually required. For this reason the chief surgeon recommended that hospital construction be authorized on the basis of the strength of an army rather than in proportion to increments of troops. Such authorization, he pointed out, would permit the development of a much more comprehensive plan of hospitalization than the phase or progressive fractional plan. This program was to contemplate the ultimate provision of a total of 200,000 hospital beds, ordinary capacity.

Pursuing this question further, a medical representative of the chief surgeon, G-4, G. H. Q., A. E. F., made an analytical study of the resources and limitations of hospitalization. The result of this study was submitted to the general staff on March 31, 1918, together with a recommendation that there be authorized an automatic bed allowance which would recognize that six months would be necessary to complete a project.29 It was also recommended that the Medical Department be authorized to arrange for new hospital accommodations on the basis of 12,000 beds a month, which would be acquired either through acquisition of existing buildings or by new construction. These recommendations were not approved at the time, and until a new policy was announced it was necessary for the Medical Department to take up direct with the general staff any new project for which new construction was necessary.

At this time 45,300 beds were allowed on the strength of the troops present, 1 corps-i. e., 300,000 men-but of these beds there were actually available in the hospitals of the American Expeditionary Forces only 21,340, leaving a shortage of 23,960.2 Projects then under way to meet the needs of present and prospective strength would provide for a total of 118,930 beds when completed.2

On June 1, 1918, headquarters, A. E. F., authorized the Medical Department to maintain an actual current bed status aggregating 15 per cent of the total strength of the American Expeditionary Forces.13 In effect, this was approximately the same percentage that previously had obtained-that is, 10 per cent for total forces and 10 per cent additional for combat forces-however, in reality, the establishment of the flat rate tended to avoid future conflict of opinion as to the ratio of combat and other troops. This latest numerical allowance was to include the accommodations in all fixed hospitals, irrespective of type, as well as in convalescent camps, and the computation was to be made on the basis of ordinary capacity.

Since it now was well recognized that projects involving new construction could not ordinarily be available for occupancy before the lapse of at least six months, and that the provision of adequate hospital accommodations must


293

keep pace with the arrival of troops, headquarters authorized the Medical Department an additional credit of 90,000 beds over the 15 per cent referred to, in order that it could make timely anticipation of its future needs. In utilizing this credit the Medical Department was to write off approximately one-sixth of it monthly.13
 

LOCATION OF HOSPITALS; PROGRESS IN HOSPITALIZATION

The first program for the location of hospitals of the American Expeditionary Forces, formulated by the chief surgeon, A. E. F., in the summer of 1917, was, of necessity, tentative for the reason that before it could be adopted certain factors must definitely be decided upon, especially the sector of the front which the American forces would occupy, and the main railway lines and ports which would afford means of communication.2 Up to the fall of 1917, the chief surgeon had not received any definite information concerning the sector our troops eventually would occupy at the front;2 however, as delay could not be countenanced, he proceeded on the assumption that our principal bases must be St. Nazaire and Bordeaux, and that our sector would be in Lorraine, in the vicinity of the training areas (Gondrecourt, Neufchateau, Mirecourt, and Le Valdahon) in which they were placing our troops.2 This assumption indicated, in turn, what probably would be our lines of communications, and events proved that these early conjectures generally were correct. The American sector eventually occupied extended from west of Verdun to east of Belfort,30 and the base ports most utilized were Bordeaux, La Rochelle, St. Nazaire, and Brest.31

While estimates of the number of troops that would be used in the American Expeditionary Forces were being formulated by general headquarters, A. E. F., the hospital program was being furthered, inspections for possible hospitals were continued and arrangements made for obtaining buildings which were suitable for hospital purposes, and, so far as could be estimated, properly located near St. Nazaire, Bordeaux, the training areas mentioned above and along the railway lines between them and the ports.2 In carrying out this project studies were made of prospective hospital sites in or near the following places: Nantes, Angers, Tours, Romorantin, Bourges, Gievres, Nevers, Beaune, Dijon, Langres, Chaumont, Martigny, Neufchateau, Vittel, Contrexeville, Bordeaux, Perigueux, Limoges, Chateauroux, St. Nazaire, Savenay, La Rochelle, Cercy-la-Tour, Le Valdahon, Besançon, Rigny-les-Salles, Cosne, Ourches, Epinal, and Sens.28 The Engineer and the Medical Departments concurred in the belief that Bordeaux and St. Nazaire were the most desirable ports, since in both places there were good facilities for docks, large base hospitals, camps, and water supply.

As stated above, the first allowance for hospital beds made by general headquarters, A. E. F., was 73,000.25 As to the location of these, headquarters directed that a joint study be made by the chief quartermaster, the chief surgeon, and the chief of engineers, A. E. F., which resulted in the geographical distribution of hospital beds as follows: 14,000 beds in the advance section, 21,000 beds between Tours and the French zone of the armies, 38,000 beds from Tours westward.


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The chief surgeon, A. E. F., now proposed that such construction for hospitals be located as follows, the several establishments in each section being entered on this list, in order of their preferability:2
 

 

To be constructed (beds)

Existing buildings (beds)

 

To be constructed (beds)

Existing buildings (beds)

Advance section (14,000 beds):

Base section (38,000 beds):

1. Bazoilles-sur-Meuse

---

800

1. Tours

2,000

0

2. Bazoilles-sur-Meuse

5,000

0

2. Perigueux

5,000

0

3. Bazoilles-sur-Meuse

1,000

0

3. Vauclaire

0

1,000

4. Chaumont

---

2,500

4. Talence

400

600

5. Bologne

---

---

5. Angers

700

300

Intermediate section (21,000 beds):

6. Nantes

2,000

0

1. Dijon

700

300

7. Savenay

700

300

2. Dijon

5,000

0

8. St. Nazaire

300

200

3. Beaune

1,000

100

9. La Boule

5,000

0

4. Moulins

2,000

0

10. La Rochelle

5,000

0

5. Vichy

3,000

0

11. Bordeaux

3,000

0

6. Chateauroux

400

600

12. Poitiers

1,000

0

7. Limoges

600

400

13. Angouleme

1,000

0

On October 6, the commander in chief, A. E. F., wrote the French military mission in part as follows:32

The attached letter shows in detail the program that is now being carried out by the Medical Corps, American Expeditionary Forces. It shows the immediate necessity of providing hospital facilities for 73,000 beds in the zone of the line of communications. It shows also the general areas in which it is desired to locate the various hospitals with the desired bed capacity of each.

It is believed, however, that during the preliminary phases of our operations here we will be forced to use existing buildings, hotels, etc., as hospitals pending the construction of new hospitals, notwithstanding their disadvantages. This is on account of the shortage of construction material.

The most practical plan for us to follow, it is believed, is to make use temporarily of the existing facilities and at the same time push new construction as fast as possible. The sites for construction of hospitals must be at points where the available ground will permit of large expansion and where the railroad evacuations will be best met.

It is therefore requested that we be given the benefit of the opinion of the French authorities on this entire question at as early a date as practicable. Please include lists of available buildings in the zone of the line of communications of these forces, not including those listed in the attached letter, suitable and available for hospitalization. At the same time, please give your recommendations as to location of definite sites for construction of hospital centers.

From the attached letter the difficulties that the Medical Corps, American Expeditionary Forces, have had in their endeavor to procure hospital accommodations and sites are clearly presented. It is requested that this matter be immediately taken up and that these headquarters be informed as to what steps it should take with reference to placing the proper representatives of the Medical Corps in relation to representatives of the French Government, to the end that any further delay in providing hospitals for these forces be prevented.

On October 8, 1917, the chief surgeon informed the chief of staff, A. E. F., that the commander in chief of the French Armies had stated that it would be necessary to hold a conference to establish a program of hospitalization.33 He added that a working basis concerning this subject in the French zone of the interior had been reached between his office and that of the French Medical Service, but that until a similar arrangement could be made for hospitalization in the zone of the armies, but little progress could be made in


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providing the absolutely necessary hospital facilities in that jurisdiction. He therefore recommended that the proposed conference between representatives of the French and American services for the consideration of hospitalization be held at the earliest practical moment.

