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Chapter XXII

Contents

CHAPTER XXII

A TYPICAL HOSPITAL CENTER

HOSPITAL CENTER, ALLEREYa

PHYSICAL CHARACTERISTICS

The hospital center at Allerey was on the outskirts of the town whence it took its name. Allerey, at the time, was a town of some 800 inhabitants on the Paris, Lyon, & Mediterranean Railroad, in the Department of Saone-et-Loire, approximately 11 miles north of Chalons-sur-Saone, the largest town (population, 30,000) of the department. The center was about three-quarters of a mile from the Saone River, which was at once, in effect, the source of its water supply, and a line of communication over which fuel and other supplies were brought to the center when access by rail was obstructed.

The site of the reservation covered an area of 172.3 acres, which consisted chiefly of farmland, but included some swampland at the eastern end and some woodland at the western. The site was low, and generally very level, most of it (e. g., section 4) being lower than the edge, so that proper drainage was difficult.

The soil consisted of a layer of loam, from 6 inches to 2 feet in thickness, superimposed on clay; and though rainfall readily percolated to the clay stratum protracted rains soon saturated the upper layer.

Climatic conditions during the existence of the center offered nothing unusual for this region. The summer of 1918 was hot, dry, and at times windy; spring, autumn, and winter were rainy, with almost constant cloudiness during the last-mentioned season, and marked by cold of a penetrating character, but without very low temperature. Rainfall averaged 840 mm. per annum; the mean temperature was 10.52° C.

HOSPITAL CONSTRUCTION

The outlay of the hospital center comprised 13 sections and a cemetery; 10 of the sections were to accommodate 1 base hospital each, 1 a convalescent camp, 1 the quartermaster and motor transport departments, and 1, secluded from the rest, a psychiatric unit. Each base hospital was to accommodate 1,000 patients with attendant personnel and to supplement its capacity by tentage for 1,000 beds-more if need be. These tents were to be pitched in the "crisis expansion" areas provided in the rear of the wards. Each hospital was to be a unit complete in itself, except for transportation and certain other communal elements. Such a unit consisted of 55 buildings apportioned as follows: Administration; reception and evacuation; dining rooms; kitchens; bathhouses and latrines for patients, nurses, and officers; wards; recreation hall; laboratory and morgue; X ray and clinic; operating; quartermaster and

aThe statements of fact appearing herein are based on "History of the Allerey hospital center, A. E. F.," by Col. J. H. Ford, M. C., commanding officer. On file, Historical Division, S. G. O.


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medical supplies; garage, shop, and disinfection; fuel house and incinerator. The convalescent camp consisted of a similar layout, except that ward buildings were replaced by tents for 2,000 patients, and the following were eliminated: Nurses' quarters and appurtenances, receiving ward, laboratory and morgue, operating pavilion, garage and shop.

The areas of the base hospital units extended in juxtaposition along both sides of a broad central highway, down whose center ran a double-track spur of the railway line. From this highway, the backbone of the camp, two branch roads ran the depth of each unit area and were connected by several crossroads passing in front of the receiving ward, kitchen, storerooms, and garage. The convalescent camp, located north of the blocks of base hospitals, was reached by the roads which traversed one of them. Roads were also in service along the back line of each block of five base hospital areas.

FIG. 87.-Map of Allerey hospital center and vicinity

The psychiatric unit, consisting of quarters, dining rooms, kitchens, bathhouses, and latrines for 200 patients and attendant personnel, faced the broad central highway beyond the end of the railway spur. It was never completed, but was occupied by the military police during the period of greatest overcrowding.

The quartermaster and motor transport section nearest the proximal end of the railway spur at the east of the reservation included the storehouse, bakery, ice plant, barrack for civilian laborers, garage, motor park, work shops, gasoline station, etc. The cemetery immediately north of this was on the reservation, so that it was readily accessible and could be cared for the best advantage.

Housing facilities were of two kinds, portable buildings and tents. The types of buildings selected for the center were known as the "Cavanair and Majoram" types, more commonly as type I. These were of knockdown construction, built by securing together uniform sections made up of double thicknesses of ¾-inch tongue-and-groove lumber, inclosing an intervening air space 4 inches in thickness. These sections, which were assembled at distant fac-


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tories, formed the exterior walls. Roofs and floors were formed of 1-inch boards, the former covered with tar paper. Partitions to form rooms were made of 2 by 4 studding and beaver board. Practically all buildings were 6 meters wide, but varied in length from 10 to 50 meters. This type of building was constructed very rapidly, but in many instances settling occurred because of the softness of saturated ground, and cracks in exterior walls developed. The tents employed were of the marqueé type and of French manufacture. Their floor dimensions were 17 by 35 feet, so that three tents, connected end to end, accommodated 50 beds. Such sets of tents to accommodate 500 patients were erected back of alternate wards in most but not all of the hospitals, there being an insufficiency of tents thus to equip the entire center. Though location back of alternate wards caused some lack of uniformity and balance in ward service, this method was adopted to lessen fire risk.

On February 16, 1918, the Engineer Corps began to lay out the site of the center and to supervise the activities of the civilians who had contracted for its construction. In the latter part of that month the wall sections of the portable buildings arrived in such quantities that the freight house at Allerey station was soon filled and 109 cars were unloaded at St. Loup, a neighboring village. Bad weather hampered the work to such an extent that by March 23 only 10 buildings had been erected, and the roads were in such condition that only slow-moving ox teams could force their way through.

From the outset the labor problem was difficult. Old men, boys, and those unfit for military service were the only French laborers available, so that it was necessary to recruit workmen for the project in other countries, especially in Spain. For this purpose agencies were maintained by the French and American Governments and in some instances by the contractors themselves. Labor procured in this manner, however, was of a very inferior quality, requiring constant supervision. Also the practice of contractors of padding their pay rolls required a constant check by the constructing engineer. Company C of the Twenty-sixth Regiment of Engineers arrived on May 19, and from that date construction proceeded much more rapidly. Eventually a labor company was assigned to the center, and its number augmented by 40 German prisoners and 20 Russians. These last had been sent to France as part of a military force in the early months of the war. Highly important work in construction was performed by enlisted men of the Medical Department and by convalescent patients. As fast as base hospital units arrived, their personnel was engaged in completing the construction in the areas to which they had been assigned, and continued on this duty even after they received patients. Throughout the life of the center, selected men were detailed for special work such as electric installations, motor repair, operation of stationary engines, etc. Similarly convalescent patients were employed in large numbers for work of every kind according to their strength and ability, and this practice expedited greatly the construction of the center. However, as orders required that patients be returned to duty as promptly as possible, a very rapid overturn of such personnel was necessary, and completion of technical work, especially, was delayed to a considerable degree by the constant necessity for finding replacements for skilled workmen transferred.


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Temporary roads were early laid out by the engineers and graded, but on account of lack of road material many became quite unsatisfactory after rains commenced. At first cinders were used as surfacing material, but because of wet weather and constant passage of heavily laden vehicles the roads were soon cut to pieces and some became impassable. Later crushed rock was received in quantities and distributed where most needed. A steam roller was operated in some sections of the camp. After the armistice was signed, 10,000 feet of duck board were procured and laid in those parts of camp which needed it most; and after January 1, 1919, some corduroy roads of railway ties were laid.

FIG. 88.-Reservoir, Allerey hospital center

The water supply was drawn by pumps, driven by gasoline motors, from three wells averaging 55 feet in depth sunk 200 yards from the bank of the Saone at the east end of the camp. A booster pump then forced the water through an 8-inch main into the supply system of the several units, and the surplus into a reservoir containing 100,000 gallons at the west end of camp. The capacity of the pumping plant varied from 20,000 gallons daily in August to 50,000 gallons in December, depending on the rate of inflow into the wells. A 4-inch pipe which could be cut off at its point of junction with the main line supplied each unit, and eventual distribution in them was effected through pipes from ¾ to 2 inches in diameter. As the central chlorinating apparatus was never satisfactorily installed, water was sterilized by the Lyster bag method in all units.

A sewerage system for liquid waste was installed. It consisted of a main 12 inches in diameter, with ramifications 4 to 6 inches in diameter, reaching


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the receiving wards, operating rooms, kitchens, and laboratory of each unit. The system was not originally intended for the reception of urine, but eventually it was used for that purpose. The sewage was discharged into a concrete sedimentation tank one-quarter of a mile north of the center. Here it was chlorinated in accordance with the requirements of the French regulations on this subject and the clarified effluent discharged through an open ditch into the Saone.

Before this system was installed, liquid waste was removed by barrels carried in a motor truck, and later by a steel tank wagon. Because of inability to procure pipe installation the sewer system was long delayed and removal of liquid waste continued to be a grave problem for some elements of the camp even after the tank wagon service was effected.

Original plans had called for a high-tension line from Chalons to furnish electric light and power, but this project was abandoned. Instead, five small 25-kilowatt electric light and power sets, each to serve two sections, were gradually installed, but as their output was small and each required constant, skilled attention, this arrangement was never satisfactory. It was particularly inadequate when later required to serve 12 sections instead of 10. Illumination was never brilliant, and when patients arrived at night, as they often did, current was not sufficient to illuminate properly the receiving stations, wards, and operating rooms, and to actuate the X-ray plant. Despite fire risk, it was necessary to supplement the electric light by lanterns in various parts of the center and at all times to exercise the most meticulous care in the proper usage of current. Exterior lights had not been provided in plans for the center, but these were authorized when their need became manifest.

Throughout the operation of the center, until toward its close, there were frequent interruptions in construction and in the operation of certain utilities. At times, for various reasons, the output of the pumps was limited or discontinued. Reception of building materials or other supplies was interrupted by embargoes, railway delays, or nonavailablity at depots. The electric-light output was at times reduced or perhaps suspended. In the original plans no provisions had been made for offices or quarters for the headquarters group, post office, and certain other elements, but these were promptly authorized and constructed.

As the center developed, and as the pressure of essential work decreased, certain public-spirited individuals in every unit charged themselves with the beautification of grounds and improvement of buildings. As a rule, the commanding officers of these units, while encouraging this, left plans and work of this character to those who were interested, believing that thereby they would secure greater enthusiasm. Rivalry in the beautification of wards, recreation halls, dining rooms, etc., was evidenced even at the period of greatest pressure. In the convalescent camp decoration of grounds was carried to a high point and a number of artistic effects secured, in differently colored stones, evergreen plants, etc. Especial care was given the cemetery. Many floral offerings from French citizens and inmates of the center, as well as the painstaking attention to paths, turf, shrubbery, and the markings of graves and boundaries attested the reverent remembrance of the dead.


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ORGANIZATION

Organization of the hospital center at Allerey was commenced June 23, 1918. On June 20, Base Hospital No. 26 had joined, being the first organization of this character to arrive. Its commanding officer, relieved from further duty with the hospital and assigned to command of the center, organized the headquarters staff from the personnel of Base Hospital No. 26, but for several weeks the staff continued to function to a diminishing degree in the positions which they had occupied in the hospital until understudies could be trained. This initial staff comprised the following departments: Adjutant, quartermaster, medical supply, receiving and evacuating, sanitary, and railway transportation. A few days later representatives of the American Red Cross and of the statistical branch, Adjutant General's Department, arrived and joined this staff.

As in other hospital centers, each staff officer at first had several positions. Thus at Allerey the commanding officer performed the duties of executive officer and, at first, inspector; the adjutant was also judge advocate, personnel and statistical officer; the quartermaster was charged with motor transport duties and immediate responsibility for those activities which were later assumed by subordinates under his general direction. The sanitary inspector was also laundry officer, fire marshal, supervisor of buildings and grounds, etc. No detailed instructions covering the administrative organization of the center were received, and development progressed as determined by force of circumstances and existing resources. Throughout this formative period staff duties were clearly delimited so that as occasion arose they could readily be distributed among individuals who could give them their undivided attention. Until the close of the center, however, a number of officers continued to exercise the duties of several positions. Assignments to the headquarters staff were a continuing problem, for only a few staff officers arrived from extraneous sources, and officers already on duty in the center who possessed administrative ability were needed in their several units to meet the great expansion which these underwent through the establishment of provisional hospitals, overcrowding, etc. Pressure was such that the loss by any unit of one or two good administrators was felt at once locally, and the local deficiencies in service arising therefrom had to be met by increased activities at headquarters. The situation was ameliorated to a degree by the assignment to the center from other points of officers for service with the convalescent camp, motor transport, engineer, military police, statistical bureau, medical supply, and the quartermaster department. Also a number of officers undergoing treatment in the convalescent camp assumed some very important duties-e. g., commanding officer of the interior guard and assistants to the receiving and evacuating officer-so that during their stay in the center they promoted greatly its staff activities.

