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Chapter XXI

Contents

The Medical Department Of The United States Army in The World War

SECTION III

HOSPITALS

CHAPTER XXI

HOSPITAL CENTERS

How the hospital center came to be adopted by the Medical Department, A. E. F., is set forth in Chapter XV, Section I. This need not be gone into further here. Following soon upon the conception, the chief surgeon, A. E. F., recommended in September, 1917, after the layout and buildings for individual type A (base) hospitals had been approved, that five such units be erected, to form a hospital center at Bazoilles-sur-Meuse.1 This project was promptly approved by the general staff, A. E. F. As the situation developed, larger and larger centers were provided, the erection of new units and the utilization of existing buildings for this purpose progressing rapidly.1 On December 12, 1917, authority was given for the construction of 10 type A hospitals at Allerey, Beaune, Mars, and Mesves.2 The next day a project for 3,000 beds at Nantes was approved. By the end of December other centers had been authorized in the following places:2 Beau Desert (Bordeaux), 5,000 beds, to be expanded to 20,000; Langres, 2,000 beds; Rimaucourt, 2,000 beds, to be expanded to 9,000; Limoges, number of beds to be determined; Perigueux, number of beds to be determined.

Other centers were gradually added at Vittel-Contrexeville, Savenay, Vichy, Toul, Kerhuon, and on the Riviera, so that eventually 20 hospital centers were operating before the armistice began, of which 5 were located in the advance section, 8 in the intermediate section, and 7 in the base sections.1 A number of others were being constructed and additional ones were projected when the armistice was signed.1

SELECTION OF SITES AND CONSTRUCTION

Sites were selected by one or another member of the hospitalization division of the chief surgeon's office, A. E. F. In some cases the sites had been suggested by French authorities.1 Proposed sites were finally accepted or rejected by a joint board, of American and French officers, on which were American representatives of the general staff (G-4), the chief surgeon's office, the Engineer Department, and a railway transportation expert.1 The sites were leased by an officer of the Quartermaster Department assigned to duty with the chief surgeon for that purpose, but construction was in charge of the Engineer Department.1

Approval of a site was determined largely by conformity with the proportion of beds authorized in the advance, intermediate, or base sections; and by availability of railway facilities.3 This latter requirement took cognizance of all matters affecting railway service, that is, distance from the front, proximity to main railway lines, grade and condition of trackage, strength of bridges


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(whether sufficient to support American hospital trains), available rolling stock, existence or practicability of sidings, and similar considerations.3 Since the French controlled the railways, their advice and cooperation were essential in locating these centers.3

Buildings utilized by centers were of two general types-preexisting French buildings and newly constructed barracks.3 The former consisted of groups of hotels or military barracks where from two to seven hospitals were operated, and whose capacity varied from 1,000 to 16,000 beds.3 Prominent centers of this type were those at Toul, Vittel-Contrexeville, Vichy, and on the Riveria, the first mentioned utilizing barracks and the last three, hotels.3 Often these buildings, especially the hotels, were poorly adapted to hospital purposes for they required extensive alterations, additions-especially of plumbing-and repairs. Also many of the hotels had no heating arrangements having been constructed for occupancy during summer only.3 Rents of such structures also were excessive.5 On the other hand, the military barracks utilized were obtained from the French practically without cost.1 These, generally speaking, were more desirable for hospital purposes than hotels for they were large, built of stone or cement, and arranged in convenient groups.1 Each barrack accommodated about 1,500 patients in rooms larger than those in hotels, thus assuring easier service to a given number of patients.1 Their disadvantages were lack of water-carriage sewer systems, inadequate water supply, and absence of suitable artificial light.1 When the armistice was signed six centers were operating in French buildings with a normal capacity of 38,340 patients and an emergency capacity of 51,523.3

Centers occupying barracks constructed for the purpose, consisted of a number of type A hospital units (whose layout is given in Chapter XV), together with some accessory, communal buildings.3

It was planned eventually that the constructed centers would consist of from 2 to 20 complete type A base hospitals of 1,000 beds each, with facilities for expansion to from 50 to 100 per cent additional.3 Each center was also to include a convalescent camp whose capacity would be 20 per cent of the "normal" beds in the center.3

The geometrical layout of the individual units was admirably suitable for this arrangement, as exemplified by the ground plan of the center at Mars.3 When a site was selected capable of accommodating a number of type A units the Engineer Department made an initial survey which had particular reference to contour lines, and units were disposed in a manner most adaptable to them, thus saving considerable piering and excavation.