On October 11, the commander in chief wrote to the chief of the French military mission calling attention to the need of hospitalization in the American Expeditionary Forces and to the necessity for immediate steps to provide adequate hospital facilities. He recommended that a conference be called at the earliest possible moment.34 Accordingly a conference was held at Chaumont, October 17, between representatives of the American and French Armies, when the following conclusions were reached:35

Seventy-three thousand beds should be provided for a force of 300,000 men. In order to shorten the journey for wounded and to effect economies in transportation, equipment, personnel, the general distribution of beds proposed by the general staff (13,000 in the advance zone, 21,000 in the intermediate, and 39,000 in the bases) should be modified, so that 40,000 beds would be located in the intermediate zone and 20,000 in the zone of the bases. The intermediate zone would be included (roughly) in the area bounded by Sens (exclusive), Orleans, Tours, Dijon, Lyon. Sanitary installations would not be restricted to the lines of communication only, but might also be developed on subsidiary branches of these lines. This arrangement would secure treatment of slight cases in the zone of the advance, of more serious cases in the intermediate zone and of the very serious cases, including those returnable to the United States, in the zone of the bases. Inspections with a view of locating suitable hospital sites would be undertaken jointly, by the Americans and French without delay and installations would be sought not only on the direct lines of communication but in subsidiary lines as well. In the zone of the armies, formations then held by the French would be turned over with their equipment to the American service as soon as its troops entered the sectors these formations served, while regional installations would be, in principle, retained under the general jurisdication of the territory they served, the transfer being decided according to circumstances in each case.

The report of the conference further reads as follows:

Hospitals in the zone of the armies: In regard to the 10 division camp hospitals which the American staff proposed to establish as hospitals of 300 beds apiece with extension possibilities to 1,000 beds, the French staff thinks that it would be advisable, in order to obtain immediately and at the lowest cost the necessary buildings for the hospitalization of the sick, to provide each zone with places for cantonment infirmaries in each of the existing cantonments, and to use, for supplementary needs, the French hospitals which would be handed over to the Americans in the zones in question and to which evacuations could be made by motor ambulances. In this connection a list of hospitals containing from 7,000 to 8,000 beds was handed the representative of the chief surgeon. These hospitals will be handed over progressively to the American Medical Service concurrently with the arrival of 300,000 men.

Beds

Vaucouleurs

50

Mandres

220

Ourches

500

Rigny

600

Chalaines

220

Mirecourt

240

Neufchateau (300 beds having already been handed over)

900

Liffol

100

Martigny

850

Contrexeville

1,080

Vittell

1,820

Bazoilles (already turned over)

1,040

It is also considered expedient to utilize as far as possible at the present time all available structures, such as chateaux and large buildings. In regard to the hospitals which are to be built, sites are to be searched for on the lines, Bricon-Chatillon, Chatillon-Troyes, Chalindrey, Boulogne-Rimaucourt.


296-297

4. Hospitals in the zone of the interior.-After the examination made of the projects entertained by the American staff in regard to the French hospitals which are to be taken over and hospitals to be built, the conclusion is reached that in dealing with numbers of beds as detailed in page 1 it is advisable only to use, in selecting important hospital centers, such plants or places that can be cleared by railroad service. In this respect sites for large hospitals will be suggested and searched for (subject to the approval of the commander in chief, A. E. F.).

(1) In the intermediate zone, sites will be located in the district of Cercy-la-Tour, of Clamecy, of Autun, of Avallon, etc.

(2) In the zone of the bases, sites will be located in the district of Redon and Auray in the northern area and in the district of Bordeaux and Arcachon in the southern area. The sites to be utilized and the hospitals in the interior which are to be taken over will be made the subject of studies and agreements, to be concluded, in each case, between the undersecretary of state of the service de santé and the general staff of the Army (fourth bureau, on the one hand, and the American staff, on the other).

5. It is agreed that this study is based on the requirements of 300,000 men and that a new conference will be held in due course for a discussion of the needs of larger numbers of effectives.

With this report was included a statement of the hospitals which had been and which would be turned over to the American Expeditionary Forces and the bed capacity of each. These were as follows:

 1. INSTRUCTION CAMPS

Beds

Gondrecourt (turned over August, 1917):

    Wooden barrack hospital capacity

180

Can be increased by additional

70

         
        Total:

250

Bazoilles-sur-Meuse (turned over July 4, 1917), formerly the Bazoilles Hospital (direction Etapes group of the Armies of the East): Wooden barrack hospital

1,000

2. ZONE OF THE BASES

St. Nazaire (turned over July 6, 1917):

    Boys' school (formerly Surgical Hospital 59)

292

    Eleventh region, possible extension of

208

         
        Total:

500

    Camp infirmary, eleventh region

100

Savenay (turned over Aug. 8, 1917):

    Normal school for teachers (formerly Surgical Hospital 14)

300

    Possible extension

700

         
        Total:

1,000

Brest (placed at the disposal, on June 17, 1917, of American patrol crews.)

Bordeaux (turned over Aug. 8, 1917): Small school of Talence (formerly Surgical Hospital 25)

1,083

    Eighteenth region-40 Adrian barracks have been asked for the personnel.

3. INTERMEDIATE ZONE

Angers (turned over Sept. 3, 1917):

Small girls' school (formerly Surgical Hospital 58)

470

Ninth region, possible extension

530

 


Total:

1,000

Chateauroux (turned over Aug. 22, 1917):

Retreat for mental affected (Surgical Hospital 23)

810

Ninth region, possible extension

190

 


Total:

1,000

Dijon (turned over Aug. 8, 1917):

Theological school (formerly Surgical Hospital 77)

546

Eighth region, possible extension

455

 


Total:

1,000

Limoges (turned over Sept. 3, 1917):

Haviland factory (formerly Hospital du Mas Loubier-Surgical Hospital 49)

510

Possible extension

490

 


Total:

1,000

Paris (in process of being turned over): Formerly Red Cross Hospital, 6 Rue Piccini

300

5. ZONE OF THE ARMIES

Chaumont (in process of being turned over): Artillery barracks (Surgical Hospital 28) twenty-first region

2,800

Two Adrian barracks have been requested for operating rooms.

Neufchateau (Rebeval Barracks)

300

HOSPITALS THAT WILL EVENTUALLY BE TURNED OVER TO AMERICAN EXPEDITIONARY FORCES

Nantes, Grand Lycée de Nance (schoolhouse): Eleventh Region Complementary Hospital No. 21

500

Perigueux, Vauclaire Abbey: Twelfth region departmental establishment, not occupied by the service de santé, which should be turned over to American Expeditionary Forces.

Limoges: Seminary.

Tours: Chateau St. Victor (to build), ninth region.

Perigueux: Mallet property (to build), twelfth region.

Bordeaux: Chateau Raoul et Chateau des Iris, eighteenth region.

Dijon: Porte Neuve station, eighth region.

Nantes: Grand Blottreau, eleventh region.

La Rochelle: Land between Lallen and La Pallice, thirteenth region.

Beaune: Eighth region.

Peppignan: Hospital (part finished)

600

The report of this conference was accepted by the administrative section, general staff.2 Concerning this program the chief surgeon wrote as follows on October 19, 1917.36

   OCTOBER 19, 1917.

Memorandum for the C. of S.

Subject: Hospitalization.

1. The conference of October 17, 1917, referred to in attached memorandum brings up three points for consideration:

(a) The acceptance of certain French hospitals located to the north and east of Neufchateau.

(b) Changing the figures accepted by the general staff, from 38,000 beds in the base section and 21,000 beds in the intermediate section, to read 21,000 beds in the base section and 38,000 beds in the intermediate section.

(c) The enlargement of the intermediate section to take in the territory shown on the attached map.


298

2. All of these propositions meet with my approval. The acceptance of the hospitals offered by the French appears at this time to be a matter of necessity. The enlargement of the intermediate zone opens a considerable field where existing French hospitals suitable for our purposes may be found.

3. The accompanying map shows very clearly the lack of existing French hospitals in the southwestern part of the divisional training areas, consequently as stated in the attached memorandum hospital facilities can be provided only by construction.

4. In paragraph 1-A of the attached memorandum the statement is made that 7,000 beds now existing in the French hospitals are available to the American Expeditionary Forces. Attention is invited to the fact that while the French hospitals shown on the map attached total, according to the figures, 7,233 beds, 1,510 beds have already been turned over to the American Expeditionary Forces and are not to be counted. This leaves 5,700 beds which it is stated are available. From information now at hand it appears that one of these proffered hospitals belongs to the civil community and can not be disposed of by the G. Q. G.

5. This number will be further reduced through the fact that it appears probable from information now at hand that some of these smaller hospitals can not be used by the American Expeditionary Forces. In addition, the capacity of the hotels at Contrexeville, Martigny, and Vittel is listed differently by the French for summer and winter; i. e., certain of the hotels were built for summer use only and it has been possible to occupy only a part of the buildings in winter time. The figures given above are the summer capacity.

6. It is recognized that in the present emergency anything that offers shelter for patients must be used. However, in concurring in this memorandum it is with the reservation that 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. The very serious obstacles to the use of buildings now employed by the French as emergency hospitals was indicated in detail in my letter of September 27, 1917, on the general subject of hospitalization.