The specialization of headquarters, developed to its final organization, was as follows:

  Commanding officer.
  Adjutant.
Personnel officer.
Statistical officer.
   Civilian employment officer.
Commanding officer, headquarters detachment.
   Post-office service.
   Banking service.


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  Quartermaster.
Subsistence.
   Center purchasing agent.
   Sales commissary.
   Bakery.
   Butchery.
   Ice-plant farm.
Clothing, equipage, etc.
Finance.
Laundry.
Animal-drawn transportation.
Utilities.
Salvage.
Commanding officer labor battalion, etc.
Cemetery.
Interment.
  Motor transport officer.
  Ambulance company.
Truck company.
Repair shop.
  Medical supply officer.
  Receiving and evacuating officer.
  Inspector.
  Sanitary inspector.
Inspection of buildings and grounds.
  Fire marshal.
  Signal officer.
  Engineer officer.b
  Assistant judge advocate.
  Assistant provost marshal.
  Commanding officer of the interior guard.
  Intelligence officer.
  Ecclesiastical officer.
  Railway transportation officer.
  Center laboratory officer.
  Consultants in professional services:
General medicine.
Psychiatry and neuropsychiatry, cardiovascular.
General surgery.
Orthopedics.
Ophthalmology.
Otology, rhinology, and laryngology.
Roentgenology.
Neurology.
Urology.
Laboratory officer.
Consultant in dentistry.
Chief nurse.
Chief dietitian.
Red Cross officer.

bThis officer was one who had been selected from the patients in the convalescent camp. As noted below the engineer who constructed this center was never a member of the staff of its commanding officer.


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After September 20 a center officer of the day, chosen by roster from among the available captains, was detailed to inspect patients' messes, assist the receiving and evacuating officer, if required, inspect the guard, and meet emergencies.

An executive officer was never detailed as in the hospital centers at Mars and Mesves. The duties of his office were divided between the commanding officer and adjutant, the former charging himself with all executive administration, the coordination of the activities of the staff departments, direct supervision of units, important correspondence, and leaves of officers.

ACTIVITIES

COMMANDING OFFICER

The commanding officer held conferences at 1 p. m. daily, except Sunday, which were attended by heads of staff departments and commanding officers of units. The constructing engineer, who was not under the jurisdiction of the commanding officer of the center, was invited to attend either in person or by representative and habitually did so. At these staff meetings the fullest discussion was invited and suggestions and recommendations sought on all subjects relevant either to the interior service of the center or to its external relationships. Most written orders were emitted only after their purport had been fully considered at these conferences by all parties concerned, their scope and limitations determined and, if necessary, their provisions clarified. By this means several ends were attained, the most important being the engendering of a spirit of cooperation, the formulation of orders in such a manner that they seldom had to be revised, despite the mutations incident to the growth of the center, and the avoidance of misinterpretations. Each officer concerned was encouraged to feel that he had an important influence in the formulation of orders concerning activities of his department; and this was believed to have promoted the solidarity of the center and smoothness of cooperation much more than could have been effected by autocratic methods. In some instances, however, as need arose orders were issued without consulting subordinates. Most orders, instructions, etc., that were of temporary or individual interest were given verbally by the commanding officer at these meetings to those concerned, who made record of them in their notebooks at this time; but orders affecting communal service or of more permanent interest, whether from higher authority or of local origin, were issued in the form of special orders or memoranda.

Similarly, staff meetings were held by the several chiefs of professional services. At these sessions professional activities were coordinated, and, so far as was feasible and reasonable, standardized throughout the center. In this field, however, individualism in methods of treatment was encouraged rather than restricted, provided results achieved were satisfactory, except that in some fields of endeavor (e. g., control of infectious diseases, débridement of wounds, etc.) orders issued were mandatory.

A stenographer attended all staff meetings and made of record discussions, verbal orders, etc. These notes were read at the next staff meeting like the


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minutes of a board of directors, and were open to inspection of any person concerned who later wished to refresh his memory on any point.

The commanding officers of units also held conferences with their subordinates daily except Sunday, when in a manner comparable to that at headquarters all items of interest, whether administrative or professional, were discussed and appropriate orders given.

The commanding officer of the center and those of the several units were accessible to any member of their commands daily during hours set aside for that purpose. The object of all these measures was to have the center and the several units respectively as highly centralized as was reasonable without infringing unduly, in the first instance, upon the prerogatives of unit commanders, and in the second upon that of individual officers on duty in the units, and that in determining the manner and degree of centralization officers concerned should have a constructive share. Apparently centralization was carried further at Allerey than at other centers for the reason that in proportion to its resources it cared for more patients during a certain period than did any other. In order to secure the fullest coordination a corresponding degree of centralization was imperative.

Each unit was allowed the fullest possible freedom in interior organization and administration, subject to existing general regulations. In order that each unit might have the benefit of acquaintance with methods evolved in others, the commanding officer of the center and his staff, accompanied by the commanding officers and staffs of the several units, visited each hospital in turn, in order that all concerned might acquaint themselves with respective methods of service. There was thus promoted mutual acquaintanceship and a free exchange of ideas throughout the center. The result was an amiable rivalry extending to every element of each unit and prompt application of new ideas wherever found. It was interesting to note, however, that many of the ideas thus exchanged were modified in greater or less degree when applied in hospitals other than that in which they had their inception. Sometimes this was due to differences in local requirements or resources; more frequently to differences in the personal coefficient of the administrator or other personnel concerned, who found that they secured better results with methods to a degree individualized. The results showed the advisability of leaving to unit commanders and to the members of their staffs the largest latitude possible in the discharge of their respective duties.

ADJUTANT

The adjutant promulgated orders, acted on furloughs of enlisted men, and on charges preferred, reviewed court-martial proceedings and acted for the commanding officer on questions which did not demand the latter's attention. In addition, he was charged with routine administration and correspondence, preparation and issue of all court-martial orders and those affecting audits of public vouchers, examination of requisitions and ration returns, command of the headquarters detachment and supervision of the sergeant major's office. Under his supervision units longest in the center instructed newly arrived units in orders, customs of the service, use of blank forms with


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which they were unfamiliar, etc. Instruction in some subjects, however, was given by selected officers, usually those more immediately charged with their execution; e. g., receiving and evacuating officer, fire marshal, sanitary inspector, the chiefs of professional services, and others. The three base hospitals which first arrived were employed as schools for the instruction of later arrivals. As soon as a new hospital reported, its adjutant, registrar, mess officer, sanitary officer, sergeants (first-class), and clerks, were distributed for instruction to one or the other of these hospitals, and remained there until they became fairly familiar with the records and their own hospitals were ready to receive patients. Usually this was a period of about two weeks. Similarly, at the direction of the commanding officer of the center, the adjutant directed the professional personnel, in conformity with the recommendations of chiefs of services to visit these hospitals and familiarize themselves with both professional and official standards required. The adjutant apportioned numerous duties among his assistants. One of these was an officer from the statistical department of the adjutant general's office who joined in July, 1918.

The sergeant major's office, under the adjutant's jurisdiction, was divided into the several sections noted below. The reports prepared and forwarded by it are mentioned in the preceding chapter, which discussed hospital centers generally. The personnel section of the sergeant major's office consolidated all data pertaining to personnel on duty in the center, other than those serving with the engineers, forwarded appropriate reports concerning them, except that the daily and weekly numerical reports were formulated by the statistical section, and kept up rosters of officers, nurses and enlisted personnel. Those for officers and nurses were entered on file cards, which carried notations concerning military status, professional and administrative aptitudes, etc., while the roster for enlisted men was kept up by appropriate entries on a copy of the muster roll of the organizations to which men belonged. The preparation of a card index for enlisted personnel, though its desirability was recognized, was not feasible with the clerical resources available. These rosters, especially that of the officers, proved of great value in making details to meet the ever-shifting needs of the center.

The statistical section checked the accuracy of all reports received from units concerning patients, consolidated these for transmission to higher authority (except those noted below under the receiving and evacuating section), formulated the daily bed reports and collective numerical reports of patients and personnel, consolidated daily reports of all cases of infectious diseases, whether among duty personnel or patients, and placed these last-mentioned data at the disposal of the sanitary officer. The head of this section was charged with the engagement, supervision and discharge of all French civilians employed in the center by the Medical Department. Such female employees to the number of 50 for each hospital were authorized by the chief surgeon, A. E. F., subject to rates of pay and terms of service required by him and the civil requirements of the French Government. These women were assigned to duty under the supervision of the chief nurses of the hospitals and by them distributed to best advantage. In order to promote prompt reply to the many queries received from outside points concerning individual patients, the statistical


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bureau maintained a card-index file for all patients, showing name, serial number, official designation, location in center (with notes of all transfers, even from ward to ward), date of evacuation, classification (A, B, C, or D) and destination, or date and cause of death and number of grave. This index was in constant use. In order to expedite the delivery of mail until the post office prepared its own card index, that office consulted it during the night.

The receiving and evacuating section was closely associated with the statistical section. It prepared all the reports concerning the reception, distribution, classification, and evacuation of patients other than the daily and weekly statistical (numerical) reports. It was responsible for the service records of outgoing patients and for the completion of their records.

The order and record section received the orders from higher authority, as well as those of local origin, recorded and promulgated them. It checked, consolidated, and forwarded the records of the various activities of the center not covered by other sections of the adjutant's office. Thus, it handled requisitions for medical supplies and blank forms, reports of progress of construction, of transportation facilities, pay rolls of marines and of civilian employees, statements of hospital fund, reports of purchases from funds allotted the commanding officer of the center and the commanding officers of units, ration returns, reports of fire marshal, etc. This section eventually had custody of all documents as they found their way into the files.

The filing, distributing and mailing section was charged with the upkeep of the index of all orders, reports and correspondence, the proper filing of papers, delivery of all documents throughout the center and obtainment of receipts for same, verification of addresses on envelopes of outgoing official mail and on telegrams, recording date when such were sent. The officer in charge of this bureau supervised the post-office activities in the center.

As commanding officer of the headquarters detachment, the adjutant supervised the assignment of its personnel and kept in the detachment office all records concerning them. His duties also included supervision of the property officer for the headquarters office, of the courier service of the post-office service and of the activities and protection of a branch bank which was established in the center.

COURIER SERVICE

Important papers, destined for headquarters, intermediate section, Nevers, and for the office of the chief surgeon, A. E. F., at Tours, usually were sent by courier, and were received from these offices in the same manner.

POST OFFICE

Post-office activities in the center began July 6, 1918, but not until August 25 was the center given its post-office number, viz, A. P. O. 785. At this time the office was moved into a building provided for it near headquarters. In September, 1918, money order and registered mail departments were organized, service in both increasing rapidly. By December, 1918, the value of the money orders handled monthly was $20,000. By November, 1918, the service handled daily approximately 40 pouches of incoming mail and 10,000 outgoing letters. At this time the service was reorganized and a card-index file was formulated


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similar to that at headquarters, carrying the names of all personnel in the center so that prompt delivery of mail was feasible. The eventual success of this service had a very important influence on morale.

BANK

In November, 1918, at the invitation of the center commanding officer, the Chalons branch of the Société Générale opened a branch bank in the center. The military police furnished guards for the movement of funds back and forth between the center and Chalons, and the motor transport park furnished transportation for funds and personnel. The bank proved to be a great convenience; in addition to cashing checks, it sold bonds of the fourth French loan. Banking hours were from 10 a. m. to 4 p. m. on Mondays, Wednesdays, and Fridays.

QUARTERMASTER

The group quartermaster had general charge of the activities of that department.