Representatives of the chief surgeon's office, A. E. F., and of the Engineer Department, in charge of construction projects, worked out together the layout for each center. Some of the more important items which they considered in this matter were the location and adequacy of railway sidings, frontage of units thereon, provision of such common buildings as offices, storehouse, garage, bakery, and ice plant, post office, telegraph and telephone exchange, fire engine house, chapel, laboratory, and morgue, for the service of the entire center, the construction of roads and installation of drainage, water, sewerage and lighting systems.1 The larger centers, some of which had a projected


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capacity of 20,000 beds, approximated veritable cities with all their accessory public-utility requirements.1

When the armistice was signed, 14 centers were operating in newly constructed barracks, with a normal capacity of 69,059 and an emergency capacity of 127,270 beds.3 Very few of these barracks hospitals, however, were fully completed and it was necessary to occupy them while yet under construction.1 The personnel of the Medical Department locally on duty and convalescent patients assisted materially in the completion of these projects. In many respects service in them was easier than in centers which occupied buildings several stories in height.1

Special hospitals were features of all centers. In each, certain units were specially equipped for the treatment of surgical, orthopedic, eye, ear, nose, and throat, maxillofacial, psychiatric, neuropsychiatric and, in some centers, contagious cases.3 The center at Savenay had a special hospital for the treatment of tuberculosis patients and that at Vichy had special facilities for maxillofacial cases.3

The following table shows not only the hospital capacity (normal and crisis) but also the number of beds occupied, grouped by section, on November 28, 1918:4

Name

Normal capacity

Crisis

Occupied

Advance section:

 

 

 

Toul center

15,250

15,250

10,963

Bazoilles

7,000

13,136

2,094

Vittel-Contrexeville

5,951

9,875

3,545

Rimaucourt

5,000

10,388

2,519

Langres

2,000

3,000

571

 

35,201

51,649

19,692

Intermediate section:

 

 

 

Beaune

4,000

10,200

4,934

Allerey

10,000

14,468

10,728

Mars

11,468

20,000

8,098

Mesves

10,490

21,500

16,346

Vichy

8,327

13,000

10,250

Clermont-Ferrand

6,712

6,712

3,017

Orleans

2,800

2,800

1,135

Tours

2,300

2,850

1,870

 

56,097

91,530

56,378

Base section No. 1:

 

 

 

Angers

3,500

4,400

2,913

Nantes

4,300

6,278

4,383

Savenay (St Nazaire)

8,000

8,316

8,500

 

15,800

18,994

15,796

Base section No. 2:

 

 

 

Beau Desert

6,924

11,000

5,439

Limoges

4,528

6,000

5,485

Perigueux

1,000

1,500

983

 

12,452

18,500

11,907

Base section No. 5: Kerhoun (Brest)

2,800

2,800

2,438

At this time these centers contained about two-thirds of all the hospital beds (other than those in field units) in the American Expeditionary Forces.1 It had been planned that should the war continue until April, 1919, the centers would contain no less than half a million beds.1 Hospital construction with this end in view was well advanced, but inadequate personnel and equipment were delaying progress. No centers were constructed in England or Italy.1


476

The center which attained the largest size was that at Mesves, which, from November 11 to December 5, 1918, reported daily a capacity of 25,000 beds.3 On November 16 this center had a total of 20,186 patients and the total strength of the command, including those on duty, was 28,828.3

On November 14, 1918, patients in hospital centers numbered 109,238, with 22,191 men in their convalescent camps-a total of l31,429.5 The total number of patients in all base and camp hospitals and of men in convalescent camps numbered on that date 190,356. In other words, 69 per cent of men then under treatment in fixed formations were occupants of these centers. The total number of normal and emergency beds (including 29,284 in convalescent camps) then provided numbered 292,049. Of this number 182,045, slightly less than 70 per cent, were in hospital centers.5

The following hospital centers were in existence December 1, 1918:6

Name of center

Hospitals comprising

Type of building

Normal bed capacity

Allerey

25, 26, 49, 56, 70, 97, and E. H. 19

Barrack construction

10,000

Bazoilles

18, 42, 46, 60, 79, 81, 116

.do.

7,000

Beau Desert

22, 104, 106, 111, 114, 121, Prov. B. H. No. 7.

.do.

6,924

Beaune

47, 61, 77, 80, 96

.do.

5,500

Clermont Ferrand

20, 30, 103; includes Chatel Guyon and Royat.

French buildings

5,137

Commercy-Lerouville

90, 91

.do.

(a)

Kerhuon

63, 92, 105, 112, 120

Barrack construction

2,700

Langres

53, 88

.do.

2,000

Limoges

13, 24, 28

.do.

4,528

Mars

14, 35, 48, 62, 68, 107, 110, 123, 131

.do.

11,468

Mesves

50, 54, 67, 72, 86, 89, 108, 122, and E. H. No. 24

.do.

10,490

Nantes

11, 34, 38, 216

.do.

4,300

Pau

71; includes Dax, Lourdes, Argeles Gazost, Bagneres de Bigorre.

French buildings

(b)

Perigueux

84, 95

Barrack construction

1,000

Rimaucourt

52, 58, 59, 64

.do.

5,000

Riviera

99; includes St. Raphael, Cannes, Nice, Menton.

French buildings

---

Savenay

8, 69, 100, 113, 119, 214, 118, and E. H. No. 29.

Barrack construction

8,000

Toul

45, 51, 55, 78, 82, 87, 210

French buildings

15,250

Tours

7 and Prov. B. H. No. 1

Barrack construction

(c)

Vannes

136-236, Quiberon

French buildings

1,400

Vichy

1, 19, 76, 109, 115

.do.

