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Chapter XXXIII

Contents

CHAPTER XXIII

OTHER HOSPITAL CENTERS

HOSPITAL CENTER, BAZOILLESa

The hospital center at Bazoilles-sur-Meuse was located about 4 miles southwest of Neufchateau (Vosges) and was built around the small village of Bazoilles-sur-Meuse. The center was located on both sides of the River Meuse.

The site was well suited for a hospital. The moderate slope of the ground afforded excellent natural drainage and the Est Railroad ran through the village.

A group of six hospital sections, each accommodating 1,000 patients, was authorized, each section to have sufficient ground space for a tent expansion accommodating 1,000 beds. The capacity of the entire group was to be about 13,000 beds. This included one hospital unit (Base Hospital No. 18), which occupied buildings that had been erected around a château in Bazoilles and operated individually before the center was organized. Another unit, Base Hospital No. 66, at Neufchateau, about 4 miles from Bazoilles, was added later to the center. The Engineer Corps began construction toward the last of October, 1917, but progress was very slow. Macadamized roads were built, and the French railway authorities put in siding to accommodate hospital and freight trains. An unloading quay was provided for patients.

The commanding officer of the center arrived June 30, at which time the construction was far from complete. Sections 1, 5, and 6 were most advanced, but in them windows and plumbing fixtures were wanting. A warehouse was nearing completion and work on a steam laundry was just beginning, but this plant did not begin operating until October 10, 1918.

The project was reported completed, with the exception of minor changes, on November 1, 1918. Its cost was approximately $2,027,266.

ADMINISTRATION

 On July 2, 1918, when the center was officially organized, three base hospitals were present. The chief surgeon, A. E. F., furnished the following outline of the organization of the center, for which personnel would be furnished.

aThe statements of fact appearing herein are based on the "History of the Bazoilles hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical
Division, S. G. O.-Ed.


538

FIG. 101.-View of Bazoilles hospital center


539

AMERICAN EXPEDITIONARY FORCES,
  OFFICE OF THE CHIEF SURGEON.

Memorandum to commanding officer, Bazoilles:
 
 Table of organizations-central administration

 

Officers

Enlisted men

Number of base hospital units, 7.

 

 

Commanding officer and assistants (colonel or lieutenant colonel)

1

3

Adjutant and assistants (major or captain)

1

5

Medical supply officer (captain)

1

2

Laboratory officer (major or captain)

1

---

Evacuation officer (major or captain)

1

1

Sanitary squads (captain or lieutenant)

2

52

Evacuation ambulance company (captain or lieutenant)

2

90

Subsistence, procurement, and issue; cold storage; clothing, equipment, procurement and issue; fuel, procurement and issue; salvage (captain or lieutenant, Quartermaster Corps)

2

a26

Detachment and records; finance, paying, accounting, railway transportation (captain or lieutenant, Quartermaster Corps)

2

a28

Technical labor troops to care for buildings, electric light plants, water system, drains (captain or lieutenant, Quartermaster Corps)

2

a23

Labor troops performing purely common labor (30 to each base hospital unit)

---

a210

Motor truck company

2

84

Assistant provost marshal (lieutenant)

1

10

Railway transportation officer (lieutenant)

2

6

Fire marshal (lieutenant)

1

2

Total

21

542

aQuartermaster.

* * * * * * *

QUARTERS ALLOWANCE

 

Administration, barracks

11/3

Officers' mess, barracks

1

Officers' quarters, barracks

11/3

Men's mess

2

Men's quarters

Total

71/6

Some of this staff personnel was sent from other stations, and some was taken from base hospital units of the center. The ambulance and truck companies did not arrive until after the armistice. No attempt was made at first to interrupt the customary administration routine of the hospitals, but as the center headquarters organization improved it was required that practically all reports, with the exception of the monthly sick and wounded report, be sent through the center commander.

The function of the headquarters was in general the same as in any other large military command. The center commander was able to keep in close touch with the activities within his command through various reports and returns, and by inspections, either personal or by members of his staff. Conferences with the unit commanders and among personnel employed on special work were of much value.