      A. E. BRADLEY,
      Brigadier General, Chief Surgeon.

On October 23 the following hospitals were under the control of the chief surgeon, A. E. F.:37

    American Red Cross Military Hospital No. 1, Neuilly.
    Base Hospital No. 6, A. E. F., Bordeaux.
    Base Hospital No. 8, A. E. F., Savenay.
    Base Hospital No. 9, A. E. F., Chateauroux.
    Base Hospital No. 15, A. E. F., Chaumont.
    Base Hospital No. 17, A. E. F., Dijon.
    Base Hospital No. 18, A. E. F., Bazoilles.
    Base Hospital No. 101, A. E. F., St. Nazaire.
    Base Hospital No. 27, A. E. F., Angers.
    Base Hospital No. 39, A. E. F., Limoges.
    Base Hospital No. 2, care of General Hospital No. 1, British Expeditionary Force, Etretat.
    Base Hospital No. 4, care of General Hospital No. 9, British Expeditionary Force, Rouen.
    Base Hospital No. 5, care of General Hospital No. 13, British Expeditionary Force, Camiers.
    Base Hospital No. 10, care of General Hospital No. 16, British Expeditionary Force, Treport.
    Base Hospital No. 12, care of General Hospital No. 18, British Expeditionary Force, Camiers.
    Base Hospital No. 21, care of General Hospital No. 12, British Expeditionary Force, Rouen.


299

CAMP HOSPITALS ESTABLISHED OR TO BE ESTABLISHED

    First divisional training area, Camp Hospital No. 1, A. E. F.
    Second divisional training area, Camp Hospital No. 2, A. E. F.
    Third divisional training area, Camp Hospital No. 3, A. E. F.
    Fourth divisional training area, Camp Hospital No. 4, A. E. F.
    Fifth divisional training area, Camp Hospital No. 5, A. E. F.
    Sixth divisional training area, Camp Hospital No. 6, A. E. F.
    Seventh divisional training area, Camp Hospital No. 7, A. E. F.
    Eighth divisional training area, Camp Hospital No. 8, A. E. F.
    Ninth divisional training area, Camp Hospital No. 9, A. E. F.
    Tenth divisional training area, Camp Hospital No 10, A. E. F.
    Camp hospital established at St. Nazaire, Camp Hospital No. 11, A. E. F.
    Camp hospital established at Le Valdahon, Camp Hospital No. 12, A. E. F.
    Camp hospital to be established at Mailly, Camp Hospital No. 13, A. E. F.
    Camp hospital to be established at Issoudun, Camp Hospital No. 14, A. E. F.

Not until October 31 did the chief surgeon receive the approval of the chief of staff of the conclusion reached at the conference of October 17.38 In the meantime very little could be accomplished in the prosecution of the hospitalization program because of the fact that it was necessary to have the approval of the commander in chief, A. E. F., before hospitals offered by the French could be accepted. These hospitals were particularly those in the region of Vittel, Contrexeville, and Martigny. Previously the general staff, A. E. F., had notified the chief surgeon that hospitalization projects should keep to the west of the general area in which these places were located.25

On October 31, 1917, the chief of staff telegraphed the approval of the commander in chief concerning the hospitalization project of October 17.39 The chief of staff drew especial attention to that portion of his approval which pertained to the utilization of existing buildings. The next day the commander in chief approved this project in the following terms:40

      A. S., G. S., November 1, 1917.

From: Commander in Chief

To: Chief, French Military Mission

Subject: Hospitalization

1. I have the honor to inform you that the hospitalization project contemplated in the conference held at the French mission October 17, 1917, meets with the approval of the commander and chief as follows:

(a) Acceptance of existing hospitals offered in the zone of the armies, to be taken over as required.

(b) Acceptance of the area Sens (exclusive)-Orleans-Tours-Dijon-Lyon for hospitalization in the intermediate area, subject to remarks given below.

(c) Acceptance of the altered distribution of the 73,000 beds in the first program so as to give about 40,000 in the intermediate section and about 20,000 in the base sections.

(d) Acceptance of the plan to seek sites for construction of hospital centers in the general areas indicated in the conference; i. e., for the advance section in the vicinity of Is-sur-Tille, Champlitte, Andilly, Boulogne, Chatillon, etc., for the intermediate section in the vicinity of Cercy-la-Tour, Autun, Avallon, and Clamecy, and for the base sections in the vicinity of Bordeaux, Redon, and Auray.

2. With reference to (c) above, and in view of the necessity of utilizing existing buildings to the maximum, it is considered advisable that the areas in which such buildings may be ocated include also the vicinity of the American line of communications from Tours to St. Nazaire and Chateauroux to Bordeaux.


300

3. The commander in chief in giving his approval of the project for hospitalization lays special emphasis on the fact that, on account of the scarcity of shipping and difficulty of obtaining material, every effort should be made to obtain existing buildings and that where construction is necessary it must be of the simplest character possible consistent with necessities. It is, therefore, requested that the facilities in existing hospitals or buildings which can be offered be made the maximum possible.

4. It is the understanding that, as soon as possible, the French authorities will furnish preliminary studies of the question of existing hospitals and other buildings in the interior and of sites for hospital construction in the three sections, as indicated under (d) above, which can be utilized by the American Army.

5. With regard to areas for construction of hospitals, it will be necessary to consider carefully the location of such hospital centers in order to avoid interference with storage depots, training areas, etc., and in order to permit this study to be made it is desirable to have the suggestions of the French authorities as early as practicable. As soon as the French authorities are ready I shall take pleasure in having the American representatives confer with their representatives to fix definite locations for these hospitals.

By direction:

      W. D. CONNOR, Acting Chief of Staff.

As of December 15 the following reports were submitted to the general staff concerning hospital status:29


301

Hospitals authorized in approved project now established and receiving or ready to receive patients

Item index

A. E. F. designation

Location

How acquired

Number of units

Present bed capacity

Eventual total ordinary bed capacity when completed

Remarks

Camp hospital:

1

No. 1

Gondrecourt

By transfer from French

1

250

300

2

No. 2

Neufchateau

.do.

1

500

500

3

No. 3

La Fauche

New construction by engineers A. E. F.

1

300

300

4

No. 11

St. Nazaire

.do.

1

100

300

5

No. 12

Le Valdahon

By transfer from French

1

300

300

6

No. 13

Mailly

.do.

1

300

300

7

No. 14

Issoudun

New construction by engineers A. E. F.

1

300

300

Now under construction.

8

No. 15

Coetquidan

By transfer from French

1

300

300

9

No. 16

Chalaines

.do.

1

220

220

To be turned back to France.

10

No. 17

Burey en Vaux

.do.

1

100

100

Do.

11

No. 18

Liffol le Grand

.do.

1

100

300

12

No. 19

La Courtine

.do.

1

---

300

Ready in about one month.

13

No. 20

Souge

.do.

1

300

300

14

No. 21

Bourbonne-les-Bains

By leasing hotels

1

200

200

Requisition necessary.

15

Total camp hospitals

---

---

14

3,270

4,020

Base hospital:

16

No. 6

Bordeaux

By transfer from French

1

500

1,300

17

No. 8

Savenay

.do.

1

450

1,000

18

No. 9

Chateauroux

.do.

1

563

1,000

19

No. 15

Chaumont

.do.

1

1,141

1,200

20

No. 17

Dijon

.do.

1

221

1,000

21

No. 18

Bazoilles

.do.

1

723

750

22

No. 27

Angers

.do.

1

314

1,000

23

No. 36

Vittel

By leasing hotels

1

700

1,000

24

No. 39

Limoges

By transfer from French

1

103

350

Occupied by skeleton unit.

25

    No. 101

St. Nazaire

.do.

1

419

1,000

26

Naval No. 1

Brest

.do.

1

400

400

27

Total base hospitals

11

5,534

10,000

American Red Cross Military Hospital:

28

No. 1

Paris

.do.

1

650

650

Under agreement with French Government. This hospital treats only French personnel. It is not available for Americans.

29

No. 2

.do.

.do.

1

300

300

Under agreement with French Government 100 beds are exclusively reserved for French patients.

30

No. 3

.do.

.do.

1

50

50

Exclusively reserved for officers and Red Cross personnel.a

aThese hospitals are operated in conjunction with American Red Cross at their expense.


302

Hospitals authorized in approved project, but not yet ready for occupancy 

Item index

Type of hospital unit or A. E. F. designation

Location

How to be acquired

Number of units authorized

Eventual total ordinary bed capacity to be provided

Remarks

Camp hospital:

1

No. 3

Bourmont

New construction by engineers, A. E. F. 

1

300

Now nearing completion.

2

No. 5

Vaucouleurs

.do.

1

300

One-half completed.

3

No. 6

Colombey

.do.

1

300

Site selected, construction not started.

4

No. 7

Humes

.do.

1

300

Do.

5

No. 8

Not determined

.do.

1

300

Site can not be selected, until 8
D. T. A. is settled.

6

No. 9

Chateau Villain

.do.

1

300

Site selected; construction not started.

7

No. 10

Prauthoy

.do.