The subsistence branch of his service was charged with those duties which its name implies. For several weeks after the first hospital arrived, bread and fresh meat were hauled from Dijon by truck, but after patients began to arrive in considerable numbers motor transport proved inadequate and a shuttle railway car convoyed by an enlisted man was put in operation. This shuttle service was continued for this purpose for about six months, until a bakery was established in the center and fresh meat was shipped in direct from depots. It was used for the transportation of soiled linen to a civilian plant in Dijon. Subsistence supplies, other than bread, were eventually received by automatic supply from the base stations and distributed by the quartermaster of the group to quartermaster units. This method of supply required about 10 cars daily but at one period (November and December, 1918), when the center was operating at its maximum and about 23,000 rations were required daily, as many as 27 cars were received in one day.

In order to meet increasing needs, a group purchasing agent was detailed. His office consolidated the requisitions of the several units for the procurement of fresh vegetables, eggs, milk, etc., not obtainable from depots. Such an arrangement was necessary in order to prevent the several hospitals from bidding against one another in local markets, to effect savings by purchasing in large quantities, to prorate available supplies according to needs, and to extend the radius of purchases beyond points accessible to the units themselves. These supplies were often bought in distant markets; e. g., potatoes in Brittany, eggs in Algiers.

To relieve congestion in the group warehouse and to meet needs that might arise because of unexpected expansion, unit commanders were required to keep on hand nonperishable comestibles to the limit of their facilities, viz, about two months' supply. This measure proved fortunate when the center expanded rapidly in October, 1918, for neither condition of roads nor available transportation would have permitted satisfactory commissary service if unit warehouses had not been well stocked.


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When fresh meat began to arrive in quantities, it was at first stored in a cooling room erected in the warehouse after plans furnished by the chief quartermaster, Services of Supply. This room was simply a box 20 feet square and 12 feet high, with walls and roof 1 foot thick. These walls were filled with packed sawdust and provided with very carefully fitted doors. The frozen meat soon brought the temperature of this room down to a point which permitted one week's supply to be kept on hand without ice. Later an ice plant was built, with an output of 1 ton of ice daily, and in conjunction therewith a cooling room where 50 tons of meat, fresh vegetables, etc., could be stored.

FIG. 89.-Exterior view of warehouse, Allerey hospital center

A sales commissary was organized promptly after the organization of the center, but it was soon found that direct sales by it alone could not meet requirements. Many patients were physically unable to visit the salesroom and attendants often did not have time to do so. The American Red Cross workers in units purchased articles in greatest demand (e. g., tobacco, confectionery, etc.) to the limit of their storage facilities, and resold these at cost to enlisted men, whether patients or duty personnel; articles for similar resale to officers and nurses were handled by the unit mess officers. All such sales were in addition to those made direct to individuals, whether commissioned or enlisted, by the sales commissary itself, and were in effect an extension of its service throughout the center.

A bakery was established by Bakery Company No. 357 in August and thereafter was gradually expanded to 7 ovens. By October, it was turning


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out 27,000 pounds of bread daily, and continued this output for several months, though less than half the bakery company had joined. This output, made possible by day and night shifts, was not quite equal to demands, however, at the high-water mark of the center, and several shipments from the bakery at Dijon were necessary to meet requirements.

Butchery Company No. 331, assigned to duty in the center, was distributed among the several hospitals, where its personnel gave instruction to cooks in the care and cutting of meats.

The property branch of the Quartermaster Department supplied fuel, forage, gasoline, clothing, equipage, ordnance, etc. Wood and forage were purchased locally, coal was shipped in from base ports, and other articles handled by this department were drawn from depots. It was necessary to keep on hand a large supply of clothing and equipment, because of the rapid overturn of patients, whose average stay in hospital was but 17 days, and who, on evacuation, had to be fully clothed and equipped. The quantity on hand at one period was sufficient for 40,000 men and approximated in value $1,000,000. As no buildings were available for the storage of such a quantity, the bulkiest articles were stored without injury under paulins, on platforms built for this purpose. No shortage of fuel or clothing occurred at any time.

The finance section disbursed all funds other than those allotted to the commanding officers of units by the chief surgeon, A. E. F. Commutation of rations and liquid-coffee money were paid by the group disbursing officer, but unit quartermasters made monthly payments of patients and personnel of their respective organizations. The monthly disbursements usually approximated $500,000, but for several months were 20 per cent greater than that figure.

The laundry service of the center was a grave problem from the opening of the center until toward its close. Some of the laundry was done under contract at Dijon, 34 miles distant, linen being sent back and forth, first by truck and later, as mentioned above, by shuttle railway car. All resources in that city soon proving inadequate, a hand laundry was organized at Verdun-sur-Doubs, 2½ miles from the center. A laundry barge was hired, 30 French washerwomen employed and 15 marmites erected. Later two portable laundries were received and operated by day and night shifts. The output of these establishments was about 200,000 pieces per month. During September, 1918, several truck loads of hospital linen were handled by the portable laundries at Beaune, when circumstances permitted that they give this assistance. In October, the steam laundry at Beaune, designed to serve both that center and Allerey, began operations, and as soon as it was able to meet demands of both centers all other service of this utility was discontinued. The laundry at Beaune was operated on day and night shifts, but its output never reached that at Mesves, which had been designed to handle 600,000 pounds monthly. The largest number of pieces done for Allerey in any month was 300,000 pieces during December, 1918. During the period of greatest pressure, female civilian employees in the several hospitals laundered the linen used in the operating rooms, but despite their efforts and the utilization of all available resources, as many as 100,000 pieces were awaiting laundry at that time. An exchange was established in the warehouse where issues were


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made against articles turned in and appropriate records kept, including numbers of all cars in which laundry was shipped.

The animal-drawn transportation at Allerey never assumed very large proportions, but several teams were kept in service until near the closure of the center. They were used chiefly to supply units inaccessible by auto trucks.

After the establishment of an auto park, the only other transportation which remained under the charge of the quartermaster were the shuttle railway freight cars, and the others which operated on the railway spur within the center. These latter cars were loaded at the warehouse and then drawn by truck, which moved on the road beside the track. It was soon found that more supplies could be delivered in this manner than by this truck alone and that this expedient released a number of vehicles that would have been necessary to move many small shipments. The quartermaster had supervision over this spur and the unloading of the cars bringing freight to the center.

Coincident with the construction work of the engineers, the quartermaster took over maintenance and the service of utilities. He effected repairs and operated cobbler, carpenter, and plumbing shops, the lighting plants, pumps, etc. So far as possible, maintenance was effected by the quartermasters of the several units, but communal service of this character was carried on by the group quartermaster, as well as that requiring large resources or technical skill not available in the units concerned.

Land was rented for a farm, to be cultivated by convalescent patients, and considerable work was done to prepare it for seeding; but it was never further developed by the center, which was closed before seeding was practicable. This farm, however, was employed to good advantage by the agriculture department of Beaune University when it took over the hospital center at Allerey.

The salvage service of the center was under the general supervision of the group quartermaster, but in fact was largely carried on in the several units. He consolidated their results. The articles receiving the greatest general attention were fats, burlap, paper, tin cans, bottles, bones, rubber, and wire. Fats collected in the several units were clarified by boiling and straining before shipment; burlap and paper were baled, and a few carloads of tin cans were shipped to salvage depots. Unsuccessful attempts were made to sell the remainder of them locally. Bottles were turned in for reissue or shipment if not needed in the center. Nails, wire, rubber, and bones were shipped to the depots designated. Salvage operations extended far beyond these simpler items, however, for all articles that could be employed to some alternative use or could be renovated were turned in for local repair or cleaned, and shipped to appropriate depots; e. g., instruments, appliances, clothing, ordnance, utensils, etc. Closely associated with salvage was prevention of waste, whether of comestibles or other supplies, especially dressings. Per capita wastage of foodstuffs, including liquids, was about 3 ounces per day, but this wastage was made to show some return through its sale to the contractors who removed garbage.

Another duty of the group quartermaster was the command of the labor battalion assigned to this center, the bakery and butchery companies, the field laundry detachment, details from the convalescent camp, civilian clerks, labor-


504

ers, and other employees in his department. Proper performance of this duty was difficult because of the wide dispersion of such personnel on different tasks, and could be met only by the detail of convalescent officers to supervise the work of the larger groups. One minor but constant duty in which the labor battalion was of especial service was that of unloading all railway cars within 12 hours and their notification, for removal, to the railway transport officer.

The cemetery for the center (A. E. F. Cemetery No. 84), was under the care of the quartermaster, in all that pertained to its physical care, such as preparation, filling, and marking of graves, provision of caskets and crosses, maintenance of roads, paths, shrubbery, etc. This office also kept a register of all burials and serial numbers of graves. In order that interments might be made with due reverence and with proper religious and military ceremonies, the first chaplain who arrived in the center was charged with making arrangements for all funerals. He also made the reports called for to the central records office and to the graves registration service, cared for all correspondence relative to interments, including the notification of relatives, and kept records of the name, rank, organization, religion, nearest relative, and cause of death and number of grave of each decedent. His records thus confirmed some of those of the quartermaster, but were more extended. He made appropriate notifications to other chaplains of the same faith as that of the deceased in order that they might officiate. Prior to the arrival of a chaplain of the Catholic faith, the parish priest at Verdun was requested to visit the center, to administer extreme unction and conduct funeral services for Catholic patients. If no chaplain of the same faith as the decedent (e. g., Jewish) was present, the services held by the officiating chaplain were as nearly as possible in harmony with those prescribed by his church. Remains were removed by ambulances. Firing squads, which attended all funerals, were detailed by the military police, and pallbearers were selected by the commanding officer of the hospital in which the patient died. Because of lack of lumber, it was at first necessary to mark graves by pegs instead of crosses. Each peg showed the notation later made on the cross which marked each grave, viz, name, rank, organization, and date of death of the deceased. To this peg, and later the cross, was fastened one of the decedent's identification tags, the other being buried with the remains.

A monument to the memory of Private Paul H. Burton, Base Hospital No. 25, the first soldier buried in the cemetery, was erected by the citizens of Allerey. A resident, whose château was located on the outskirts of that village, later offered to donate an elaborate monument to the cemetery, but as orders had been received in the interim that no monuments were to be erected, the offer was declined. A number of floral and other offerings were made by the French citizens of the neighborhood as well as by the occupants of the center.

MOTOR TRANSPORT

The motor transport service was charged with the procurement, maintenance, and operation of all motor vehicles assigned to the center, procurement of spare parts, provision of adequate transportation for all units, control of personnel assigned to this service, and preparation of appropriate reports, returns, etc. This service at Allerey was at first under the supervision of the


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quartermaster, but in July, 1918, a separate department was organized by which all transportation belonging to the medical service of the center was pooled and repair shops operated. In the early period of occupancy no trucks were available for the service of hospitals, but needs were met to a degree by borrowing from the constructing engineer after 6 p. m., and at other times to meet emergencies. The motor park grew gradually and was placed on a much better footing after the arrival of Truck Company No. 554, with 72 men and adequate transportation. Truck and ambulance companies were formed, but service frequently was impaired by nonreceipt of spare parts or lack of gasoline. The automatic supply of 4,000 gallons per month authorized for the center proved quite inadequate and was increased from time to time until double the amount was being furnished. Much of this was used to operate pumps and the stationery engines, for lighting plants, etc. On several occasions, when grave difficulties arose because of nonreceipt of spare parts and of gasoline, it proved necessary to send trucks that could hardly be spared to Nevers and Dijon for enough of these to tide over an emergency. By November, however, shops were well equipped; the gasoline station had been established and these shortages had ceased; expert auto mechanics had been found among the personnel on duty in the center and in the convalescent camp and had been attached to the truck company. Usually not more than 1 vehicle of the 50 then in the center was in the shop at one time; rarely more that 2, though work was normally carried late into the night. Orders required that the drivers should not leave for the day until they had cleaned and oiled their vehicles, filled the gasoline tanks, performed necessary minor repairs, or reported these to the shop if unable to effect them themselves. One of the greatest handicaps to the motor service was the poor condition of the roads, which not only obstructed operation of vehicles but was responsible for many damages to them.

The three hospitals in the center which had been organized as American Red Cross units had each collected certain motor transportation in the United States, but these never reached their units in France, because of pooling and redistribution of motor equipment at base ports. The American Red Cross provided four Ford cars, which were put at the disposal of the several units by roster.