8,327

Vittel

23, 31, 32, 36

.do.

5,951

aEvacuation Hospital No. 13 was operating here until November 30, when it was relieved by Base Hospital No. 91. Base Hospital No. 90 never received patients.
bStaffed, but never received patients.
cDid not receive patients until after the armistice began.

The increase in bed capacity of all the centers is shown by the following table:1

 

Normal

Emergency

1918

 

 

July 1

30,890

33,498

Aug. 1

70,124

86,252

Sept. 1

78,371

102,144

Oct. 1

109,897

160,286

Nov. 1

143,869

221,421

Dec. 1

163,368

282,182

As an index of the extent of activities of the different centers, the following table is given. It shows the total number of patients passing through the principal hospital centers to March 31, 1919:3


477

 

Patients

Toul (nearest front)

67,866

Bazoilles

66,284

Savenay

61,973

Beau Desert

47,238

Vichy

46,297

Vittel-Contrexeville

44,855

Mesves

38,765

Allerey

33,658

Mars

33,256

Nantes

29,538

Kerhuon

24,533

Limoges

23,818

Rimaucourt

21,067

Joue-les-Tours

13,701

Riviera

13,446

Beaune

13,500

Perigueux

4,540


CONTROL

Hospital centers were under the direct control of the commanding general of the Services of Supply, except in matters of discipline, guard, fire control, supplies, and inspection.1 For all these excepted matters each center was under control of the commanding general of that section of the Services of Supply in which it was located.1

In so far as subordination to the commanding general, Services of Supply, was concerned, centers were more immediately under the jurisdiction of the chief surgeon, A. E. F., who (after the promulgation of General Orders, No. 31, in March, 1918) was also the chief surgeon of the Services of Supply; with yet greater particularity they were under the hospitalization division of his office.1 After the armistice was signed and the Third Army advanced into Germany, its hospitals functioned in the Coblenz area virtually as a center, which also was under control of the hospitalization division. Eventually commanding officers of centers were given full authority in many matters. Thus, they were authorized to transfer and assign commissioned and enlisted personnel from one unit to another within their command without reference to higher authority, to promote or demote enlisted men up to and including the grade of sergeants, first class, Medical Department, to direct the disposal of all supplies received, to approve requisitions on the American Red Cross, employ civilian labor (under certain limitations imposed) authorize expenditures of Medical Department funds, convene special (but not general) courts-martial and issue necessary travel orders for patients transferred.1 Bulletin 29, 1918, Services of Supply, A. E. F., conferred on center commanders all the authority of a post commander.1 They did not have authority to approve for issue requisitions upon depots nor did they have jurisdiction over the engineers constructing the center.1 On November 13, 1918, the judge advocate general, Services of Supply, ruled in reference to this matter that "the senior officer present of the department to which the formation belongs is the commanding officer, regardless of what other officers, line or staff, are present.7 All sick and wounded records were forwarded direct to the chief surgeon's office by each hospital, but other documents from those units were required to pass through the office of the center commander.1


478

STAFFS

As no orders from higher authority prescribed the staff organization of hospital centers, each developed that organization which was most compatible with its needs and resources. Inevitably this led to some minor differences in such organization, but these were relatively few and unimportant. Thus at Mars,8 and Mesves,9 the commanding officer designated an executive officer, while at Allerey10 and Beaune11 because of the shortage of officers and nurses, the commanding officers assumed the duties of that officer. At Allerey a chief dietitian for the entire center was appointed-an assignment which appears to have been unique.10

At Mesves the staff organization, consisting of 40 members, was as follows:9 1 colonel, commanding officer; 1 major, executive officer; 1 captain, adjutant; 1 lieutenant, statistical officer; 1 major, quartermaster; 8 first lieutenants, assistants to the quartermaster; 1 captain, central purchasing agent; 1 captain, salvage and burial officer; 1 captain, supervisor of buildings; 1 lieutenant, medical supply officer; 1 lieutenant, motor transport officer; 1 lieutenant, assistant to motor transport officer; 1 lieutenant, railway transport officer; 1 captain, provost marshal; 4 first lieutenants, assistants to provost marshal; 1 intelligence officer; 1 captain, commanding headquarters detachment and band and fire marshal; 1 major, evacuation officer; 1 captain, assistant to evacuation officer; 1 captain, sanitary inspector; 1 major, medical inspector; 1 lieutenant colonel, medical consultant; 4 majors, medical consultants; 1 major, laboratory officer; 2 captains, assistants to laboratory officer; 1 chief nurse.