Various orders, bulletins, and circulars received from higher headquarters were distributed and the most important of these abstracted, or had attention called to them in special memoranda. The usual difficulties in getting officers among the personnel to read and study instructions were met with in a degree corresponding to the experience of the personnel, and an effort was made to overcome this by means of informatory memoranda and by requiring attendance upon formal instruction, devoting to it a certain number of hours each week for both officers and enlisted men.


540

The following data summarize the activities of the organizations forming the center:

Designation

Arrived

Began operation

Ceased operation

Departed

Base Hospital No. 18

July 26, 1917

July 31, 1917

Jan. 9, 1919

Jan. 18, 1919

Base Hospital No. 42

July 15, 1918

Aug. 6, 1918

Jan. 7, 1919

Jan. 29, 1919

Base Hospital No. 46

July 2, 1918

July 23, 1918

Jan. 1, 1919

Mar. 19, 1919

Base Hospital No. 60

Sept. 15, 1918

Oct. 4, 1918

Mar. 31, 1919

 

Base Hospital No. 66a

Jan. 13, 1918

Jan. 15, 1919

(b)

 

Base Hospital No. 79

Oct. 16, 1918

Nov. 5, 1918

(c)

 

Base Hospital No. 81

Sept. 25, 1918

Oct. 4, 1918

Mar. 31, 1919

 

Base Hospital No. 116

Apr. 9, 1918

June 2, 1918

Jan. 31, 1919

Mar. 19, 1919

Evacuation Hospital No. 21

Jan. 4, 1919

Jan. 7, 1919

Apr. 22, 1919

 

Provisional Base Hospital No. 1

.do.
(org.)

Jan. 9, 1919

Apr. 27, 1919

 

Convalescent Camp No. 2

June 10, 1918

July 13, 1918

Jan. 25, 1919

Mar. 7, 1919

Sanitary squad No. 29

July 13, 1918

---

---

Mar. 12, 1919

Sanitary squad No. 30

.do.

---

---

Do.

School of Roentgenology

Sept. 1, 1918

---

---

Dec. 4, 1918

Evacuation Ambulance Company No. 10

Dec. 29, 1918

---

---

 

Hospital unit A

Feb. 1, 1918

(d)

---

Jan. 18, 1919

aThis unit, located at Neufchateau, was assigned to this center and first included in its bed report on Aug. 15, 1918.
bCeased to be part of center Nov. 10, 1918.
cStill operating Apr. 30, 1919.
dAttached to Base Hospital No. 18 (enlisted personnel only) on Feb. 4, 1918.

ENGINEER OPERATIONS

 

Date of arrival

Companies B and C, 101st Engineers

Oct. 23, 1917

Companies C and F, 6th Engineers

Feb. 5, 1918

Company C, 502d Engineers Service Battalion

Feb. 8, 1918

Companies A and D, 508th Engineers Service Battalion

Feb. 11, 1918

At various intervals during construction, detachments of 23d, 26th, 28th, 33d, and 37th Engineers, 162d Labor Company (Portuguese), and Chinese Labor Company No. 26 were attached to 508th Engineers Service Battalion.

All engineer organizations withdrew from the center November 1, 1918.

MILITARY POLICE

Company L, 2d Pioneer Infantry, arrived July 27, 1918. On December 13, 1918, the detachment of 210th Company Military Police Corps was organized by transfers from Company L, 2d Pioneer Infantry.

LAUNDRY COMPANIES

Designation

Arrived

Departed

313th Mobile Laundry Company

Oct. 8, 1918

Feb. 27, 1919

505th Laundry Company

May 12, 1918

 

517th Laundry Company

Sept. 13, 1918

 

519th Laundry Company

Mar. 1, 1919

 

Provisional Laundry Company 1, Company B

.do.