MEDICAL SUPPLY SERVICE

A depot for medical supplies was established at Allerey, as at other centers, for the following purposes: (1) To have on hand supplies to meet immediate needs, (2) to lessen fire risk at central depots, and (3) to facilitate shipments by enabling these to be made in bulk and when cars were available. To further reduce fire risk, storehouses were also established in all units in the centers.

The medical supply personnel at Allerey consisted at first of but 1 officer and 3 enlisted men, but this force was later augmented as need arose to 2 officers, 8 noncommissioned officers, and clerks and laborers as required. Valuable additions were officers and enlisted men who had seen service in larger depots. Duties were divided as follows:

Record section.-The sergeant in charge of the record section supervised all other personnel and had immediate custody of records, correspondence and reports, requisitions and returns of the depot.


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Receiving and storage section.-This section checked in all supplies, received and arranged in the storehouse those not issued to units direct from cars, and was in charge of the storehouse. Its personnel checked the unloading of all cars, whether unloaded into the storeroom or direct to units, and made record of contents of each car, with number of same.

Issuing section.-This section modified requisitions as needs required and made issues from the depot to units. It also received notations from the receiving section of such issues as it had made direct from cars. Such issues comprised chiefly beds, cots, bedding, and the supplies belonging to certain units which they had had shipped from the United States.

The first duty of the medical supply officer at Allerey was to inventory the considerable quantity of property already there when the center was organized and for which no packers' lists or invoices had been received. Supplies accumulated in the United States by the unit which first joined the center were not received until some two months after it arrived, so that meanwhile articles were drawn to meet its needs. An acute emergency which arose at the outset of the service at Allerey before all needed supplies had been received was met by securing supplies by truck from the depot at Is-sur-Tille instead of awaiting their arrival by train from the more distant depot at Cosnes, which normally supplied the center; also, by shipments from the American Red Cross depot at Dijon and by purchase in open market of some articles not obtainable from either of these sources. After this initial deficiency, supplies secured were, generally speaking, adequate, though sometimes very limited and in a few items, insufficient. Often, supplies sent from the depot at Cosne were from two to four weeks in transit, for one reason or another, such as an embargo. Hence, constant provision was required of all concerned and responsibility clearly fixed for any deficiency through lack of timely requisition. Whenever less than 10 days' supply of needed articles were on hand in a unit depot the fact was reported to the officer in charge of the center depot, who took appropriate measures to prevent shortages becoming deficiencies. Similarly this depot sought to keep a month's supply in stock. It had been planned to keep on hand supplies for 20,000 men for three months, but quantities for such reserves were not available at the depots.

As no separate storeroom had been provided for medical supplies, the quartermaster allotted half of his warehouse to that purpose. This was supplemented by the medical storehouses in all units which were kept filled to capacity, with the result that storage facilities proved adequate. Whenever possible, cars were unloaded at the unit needing their contents, so that much bulky property did not pass through the warehouse, being checked direct from the cars to the units. In October, on account of the sudden demand for beds because of the influenza epidemic and the Meuse-Argonne operation, each of the best-equipped hospitals in the center established a provisional hospital of 1,000 beds, for whose supplies the parent unit assumed accountability. In order to reduce paper work, these slenderly staffed provisional hospitals carried all property on memo, receipt, and issues made to them were taken up and accounted for by the parent unit.


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The quantity of medical supplies reaching the center is indicated by the following figures:

Cars received 

280

Beds

13,000

Cots

7,000

Mattresses

15,334

Blankets

100,000

Ether, ¼-pound tins

32,000

Sheets

65,000

Pillow cases

62,000

Hand towels

87,000

Cotton, pounds

33,000

Gauze, yards

600,000


RECEIVING AND EVACUATING OFFICER

The receiving and evacuating officer was responsible for the proper reception and distribution of patients and their evacuation as soon as their condition permitted, with proper records and equipment, to stations designated by higher authority. He received from the statistical officer daily abstracts showing the number of patients and empty beds in each hospital and in the convalescent camp, the number of officers and enlisted men ready for transfer to the camp and from the camp to depots. His office maintained graphic charts showing these data. Usually, but not always, the arrival of trains would be previously reported by telegram to the center by the regulating station at Is-sur-Tille, giving the number of the train, time of arrival, and number of medical and surgical cases. The receiving and evacuating officer then determined where these patients should be distributed, taking into consideration not only the number of empty beds in each hospital but also the respective facilities of each hospital. The most serious surgical cases including all litter surgical cases were sent to the hospitals which had first reached the center, as these were best equipped to handle them. Incoming patients with influenza were sent to one hospital; other infectious diseases, including venereal, to another, etc. Having decided upon numerical distribution so far as possible, the receiving officer made appropriate notification to the hospitals concerned and to the motor transport and sanitary officers. The receiving officer furnished details to remove patients and prepared for their reception, the motor transport officer furnished ambulances at the time and place specified, and the sanitary officer arranged for the cleaning and disinfection of trains and the police of the railroad spur. Triage was effected in the train by the receiving and evacuating officer, his assistant, the center officer of the day, and officers detailed from each hospital. This method delayed somewhat the cleaning of the train, but 600 cases could thus be classified and removed in three hours. During a certain period more than 2,000 patients a day were distributed in this manner, with a minimum of inconvenience both present and subsequent to all concerned. When necessary to release trains more promptly triage was expedited and effected in from one-half to three-quarters of an hour, but it was always found that this required some subsequent transfer of patients between hospitals. During the removal of contagious respiratory cases the hospital personnel discharging this duty wore masks.

The receiving and evacuating officer also supervised the activity of the disability boards in the several hospitals meeting with them frequently to assist in the classification of patients. When it appeared from daily morning reports that any hospital was not evacuating its patients as rapidly as it should-i. e.,


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was allowing patients to remain an undue time on sick report-he visited its wards and, by personal examination of patients and service with its board, expedited their transfer to the convalescent camp.

These boards classified patients into four categories: A, fit for combat service; B, temporarily unfit for combat service but retained for early reclassification; C, permanently unfit for combat but fit for service in the rear; D, unfit for further service in France.

At first all patients of whatever class were evacuated direct from the several hospitals to the depots designated by higher authority, but later all except those in class D, and a few special cases, were evacuated only through the convalescent camp. Class D patients, including those seriously wounded who could be moved, psychiatric cases, etc., were evacuated directly from the several hospitals by special trains, which, on request of the center commander, were sent by the chief surgeon, A. E. F., from time to time for this purpose. Lists of these patients submitted by the several hospitals were consolidated and appropriate orders made when notice was received of the prospective arrival of a train. Each hospital evacuating class D patients was furnished a list with date, time, and place of entraining. It checked its patients into the train under the direction of the receiving and evacuating officer, and transmitted their completed records. Special cases requiring hospital treatment elsewhere-e. g., those requiring fitting with artificial eyes-were sent direct from the hospital in which they were being treated. They, like class B and D cases, were transported on ordinary passenger trains.

FIG. 90.-Interior of receiving ward, Allerey hospital center


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Patients were tentatively classified by their ward surgeons, then examined by the chief of service, and finally by the disability board of the hospital where they were undergoing treatment. Patients suitable for transfer to the convalescent camp were moved at a specified hour daily under a noncommissioned officer on order of the receiving and evacuating officer, who also notified the camp of the number to be expected from each hospital. With these men was sent a nominal roll, giving names, serial numbers, military status, age, race, religion, civil occupation, diagnosis in full, and classification, together with a certificate signed by the chief of service of the hospital whence they came, to the effect that they were free from vermin and infectious disease, were fully equipped and accompanied by complete records. All inmates of the convalescent camp were reexamined at frequent intervals, and when fit for transfer were paraded, their equipment was inspected, and those who did not feel fit for duty were ordered to fall out for reexamination. All these last-mentioned measures, including the preparation of proper orders, lists, etc., were in effect part of the evacuation service, but were performed under the commanding officer of the convalescent camp.

Several advantages were secured by evacuating all patients except class D and special patients through the camp. The most important of these were verification of patients' physical condition, frequent examination by trained physicians who specialized in this duty to determine progress, coordination, and verification of records, provision of a depot whence men could be drawn for needed service in the center while awaiting transfer, collective supervision by specialists of graded calesthenic exercises, and reestablishment of military discipline which may have been lost to a degree by patients while undergoing treatment in hospital.

Outgoing men had to be grouped according to destinations, for the several arms of the service had individual replacement depot or regulating stations to which class A patients were sent and, similarly, B and C patients were evacuated to designated points. It was found to be much simpler to evacuate one consolidated convoy than to notify all hospitals concerned and move a number of small detachments, the method that would have been necessary had evacuations taken place direct from hospitals and which had been practiced during the early days of the center.

Patients were transferred from unit to unit in the center as occasion required-e. g., transfer of infectious cases-by mutual arrangement between the respective commanding officers, and such transfers were then reported to headquarters of the center.

Arrangements for transportation of troops were made by the local railway transportation officer (on notification from the evacuating officer) who, in turn, made arrangements with the troop movement bureau headquarters, Services of Supply. It was sometimes difficult to get the reservations desired. Space allotted on local trains was often usurped by other organizations before they arrived at Allerey, and very frequently trains were many hours late. To diminish discomfort of men scheduled to leave during the night, they were transferred after the evening meal to quarters nearest the railroad station and not moved until the railway transport officer telephoned the near arrival of


510

the train. This measure, not available until overcrowding diminished, was important, for it saved many hundred patients the necessity of marching to the station, three-quarters of a mile distant, and then waiting through the night in cold and rain for transport, which occasionally did not arrive. Special trains, which were sometimes necessary, were available as a rule after three or four days' notice. Class B and C cases were evacuated on ordinary trains. Outgoing convoys, if their size warranted, were under charge of an officer. Sometimes several officers were detailed for this duty, as when, in one convoy, more than 1,200 men were transferred.

INSPECTOR

The duties of an inspector for the center never received undivided attention of an officer, for there was none available for this duty exclusively. To meet as well as possible a very evident need, the commanding officer directed the only other officer of the Regular Army who was present for any considerable period to assume these duties in addition to those of the commanding officer of Base Hospital No. 49. This hospital functioned so well that this officer was able to devote most of his time to inspections which took cognizance of both conditions within the center and its external relationships with French communities and individuals. He followed no routine, but inspected all elements of the command as need arose, recommending appropriate changes of method, transfers of personnel and equipment, investigated complaints, reported defects in service of units and individuals, etc. An important duty was the investigation and rectification, if just, of any complaint arising from misconduct of occupants of the center while on pass, and his activities in this field promoted amicable relations between the Americans and the French.

SANITARY INSPECTOR

The sanitary inspector supervised the sanitation of the center and was authorized to give orders on this subject. More specifically he was charged with making suitable arrangements for the disposal of excreta, waste, and refuse, disinfection of clothing, bedding, buildings, and hospital trains, supervision of measures ordered effected for the control of infectious diseases, inspection and report on the sanitation of units, coordination of the efforts of the sanitary officers of units, and report on progress of construction of buildings and grounds. Sanitary problems were numerous, and were intensified by overcrowding, shortage of equipment, and poor condition of roads.

The sanitary officer of the camp was assisted by the officers holding similar positions in the respective units. Also, in each unit there was a small, permanent detail of enlisted men engaged in sanitary work. At first, these enlisted men were selected from the units concerned; however, when sanitary squads No. 23 and No. 77 joined, personnel from these squads were distributed among the several units, thus permitting the release of the unit personnel. Members of the sanitary squads inspected and reported to the center sanitary officer upon all matters affecting sanitation therein; e. g., quantity and removal of garbage, collection and disposal of other refuse, ventilation, and water purification. Defects reported were corrected by the sanitary officers of the


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center and of the unit concerned. Another section of the sanitary squads supervised general police duty, such as that of the railway spur, the cleansing and disinfection of hospital trains, operation of the center incinerator, and cleansing of the settling tanks of the sewer system.

The condition of buildings and grounds and of water, food, and clothing supplies of the center have been discussed above under the construction and the quartermaster service, respectively. No further reference need be made to these subjects here, except that milk was purchased from neighboring dairies, but it was so heavily contaminated that local orders required its Pasteurization before use.