PROFESSIONAL SERVICES

Medical officers who were consultants in their respective specialties were designated as chief of their several services in each hospital center.1 These officers were drawn habitually from the local personnel and, at first, performed their duties as consultants in addition to personal attendance on patients; however, as the centers developed, these officers found it necessary to delegate more and more of their personal practice to assistants.1 The consultants in general medicine, general surgery, and orthopedics usually were members of the staff of the center, together with the center laboratory officer who, as described below, was in a somewhat different category. In some centers the consultants for each of the special services prescribed by general orders, A. E. F., were members of the staff. Whether on the center staff or not, designated consultants supervised the urological, X-ray, neurological, ophthalmological, maxillofacial, and otolaryngological services, corresponding to the branches of the professional services of the American Expeditionary Forces.1 Occasionally, in some centers, certain officers were designated who, to a degree at least, acted as consultants in other specialties; e. g., cardiovascular and cutaneous diseases. In general, the duties of consultants were as follows:1 To investigate and report to the commanding officer on all professional matters within their jurisdiction, control professional emergencies, keep themselves informed of the qualifications and character of the service of their subordinates and of the equipment, service, and acute needs of the several hospitals, recommend changes in assignments and distribution of equipment, coordinate professional efforts, and disseminate


479

professional information.1 Their services were purely advisory. In each base hospital the chief of a service performed the duties of a consultant for his specialty in so far as that unit was concerned, conforming his activities and policies to those of the consultant for the center, who, in turn, conformed to the policies of the chief consultant, in that specialty, of the American Expeditionary Forces.1

CONSULTANT IN GENERAL MEDICINE

The consultant in general medicine was essential at all times but especially so in October and November, 1918, when the overcrowding in most centers facilitated the spread of epidemic diseases. His most important duties were the recommendation of assignment of personnel to the best advantage, recommendations concerning the control of infectious diseases, and the dissemination of professional information. He cooperated with other consultants in organizing the medical society of the center.1

CONSULTANT IN GENERAL SURGERY

In the field of general surgery, the surgical consultant exercised duties altogether comparable to those of his colleague at the head of the medical service.1 An important part of his work was checking and reporting to the chief consultant in surgery, A. E. F., the results obtained by hospitals further forward which cleared into the center.1 Other important duties were recommendations for assignment of personnel, supervision and coordination of service, distribution of equipment to the best advantage, supervision of requisitions for supplies and dissemination of information.1 Because of the limited quantity of instruments and some other surgical supplies available, it was especially necessary that patients requiring surgical or orthopedic treatment be concentrated in certain hospitals, and here he was especially active.1 He also supervised instruction in minor surgery given to nurses and enlisted men. The subjects most considered in the classes organized for this purpose were anesthesia, practice in the application of dressings and splints and aftertreatment of battle casualties.1 As the shortage of nurses in the American Expeditionary Forces necessitated the employment of enlisted men to a very considerable degree to perform nurses' duties the training of selected men was an important, continuing service.1

CONSULTANT IN ORTHOPEDICS

The orthopedic consultant cooperated with the consultant in surgery in matters pertaining to instruction, assignment of personnel, obtainment and distribution of supplies, and similar duties. In a number of centers the consultant in surgery was also the consultant in orthopedics.1

CONSULTANT IN MAXILLOFACIAL SURGERY

The center consultant in maxillofacial surgery was instructed to keep in view both the best possible treatment of the wounded and the early determination of those who would not be fit to return to duty within a reasonable time. It was not practicable to assign a specialist in this subject to each


480

center, but one most qualified among the general surgeons was in such cases assigned to this duty.12 With him cooperated a specially qualified dental surgeon who performed the splinting and prosthesis required and gave such other care as came properly within his province.12 He also consulted in a number of cases with the center oculist and center otolaryngologist.12 Habitually, maxillofacial cases were concentrated in one hospital in each center, but when their needs required and their condition permitted they were transferred to the hospital center at Vichy, which was designated as the organization which would care for cases of this nature.12 It was staffed and equipped accordingly. A number of cases were sent to American Red Cross Hospital No. 1 at Paris. Such patients as could not be transferred to the Vichy center or to the hospital at Paris, or whose transfer was not indicated, were retained in the center to which they had been admitted. It was not the policy to remove cases from the care of those who had shown interest and competence, except as the exigencies of hospital service demanded.12

CONSULTANT IN ROENTGENOLOGY

The center consultant in Roentgenology supervised and coordinated all activities in his specialty throughout the center.1 Habitually he was also a member of the staff of some base hospital. Ordinarily only three hospitals in a center were equipped with the Army base hospital outfit for X-ray work, the other units being supplied with the Army portable machine and the bedside unit.1 Supplies pertaining to this specialty were handled in a different manner from the others under control of the Medical Department, for requisitions for them were sent to the chief consultant in this service. He modified them if need be and sent them to the medical supply officer at Cosne for issue.1 Some centers had abundant supplies while others needed them very badly. Electric current from French plants was utilized in some hospitals but in others 8-kilowatt generators were installed for each X-ray plant in operation.1

CONSULTANT IN UROLOGY

In most centers one officer was assigned to the staff as consultant in urology, dermatology, and venereal diseases, but in others one officer was charged with control of dermatology and another with the other specialties mentioned.1 The dermatological service was especially developed in the convalescent camp at Mars. The consultant in urology, as the officer usually charged with these collective duties was designated, supervised the establishment and operation of prophylactic stations, both in the center and in nearby towns; he handled all venereal reports and statistics, supervised, directed, and coordinated the activities pertaining to his specialty throughout the center, promoted compliance with military orders concerning venereal disease, requested the personnel necessary for practice of these specialties, and received all reports, returns, and statistics pertaining to them.1