1

300

Do.

8

No. (?)

Meucon

By transfer from French

1

300

9

No. (?)

Le Courneau

.do.

1

300

10

Total camp hospitals

---

---

9

2,700

11

Base hospital units

Bazoilles

New construction by engineers, A. E. F.

6

6,000

Authorized Sept. 18 and Oct. 19; work on one hospital under way.

12

.do.

Limoges

By leasing a seminary

1

1,000

Authorized Sept. 22; alterations now under way.

13

.do.

Vauclaire

By lease of new civil hospital

1

1,000

Authorized Sept. 22; alterations and additions necessary.

14

.do.

Bordeaux

New construction by contractor

5

5,000

Authorized Nov. 8; see proposed projects (b).

15

.do.

Rimaucourt

New construction by engineers, A. E. F.

2

2,000

Authorized Nov. 12; see proposed projects (b).

16

.do.

Langres

.do.

2

2,000

Do.

17

.do.

Vittel

By leasing hotels

1

1,000

Authorized Nov. 12.

18

.do.

Contrexeville

.do.

1

1,000

Do.

19

.do.

Nantes

.do.

1

1,000

Authorized Nov. 15; additions and alterations necessary.

20

.do.

Allerey

New construction by engineers, A. E. F.

10

10,000

Authorized Dec. 12.

21

.do.

Mesves

.do.

10

10,000

Do.

22

.do.

Beaune

.do.

10

10,000

Do.

23

.do.

Mars

.do.

10

10,000

Do.

24

.do.

Nantes

.do.

3

3,000

Authorized Dec. 13.

25

Total base hospitals

---

---

63

63,000


303

Additional hospitalization projects at the following-named places were also tentatively proposed at this time in order to meet further prospective needs.28
 

Location

Ordinary bed capacity to be provided

Remarks

Rimaucourt

3,000

Tentatively authorized by adjutant general, A. E. F., Nov. 12.

Langres

3,000

Do.

Contrexeville

1,000

Additional hotels to be acquired.

Vittel

1,000

Do.

Veuxhaulles

5,000

Site proposed by French general headquarters.

Chatillon-sur-Seine

5,000

Do.

Coublanc

5,000

Do.

Mirebeau

5,000

Do.

Martigny

1,000

Hotels to be acquired.

Bordeaux

15,000

Tentatively authorized by adjutant general, A. E. F., Nov. 8.

Savenay

4,000

Severac, or Questembert, or Guemene-Penfao

5,000

Sites proposed by French fourth bureau.

Limoges

3,000

Perigueux

5,000

Tours

2,000

Vichy

5,000

Hotels to be acquired.

Other sites not yet selected but to be chiefly in the intermediate zone

59,000

Total

127,000

It was believed now that a proper regional distribution of hospital facilities would be approximately as follows:28 Advance section, 15 per cent; intermediate section, 60 per cent; base sections, 25 per cent.

The chief surgeon's office also reported that, as had been planned, hospitals were located in general in the training areas centered around Neufchateau, along the lines of communications, and at Bordeaux, St. Nazaire, and Brest.28 Considerable hospitalization was necessary at base ports for the permanently disabled. In selecting sites, consideration had to be given also to such questions as availability of railroad sidings, situation at points where these formations would not interfere with the movement of troops, or those in training areas, and accessibility from camps and depots as well as from the front. Future experience, it was added, might show that some readjustments of these percentages might be necessary, but in any event these would serve as a basis for present plans and could be changed if the necessity arose.

On February 23 the chief surgeon forwarded to the Surgeon General the following data concerning the hospitalization facilities of the American Expeditionary Forces:41
 

ALPHABETICAL INDEX OF LOCATIONS, FIXED MEDICAL DEPARTMENT UNITS

Allerey: 10 type A, A. E. F. base hospital units under construction. Total ordinary capacity of this center to be 10,000 beds. Work in hands of French contractors and will soon be under way.

Angers: Base Hospital No. 27, with a capacity of 334 beds, in operation in old French hospital. Construction under way to increase capacity to 2,000 beds, thus providing for a special clinic for the treatment of "Diseases of the heart."

Bazoilles: Base Hospital No. 18, with a capacity of 740 beds in operation in barrack hospital acquired from the French. Six type A, A. E. F. base hospital units under construction by the Engineer Corps. Total ordinary capacity of this center to be 6,740 beds.


304

Beaune: 10 type A, A. E. F. base hospital units under construction. Total ordinary capacity of this center to be 10,000 beds. Work in hands of French contractors and will soon be under way.

Blois: Camp Hospitals Nos. 25 and 26, with a total bed capacity of 430, in operation in old French hospitals.

Bordeaux: Base Hospital No. 6, with a capacity of 900 beds, in operation. Five type A, A. E. F. base hospital units under construction on Beau Desert site. This site will be the eventual center for the construction of a total of 20 type A, A. E. F. base hospitals with an ordinary capacity of 20,000 beds. Receiving and forwarding medical supply base No. 2. Base medical laboratory, base section No. 2, temporarily housed in Base Hospital No. 6.

Bourbonne-les-Bains: Camp Hospital No. 21, with a bed capacity of 200, in operation in hotel leased for hospital purposes.

Bourmont: Camp Hospital No. 3, with a bed capacity of 300 beds, in operation.

Brest: Naval Base Hospital No. 1, with a capacity of 407 beds, in operation in old French hospital. Camp Hospital No. 33, with a capacity of 500 beds, capable of expansion to 1,000 beds, in operation at Pontanezen Barracks. Receiving and forwarding medical supply base No. 5. Base medical laboratory, base section No. 5.

Burey-en-Vaux: Camp Hospital No. 17, with a capacity of 125 beds. Vacated because of evacuation of training area.

Chateauroux: Base Hospital No. 9, with a capacity of 817 beds, in operation in old French hospital. Base medical laboratory, base section No. 3 (intermediate section) temporarily housed in Base Hospital No. 9.

Chateau Villain: Base Hospital No. 9, with a capacity of 300 beds, under construction by Engineer Corps.

Chalaines: Camp Hospital No. 16, with a bed capacity of 220, vacated because of evacuation of training area.

Chaumont: Base Hospital No. 15, with a capacity of 1,414 beds, in operation in old French hospital.

Coetquidan: Camp Hospital No. 15, with a bed capacity of 525, in operation in an old French hospital.

Colombey: Camp Hospital No. 6, with a capacity of 150 beds, vacated because of evacuation of training area.

Contrexeville: Base Hospitals Nos. 31 and 32, with a capacity of 1,250 beds each, in operation in hotels, leased for hospital purposes.

Cosne: Intermediate medical supply depot No. 3.

Dijon: Base Hospital No. 17, with a capacity of 833 beds, in operation in an old French hospital. Central medical laboratory, on University of Dijon property.

Gievres: Intermediate medical supply depot No. 2.

Gondrecourt: Camp hospital No. 1, with a capacity of 300 beds, in operation in barrack hospital acquired from the French.

Humes: Camp Hospital No. 7, with a capacity of 300 beds, under construction by Engineer Corps.

Issoudun: Camp Hospital No. 14, with a capacity of 300 beds, in operation.

Is-sur-Tille: Advanced medical supply depot No. 1.

La Courcelles: Camp Hospital No. 38, with a capacity of 240 beds, ready for occupancy.

La Courtine: Camp Hospital No. 19, with a capacity of 300 beds, in operation in old French hospital.

La Fauche: Camp Hospital No. 4, with a capacity of 300 beds, ready for occupancy.

Langres: Five type A, A. E. F. base hospital units approved for this place. Acquisition of site still under consideration by the French. Camp Hospitals Nos. 22, 23, and 24, with a total capacity of 520 beds, in operation in old French buildings.

Le Courneau: Camp Hospital No. 29, with a capacity of 1,000 beds, in operation in old French hospital.

Le Valdahon: Camp Hospital No. 12, with a capacity of 300 beds, in operation in an old French hospital.


305

Limoges: Base Hospital No. 38, with a bed capacity of 242, in operation in old French hospital; two modified type A, A. E. F. base hospital units, with a capacity of 1,500 beds each, under construction by Engineer Corps. New Grand Séminaire, with alterations and additions under way to provide a capacity of 1,000 beds, will soon be occupied by a unit.

Liffol-le-Grand: Camp Hospital No. 18, with a capacity of 300 beds temporarily vacated.

Mailly: Camp Hospital No. 13, with a capacity of 250 beds, in operation in old French hospital.

Mars: Ten type A, A. E. F. base hospital units under construction. Total ordinary capacity of this center to be 10,000 beds. Work in hands of French contractors and will soon be under way.

Mesves: Ten type A, A. E. F. base hospital units under construction. Total ordinary capacity of this center to be 10,000 beds. Work in hands of French contractors and will soon be under way.