 

162d Administrative Labor Battalion

Mar., 1918

Oct. 7, 1918

185th Administrative Labor Battalion (organized Sept. 13, 1918)

 

 

CASUAL ORGANIZATIONS

Designation

Arrived

Departed

Evacuation Hospital No. 2

(a)

(a)

Evacuation Hospital No. 6

(a)

July 18, 1918

Evacuation Hospital No. 16

Sept. 23, 1918

Oct. 12, 1918

Evacuation Hospital No. 20

.do.

Oct. 2, 1918

Convalescent Camp No. 1

(a)

Aug. 25, 1918

Mobile Operating Unit No. 1

July 18, 1918

Sept. 4, 1918

Evacuation Ambulance Company No. 64

Dec. 5, 1918

Dec. 15, 1918

115th Sanitary Train

Dec. 14, 1918

Dec. 29, 1918

Motor Supply Train No. 46

Oct. 23, 1918

Nov. 4, 1918

156th Infantry Band

Nov. 19, 1918

Dec. 5, 1918

aBefore organization of cente


541

In July and August, 1918, the quantity of water was insufficient. At one time it seemed as though the operation of the center would be seriously hampered on this account. Several wells were drilled and dug near the river and pumped to a collecting reservoir at the main pumping plant, where the water was chlorinated and pumped into the system through 3-inch turbine pumps. Water was drawn also from an old French system in Bazoilles, a booster pump being located at the spring about 3½ miles south of the center.

The sewer system carried only the drainage from sinks and bathhouses, as the pail and soakage pit system was used for all latrines. Two Horsfall destructors were installed in each hospital unit. One sink was installed in each ward and in other buildings as required. A part of the kitchen waste was burned; some was disposed of to civilians. When sold, usually little or nothing could be received for it, and sometimes it was necessary to pay for its removal.

FIG. 102.-Covered walk connecting the wards at Base Hospital No. 18, Bazoilles hospital center

Electrical power for lighting and X-ray machines was supplied by 19 generating units; eighteen 17-kilowatt and one 14-kilowatt machines being used. Each of the seven hospital units had a separate power plant and could be supplied independently with electric power from its own machines. Some trouble was experienced by the hospitals in adapting the large 7½-kilowatt X-ray machines to the 110-volt direct current furnished, as their rotary converter had been built for 220-volt direct current.

Disinfection of clothing and bedding was accomplished by means of large Thresh or American steam sterilizers. The Thresh apparatus was


542

stationary and required a good deal of labor and material. Six of these were received, one for each hospital section. Four were installed and work on others was stopped when hostilities ceased. The American sterilizers were portable and four hospitals used this type during the period of their activity. This model was considered the better of the two.

The supply service of this department was uniformly satisfactory, for rarely was there any shortage or inability to furnish articles. No bakery was operated, and bread was obtained from the Quartermaster Corps at Neufchateau. A small cold-storage plant was built, but was not operated, as weather was never sufficiently warm to require the use of a cold room. A small amount of ice was made, but the hospitals showed no inclination to make use of it.

From six to nine men were constantly employed as clerks, checkers, and packers. In addition, 10 men on an average were used in handling property; unloading it from cars and delivering it to hospital units. The amount of property received during the 10 months beginning July 1, 1918, aggregated 310 carloads. Supplies were received from supply depots at Is-sur-Tille, Gievres, Cosne, and the base ports. The American Red Cross also supplied 10 carloads of prepared dressings and mess and kitchen equipment. All supplies were formally transferred to supply officers of separate units on invoices. It was believed, however, that the issue of supplies on memorandum receipt would have been better, thus leaving the center supply officer accountable for all property in the center. This arrangement would have put one experienced man in charge rather than several who usually were very inexperienced.

On July 1, 1918, the available transportation was such as had been furnished to hospital units then operating, namely, 9 ambulances and 9 trucks, and other motor cars. The greater part was old and in poor condition, but no material additions were made until after signing of the armistice. Trucks were used for transportation of patients throughout the whole period prior to November 11, 1918.

In the latter months additional transportation was received, and on April 1, 1919, there were on hand: 11 motor cycles, 8 touring cars, 5 Ford ambulances, 15 G. M. C. ambulances, 6 Ford light trucks, 12 one and one-half and two ton trucks, and 30 three-ton trucks.