CONSULTANT IN OPHTHALMOLOGY

In one hospital in each center a department was organized to which all cases in the center requiring ophthalmological treatment were sent.1 This section was equipped as thoroughly as possible and staffed to the best advantage


481

by personnel drawn from any hospital in the center. The consultant, who was (at least nominally) assigned to this hospital, himself rendered professional service so far as practicable.1 This department conducted an out-patient clinic to which patients, in such other hospitals as did not have proper equipment, were sent for refractions and minor operations.1 All personnel including nurses and enlisted men on duty in this department were especially trained. The consultant in ophthalmology supervised and coordinated the ophthalmological work of other units, for these, as rapidly as equipment was received, organized their own departments where such cases were cared for.1

CONSULTANT IN OTOLARYNGOLOGY

In the otolaryngological service, the consultant's duties were similar to those just mentioned.1 Usually this service was conducted in some hospital other than that in which the center ophthalmological service was operated because of the limits of available space in any one unit for operating room bed capacity and other facilities.1 The hospital designated for each of these clinics was adequately equipped in other respects as well, that is, X-ray, surgical, and isolation facilities, in order that these also could be used if necessary.1

CONSULTANT IN NEUROLOGY

Psychiatric and neuropsychiatric cases were clearly differentiated, and habitually were segregated in different groups in respective hospitals.1 Plans for hospital centers provided for a separate hospital unit, located at a quiet point on its outskirts, where psychiatric cases would be cared for, but in a number of centers this was never completed. The two classes of patients above mentioned were habitually cared for by different groups of specialists, both of which were under the general supervision of the neurologist for the center.1 As resources improved, reconstruction facilities, such as those afforded by shop and art work for the rehabilitation of the neuropsychiatric cases, were rapidly developed, especially in the centers at Beau Desert and Kerhuon.1

SENIOR DENTAL OFFICER

One or more dental officers were assigned to each hospital where minor and emergency work were performed.1 Much of the more elaborate work of these specialists was performed at a central clinic, which was more thoroughly equipped than were the others, and was under the direct supervision of the senior dental officer, who was also in general control of the dental service throughout the center.1 Like the laboratory officer, the senior dental officer was not a local representative of any member of the staff of consultants for the American Expeditionary Forces.1 In professional matters he was directly under the senior dental officer of the American Expeditionary Forces.1 As consultant he performed duties similar to those of other chiefs of service, but in a number of centers no consultant in this service was designated.1

SPECIALISTS IN CARDIOVASCULAR AND DERMATOLOGICAL DISEASES

Specialists in cardiovascular and dermatological diseases were not, generally speaking, designated as consultants in all centers.1 They were of special value in the convalescent camp, through which, in many centers, all patients


482

were made to pass before they were sent to replacement camps or depots.1 Here medical officers examined all patients to determine the presence of the effort syndrome, and in this service cardiovascular specialists proved of essential value.1 At Mars, all patients, before they were returned to full class A duty, were required to march 12 miles, after which they were examined.1 At the same center a dermatologist examined all patients when they entered the camp and, when called in consultation, he also examined patients in other formations.1 By his systematic methods he discovered that an unexpectedly large number of patients was suffering from cutaneous diseases, some of which were rarely found in civil practice.1

LABORATORY SERVICE

The laboratories of the several centers were under the jurisdiction of the central laboratory of the American Expeditionary Forces at Dijon, which in turn was under the sanitation division of the chief surgeon's office.1 The center laboratory officer was therefore in a somewhat different category, though in the same status as a consultant, as were the chiefs of the other professional services.1 The general plan for the laboratory service of the centers was prescribed in Memorandum No. 8, from the director of laboratories, dated July 23, 1918, but the degree of centralization developed under that plan, varied among the different centers according to circumstances.1 A center laboratory and usually a morgue were provided which supplemented the similar small installations operated in the several hospitals.1 Autopsies usually were performed at the center morgue. In general, all work requiring use of animals, serology, water analysis, inoculations, and special pathological or chemical study was carried out at the center laboratory, and all other laboratory work was performed in the plants of the several hospitals.1 The laboratory officer coordinated this service throughout the center and made appropriate recommendations concerning distribution of personnel, supplies, and duties.1 At Mesves he was a member of a permanent board which, as stated above, was organized for the control of infectious diseases.1

NURSING SERVICE

Each of the several centers had about 40 nurses to each 1,000 patients, distributed as most needed throughout the several hospitals.1 The plan designating a chief nurse for a center, which developed in November, 1918, was soon applied in most of these formations. She was elected from among the nurses on duty in the center and exercised over their service a general supervision comparable in some respects to that of the consultants.1 One of her most important duties was the distribution of the nursing personnel to the best advantage to meet the shifting needs among the different units.1 Other duties were the following:1 To meet incoming nurses and provide for their reception, systematize the rules and regulations governing the nurses, carry out the policies of the chief nurse, A. E. F., keep informed concerning the nurses' quarters, subsistence, social activities, and the care they received when sick, recommend assignments and transfers, keep a file of nurses' qualifications, act on all papers pertaining strictly to the Nurse Corps, and keep the commanding officer of the