Meucon: Camp Hospital No. 31, with a capacity of 500 beds, under construction by French engineers

Montigny: Camp Hospital No. 8, with a capacity of 300 beds, under construction by Engineer Corps.

Nantes: Base Hospital No. 34, occupying Grand Seminary; alterations and additions under way to increase capacity to 1,000 beds. Three type A, A. E. F. base hospital units under construction on the Grand Blottereay site. Work in the hands of French contractors.

Neufchateau: Base Hospital No. 66, with a capacity of 735 beds, in operation in Rebeval Barracks. Army medical laboratory No. 1.

Nevers: Camp Hospital No. 28, with a capacity of 130 beds, in operation in old French hospital.

Paris: American Red Cross Military Hospitals, No. 1, with a capacity of 600 beds; No. 2, with a capacity of 186 beds, and No. 3, with a capacity of 50 beds.

Perigueux: Five type A, A. E. F. base hospital units under construction. Total ordinary capacity of this center to be 5,000 beds. Work in hands of French contractors and will soon be under way.

Prauthoy: Camp Hospital No. 10, with a capacity of 300 beds, now under construction by Engineer Corps.

Rimaucourt: Five type A, A. E. F. base hospital units approved for this place. Work is to begin immediately upon two of these units by the Engineer Corps.

Savenay: Base Hospital No. 8, with a capacity of 800 beds, which construction, now under way, will increase to 1,300 beds; will eventually be center for 5,000 beds, the work to be carried on by Engineer Corps. To become center for psychiatric clinic of 100 beds.

Souge: Camp Hospital No. 20, with a present capacity of 120 beds, which construction by Engineer Corps, now under way, will bring to 500 beds.

St. Maixent: Camp Hospital No. 30, with a capacity of 117 beds, which construction by Engineer Corps, under way, will increase to 300 beds.

St. Nazaire: Base Hospital No. 101, with a capacity of 890 beds, in operation. Camp Hospital No. 11, with a capacity of 350 beds, under construction by Engineer Corps. Receiving and forwarding medical supply base No. 1. Base medical laboratory, base section No. 1.

Toul: Five hundred beds in wing of French H. O. E. Justice (Field Hospital No. 12 to operate here); 400 beds in Sebastopol Barracks (Evacuation Hospital No. 1 to operate here); 400 beds at Menil-la-Tour, evacuation ambulance company to operate at railway station.

Tours: Camp Hospital No. 27, with a capacity of 300 beds, in operation in old French hospital.

Vauclaire: Base Hospital No. 25, with a capacity of 1,000 beds, to be located in French buildings leased for that purpose.

Vaucouleurs: Camp Hospital No. 5, with a capacity of 300 beds, vacated because of evacuation of training area.

Vichy: Base Hospital center for 3,500 beds, to be acquired by leasing French hotels.

Vittel: Base Hospitals 23 and 36, with a capacity of 1,750 beds each, in operation in hotels, leased for hospital purposes.


306

Cross reference

BASE HOSPITALS

[Receiving, or ready to receive, patients] 

A. E. F. designation

Location

Eventual ordinary bed capacity to be provided

Town

State

Region

Where organized

6

Bordeaux

Gironde

18

Massachusetts General Hospital

1,860

8

Savenay

Loire Inferieure

11

New York Post-Graduate Hospital

2,500

9

Chateauroux

Indre

9

New York Hospital

1,500

15

Chaumont

Haute Marne

Z. A.

Roosevelt Hospital, New York

1,500

17

Dijon

Cote d'Or

8

Harper Hospital, Detroit

1,000

18

Bazoilles

Vosges

Z. A. 

Johns Hopkins, Baltimore

1,000

23

Vittel

.do.

Z. A.

Buffalo General Hospital

1,750

27

Angers

Maine et Loire

9

University of Pittsburgh Med.

2,000

31

Contrexeville

Vosges

Z. A.

Youngstown Hospital

1,275

32

.do.

.do.

Z. A.

Indianapolis City Hospital

1,225

34

Nantes

Loire Inferieure

11

Philadelphia Episcopal Hospital

1,000

36

Vittel

Vosges

Z. A.

Detroit College of Medicine

1,750

39

Limoges

Haute Vienne

12

Massachusetts Homeopathic Hospital

350

66

Neufchateau 

Vosges

Z. A. 

United States at large

800

101

St. Nazaire

Loire Inferieure

11

American Expeditionary Forces at large.

1,000

Naval

Brest

Finistere

11

United States at large

410

CAMP HOSPITALS

[Receiving, or ready to receive, patients]

A. E. F. designation

Location

Eventual ordinary bed capacity to be provided

Town

State

Region

1

Gondrecourt

Meuse

Z. A.

300

3

Bourmont

Haute Marne

Z. A.

300

12

Le Valdahon

Doubs

7

300

13

Mailly

Aube

Z. A.

300

14

Issoudun

Indre

9

300

15

Coetquidan

Ille et Vilaine

10

500

19

La Courtine

Creuse

12

300

20

Souge

Gironde

18

500

21

Bourbonne les Bains

Haute Marne

Z. A.

200

Langres:

22

Turrenne Barracks

.do.

Z. A. 

120

23

Physic. Hospital

.do.

Z. A.

100

24

Comp. Hospital No. 3

.do.

Z. A.

300

Blois:

25

Comp. Hospital No. 13

Loire et Cher

5

130

26

Comp. Hospital No. 29

.do.

5

300

27

Tours, Comp. Hospital No. 3

Indre et Loire

9

300

28

Nevers, Comp. Hospital No. 14

Nievre

8

130

29

Le Courneau

Gironde

18

1,000

30

St. Maixent

Deux Serves

9

300

31

Meucon

Morbihan

11

500

32

Courcelles

Haute Marne

Z. A. 

240

33 

Brest

Finistere

11

1,000


307

Cross reference-Continued

CONSTRUCTION PROGRAM 

Location of site

Number of units authorizeda

How to be acquired

Eventual ordinary bed capacity to be provided as authorizedb

Town

State

Region

Base hospitals:

Bazoilles

Vosges

Z. A.

6

New construction

6,000

Limoges

Haute Vienne

12

3

Two new construction, 1 remodeled seminary.

4,000

Vauclaire

Dordogne

12

1

Completing existing building

1,000

Bordeaux

Gironde

18

5, a15

New construction, French contract

5,000
b20,000

Rimaucourt

Haute Marne

Z. A. 

2, a3

New construction

2,000
b5,000

Langres

.do.

Z. A.

2, a3

.do.

2,000
b5,000

Allerey

Saone et Loire

8

10

New construction, French contract

10,000

Mesves

Nievre

8

10

.do.

10,000

Beaune

Cote d'Or

8

10

New construction

10,000

Mars

Nievre

8

10

New construction, French contract

10,000

Nantes

Loire Inferieure

11

3

.do.

3,000

Savenay

.do.

11

1

New construction

2,500

Perigueux

Dordogne

12

5

New construction, French contract

5,000

Vichy

Allier

13

2

Leasing hotels from French

3,000

Camp hospitals:

Humes

Haute Marne

Z. A. 

1

New construction

300

Montigny

.do.

Z. A. 

1

.do.

300

Chat. Villain

.do.

Z. A. 

1

.do.

300

Prauthoy

.do.

Z. A. 

1

.do.

300

St. Nazaire

Loire Inferieure

11

1

.do.

300

aAdditional contemplated.
bAs contemplated by future addition.

MISCELLANEOUS MEDICAL DEPARTMENT ACTIVITIES
  

A. E. F. designation

Location

Remarks

Town and State

Region

AMERICAN RED CROSS MILITARY HOSPITALS

1

Paris, Seine

C. R.

650 beds, formerly American ambulance.

2

.do.

C. R.

300 beds.

3

.do.

D. R. 

50 beds; reserved for officers and Red Cross personnel.

EVACUATION HOSPITALS

1

Toul, M. et Moselle

Z. A. 

2

Bazoilles, Vosges

Z. A.

3

Blois, Loire et Cher

5

MEDICAL LABORATORIES

1

Neufchateau, Vosges

Z. A.

Central

Dijon, Cote d'Or

8

Base 1

St. Nazaire, Loire Inferieure

11

Base 2

Bordeaux, Gironde

18

Base 5

Brest, Finistere

11

Intermediate

Chateauroux, Indre

9

MEDICAL SUPPLY BASES AND DEPOTS

1 advance

Is-sur-Tille, Cote d' Or

8

Supply depot.

2 intermediate

Gievres, Loir et Cher

9

Do.

3 intermediate

Cosne, Nievre

8

Do.

Base 1

St. Nazaire, Loire Inferieure

11

Receiving and forwarding bases.

Base 2

Bordeaux, Gironde

18

Do.

Base 5

Brest, Finistere

11

Do.