The pooling of all transportation was highly successful, for by so doing, the work of seven or eight hospital units was done with the normal allowance of two or three.

As all of the buildings of the center were of light wood construction and the intervals between hospitals were taken up with tentage, the fire hazard was very great. A center fire marshal was appointed, and working under his supervision each hospital unit had its local fire marshal in charge of a fire platoon. The loss from fire was insignificant. During the winter some hundreds of stoves were installed, usually in a very crude way. Many times fires started, but were extinguished almost at once.

A school was established and began operating January 4, 1919. Qualified enlisted men were detailed as instructors. Organization commanders were


543

required to have attend such men as were most in need of instruction, including those deficient in primary branches. By April the number of students reached a total of 167, and classes were held in reading, spelling, and writing, French, French history, United States history, civics, economics, mechanical drawing, and agriculture.

LABORATORY

At first the center laboratory was located in Base Hospital No. 18. Later a building was provided, and on September 2, 1918, the equipment was transferred to the new location. As the several units arrived in the hospital center the laboratory personnel of each unit came under the control of the laboratory officer of the center, who was empowered to detail them to the central laboratory as needed. The work of the laboratory was organized as noted below, but elasticity in the scheme was allowed in order that the personnel could assist in any department whose work might suddenly increase. There were eight general divisions, with one of the laboratory staff in charge of each, as follows:

1. General bacteriology-blood cultures, throat cultures, spinal fluid examination, and general bacteriologist work.
2. Typhoid-dysentery examination and water analysis.
3. Wound bacteriology.
4. Pneumococcus typing.
5. Serology.
6. Pathology. This department handled the surgical specimens submitted for diagnosis and performed all the post-mortem examinations into the hospital center.
7. Preparation room. This department made all stains and solutions used by the sterilization of discarded cultures and glass ware.
8. Office and supplies.

No chemical work was done in the central laboratory. All clinical pathology was done in the subsidiary laboratories and the center laboratories assisted in an advisory capacity. No operative procedures were done by the staff of the center laboratory.

OPTICAL AND OPHTHALMOLOGICAL DEPARTMENT

This service for the center was maintained at Base Hospital No. 18 until November, 1918, when it was transferred to Base Hospital No. 46. In May, 1918, an optical unit was added to this department. The personnel usually consisted of 5 officers and 6 enlisted men. This department served not only the center, but also a large part of the entire advance area, including other base hospitals in the vicinity and the army of occupation in Germany.

SCHOOL OF RÖENTGENOLOGY

A school of Roentgenology was established in August, 1918, its purpose being the provision, at a convenient point near the
American front-line sector, of a school for the instruction of officers and enlisted men in various matters pertaining to X-ray
work under war conditions and to maintain a depot from which skilled operators could be taken for service when needed.
From September 1 to November 11, 1918, the school was in constant operation. Both officers and enlisted men were
received and after a period of training sent to the front.


544

RECEIVING AND EVACUATION

The receiving and evacuating system was organized in July, 1918. The evacuating officer maintained control over all admissions, distribution, transfer, classification, and evacuation of all patients. During the earlier months of our military operations, unremitting efforts were made to evacuate to hospitals farther toward the rear; later, when the fighting progressed more nearly in the immediate front of this hospital center, all the hospitals were in reality functioning as evacuation hospitals. Frequently patients were received, operated upon, and transferred to the rear within 48 hours. During the Meuse-Argonne operation approximately 7,000 sick and wounded were received and about 12,000 evacuated. At this time, many of the wounded were received in bad shape. Conditions in the advanced area were such that many battle casualties did not reach the center for four or five days after receiving their wounds. A fair proportion had not been operated upon, and severe infections were present. The following charts show the admissions and dispositions in the center.