483

center fully informed concerning the nursing personnel.1 Nurses' hours were long and the strain on them severe, for their number was insufficient and for a long time their recreational facilities were almost nil, but after the armistice, when tension lessened somewhat, it was possible for them to enjoy recreation to a much greater degree than formerly. Small social affairs such as dances were very frequent and of great value in promoting morale.1 Until March, 1919, social relations between nurses and enlisted men were forbidden, but in that month a circular from the chief surgeon's office directed that in social matters there would be no distinction between officers and enlisted men when off duty.1 This circular was in conformity with a law recently enacted by Congress.1

Centers located near cities sometimes furnished for nurses' use a limited amount of automobile transportation between the two communities.1

SANITARY SQUADS

A number of sanitary squads, each consisting of 1 officer and 25 enlisted men, had been withdrawn from divisions which had been assigned to replacement duty and which for this reason no longer needed them, and were distributed among the hospital centers.1 Some centers such as Mars, Mesves, Beau-Desert, Allerey, and Savenay had two of them.13 Usually, but not invariably, the commanding officer of a squad was assigned as the sanitary inspector of a center.1 In certain centers, because of shortage in personnel, these squads were absorbed by other organizations and assigned to miscellaneous duties, but in others they retained their autonomy and were used for purely sanitary services-e. g., construction, repair, and direction of operation of sanitary appliances, such as incinerators, latrines, grease traps, etc.; inspection of water supply and sewer systems and of alterations in the same; operation of disinfesting plants; inspection and direction of proper sanitary operation of laundries and bathhouses; inspection of bakeries, butchers, kitchens, barracks, and provision of men as superintendents over details of special sanitary or police work; and preparation of all necessary reports in connection with the above services.1

CIVILIAN LABOR

Without civilian labor the operation of hospital centers would have been very difficult1 to a large degree, the only labor of this character available for the Medical Department consisted of French women, about 50 of whom were employed by each hospital.1 It was found they could be hired, controlled, and distributed most efficiently by a central employment bureau which generally was operated by the quartermaster, but in some centers was conducted by other offices.1 These employees served in various capacities, such as interpreters, cooks, waitresses, laundry workers, and scrub women, and were paid upon civilian rolls by the Quartermaster Department.1 Their pay averaged about 5 francs a day when they were not furnished subsistence, or 3½ francs when furnished it. Some male labor also was employed by the Quartermaster Department in some centers to perform such labor as removal of garbage.1


484

MEDICAL SUPPLY DEPOT

The personnel of a hospital center depot usually consisted of an officer of the Sanitary Corps, assisted by a chief clerk, returns clerk, and stenographer, and a warehouse force consisting of a noncommissioned officer and some 20 other enlisted men, among whom were the receiving clerk, who received, checked, and arranged supplies and checked cars, and the issue clerk, who made issues on approved requisitions.1 The chief clerk kept the office records, which included a correspondence book, a requisition book, and a car book. The first contained records of letters received and sent. The second contained captions giving the number of each requisition, the date and place from which it was received, class of supplies called for, date requisition was filled, date shipped, voucher number, and name of checker.1 In the car or receiving book were recorded the initials and number of each car received, by whom and when shipped, when received, contents as actually inventoried on receipt, date emptied, date goods were placed in warehouse, and the name of the checker.1

From the medical supply depot of the hospital center articles were distributed locally among the several units, each of which had its own depot.1 Because of the important and technical nature of this service, the medical depot at each center required exceptionally competent personnel. Eventually a number of men from each center were sent to the medical supply depot at Cosne or Gievres for a brief period of training.1

Other records maintained in this office were a file of warehouse receipts, a special order book for emergency issues only, a file of retained copies of orders for supplies purchased, depot property returns, warehouse records (which included a copy of warehouse receipts), a special issue book and separate stock lists. Surgical instruments, poisons, alcoholic liquors were kept in a locked closet.1

Medical supplies usually were classified and sorted in the following categories: Medicines, antiseptics, and disinfectants, surgical (including splints and dressings), dental, laboratory, X-ray, identification, furniture, and miscellaneous.1

One of the most difficult problems connected with the administration of centers was obtaining medical supplies. Particularly was this true of those units which began to operate between July and October, 1918. Usually a base hospital unit had asked for initial equipment before leaving the United States and of its own efforts often had procured considerable material.1 After the unit reached France its equipment did not arrive until one or more months later, and equipment received from depots was inadequate for the complete outfitting of all hospitals so that each could serve all classes of patients. Largely because of the restrictions on shipping space, to which all departments were subjected, and the lack of many articles in European markets, the chief surgeon, A. E. F., urged that the organization of these centers be made in such a manner that deficiencies could be compensated for by providing special equipment for only a fraction of the hospitals present.1 Supplies that could not be
procured from A. E. F. depots were obtained to a limited degree by purchased in the open market or from the American Red Cross.1