NOTE.-The following mobile sanitary units are automatically attached to each division of troops in the field: Four ambulance companies (3 motor and 1 horse-drawn); 4 field hospital companies (3 motor and 1 horse-drawn); 1 evacuation ambulance company (motor).


308

The following memorandum for the chief surgeon, A. E. F., from his deputy at general headquarters, A. E. F., gives a good perspective of the location of our hospitals necessitated by the acquisition of the fact that our principal sector of the front was to be from St. Mihiel eastward:

GENERAL HEADQUARTERS, AMERICAN EXPEDITIONARY FORCES,

                            France, August 9, 1918

Memorandum for the chief surgeon (attention of hospitalization section):

1. Recent developments up here show that our principal sector is to be from St. Mihiel eastward. How far to the east we will go depends upon the number of troops available for holding the line.

2. The assistant chief of staff, G-4, has given instructions that all projects originally outlined for the development of railways, regulating stations, hospitals, etc., for the Toul sector are again in force. I asked the assistant chief of staff, G-4, particularly about Chatillon-sur-Seine. He approves of it as a hospital site; and if the chief surgeon's office desires, hospital construction can be gone ahead with at that place. A study of the railroad map will show how very well located this place is for our purpose. Moreover, this is the finest hospital site I have seen in France. If more hospital facilities are desired in the advance section, this is undoubtedly the place.

3. We have another approved site at Mirebeau, near Dijon, which as a site is not as desirable as Chatillon.

4. The assistant chief of staff, G-4, is very anxious that we should have hospital facilities along the different lines north and south controlled by the different regulating stations. This in order to prevent the cutting across in the rear of different armies with our hospital trains. This is the case at the present time when the regulating officer at Le Bourget sends a train down into the advance section. It can be done, as has been shown, but if railroad traffic is heavy it becomes practically impossible to cut across from west to east, or vice versa. The assistant chief of staff, G-4, thinks that we should plan our hospitalization in the future to permit of evacuation practically from any part of the entire line along the north and south lines. I was surprised to find that he included in this the English front. In this connection, I would like to suggest Evreux as a site for hospital development. I am inclosing a railroad map which my assistant has prepared from one furnished him by the French G. Q. G. This shows the lines of evacuation from each one of the French regulating stations, beginning on the west with Sotteville, then to Nantes, Creil, Le Bourget, Connantre, St. Dizier, Is-sur-Tille, and Gray. These regulating stations are also the stations which our troops will use. As far as we have gone, we have followed the regulating system from Is-sur-Tille as far as it was possible to do so and reach our ports. Everything that has been done in the way of locating hospitals will fit in there nicely with future developments along the lines indicated.

On August 17 the chief surgeon notified the chief of the French mission that the offer of the French for accommodation for 3,300 beds in various localities was accepted.42 In the Paris district, in addition to what was already organized, it was desired that facilities for 15,000 beds be provided, and that extensive hospitalization be provided at Vichy because of its accessibility by rail from the front, and the suitability of the buildings there.42

On August 24, 1918, the chief surgeon reported as follows: [Memorandum]

AUGUST 24, 1918.

From: Chief surgeon

To: Assistant chief of staff, G-4, Services of Supply.

Subject: Hospitalization.

1. There are 75,000 beds at present in base hospitals; 50,000 are occupied. There are 1,400,000 troops in France, and 15 per cent of hospitalization would give 210,000 beds that should be available, making a shortage of 135,000 beds.


309

2. It is not believed that any construction should be eliminated from this program. The projects under construction as follows:

Beds

Bazoilles

7,000

Langres

2,000

Allerey

10,000

Beaune

10,000

Mars

20,000

Mesves

20,000

Tours

10,000

Rimaucourt

5,000

Bordeaux

20,000

Limoges

4,000

Brest

3,600

Montoire

10,000

La Suze

5,000

Avoine

5,000

Savenay

20,000

Nantes

3,000

Angers

2,000

Rochette

5,000

Périgueux

5,000

England (by procurement and construction)

20,000

Each to include its proportionate convalescent camp and crisis expansion.

3. It is believed that the following should be given priority for construction: Brest, Rimaucourt, Allerey, Mars, and Savenay.

By the end of August, 102,144 beds (including emergency beds) were provided, of which total 54,485 were occupied.2

The selection of sites, procurement of existing buildings, and construction of new ones progressed steadily, though scarcely keeping pace with the now rapidly increasing demand for beds, for large numbers of American troops were now engaged and battle casualties reached the hospitals in considerable numbers.21 One evacuation hospital (No. 7) received 27,000 patients between June 15 and August 11. Also a considerable amount of sickness had developed, including scattered outbreaks of influenza and quite general epidemics of diarrhea and dysentery. Further preparation of hospitals was necessary for the impending offensive, but no one could foresee that contemporaneously with this conflict there would occur a great influenza epidemic that would call for almost as many hospital beds as would the destructive efforts of the enemy.

During September 10, 150 beds were provided at Cannes, Nice, Menton, and other points on the Mediterranean and a lesser number at Biarritz, near the Pyrenees.21

The French submitted another long list of hotel buildings which might be used as hospitals, and a list of barracks and school buildings which were made available by their Government.44 Of their last mentioned structures certain were accepted, to a total capacity of 11,550 beds. The director of construction and forestry, A. E. F., was notified of that fact, given the names and addresses of medical officers who would be concerned in the operations of the hospitals located in these public buildings, and requested that the Engineer Department consult with them in each case concerning the location of the building, repairs required, and any information desired in connection with their operation.

By the end of September, 1918, the total fixed hospital capacity, including emergency beds, was 148,596 beds. Of these, 79,580 were occupied. A hospital center providing 10,240 beds was being established in 25 hotels on the Riviera. A center had also been established at Clermont-Ferrand.

During October the French furnished a long list of buildings which could be turned over to the Americans for use as hospitals, the total providing accommodations for more than 30,000 beds.21 Most of these buildings were schools, barracks, hotels, chateaux or residences.


310

The demands for beds was increased to an unexpected degree at this time because of the epidemic of influenza which assumed grave proportions simultaneously with the prosecution of the Meuse-Argonne operation. American battle casualties during that action included 72,584 wounded and 23,934 gassed.2

This cumulative combination of circumstances subjected the hospitalization facilities to a severe test-not so much because of the number of beds necessary, as because of demands for equipment and especially for personnel.2 The inadequacy of Medical Department personnel to meet the demands now made upon it, is discussed in another chapter of this volume.

In the procurement of existing buildings for hospital purposes full cooperation had been received from the French with the result that space for thousands of beds had been secured.27 Though far from ideal for hospital purposes, these buildings at least afforded shelter. In spite of all that could be done, however, with the heavy fighting at the front and a serious influenza epidemic during the months of September and October, the margin of safety, consisting of unoccupied beds, steadily decreased. On October 10 there were more beds occupied than were shown by the normal bed capacity, and by October 17 the 166,200 beds occupied included 30,798 for emergency use.27 The authorized program at this time provided for approximately 100,000 beds in addition to those already available. Careful consideration was directed toward the provision of 600,000 beds before July 1, 1919, and all needed aid in the carrying out of the program was promised.27 On October 19, the commander in chief wrote to the commanding general, Services of Supply, as follows:

        G. H. Q., A. E. F., 4TH SEC., G. S., October 19, 1918.

    From: C. in C.

    To: C. G., S. O. S.

    Subject: Hospitalization program.

    1. The situation of the American Expeditionary Forces, from the point of view of hospitalization, has become alarming. The small margin of safety which has existed heretofore has disappeared. The commander in chief is deeply interested in this matter, and has expressed his concern over the outlook. He directs that immediate steps be taken to remedy the critical situation with which we are now confronted, and that a hospitalization program, more comprehensive in scope and sufficient to provide for our future needs, be inaugurated with the least practicable delay.

    2. In this connection, attention is invited to the indorsement from this office of June 1, 1918, a copy of which is herewith attached, which authorizes American Expeditionary Forces hospitalization requirements on the basis of 15 per cent of hospital beds for all American Expeditionary Forces troops in Europe. In this indorsement it was specifically stated that so-called "emergency expansion" was not to be included in computation of beds available. Based on the estimates as outlined in the indorsement referred to, an analysis of this date shows a deficit of approximately 100,000 beds therein prescribed, with apparently insufficient provision for the future. It would appear that a most unsatisfactory situation has been permitted to develop. It must be rectified at the earliest possible moment.

    3. In a recent communication, the War Department commented upon the insufficiency of the American Expeditionary Forces hospitalization program. It is recognized that the War Department has been somewhat remiss in that it has failed to ship the necessary and authorized personnel and equipment for hospitals which are now available for occupancy. However, as a result of repeated cables and statements of the extreme seriousness of the existing situation, it is believed that the personnel and equipment phase of our present difficulties will soon be relieved. In any event, this is not a factor which should be taken into consideration at this time in providing hospitals on the scale which is necessary, if the needs of the future are to be met.