Garbage was removed under contract twice a day by a nearby farmer who, under supervision, performed this service very satisfactorily.

The pail latrine system was employed. As to the final disposal of excreta, this was buried in a pit north of the center, until an extemporized incinerator was built of salvaged material. The pails were emptied into covered barrels which were hauled by truck to this point. Unsatisfactory as was this method, it had to be employed from time to time until toward the close of the center. No excavator wagon was obtainable. Five Horsfall incinerators were received from time to time, but these proved quite inadequate for the needs of the maximum population in the center, so that recourse was had, with satisfactory results, to the use of the center incinerator. Pits were dug to collect urine and waste water, but because of the impermeable soil these soon filled and their contents were removed in barrels to a disposal tank on the outskirts of center. Eventually these fluids were removed largely through the sewer, though by the end of October, 1918, not more than half of the sewerage system had been completed. Urine pits were never connected with the sewer, but their contents were pumped into it by hand pumps.

Disinfection was effected at first in Serbian barrels, but later four portable disinfectors, American type, were installed from time to time. These, together with a Canadian hot-air disinfector built in the convalescent camp, met most needs, but during periods of stress were supplemented by the Serbian barrels until toward the end of the center's existence. The portable appliances were distributed, and their use by neighboring units regulated, according to roster. Mess utensils were disinfected after each meal by immersion in boiling soapy water and boiling clean water successively.

The sanitary officer inspected all parts of the camp at least twice monthly and daily any part of it which required especial attention (e. g., wards for infectious diseases). He kept a blue print of the camp, marked each day with colored pins, which indicated the location and character of sanitary defects reported by the sanitary squads or the sanitary officers of units, or discovered on his inspections. He graded on a percentage basis the sanitary condition of wards, kitchens, latrines, food wastage, and general police of the several units. These gradings of all units, published twice a month to the command, proved a stimulus to amiable rivalry

An important duty of the sanitary officer was the enforcement of orders for the control of infectious diseases. Such orders, in so far as professional measures


512

were concerned, were initiated by the chiefs of the medical and laboratory services; methods of their application were determined by the sanitary officer in conjunction with them.

The sanitary officer kept up graphic charts showing the number of cases of each infectious disease in the center. The occurrence of each case of diphtheria, meningitis, mumps, and measles in each building in the center was shown on a diagram of the center, by the appropriate insertion of pins with differently colored heads-one color for each disease.

FIG. 91.-Delousing apparatus, Allerey hospital center

In November, 1918, the center at Allerey was housing over 22,000 in addition to about 600 troops and employees of the engineers and was severely overcrowded. A number of cases of influenza and pneumonia had been received during October, together with many gassed cases who were very susceptible to respiratory infections. The greatest number of influenza cases was 1,002 on November 4, when the total number of patients in the center was 16,063; and the greatest number of pneumonia cases, 291, was reached four days later. By January 1, 1919, the number of cases of each of these infections had fallen to 100 and 51, respectively. Influenza and pneumonia cases developing in the center were transferred so far as practicable to appropriate wards in the same hospital in which they arose, but all other infectious cases were transferred to appropriate wards in Base Hospital No. 56. Though other infectious diseases-diphtheria, cerebrospinal meningitis, mumps, measles, German measles, erysipelas, typhoid, paratyphoid, and scarlet fevers-were introduced into the center,


513

only diphtheria occurred in any alarming number. It had been introduced by chronic carriers, especially those who had been gassed, these latter being highly susceptible to the disease. The number of cases rose gradually to 95, on December 2, the most important factors in its spread being overcrowding, contaminating hands, and fomites (indirect droplet infection), and, at first, delayed diagnosis in laryngeal cases. Clinically these cases often were very similar to membranous laryngitis caused by "mustard" gas. Measures for control adopted were:

(1) Inspection of all throats daily and prompt segregation of positive cases, carriers, and suspects. These were transferred to cubicled wards and wore masks when out of their cubicles.

(2) Quarantine of wards in which a case developed until the throats of all therein were cultured, inmates meanwhile wearing masks.

(3) Contacts, including those occupying, or working in, the same building were given the Shick test, and if this proved positive they were given antitoxin.

(4) Carriers and contacts were quarantined until two negative cultures were obtained, at 48-hour intervals, from the nose and throat.

FIG. 92.-Clothing preparatory to delousing process, Allerey hospital center

When five or less positive atypical cases were found in a ward when a case of diphtheria had appeared, they were sent to the quarantine wards in Base Hospital No. 56; when more than that number were found in a ward, the ward was quarantined. The throats of all its inmates were treated for 3 days and, after 24 hours' respite, were recultured. Quarantine, though rigorous, was made as brief as possible, in order to insure cooperation of those affected by it.


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Similarly, meningococcus carriers were quarantined until after two negative cultures were obtained at one-week intervals. Eighteen cases of this disease developed, between no two of which could close contact be established. Ten cases appeared at the time of greatest crowding, but epidemic developed.

Observation wards were provided in each unit for the segregation of suspected cases of infectious disease. All these beds, as well as in the contagious wards, were cubicled and attendants were masked. The sanitary officer in each hospital made frequent day and night inspections of the wards for contagious cases, and exemplary punishments were inflicted for violation of quarantine. Proper ventilation and head-to-foot sleeping arrangements were enforced. Public gatherings were forbidden for a few weeks during the height of the influenza epidemic.

FIG. 93.-Interior of one of the quarters for enlisted men, Allerey hospital center
Buildings were heated by coal and wood stoves, but a sufficiency of these to make all structures comfortable never was received. Proper heating of tents was especially difficult.

French shower baths, provided in adequate number, proved very satisfactory. Personnel and ambulant patients were required to bathe twice weekly at least, and permitted to do so more frequently if they did not interfere with the use of these baths by roster.

Very few venereal cases developed. Preventive measures were those usually employed.


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FIRE MARSHAL

The fact that the housing facilities in the center were constructed entirely of pine or were canvas caused the fire hazards to be exceptionally great, though these were minimized as far as possible by the spacing of units and tents and by the installation of spark arrestors on all smokestacks or chimneys.

FIG. 94.-Heating apparatus for patients' baths, Allerey hospital center

The fire marshal of the center was charged with the formulation of fire regulations, procurement and distribution of fire-fighting material, instruction of the fire marshals and squads of the several units, supervision of their drills, inspection of apparatus at least twice monthly, etc. The fire marshal being also sanitary officer, he added the duties of firemen to those of the sanitary squads and required that, when making sanitary inspections, the members of these squads were to note the condition of buildings and grounds and of fire-fighting apparatus. Such apparatus was rather delayed on delivery. When received, much of it was placed in those units treating the greatest number of bed patients and the remainder as equitably as might be throughout the center. At first the only facilities were fire buckets (which were used for no other purpose), 45 fire barrels, and 2 hand pumps to each unit. Eventually all units were equipped with Pyrene and Hardin extinguishers, 10 pumps of 5-gallon capacity, and 640 feet of 2-inch hose. A central fire department, consisting of 12 men on day and night duty who were in charge of a 90-gallon chemical fire engine, was soon expanded to operate three other such engines, which were distributed through the center. Detailed regulations covering fire service were posted in all wards, barracks, etc., and fire drills in accordance therewith were held weekly in each


516

unit and by the fire department of the center. Notwithstanding all precautions a number of small fires occurred, of which about 90 per cent were attributed to cigarette stubs; the only one that was at all serious was caused by an explosion of a small gasoline tank. Because of the danger of fire to the bed patients and the grave effects of the loss of even one structure in so crowded a community, smoking in wards and barracks was forbidden until the number of bed patients and the population of the center were considerably diminished and fire apparatus fully installed. The gravity and imminence of the fire menace is attested by the fact that within two hours after the premises were turned over to the French, four buildings were burned and the conflagration arrested only with considerable difficulty.

SIGNAL SERVICE

During the early history of Allerey, the French telegraph line was the only one available. An interpreter in the engineer's office was the connecting link, receiving and delivering by telephone, through the French office at the railroad station, messages pertaining to the center; but this service was very unsatisfactory as messages were often garbled in transmission. Exterior telephone service was soon extended to Dijon, but connections were difficult to get, and these usually were cut before a conversation was completed. It was not until after the center was linked up with the American lines that exterior service was reliable. At first no telephones were provided for interior communication, a circumstance which both slowed up service and necessitated the use of runners who could illy be spared from other duties, but these instruments were gradually installed, until by October, 1918, 46 were in operation. At that time a detachment of the Signal Corps joined and began operating a central office, which soon handled the following average business daily: Telephone calls, internal, to the center, 425; outgoing, long distance, 25; incoming long distance, 36. Telegrams received (2,950 words), 60; telegrams sent (3,400 words), 75. In addition to the foregoing were the internal calls (of whose number no record was kept) to the several units which had separate systems of local calls.

ENGINEER OFFICER

Throughout the occupancy of the center, the constructing engineers continued to be engaged in the completion of the project, but were also concerned to a degree with the solution of engineering problems which arose in sections already occupied; e. g., settling of water mains, upkeep of roads, etc. As this constructing force was to be withdrawn, however, as soon as the center was completed, and as no provision was definitely made for the assignment to the center of an engineer to solve problems that might later arise in this field of work, an officer of engineers in the convalescent camp was assigned to duty at headquarters to acquaint himself in detail with the problems which the constructing force had encountered and how they had been overcome. It was proposed to have him detailed as the engineer officer of the center when the constructing force was withdrawn, but this never proved necessary as the constructing force remained until the center closed.


517

ASSISTANT JUDGE ADVOCATE

The duties of an assistant judge advocate were discharged by the adjutant in addition to his other services. These comprised examination and, if need be, the correction of charges and findings, details of special courts, etc. General courts-martial for the center were detailed by the commanding general, Services of Supply.

ASSISTANT PROVOST MARSHAL AND COMMANDANT OF GUARD 

When the first unit arrived at Allerey, the only guard provided was a detachment of 10 men of Company F, 162d Infantry, engaged in protecting property of the engineers. This nucleus was gradually augmented, partly from outside sources, partly by details from the convalescent camp. But few firearms were available for several months, a circumstance which made it necessary to arm with clubs the interior guards and some of the personnel at posts outside the center. French gendarmes were too few to effectively restrict the American soldiers or to enforce the laws controlling sale of alcoholic stimulants. The police and guard services grew with the center's development, and by September there were 10 military police posts which covered 6 adjoining towns and adjacent territory. These were under the command of the assistant provost marshal detailed by headquarters of the Services of Supply. This officer was responsible for the discipline, records, etc., of the military police quartered in the center, reports of their activities, establishment of an adequate number of police posts throughout adjoining territory, protection of inhabitants against disorders and depredations by American troops, supervision of travel by military personnel, arrest and detention of all stragglers, absentees without leave, and other violators of the laws and orders whether of French or American origin, to which Americans were subject. At first the assistant provost marshal also commanded the interior guard, but this organization later was separated entirely and placed under the command of a line officer detailed from patients in the convalescent camp. At this time the guard consisted of 3 platoons, each having 3 sergeants, 12 corporals, and 79 privates, each platoon being commanded by a commissioned officer. Almost all this personnel was drawn from the convalescent camp and, under existing orders, had to be returned to duty as soon as fit, a circumstance which required the return of its members about as soon as they were trained, and enhanced greatly the difficulty of this service. In August, Provisional Company No. 6 and Provisional Company No. 20, each comprising 100 class B men, were assigned to the center for guard duty. An efficient military police who, as distinguished from the guard, functioned outside the camp was necessitated by infractions of law on the part of some of the local French population. The most serious of these offenses were illegal sale of alcoholic stimulants and the purchase of Government property, such as military clothing and blankets. These offenses were controlled only by numerous arrests, search warrants, and prosecutions in the French courts. Clandestine sales of liquors in camp by employees and by laborers were suppressed by similar means. Absences without leave were controlled by demanding passes of all men encountered by the police outside


518

of camp, and by sentencing men found guilty to unpleasant duty, as with the labor battalions. One motor cycle was employed by the military police for the apprehension of such delinquents. By means of this vehicle the police reached points where it was impractical to post guards, and the radius and intensity of their control were notably increased.