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MOTOR TRANSPORTATION

In each of the large centers an officer of the Motor Transport Corps was assigned to duty with personnel which usually was insufficient.1 At no time before the armistice was motor transportation adequate.1

All motor transportation at centers was pooled and vehicles were furnished only on signed requests of the commanding officers of units.1 Supplies were delivered from the depot by trucks assigned to that duty and much hauling was done at night. Experience led to the conclusion that a center of 15,000 beds with the most favorable arrangement of buildings, railway spurs, depots, and roads would require 15 trucks of from 3 to 5 tons, 15 light trucks of three-fourth ton, 12 G. M. C. ambulances, 2 touring cars (7-passenger) 5 touring cars (light type), and 12 motor cycles with side cars.1

It became fully apparent that for several reasons all motor equipment should be standardized.1

After the armistice was signed, evacuation ambulance companies became available for the purpose and were stationed at a number of centers.1 Each of these companies consisted of 1 officer, 39 enlisted men, and 12 G. M. C. ambulances, in some centers operating under the evacuation officer.1 They answered local calls as well as calls from outlying organizations which had no transportation, served in the evacuation and loading of hospital trains, and, in emergencies, carried supplies. Their vehicles were also used to convey the remains of the dead.1

A central garage and repair shop was provided in each center.1

DISINFESTING PLANT

Central disinfesting plants were established in most centers for there were not available in France enough mobile disinfestors to serve all units individually.1 In some centers this communal plant was assigned for one day each week to each unit. One plant at Mesves, for example, by operating day and night did all the work of the center for almost a month. In some other centers portable disinfestors were furnished the units caring for the most serious cases, other units employing a central disinfestor of the Canadian hot-air type in the convalescent camp.1

FIRE DEPARTMENT

Fire control at hospital centers was under the general jurisdiction of the bureau of fire prevention, Services of Supply.1 Fire fighting apparatus, including chemical engines, ladders, hose, buckets, barrels, and extinguishers were obtained through it. Fire regulations were promulgated in each center. Each hospital and other unit organized its fire-fighting force and conducted drills under the general supervision of the fire marshal of the center.1 Fire risks in barrack hospitals were very great; fortunately, however, no serious conflagration occurred in any center.1

SALVAGE OF PROPERTY

The salvaging of property of whatever character was an important and extensive undertaking.1 Each center provided a salvage dump where material coming for the separate hospital units was sorted, cleaned, renovated if pos-


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sible, and either redistributed locally or shipped to a central salvage depot.1 The principal classes of supplies salvaged were: Clothing, ordinance, boxes, bags, crates, paper, metal scraps, tin cans, grease, garbage, and writing paper.1 Clothing was disinfected, laundered, repaired, renovated, and, if possible, reissued; otherwise it was sent to a central salvage depot. Mess kits were assembled and placed in stock for reissue.1 Gas masks, helmets, and rifles were cleaned and transferred to any neighboring replacement camp or were shipped to a large salvage depot.1 Boxes, crates, etc., except such as were needed for use at the center, were shipped in returning cars to large salvage depots. Tin cans were cleaned in boiling water at each hospital, flattened at the center salvage dump, and then shipped to a local salvage depot. Grease was saved by the units and generally used for making soap; several centers had efficient soap factories.1 Garbage was reduced to a minimum by food
saving; one hospital with 540 ambulant patients had less than half a can of garbage daily. That remaining was disposed of either by a central incinerator, by sale to French civilians (an arrangement which gave very different degrees of satisfaction), or at the center's pig farms.1

FARMS

At several of the centers, especially that at Savenay, farms and gardens were operated successively and arrangements were under way for their provision at almost all centers when the armistice was signed.1 Land for this purpose was procured through the American Expeditionary Forces garden service, and whenever possible animals and manure were provided from neighboring veterinary hospitals. Implements were procured through the garden service, the American Red Cross, or from hospital funds. Seeds and plants were supplied by garden service; labor was performed by volunteers from the convalescent camp. Farms that were most highly developed were equipped with a small barracks and appurtenances for 100 men and a dispensary, the convalescent camp exercising medical and disciplinary supervision over the personnel.1

Pig farms proved especially lucrative, the animals being subsisted on garbage from the center.1

CEMETERIES

On request of the Medical Department, land for cemeteries was acquired in the vicinity of all large centers, or permission obtained to make interments in French cemeteries.1 Laws in France were such that new locations for cemeteries could be obtained only after compliance with a number of requirements, but through the graves registration service these were complied with, sites obtained, and arrangements made for their control and maintenance, and for the proper marking and preservation of graves.1 Graves were dug by personnel assigned to the quartermaster. The chaplain of the unit in which a death occurred conducted funeral services, except when the deceased belonged to another denomination, in which case, if at all available, a chaplain of the same faith officiated.1