    311

    4. Accordingly, the commander in chief directs that this matter be given careful consideration, and that a hospitalization program aiming at the provision of 600,000 beds for the American Expeditionary Forces by July 1, 1919, be immediately inaugurated. As the possibilities of acquiring existing buildings or hospitals from the French have been practically exhausted, the greater part of this program will, of necessity, be possible of fulfillment only through the means of new construction, chiefly of the hut or portable barrack type.

    5. In accomplishing this project, the skilled services of civilian contractors should be utilized to the maximum extent possible, and provision be made to furnish them as much additional labor and other assistance as may be necessary to expedite construction undertaken by this means. If necessary, every effort will be made to assign or procure for you such additional labor or construction troops as will be required to carry out this program.

    6. The chief surgeon should make an immediate general survey and submit to you his recommendations as to where the hospitalization herein prescribed can most advantageously be established. As the changing military situation will probably frequently require the presence of our troops as far north as the channel ports, the need for new hospitalization north and west of Paris should be given careful consideration. The evacuation lines from the regulating station at Creil should be given careful consideration. As a beginning, the French have already consented to the establishment of an American Expeditionary Force hospital at Evereux, authority for which has already been transmitted to you.

    7. If this headquarters can assist in any way toward furthering the accomplishment of this hospitalization program, your recommendations thereon are desired, and will be carefully considered.

    8. A brief report by letter as to the progress made, particularly with reference to new construction undertaken to meet future needs, will be forwarded to these headquarters at the end of each month.

    By order of the commander in chief.

          GEO. VAN HORN MOSELEY,
          Brigadier General, G. S., Assistant Chief of Staff, G-4.

      In his reply the commanding general, Services of Supply, stated that the hospitalization program of the American Expeditionary Forces had always been under the most careful observation and that every effort possible had been put forth to carry it out successfully.23 The reasons why this had not been actually accomplished were pointed out substantially as outlined above; i. e., difficulties incident to procurement of suitable sites and to effecting new construction. Following this correspondence, a telegram was issued by the chief of staff American Expeditionary Forces, to the commanding general, Services of Supply, as follows:

      G. H. Q., A. E. F., 4th SEC. G. S., October 20, 1918.

      COMMANDING GENERAL,

      Services of Supply, American Expeditionary Forces:

      Because of the critical situation produced by the heavy demands on hospitals, the commander in chief directs as follows: First, the completion of all buildings under construction for hospital purposes and the necessary alteration in buildings taken over by the Medical Department from the French must be expedited in every possible manner. Second, commanding officers of base hospitals and hospital centers are authorized to retain class B privates capable of assisting hospital personnel for temporary duty. The number of these men will be determined by the commanders mentioned above, but will be kept at the minimum necessary to permit hospitals to function under emergency conditions now prevailing. Commanding officers will be held responsible for not exceeding the number hereby authorized. Third, every effort must be made to move Medical Department personnel, units, and hospital equipment coming into ports, other equipment being shipped from depots to hospitals with least possible delay. When hospital units arrive at ports with equipment, trains should be made up and equipment shipped at once with unit.

      MCANDREW.

                     

      Official:

      ROBT. C. DAVIS, Adjutant General.


      312

      On October 28 the bed status of the American Expeditionary Forces was as follows:

      AMERICAN EXPEDITIONARY FORCES,
      OFFICE OF THE CHIEF SURGEON,
        October 28, 1918.

      Memorandum for the A. C. of S., G-4, Hdqrs. S. O. S., A. E. F.:

      1. In reply to your memorandum of October 26, 1918, file No. 010186, submit the following information:

        (a) Number of beds installed in hospitals ready to receive patients:

        Beds

        Camp hospitals:

        Occupied

        17,751

        Vacant

        7,481

         


        Total

        25,232

        Base hospitals (includes normal and crisis expansion beds):

        Occupied

        142,675

        Vacant (the vacant beds in base hospitals are all emergency)

        50,289

         


        Total

        192,964

        Convalescent camps:

        Occupied

        15,995

        Vacant

        4,927

         


        Total

        20,721

        Total beds in camp hospitals, base hospitals, and convalescent camps

        238,917

        Total occupied beds in camp hospitals, base hospitals, and convalescent camps

        176,421

        Total vacant beds in camp hospitals, base hospitals, and convalescent camps

        62,496

        (b) Number of beds complete now in depots and shipped but not installed and not taken up on daily bed report, 47,500.

        (c) Personnel in Europe not operating hospitals, one base hospital. This personnel can operate 1,500 beds.

        (d) Number of beds complete expected from the United States, to include February, 1919, as shown on priority schedule, 250,000.

        (e) Personnel expected from the United States to include January 31, 1919, as shown on the priority schedule, officers, 9,324; nurses, 16,717; enlisted men, 100,748.

        February shipment schedule not yet made up. Beds which this personnel can operate:

        Normal beds in base hospitals

        124,000

        Normal beds in camp hospitals

        13,500

        Normal beds in convalescent camps

        24,800

        Total normal beds

        162,300

        Total normal beds

        162,300

        Crisis expansion beds

        62,000

        Total normal and crisis expansion beds

        224,300

           For the chief surgeon:

        J. D. GLENNAN,
        Brigadier General, Medical Corps.

        On October 31, of 221,421 beds in camp and base hospitals 163,767 were occupied.45 A number of casualties were passing through field, mobile, and evacuation hospitals, and there were yet others-relatively very few-in allied and Red Cross hospitals.2 In camp and base hospitals 35,045 normal beds were vacant, for a number of patients were occupying emergency beds.45 But for


        313

        that fact 98.3 per cent of the 166,534 normal beds then provided would have been occupied by 163,767 patients then in these institutions. In addition to the 221,421 normal and emergency beds in camp and base hospitals, as noted above, there were in operation convalescent camps which provided 25,070 beds. Of these, 19,047 were occupied. The grand total of all vacant beds, normal and emergency and in hospitals and convalescent camps, was 88,807. On November 1 the total number on sick report amounted to 9.08 per cent of the American Expeditionary Forces, i. e., in round numbers, 180,000 patients.21

        The number of vacant beds, normal and emergency, during August and September had been well above double the number of patients, but during October, when the number of patients nearly doubled, the factor of safety fell from 100 to 33 per cent.23

        Shortly before the armistice was signed 115,000 additional beds were authorized either in existing institutions or in new formations, and buildings for accommodations to shelter 103,000 of this number of beds were under construction.23 Also French buildings were secured and structures authorized in connection therewith for a total of 73,000 other additional beds. Buildings for 31,000 of the latter number were under preparation. New convalescent camps were also being constructed and others enlarged, increasing their total capacity by 15,000 beds. The total of new beds thus contemplated was:23

        Authorized

        Under construction

        New construction

        115,000

        103,000

        In French buildings

        73,000

        31,000

        Convalescent camps

        15,000

        15,000

        Totals

        203,000

        149,000

        Completion of these projects in addition to the 281,598 beds already provided would have given a bed capacity of 484,598. This would have been sufficient for 15 per cent sick and wounded of a force of 3,210,000 men. There were nearly 2,000,000 men in France at this time, and it was expected that this number would rapidly be increased so that the entire bed allowance authorized would be required by the spring of 1919.23

        This project was soon increased so that when the armistice was signed on November 11 the hospitalization program included construction projects and leased buildings which together with those already established would be capable of providing ultimately for 423,722 normal beds and for emergency beds in addition to these to a grand total of approximately 541,000. These were to be distributed as follows:23

        Beds normal

        Beds emergency (including normal)

        Base hospitals

        322,376

        437,744

        Camp hospitals

        38,686

        40,835

        Convalescent camps

        62,660

        62,660

        Totals

        423,722

        541,239


        314

        Among the large projects planned at this time were the following:21 In Paris, 20,000 beds; Lyons, 15,000 beds; the Riviera, 15,000; Pau and vicinity, 10,000; Clermont and vicinity, 10,000; Vichy, expansion to 30,000; Orleans, 5,000; Blois, 3,000. Smaller projects were to be provided at Poitiers, Bordeaux, Angouleme, Rouen, Moulins, Roanne, Caen, and Parthenay. These plans, however, were changed after the armistice so as to provide hospitalization for an army of 80 divisions, or about 400,000 men.21

        On November 1 the number of patients on sick report numbered approximately 182,000-i. e., 9.08 per cent of the entire force-but a number of these were under treatment in field formations. The number of patients in fixed formations reported on November 7 totaled 31,813. They were then distributed as follows:46