INTELLIGENCE OFFICER

The intelligence officer for the center was assisted by others occupying comparable positions in all units, by officers censoring mail, the post-office force, the telephone and telegraph operatives, etc., so that very complete information reached headquarters of the conduct and loyalty of individuals and of morale throughout the center. This service was important, for it was an additional means of determining the needs of personnel and how they might best be met. Derelictions discovered through it were met in other ways than by court-martial, for none were grave enough to warrant this, and could be handled better by administrative than by juridical methods.

CHAPLAIN

As the center expanded, the number of chaplains present, 4 Catholic and 4 non-Catholic, proved inadequate without some organization, to the many needs arising for their service. The senior chaplain present therefore was placed in general supervision of the chaplains' activities and in charge of the center chapel. His functions in these capacities were to make suitable provision for all those seeking the services of ministers of their faith and to prepare a roster for the use of the chapel by all ministers in turn. Thus such needs throughout the center were coordinated. As chaplains made their visits through wards and elsewhere, they learned the names of those of other faiths who desired the services for chaplain and promptly took appropriate measures to secure these services. Each chaplain normally served those of his faith, not only in his own unit but in others as well.

In addition to the services in the chapel, others were held in the several units in the recreation halls and, when these were filled at one time by beds, in dining rooms. Dining rooms were by no means suitable for the purpose, but the fact that any other arrangement was temporarily impossible was recognized by ministers and congregations alike, and services were conducted with normal decorum and success. As noted above, suitable provision for interments was made by the interment officer, who was the first chaplain to come to the center.

From time to time the chaplains met informally to discuss questions pertaining to divine services and social needs, for they charged themselves with the performance of whatever duty they could discharge which came to hand. These duties included the promotion of entertainment within the several units, in conjunction with the American Red Cross, the organization of orchestras, glee clubs, etc., preparation for Thanksgiving and Christmas celebrations, writing letters for disabled or uneducated men, and, by sympathetic helpful interest, promotion of the happiness of such as sought their aid, or when they


519

proved in need of help or encouragement. Their counsel was constantly being sought by patients and duty personnel alike in matters affecting their secular welfare.

RAILWAY TRANSPORTATION

The railway transportation officer was responsible for the transportation by rail of personnel and supplies to and from the center, except movement of hospital trains and supervision of the railway spur, the former being under the orders of the regulating station at Is-sur-Tille and the latter under the center quartermaster. Upon notification of the number of patients fit for transfer, and their destination, he made appropriate request on the troop movement bureau at Tours and notified the evacuation officer when transportation was made available. He traced lost freight, notified the center headquarters of the time of arrival of hospital trains, arranged for the movement of the shuttle railway car back and forth to Dijon, and maintained liaison with the fourth bureau of the French War Department. His office in the railway station was connected by telephone with the hospital center and maintained day and night service, with the result that local business was handled promptly, and, by means of long-distance telephone calls, hour of arrival of trains for outgoing drafts was notified to the center in due time for them to be moved without tedious waiting, yet without delay.

AMERICAN RED CROSS

Shortly after the hospital center at Allerey was organized, an officer of the American Red Cross joined the headquarters staff and remained in charge of Red Cross activities until the center neared its close. His department grew until it consisted of 3 officers, 23 workers, 2 searchers, and a variable number of civilian employees. He exercised general supervision over his department, obtained and distributed needed Red Cross supplies, and coordinated efforts of his department personnel; one of his assistants arranged for entertainments to be given in the center from extraneous sources, procured moving-picture apparatus, films, etc., and another, as a field inspector, determined needs of patients, efficiency of workers, etc. The workers, distributed among the units, met incoming hospital trains to serve hot chocolate and coffee and to distribute cigarettes. They assisted patients in many ways throughout their stay in hospitals, as by the donation of tobacco, confectionery, stationery, etc., resale at cost of supplies purchased from the commissary, writing of letters, etc. Among the gifts distributed by the Red Cross prior to January 1, 1919, were 35,000 comfort kits, 375 cases of bar chocolate, 50,000 pairs of socks, 35,000 sweaters, 5,000 cases of cigarettes and tobacco, 100 cases of chewing gum; at Christmas, 1918, 15,000 pairs of socks were filled and distributed. Part of the contents of these were 200 sacks of nuts and confectionery made from 15 tons of sugar. The Red Cross also met the graver needs of patients, its depot supplying many articles required for their care and comfort, especially in emergencies when there was not time to get them from Army depots. Thus, to meet the needs occasioned by the Meuse-Argonne operation and when shipments from the medical supply depot at Cosne were held up by embargo,


520

the local chief of the American Red Cross procured from the depot of that society in Paris 10,000 blankets, 10,000 sheets, 1,000 operating gowns, 1,000 helmets, 1,000 pairs of bed socks, 600 suits of pajamas, 2,000 yards Carrel tubing, and 2 cars of surgical dressings. The promptitude with which these essential articles were received at this time undoubtedly saved a considerable number of lives. These articles were shipped by freight cars attached to the Paris-Marseille express to a point near the hospital center, whence they were transported to the center by truck.

On the one hand, the searchers located relatives and friends at home, of patients in hospital, and, on the other, for interested ones at home, men who had been lost in the American Expeditionary Forces. One of their duties was the detailed report of the American prisoners of war who reached the camp from Switzerland and to assist these men in straightening out their affairs.

The several hospital units of the center provided to a degree their own entertainment, such as dances, theatrical performances, and concerts, but to the local American Red Cross fell the duty of promoting entertainment generally, obtaining troups, films, etc., from outside sources, and coordinating resources among the organizations. Each hospital unit had a recreation hut accommodating 600 persons; the convalescent camp had a hut accommodating 1,500. All of these buildings were donated by the American Red Cross. That society installed 10 pianos in these buildings and furnished instruments for a band, three orchestras, and a fife, drum, and bugle corps. From the middle of October, 1918, until November 25, the recreation huts in most units were filled with beds, but as rapidly as these were cleared performances were staged, and when, in December, sufficient electric current became available moving pictures were exhibited. These were shown five nights a week in each unit, and from one to three of the American Expeditionary Forces traveling shows played nightly in the center.

About January 15, 1919, a nurses' recreation hut was opened by the American Red Cross, providing reading, writing, and lounge rooms. Tea was served here each afternoon and a dance given every evening except Sundays, the chief nurses of the hospitals acting as hostesses by roster. In the same month the Red Cross opened in Chalons-sur-Saone, the nearest large town, a centrally located building which provided a recreation and writing room for enlisted men, separate sitting rooms for officers and nurses, and a common drawing room where tea was served by the Red Cross worker in charge.

A library of 500 books was maintained in each unit and large numbers of current American, English, and French periodicals, especially those carrying illustrations pertaining to current events, were distributed.

In the headquarters building, the Red Cross operated a bank and an information bureau. The bank made loans and cashed checks, the amount of its business amounting to over 785,000 francs. The information bureau assisted some 300 men daily.

CONSULTANTS IN THE PROFESSIONAL SERVICES

The consultants of the several professional branches supervised the activities of their respective specialties throughout the center, in addition to performing the duties of chief of service in the hospitals to which they were assigned.


521

They were charged with the study of pertinent professional needs and available resources, in personnel and material, recommending transfers as required to the best advantage. They acquainted themselves with the qualifications of their own resources as far as possible, but reported to the commanding officer those matters needing his cooperation, acquainted themselves with new methods of treatment, and disseminated professional information. This last important duty was effected in several ways, such as by conferences attended by all officers in the center belonging to a given service, by personal discussion with individuals concerning treatment of a particular case or group of cases, and by presentation of cases or papers read at meetings of the medical society. In order to afford a clearing house for professional knowledge, the "clinico-pathological society" was organized, to meet twice weekly. At one of these weekly meetings unusual cases were presented and discussed; at the other, reports of autopsy findings and demonstrations were made. It had been noted early that certain clinical diagnoses had proved difficult, such as certain cases of laryngeal diphtheria, complicating injury caused by inhalation of "mustard" gas, pericarditis, and empyema, and cases selected for presentation were those that had presented difficulties in diagnosis and treatment. Similarly, difficult surgical cases were presented and discussed. By such means there was promptly disseminated much information of a highly technical character, which was of immediate value, especially to medical officers who had newly arrived overseas and had not yet had practical experience in treatment of certain newly encountered conditions. By the report of autopsy findings, an error in diagnosis or treatment by any medical officer was immediately made known to the chief of service so that appropriate action could be taken. Frequently, the respective staffs of the several hospitals met to discuss professional matters internal to the units. A number of papers were written, and later published, on professional activities in the center. It had been planned that each service eventually would organize its professional society, but because of shortage of personnel and pressure of duties, this project could not be effected.

Through the visits of the consultants from ward to ward, and the discussions in the medical society and out of it, a standardization and coordination of service was effected. Though certain professional measures were mandatory, for example, those for the control of diphtheria, medical officers were encouraged to feel that they had an active part in the development of professional methods, and they formulated the few orders published concerning professional activities.

To meet the fluctuating needs in the nursing service in different parts of the center, the senior chief nurse, in addition to her other duties, made frequent surveys to determine what transfers of nurses should be effected between hospitals and to make recommendations concerning their activities and welfare. Similarly, the senior dietitian made surveys concerning dietaries, the preparation and service of foods, recommended transfers of dietitians with the different hospitals, and gave assistance in her specialty wherever this appeared advisable.


522

COLLECTIVE ACTIVITIES OF HOSPITAL UNITS

It is the purpose of this chapter to consider collective, rather than individual, activities of the hospitals of which the center at Allerey was composed, the individual activities were comparable to those of detached base hospitals. Certain notations regarding each unit composing the center are made, however, to show how each fitted into the general plan.

The following hospitals joined the center in sequence: Base Hospital No. 26, comprising personnel from the University of Minnesota, the Mayo clinic, and the medical profession of Minnesota at large, had been joined in the United States by 12 officers and 50 enlisted men from Baylor University, Texas. This hospital joined June 20, 1918, with 36 officers, 65 nurses, 1 dietitian, 2 technicians, 3 stenographers, and 207 enlisted men. Base Hospital No. 25, comprising personnel from the Cincinnati Medical College, and the medical profession of Ohio at large, joined July 15, with 41 officers, 100 nurses, 1 dietitian, 2 technicians, 3 stenographers, and 208 enlisted men. Base Hospital No. 49, with 38 officers, 100 nurses, 1 dietitian, 2 technicians, 2 stenographers, and 208 enlisted men, from the University of Nebraska and the medical profession of that State at large, joined August 5, 1918. Evacuation Hospital No. 19, with 33 officers, 100 nurses, and 237 enlisted men, organized at Fort Riley, Kans., joined September 19. Base Hospital No. 70, with 40 officers, 100 nurses, and 200 enlisted men, organized at Fort Riley, Kans., joined September 28. Base Hospital No. 56, with 30 officers, 99 nurses, and 188 enlisted men, organized at Fort Oglethorpe, Ga., joined September 30. Base Hospital No. 97, with 31 officers, 2 dietitians, 192 enlisted men, organized at El Paso, Tex., joined November 30. It was joined on December 14 by 97 nurses. Base Hospital No. 82 joined September 19, but on September 21 it was transferred to Toul.

In conformity with the urgent demand for increased hospitalization in the American Expeditionary Forces, the first five hospitals which reached the center each organized a provisional hospital consisting of from 7 to 12 officers and about 40 enlisted men. Each of these provisional units took over an unoccupied, uncompleted section of the center and undertook to care for 1,000 patients whose condition was not severe but who were not ready for transfer to the convalescent camp. The senior unit relieved its respective provisional hospital of as much as possible of administrative work-e. g., reports of sick and wounded, returns for property (except clothing and ordnance)-but, generally speaking, these junior units were autonomous.

The convalescent camp was organized June 26, 1918, from personnel on duty at Allerey and by limited casual personnel assigned to the center for that purpose.