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CHAPLAINS

A chaplain was to be assigned to each base hospital unit, primarily to minister to both patients and personnel. There was never a full quota of these officers in the American Expeditionary Forces, in so far as hospital units are concerned, for which reason each chaplain habitually performed duties in several hospital units, including that to which he was specifically assigned.1 All chaplains in a center were under the supervision of the senior chaplain present, who distributed the services of his colleagues to the best advantage.1 The senior chaplain supervised recreational and entertainment activities, conducted services for the group weekly, was responsible for the proper conduct of funerals, and in some centers was liaison officer between the hospital center and the graves registration service, reporting to that organization all interments and supervising the proper marking of graves. The last-mentioned duties were sometimes delegated to a junior chaplain.1

AMERICAN RED CROSS ACTIVITIES

American Red Cross activities in the center were supervised and coordinated by the representative of that service on the staff of the commanding officer. They were concerned chiefly with home and hospital service, recreation, and procurement of hospital supplies. The home and hospital service had one or more workers in every hospital who assisted in tracing the missing, distributed chocolates, cigarettes, and other articles of this kind, to incoming patients and throughout the wards. An important part of their service was the writing of letters for disabled patients.1 As mentioned above, Red Cross activities in promoting recreation were coordinated with those of the chaplains and were under their general control but more immediately under the direction of the Red Cross worker in charge of the Red Cross hut.1 Here a library, reading and writing rooms were provided, a piano or phonograph installed, and space was available for presentation of vaudeville or moving-picture shows, and such social diversions as dancing and receptions. In the provision of medical supplies the American Red Cross supplemented the Medical Department, sometimes furnishing articles in very large quantities.1 Requisitions from units habitually passed through the center commander before being referred to the American Red Cross. This organization maintained in many centers a small depot where there was a rapid turnover of the delicacies, stationery, toilet articles, and similar supplies which it distributed to personnel and patients.1

RECREATIONAL ACTIVITIES

Even before the armistice, entertainment of patients and personnel was an important element of center service, which was under the general supervision and control of the senior chaplain.1 In the several units the chaplains organized recreational activities, promoted sports, provided moving picture and other shows and organized similar diversions, but it was not until after the armistice was signed, when pressure of other duties relaxed, that this service attained its


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highest development.1 There was a general exchange between units throughout each center of entertainers drawn from the personnel or patients. A number of others, including many professional entertainers sent overseas to serve the troops in this capacity and volunteer companies organized by other units, greatly promoted this service during the armistice.1 If a band was not assigned to a center by higher authority, one usually was organized in its convalescent camp, and orchestras were developed in a number of units. The orchestra developed by the center at Mars, comprising over 70 pieces, was a remarkably fine organization. Instruments for bands and orchestras usually were furnished by the American Red Cross, which cooperated with the chaplains in furnishing diversion and were in immediate charge of a number of details connected therewith. The recreation huts provided, so far as possible, for each base hospital were erected at the expense of the American Red Cross, and a Red Cross worker was immediately in charge of the social and recreational activities in each.1

REFERENCES

1. Report on organization of hospital centers, A. E. F. (undated), prepared under the direction of the chief surgeon, A. E. F., by Col. H. C. Maddux, M. C. On file, Historical Division, S. G. O.

2. Report from the chief of the medical group, fourth section, general staff, G. H. Q., A. E. F., to the chief of G-4, general staff, G. H. Q., A. E. F., December 31, 1918, on activities of G-4 B, for the period embracing the beginning and end of American participation in hostilities: Appendix E. On file, Historical Division, S. G. O.

3. Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1, 1919, on the activities of the chief surgeon's office, A. E. F., to May 1, 1919. On file, Historical Division, S. G. O.

4. Consolidated weekly bed reports, A. E. F., office of the chief surgeon, A. E. F., November 28, 1918. On file, Historical Division, S. G. O.

5. Consolidated weekly bed report, office of the chief surgeon, A. E. F., November 14, 1918.

6. Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April 17, 1919, on the activities of the Medical Department, A. E. F., to November 11, 1918. On file, Historical Division, S. G. O.

7. Report of activities of the hospital center at Bazoilles, undated, prepared under the direction of the commanding officer. On file, Historical Division, S. G. O.

8. Report of the activities of the hospital center at Mars, undated, prepared under the direction of the commanding officer. On file, Historical Division, S. G. O.

9. Report of the activities of the hospital center at Mesves, undated, prepared under the direction of the commanding officer. On file, Historical Division, S. G. O.

10. Report of the activities of the hospital center at Allerey, undated, prepared under the direction of the commanding officer. On file, Historical Division, S. G. O.

11. Report of the activities of the hospital center at Beaune, undated, prepared under the direction of the commanding officer. On file, Historical Division, S. G. O.

12. Letter from the senior consultant in maxillofacial surgery, A. E. F., to local consultant in maxillofacial surgery, September 24, 1918. Subject: Information. On file, A. G. O., World War Division, chief surgeon's file, 321.624.

13. Based on reports of activities of hospital centers, A. E. F. On file, Historical Division, S. G. O.

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