        Recapitulation
         

        Bed situation

        Per cent of beds occupied

        Percentage
        on sections

        Occupied

        Vacant

        Normal

        Emergency

        Normal

        Emergency

        Base

        Camp

        Base

        Camp

        Base

        Camp

        Base

        Camp

        Base

        Camp

        Base

        Camp

        Normal

        emergency

        Advance section

        22,521

        3,425

        20,463

        2,622

        42,472

        5,616

        58,050

        6,411

        53.0

        61.0

        38.7

        53.4

        54.0

        40.3

        Intermediate
        section

        69,802

        6,226

        5,198

        2,360

        52,624

        7,527

        98,993

        7,709

        132.6

        82.7

        70.6

        70.6

        126.4

        71.2

        District of Paris

        11,683

        ---

        677

        ---

        8,306

        ---

        12,498

        ---

        140.6

        ---

        81.2

        ---

        140.6

        81.2

        Base section
        No. 1

        17,992

        1,591

        2,169

        998

        16,717

        2,589

        22,677

        2,629

        107.6

        61.7

        79.3

        60.5

        101.4

        77.4

        Base section
        No. 2

        22,663

        1,747

        415

        1,420

        16,283

        3,167

        26,641

        3,126

        139.2

        55.2

        84.7

        55.9

        125.5

        82.0

        Base section
        No. 3

        6,906

        1,200

        197

        220

        6,350

        1,420

        7,137

        1,420

        108.7

        84.5

        96.7

        84.5

        104.3

        94.7

        Base section
        No. 4

        7

        ---

        473

        ---

        480

        ---

        480

        ---

        1.4

        ---

        1.4

        ---

        1.4

        1.4

        Base section
        No. 5

        2,202

        1,780

        942

        3

        3,144

        1,450

        3,280

        1,450

        70.0

        122.7

        67.1

        122.7

        88.7

        84.2

        Base section
        No. 6

        ---

        187

        1,000

        113

        1,000

        300

        1,000

        300

        ---

        62.3

        ---

        62.3

        14.4

        14.4

        Base section
        No. 7

        ---

        373

        ---

        64

        ---

        413

        ---

        463

        ---

        90.3

        ---

        80.6

        90.3

        80.6

        Subtotal

        153,776

        16,529

        31,534

        7,800

        157,379

        22,482

        230,756

        23,508

        97.7

        73.5

        66.5

        70.3

        94.7

        66.9

         

        Summary
         

        Bed situation

        Per cent of beds occupied

        Occupied

        Vacant

        Normal

        Emergency

        Normal

        Emergency

        Base hospitals

        153,776

        31,534

        157,379

        230,756

        97.7

        66.5

        Camp hospitals

        16,529

        7,800

        22,482

        23,508

        73.5

        70.3

        Grand total

        170,305

        39,334

        179,861

        254,264

        94.7

        66.9

        Total beds including convalescent camps ----------------------------------------------------------------------------------------------------------------------- 281,598

        Total patients including convalescent camps ------------------------------------------------------------------------------------------------------------------- 193,813

        Vacant beds ---------------------------------------------------------------------------------------------------------------------------------------------------------------  87,785

        REFERENCES

        (1) G. O. No. 70, G. H. Q., A. E. F., May 6, 1918.

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

        (3) Tables of Organization, No. 28, W. D., 1918.

        (4) Manual for the Medical Department, U. S. Army, 1916, Art. XIII.

        (5) Evacuation system of a field army, by Col. C. R. Reynolds, M. C., undated. On file, Historical Division, S. G. O.


        315

        (6) Report of the activities of the neurological service, A. E. F., by Col. Harvey Cushing, M. C., December 2, 1918. On file, Historical Division, S. G. O.

        (7) Tables of Organization, No. 101, W. D., 1918.

        (8) Tables of Organization, No. 201, W. D., 1918.

        (9) Manual for the Medical Department, U. S. Army, 1918, par. 793.

        (10) Manual for the Medical Department, U. S. Army, 1916, Art. XIV.

        (11) Tables of Organization (Medical Department). On file, Record Room, S. G. O., 320.3-1 (Tables Organ.).

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

        (13) 1st indorsement from the commander in chief, assistant chief of staff, G-4, general staff, G. H. Q., A. E. F., June 1, 1918, to the commanding general, S. O. S. Copy on file, Historical Division, S. G. O.

        (14) Memorandum for the assistant chief of staff, G-4, G. H. Q., A. E. F., from Maj. A. D. Tuttle, M. C., March 31, 1918. Subject: Hospitalization data. Copy on file, Historical Division, S. G. O.

        (15) Memorandum on convalescent camps for the assistant chief of staff, G-4, G. H. Q., A. E. F., May 17, 1918. Copy on file, Historical Division, S. G. O.

        (16) Letter from the commander in chief, A. E. F., to the chief French military mission, September 27, 1917. Subject: Program for hospitalization, A. E. F. Copy on file, Historical Division, S. G. O.

        (17) Letter from the commander in chief, A. E. F., to Maj. Gen. Omar Bundy, September 18, 1918. Subject: Camp infirmaries (hospitals) in division areas. On file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (18) Manual for the Medical Department, U. S. Army, 1916, par. 757.

        (19) Report of the activities Camp Hospital No. 26, St. Aignan-Noyers, as of January 1, 1919, by Lieut. Col. Wm. C. Riddell, M. C. On file, Historical Division, S. G. O.

        (20) Report of activities of Camp Hospital No. 52, Le Mans, as of January 1, 1919, by Maj. Wm. J. Buck, M. C. On file, Historical Division, 
        S. G. O.

        (21) War Diary, chief surgeon's office, A. E. F., 1917-18. On file, Historical Division, S. G. O.

        (22) 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, Washington, xlv, No. 6, 636.

        (23) 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.

        (24) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., August 2, 1917. Subject: Study of hospitalization. Copy on file, Historical Division, S. G. O.

        (25) 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.

        (26) Confidential memorandum for the chief surgeon, A. E. F., from the adjutant general, A. E. F., November 17, 1917. Subject: Hospitalization program. On file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (27) 1st indorsement, chief surgeon's office, A. E. F., November 21, 1917, to the chief of staff, G. H. Q., A. E. F. On file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (28) Report from the chief surgeon, A. E. F., to the commander in chief, A. E. F., December 15, 1917. Subject: Hospital construction, personnel, and equipment, as of December 15, 1917. On file, A. G. O., World War Division, chief surgeon's files, 329.1.

        (29) Memorandum on hospitalization for the assistant chief of staff, fourth section, general staff, prepared by Maj. A. D. Tuttle, M. C. Copy on file, Historical Division, S. G. O.

        (30) Final report of General John J. Pershing, September 1, 1919.

        (31) Monograph No. 7, prepared in the Historical Branch, War Plans Division, General Staff, June, 1921.


        316

        (32) Letter from the commander in chief, A. E. F., to the chief, French Military Mission, October 6, 1917. Subject: Program for hospitalization, A. E. F. Copy on file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (33) Memorandum from the chief surgeon, A. E. F., to the chief of staff, G. H. Q., A. E. F., October 8, 1917. Subject: Conference for hospitalization program. On file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (34) Letter from the commander in chief, A. E. F., to the chief, French military mission, October 11, 1917. Subject: Hospitalization, A. E. F. Copy on file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (35) Report of conference held October 17, 1917, at Chaumont, on the study of the hospitalization program, A. E. F. Translated copy on file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (36) Memorandum for the chief of staff, from the chief surgeon, A. E. F., October 19, 1917. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (37) Report of hospitals under control of the chief surgeon, A. E. F., October 23, 1917. Copy on file, A. G. O., World War Division, chief surgeon's files, 322.329 (Misc.).

        (38) Memorandum for file, by Col. S. H. Wadhams, M. C., October 30, 1917. Subject: Information concerning hospitalization. On file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (39) Memorandum for the chief surgeon, A. E. F., from the acting chief of staff, October 31, 1917. Subject: Hospitalization. On file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (40) Letter from the commander in chief, A. E. F., to the chief, French military mission, November 1, 1917. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (41) Letter from the chief surgeon, A. E. F., to the Surgeon General, February 23, 1918. Subject: Hospitalization data. On file, Record Room, S. G. O., 322.3 (Med. Dept. Units, France).

        (42) Letter from the chief surgeon, A. E. F., to the chief, French military mission, August 17, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (43) Memorandum for assistant chief of staff, G-4, S. O. S., from the chief surgeon, A. E. F., August 24, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief surgeon's files, 322.32911.

        (44) Memorandum for the director, construction and forestry, A. E. F., from the chief surgeon, A. E. F., September 28, 1918. Subject: Hospitalization. Copy on file, A. G. O., World War Division, chief surgeon's files, 329.32911.

        (45) Weekly bed reports, October 31, 1918, proposed in the office of the chief surgeon, A. E. F. Copy on file, Historical Division, S. G. O.

        (46) Weekly bed report, November 7, 1918, prepared in the office of the chief surgeon, A. E. F. Copy on file, Historical Division, S. G. O.

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