The personnel of the three American Red Cross hospital units which had been the first hospitals to join had been selected from large resources so that their commissioned staffs were composed of men well trained in their several specialties, whether surgery, medicine, laboratory, or dental, and who were mutually acquainted with the professional methods of others in their units. Nurses, dietitians, technicians, and enlisted men comprising college men, professional cooks, technical draftsmen, also had been selected from


523

among many who were eligible. Thus each of these units was well balanced. This balance, however, was considerably disturbed by the need of supplying personnel to form the headquarters organization, organize provisional hospitals, provide surgical teams which were sent to the front, and to meet other needs. The other hospitals which composed the center contained many very capable officers, nurses, and men, but in comparison with the Red Cross units they were handicapped by the lack of prior mutual acquaintance; also, they were handicapped in their earlier professional efforts by the necessity for concentrating, as described below, a considerable part of the limited equipment available in the hospitals which first arrived in order that the most serious cases could receive suitable care.

FIG. 95.-An operating room, Allerey hospital center

Each of the Red Cross hospital units had accumulated medical property to the value of from $30,000 to $100,000 in the United States. But since the property was not received until about two months after they reported at Allerey, it was necessary to completely equip them, even at the expense of other units, so that they could care for all types of cases, and for this reason they were at first given preferential consideration in the distribution of equipment. This procedure made it possible to treat satisfactorily all classes of cases who could not have been so well cared for had equipment been scattered. Later, as resources developed, other hospitals were equipped to greater or less degree, especially in their laboratories, operating, and X-ray departments.


524

This distribution of equipment had a corresponding influence on distribution of patients. Thus, grave surgical cases were concentrated at first in Base Hospitals Nos. 25, 26, and 49; psychiatric in Base Hospital No. 25; neuropsychiatric in Base Hospital No. 49; infectious diseases (other than influenza and pneumonia), complicated venereal and dermatological diseases in Base Hospital No. 56; ophthalmic in Base Hospital No. 26; otolaryngological in Base Hospital No. 49; influenza and pneumonia in Base Hospitals Nos. 25, 26, 49, and 70; complicated dental cases in Base Hospital No. 26, etc. Since many cases admitted were suffering from two or more conditions a sorting of them was effected in such a manner as to give the graver condition preferential consideration. The most serious cases of this class were the severely wounded who had contracted pneumonia. The provisional hospitals cared for patients not ready for transfer to the convalescent camp.

FIG. 96.-Sterilization room, Allerey hospital center

All hospital units of the center had their medical and surgical cases in wards devoted as far as might be to the treatment of one class of patients only. Thus wards were established for patients with infected wounds, fractures, and dislocations, clean surgical cases, surgery of the head, face, nose, throat, dental cases, gassed cases, cases of pneumonia, influenza, etc. Each hospital established a cubicled observation ward, to which was transferred each suspected case of contagious disease, until diagnosis was established, when it was properly assigned. A nurses' ward for the service of the entire center was established in Base


525

Hospital No. 49. The infectious cases grouped in Base Hospital No. 56 were segregated, as far as possible, though because of the great overcrowding of the center and limited personnel and equipment, it was not possible to provide a separate ward for each type of disease. At the period of greatest overcrowding in the center, wards built for 50 patients were sheltering 70; however, the wards for infectious cases were made to house but 48 inmates each.

Consequent upon this segregation of cases was the local development of several departments in certain hospitals; e. g., an occupational work shop for psychoneurotic cases in Base Hospital No. 25, orthopedic shops in Base Hospitals Nos. 25, 26, and 49, and the especial equipment of hospitals which were carrying on special activities. A central orthopedic workshop was never established. The plan had manifest advantages, but at Allerey shops were operated in several hospitals in order that orthopedic appliances might be made under the immediate supervision of the respective surgeons, who could illy afford the time necessary to go to a central workshop for this purpose.

FIG. 97.-A surgical ward, Allerey hospital center

Except that certain departments were more developed in some hospitals than in others and that personnel was depleted for various reasons, the organization of each hospital conformed to the general plan formulated by the War Department for these institutions. The detail of from 1 to 6 surgical teams from each unit, except Base Hospital No. 97, took from the center, from time to time, much of its best operating personnel for from a few days to several months. These teams usually consisted of 2 medical officers, 3 nurses, and 2 enlisted men.

The total number of cases admitted was 33,658, distributed as follows: Base Hospital No. 26, 5,512; Base Hospital No. 25, 5,860; Base Hospital No.


526

49, 4,626; Base Hospital No. 56, 7,338; Base Hospital No. 70, 5,371; Evacuation Hospital No. 19, 4,951. Base Hospital No. 97 received convalescents from other units.

The following summary of medical cases treated in Base Hospital No. 25 prior to January 1, 1919, indicates the general scope of the medical activities of the center:

Disease

 

Cases

Deaths

Disease

Cases

Deaths

Pneumonia and empyema

248

74

Typhoid fever

5

---

Influenza and bronchitis

859

---

Paratyphoid fever

1

---

Diphtheria

42

1

Pulmonary tuberculosis

9

---

Diphtheria carriers

97

---

Malaria

3

---

Measles

4

---

Dysentery and other diarrheas

261

---

German measles

1

---

Nephritis

10

3

Mumps

3

---

Psychoneurosis

575

---

Scarlet fever

2

---

Cardiovascular

17

---

Erysipelas

6

---

Tonsillitis

52

---

Epidemic meningitis

2

---

Arthritis

70

---

Meningitis carriers

3

---

Miscellaneous

29

---

Gas cases

741

---

 

 

 

 

FIG. 98.-A psychiatric ward, Allerey hospital center

Similarly, the range of surgical activities is indicated by the following list of operations in Base Hospital No. 49:

Amputations

12

Hemorrhoidectomies

22

Aneurysms

3

Herniotomies

12

Appendectomies

17

Laminectomies

2

Aspirations

1

Skin draft

1

Circumcisions

4

Thoracotomies

1

Closures

305

Tracheotomies

2

Colostomies

2

Tubercular glands

1

Débridements

13

Venectomies

2

Decompressions

3

Total

506

Drainages

75

Foreign bodies

27


527

The greatest number of surgical operations was performed in Base Hospital No. 26, where, 1,021 operations were performed in the operating room.

In the treatment of surgical cases, certain hospitals of the center required, in order, the débridement of wounds if this had not already been done, the culturing of all deep wounds, preparation of smears from all wounds, treatment of all wounds by Dakinization, and secondary closure after three clean smears had been obtained, the last of which had preceded operation 24 hours.

In the center otolaryngological clinic, the following cases were treated and operations were performed from the date of organization (August 20, 1918) to January 8, 1919:

FIG. 99.-Eye and ear clinic in one of the hospitals, Allerey hospital center

New cases seen in clinic

1,026

Old cases seen in clinic

1,023

 

 

2,049

Consultations by ear, nose, and throat department in other hospitals in center

645

Operations:

 

Tonsillectomy

85

Mastoidectomy

49

Submucous resection nasal septum

47

Antrum of Highmore

13

Frontal sinus

14

Ethmoid

12

Sphenoid

2

Closure

3

Miscellaneous

25

 

Total

250

Deaths in the center totaled 429, including several deaths by accident, such as drowning or railway accident, giving a mortality of 1.27 per cent. Seventy-


528

four and two-tenths per cent of the deaths were from disease, 24.8 per cent from surgical causes, but an exact differentiation is difficult for the reason that though 40 per cent of the deaths among wounded were returned as due to intercurrent disease, chiefly pneumonia, in certain of these cases the impaired vitality caused by the wound was a contributing factor. The highest death rate was during October, when 245 deaths occurred, the majority being due to respiratory diseases. It was during this month that influenza and pneumonia were at their height. Pneumonia was present in 61.2 per cent of the 356 cases which came to autopsy, bronchopneumonia constituting three-fourths of such cases.

LABORATORY SERVICE

In addition to the unit laboratories, provided for the several hospitals, a more fully equipped laboratory was operated for the entire command under the center laboratory officer. The distribution of duties between the unit and center laboratories was prescribed by the director of laboratories and infectious diseases, A. E. F. In general terms, the duties of the unit laboratories included routine urine analyses, blood counts, examinations of sputa and stools, media making, wound bacteriology, preparation of Dakin's solution, and grouping of blood for transfusions. For November, 1918, when the center was at its maximum, the following figures were reported from five of the hospitals in the center:

 

Hospital laboratory

No. 25

No. 26

No. 56

No. 70

No. 19

Red cell count

23

20

15

7

16

White cell count

47

97

54

40

52

Differential count

40

35

48

30

5

Lime (quantitative)

253

396

181

141

114

Feces examination

25

95

9

8

2

Sputum examination

68

135

34

52

14

Bacteriological examination

1,257

1,228

346

270

399

Wound smears

73

324

333

320

125

Miscellaneous

1,115

445

109

514

257

 
Total

2,901

2,773

1,129

1,382

874

Total examinations, 9,059

For the period prior to January 1, 1919, the following are the figures for the more important laboratory examinations made at Base Hospital No. 49:

Aerobic wound cultures (1,529 wounds)

3,198

Wound smears

3,198

Anaerobic wound cultures

210

Sputum examination for tuberculosis

213

Number positive to tuberculosis

5

Urinalysis (chemical and microscopical)

1,468

Bloods grouped for transfusion

30

Throat cultures for diphtheria made in unit laboratory and examined in central laboratory

4,116

Schick tests

747

Smears for Vicent's organisms

121

White blood counts

214

Red blood counts

29

Differential blood counts

63


529

The following statistical list shows some of the more important work performed by the center laboratory up to January 1, 1919:

Autopsies

356

Spinal fluids:

 

Smears for meningococci

37

Colloidal gold

27

Dark field examinations for treponema pallida

15

Positives

3

Stools for typhoid and dysentery

157

Positive typhoid

5

Positive dysentery

0

Pneumococcus typing, Avery

90

Throat cultures for diphtheria

23,726

Pharyngeal cultures for meningitis

1,293

Positives

34

Throat cultures for hemolytic streptococci

871

Wassermann tests

536

Positives

119

Autogenous vaccines

25

Wound anaerobic cultures examined

60

B. Welchii

13

Vibrion septique

5

Histologic slides

504

Total examinations

27,627


F
IG. 100.-Center medical laboratory, Allerey hospital center


530

In addition to the foregoing, much miscellaneous work was performed in the center laboratory, such as daily examinations of raw water and treated water from each unit, examination of clothing harboring nits to determine efficiency of disinfesting apparatus, supply of cultures of hay bacillus to test sterilizing apparatus, isolation of milk-curdling organisms, bacteriological examination of doubtful canned foods, examination of chemicals from the local supply depot and of gonorrheal smears from the convalescent camp, and disinfection of mail and personal effects of inmates of the contagious wards.

CONVALESCENT CAMP

The convalescent camp at Allerey was organized June 26, 1918, the first group of convalescents, 11 officers and 116 enlisted men, arriving on July 31. The camp at first occupied one of the hospital sections, for it was not until September 19 that its tents were ready for occupancy. Meanwhile, its patients and duty personnel had been employed in completing construction of that unit, grading and draining the recreation field (1,060 feet by 700 feet), building roads and walks, pitching tents, etc. Electric wiring was completed by the end of October, and a Red Cross recreation hut, measuring 50 by 252 feet, was ready for use December 11. This hut, which had an important influence on the welfare of the camp and of the center at large, included an auditorium seating 1,500 persons, a stage, quarters for Red Cross personnel on duty in it, canteen space, writing and billiard tables, piano, etc. About half the hut was given over to basket ball, croquet, and a boxing ring.

Convalescents were organized into a regiment, subdivided into battalions of 1,000 men each, and these, in turn, into companies of 250 and platoons of 50. The staff consisted of the commanding officer (who also acted as inspector), a receiving and evacuating officer, an adjutant, a field adjutant, a supply officer, mess officer, physical director, six medical officers who sat on disability boards and cared for medical and surgical cases, respectively, and a sanitary inspector.

The adjutant's duties were of a dual character, one pertaining to military supervision, the other to medical records. In the former he was assisted by a regimental sergeant major, 1 duty sergeant, and 1 clerk; in the latter by 1 sergeant, first class, Medical Department, and 10 clerks, including 4 stenographers. This number was increased to 21 clerks when the camp reached its maximum strength, of approximately 6,000.

The regimental sergeant major prepared the camp morning report, sent a list of absentees to the assistant provost marshal, organized details for special duties, furnished lists of men on detached service, and took charge of many minor administrative details that arose, including supervision of the post office established in the camp and the card index of convalescents. The office of the sergeant, Medical Department, checked the field medical cards against the nominal roll received with each convoy, placed these in the dead file when men were to be evacuated, and forwarded them monthly to the chief surgeon, A. E. F., prepared diagnosis cards for all men admitted, listed B and C class cases for the camp disability board, prepared the roll of casualties and changes, and


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listed outgoing men. At the time each platoon was examined, the platoon sergeant made one list of men placed in class A for his own use and one for the office so that the sergeant, Medical Department, knew, when an evacuation was ordered, which men were to be transferred. As travel orders were prepared in advance, this measure made it possible for an evacuation of 1,500 men to be effected within two hours after notice was received that transportation was available.

The field adjutant met and inspected incoming drafts, gave them a short talk on discipline, and, in the absence of the camp commander, inspected outgoing men and their equipment, marched them to the railroad station, superintended entraining and rationing for the journey. He was, furthermore, fire marshal and summary court officer of the camp and acted on passes for patients and duty personnel.

The supply officer was charged with reception and disposition of both medical and quartermaster property. He was assisted by 12 enlisted men who performed the following duties: General supervision, 1 sergeant; subsistence, including office and field work pertaining thereto, 1 sergeant; transportation of all supplies to kitchens subsisting men under the camp's jurisdiction but quartered outside of its main element, 1 sergeant; paper work pertaining to subsistence, 1 sergeant and 1 private; subsistence storeroom, 1 private; clothing, blankets, and other durable property, 1 sergeant and 2 privates; transportation of fuel, 1 sergeant; medical supplies, requisitions, and returns, 1 private.

The mess officer was assisted by 1 mess sergeant, 14 cooks and assistant cooks, 5 butchers, and necessary details of 20 men for kitchen police, 6 stokers, etc.

The physical director had charge of all calesthenic drills and exercises. These will be discussed below.

The sanitary inspector performed the duties indicated by his title, including supervision of water-heating appliances, bathrooms, bathing schedules, operation of delousing plants, and preparation and service of food, disposal of waste.

The convalescent officers rendered very valuable assistance in camp administration, and in the service of the center generally. Though patients, they took charge of details, conducted drills and inspections, organized the guard, and took command of troops en route to regulating stations.

Other departments in the organization of the camp were as follows: Pay office, 1 sergeant and 2 clerks; provost, 1 sergeant, 3 enlisted men; sanitation, 1 sergeant, 1 corporal and 3 privates for each incinerator, 1 corporal and 3 privates for each set of latrines; medical dispensary 1 noncomissioned officer; druggist, 1 private; surgical dispensary, 1 noncommissioned officer, 1 private; phyiscal training, 1 sergeant for each company; fire department, 1 sergeant, 10 privates; prophylaxis, 2 corporals; baths, 1 corporal and 2 privates for each bath and ablution barrack, 1 corporal and 2 private for each laundry barrack; battalion organization, 1 battalion sergeant major, 1 duty sergeant, 1 clerk, 1 corporal of the sick; company organization, 1 first sergeant, 1 company duty sergeant, 1 orderly corporal, 1 clerk; platoon organization, 1 sergeant, 1 clerk.


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Incoming drafts were received by the regimental duty sergeant, who arranged the men in two lines, one on each side of the infirmary, for inspection by medical officers. They were examined for vermin, scabies, venereal disease, and were classified as A, B, or C patients. After  examination, those not rejected were formed in columns of squads and were marched to headquarters. There their field records, clothing, slips, etc., were checked, the roll called by the sergeant major and checked with the field medical cards. They were inspected by the camp commanding officer, who noted if their clothing and equipment were complete. Men rejected for any reason, such as physical ailment, vermin, and lack of equipment were returned with their field medical cards and appropriate notation to the hospital whence they came. Men passing medical and military inspection were then given a short talk on discipline, standing orders, and daily schedule, divided into detachments and assigned to platoons according to vacant bed reports. The platoon sergeants then listed names of men assigned to them, and gave the lists to the sergeant major, who checked them against the nominal rolls from base hospitals. The admission classification was given the platoon clerk.

The duties of the personnel were such as normally fall to men in comparable positions with line troops, except that the noncommissioned officers performed also some duties usually discharged by commissioned officers. The object of this measure was to reduce the commissioned staff of the camp to a minimum.

The battalion sergeant major received incoming men and distributed them among the companies. He saw that the men were properly quartered and fed, supervised sanitation and police, formed promptly all details called for, consolidated company morning reports, verified same, enforced orders from higher authority, and convoyed evacuation groups from his battalion to the railroad station. The battalion duty sergeant verified service details called for, checked battalion and company formations and all reports of company first sergeants, turned over delinquents to the labor squad, reported to the adjutant men returning from absence without leave, reported the battalion at drill formations and took command of it during the absence of the battalion sergeant major. The company first sergeants carried out orders from battalion headquarters, checked convalescents into and out of their companies, supervised all efforts to promote health and comfort of their men, furnished details promptly, verified company and platoon reports. The platoon sergeants informed the incoming men of the regulations of the camp, which were few as possible, checked absentees at formations, taps, and reveille, organized details promptly, made out nominal rolls, and marched platoons to the medical hut for classification.

The repeated classification of patients was one of the most important and probably the largest portion of the routine medical work in the camp. It was essential that the machinery for doing this be simple, adequate, and accurate. Therefore, men were examined, by platoons, at semiweekly intervals, and as their condition improved were advanced to a higher category. Those in class A constituted the standing evacuation list. A man remaining for from two to four weeks in class C was usually examined by the disability


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board and assigned to suitable service for a limited period in the Services of Supply, after which he was reexamined.

The average stay in camp was from two to six weeks. If the convalescent period was longer than six weeks, the patient was examined by the disability board with a view to reclassification and appropriate transfer.

Accurate physical classification was essential to the success of the camp; therefore, the physical and recreation trainers kept new arrivals under close surveillance to notice lagging during exercises, with a view to reclassification if indicated. Men properly classified were soon infused with a spirit of enthusiasm and competition so that malingering was rarely found. Within one week all patients were carefully reexamined and reclassified. Men suffering from cardiac insufficiency, effort syndrome, joint diseases, war neuroses, effects of gassing, or were convalescent from infectious disease were assigned to special schedules. The medical staff included specialists for cardiac, pulmonary, and orthopedic conditions.

Second only to proper classification and prescription of appropriate exercises, the establishment of a cheerful and competitive spirit was looked upon as the most important factor in furthering convalescence. The treatment in general consisted of graded exercises, work that interested, and play that diverted and cheered. To keep the convalescents as fully occupied as possible, any measure that might promote among them good fellowship and light-heartedness was eagerly sought and practiced. Games productive of enthusiasm and merriment in which all participated were especially successful. As a measure of the success obtained, 95 per cent of the patients advanced regularly, upon the weekly physical examinations.

Because of the fact that many men in hospital tended to lose interest in military precision, personal responsibility and enthusiasm in their activities, the physical exercises for convalescents were diversified to meet these several needs. Commands were given from a drill stand, and as the troops were under the surveillance of their sergeant instructors, there was no difficulty in identifying delinquents. Parades and military formations before and after exercises helped appreciably. Garrison schedule was conducted with evening parade, which was attended by the band.

The routine of the camp was as follows: Reveille, 6.45; breakfast, 7.10; sick call, 7.30. At 8 a. m., the morning reports were received by the regimental sergeant major from battalion sergeant majors. From these reports the regimental report was made, the list of absentees being sent to assistant provost marshal. Service detachments were organized and distributed as requested. From 8 to 8.45 a. m., calisthenics; 9 to 9.15, running and walking; 9.25 to 9.40, athletic games. At 10 a. m., the guard was mounted; from 10 to 10.30, jumping exercises were held for other troops; 10.30, recall; 12, dinner; 1 p. m., first sergeant's call; 1.30 p. m. reception, inspection, and disposition of incoming convalescents; 2 p. m. athletics, 2.30 p. m., parade, inspection, and entraining of outgoing convalescents; 3.30 p. m., recall from calisthenics; 4.10 p. m., parade; 5, supper; 10.30 p. m., taps.

In order that the military purport of the training might not be slighted, the men were brought into platoon formation before and after each period. Sunday was a holiday.


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It will be noted that calisthenics, games, etc., were conducted simultaneously with military formations which affected only certain details. Class C patients had a routine somewhat different from the foregoing schedule, which was for class A and class B men. Their schedule of exercises was as follows: From 8 to 8.45 a. m., exercises with A and B men; 9 to 9.15 a. m., short relay races, passing ball to rear of column, etc.; 9.30 to 9.40 a. m., falling exercises for the arms; 10 to 10.30, jumping contest with A and B men; 10.30 recall; 2 to 2.20, indoor base ball, or relay race; 2.45 to 3, passing the ball; 3.30, recall. Gassed cases received a special set of exercises.

Complementary to the schedule of exercise and drills was the system of employments. There was grave and urgent need that construction of the center be pushed as rapidly as possible, and for this purpose convalescents were detailed to the constructing engineer for service wherever needed. They proved indispensable, for the camp was a reservoir of highly skilled workmen, mechanics, clerks, chauffeurs, etc., as well as of unskilled labor. A labor bureau was maintained in the sergeant major's office. As occasion required, he called on company sergeants for lists of men for designated duties, listed them and assigned them for temporary duty, rations, and quarters to the unit making the request. After a variable period, determined by circumstances, these men were recalled and others detailed. In the same manner, carpentering, plumbing, and ditching details were kept up in the camp at all times.

The only patients receiving continued medical attention who were treated in the camp were the uncomplicated cases of venereal disease. Originally all such cases had been cared for in Base Hospital No. 56, but when this became overcrowded, the uncomplicated cases were transferred to the camp. The clinic there was found to function so satisfactory and disciplinary control was so effective that this clinic was continued until the camp closed.

As the reports were received daily from the medical examiners, lists of patients fit for evacuation were prepared and the men named therein were paraded for the inspection of the commanding officer. He inspected all equipment, assured himself that each man was fit for transfer, and ordered all who did not feel fit for duty to fall out. Such men were immediately reexamined by the disability board. The remainder, under the officer in charge of the movement, were marched to the railroad station with the band and field music. At the station, the command was divided into platoons of 40 men, with a noncommissioned officer in charge of each, and entrained. One noncommissioned and six men from each car loaded its rations. The travel order was checked by the sergeant major with the officer detailed to accompany the detachment to its destination.

Until October 14, 1918, the organization of two battalions of 1,000 men each was adequate, but thereafter the camp grew constantly until by December 9 it contained 6,004 men. This eventuated from the fact that evacuations from the center were stopped by higher authority and orders were received from the same source that men fit for duty be not carried as patients. To simplify administration and to reduce congestion, certain hospitals transferred men fit for duty to others and these operated under the jurisdiction of the convalescent camp. The largest incoming groups to the camp were on Novem-


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ber 19, when 1,763 men were received. The largest outgoing group was 1,918 men on November 17.

Theatrical troups, glee clubs, and orchestras were organized in the camp. Motion pictures of the center were taken and exhibited. A band of 35 pieces and a fife and drum corps of 15 pieces organized in the camp participated in military formations, assisted at theatrical performances, gave band concerts, etc. For a few weeks the band of the 155th Infantry was attached to the camp.

Provision was made from the outset for diversion of the men when the day's schedule was completed. In addition to the many entertainments procured from outside sources for the camp, a number were provided from local resources. The convalescent camp was closed January 31, 1919.

CLOSURE

As patients in the center diminished after January 1, when the ban on their transfer was lifted, hospitals were cleared and closed. Evacuation Hospital No. 19 was transferred to the army of occupation on the Rhine, and most of the personnel of Base Hospital No. 97 was retained to form Camp Hospital No. 108. With these exceptions all units were returned to the United States upon closure. On March 1 the center became the agricultural department of the American Expeditionary Forces University, whose headquarters were established at Beaune. On May 28, when the university ceased its activities at Allerey, this place was closed and turned over to the French.

COMMANDING OFFICER

Col. Joseph H. Ford, M. C.

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