Admissions and dispositions, by hospitals, August 1, 1917, to April 30, 1919; hospital center, Bazoilles-sur-Meuse, France, including hospitals operating independently prior to July 1, 1918

Hospitals

Base Hospital No. 18

Base Hospital No. 116

Base Hospital No. 46

Base Hospital No. 42

Base Hospital No. 66

Base Hospital No. 60

Base Hospital No. 81

Provisional Base Hospital No. 1

Evacuation Hospital No. 21

Base Hospital No. 79

Total

Period, Aug. 1, 1917, to June 30, 1918:

 

 

 

 

 

 

 

 

 

 

 

Admissions

7,066

855

---

---

---

---

---

---

---

---

7,921

Disposed of

6,411

262

---

---

---

---

---

---

 

---

6,673

Remaining June 30, 1918

655

593

---

---

---

---

---

---

---

---

1,248

Period, July 1, 1918 to Apr. 30, 1919:

 

 

 

 

 

 

 

 

 

 

 

Remaining July 1, 1918

665

593

---

---

(a)

---

---

---

---

---

1,248

Remaining at Base Hospital No. 66, Aug. 11, 1918

---

---

---

---

b562

---

---

---

---

---

562

Admitted

7,106

11,526

8,323

7,111

6,913

5,988

5,991

2,413

3,391

4,993

63,755

Total

7,761

12,119

8,323

7,111

7,475

5,988

5,991

2,413

3,391

4,993

65,565

Disposed of

7,424

11,328

7,915

6,443

6,624

5,723

5,781

2,261

3,240

4,781

61,520

Transferred

c337

d791

e408

f668

g851

h265

i210

j152

k151

---

3,833

Remaining Apr. 30, 1919

0

0

0

0

0

0

0

0

0

l212

212

aBase Hospital No. 66 was operating independently of the center until Aug. 11, 1918.
bNumber of patients in Base Hospital No. 66 when the organization came under the command of the center.
cTransferred to Provisional Base Hospital No. 1 when Base Hospital No. 18 discontinued operations on Jan. 5, 1919.
dTransferred to Base Hospital No. 79 when Base Hospital No. 116 discontinued operations on Jan. 31, 1919.
eTransferred to various hospitals of center when Base Hospital No. 46 discontinued operations on Jan. 19, 1919.
fTransferred to Evacuation Hospital No. 21 when Base Hospital No. 42 discontinued operations on Jan. 7, 1919.
gNumber of patients in Base Hospital No. 66 when the organization was taken from the command of the center.
hTransferred to Evacuation Hospital No. 21 (165), Provisional Base Hospital No. 1 (100), when Base Hospital No. 60 discontinued operations on Mar. 31, 1919.
iTransferred to Base Hospital No. 79 (145), Provisional Base Hospital No. 1 (65), when Base Hospital No. 81 discontinued operations on Mar. 31, 1919.
jTransferred to Base Hospital No. 79 when Provisional Base Hospital No. 1 discontinued operations on Apr. 27, 1919.
kTransferred to Base Hospital No. 79 when Evacuation Hospital No. 21 discontinued operations on Apr. 22, 1919.
lRemaining in Base Hospital No. 79, the only unit operating Apr. 30, 1919.

 


545

Summary of sick and injured admitted to hospital center, Bazoilles-sur-Meuse, France, July 1, 1918, to April 30, 1919

Cases of sickness

Total

Pneumonia

Dysentery

Malaria

Venereal

Paratyphoid

Typhoid

Measles

Cerebrospinal meningitis

Scarlet
fever

All other
diseases

Hospital

Quarters

Total

Disease

Injury

Remaininga

a1,248

0

1,248

447

801

5

0

0

24

20

0

0

0

2

416

Admitted

62,521

0

62,521

36,718

25,803

1,450

85

18

1,481

45

280

111

80

72

33,096

Total treated

63,769

0

63,769

37,165

26,604

1,455

85

18

1,505

45

280

111

80

74

33,512

Died

850

0

850

564

286

414

2

0

1

2

28

1

28

2

86

Transferred to organization

15,908

0

15,908

11,254

4,654

324

42

5

576

10

43

33

6

24

10,191

Otherwise disposed ofb

46,799

0

46,799

25,135

21,664

705

41

12

828

33

209

67

43

48

23,149

Remaining sickc

212

0

212

212

0

12

0

1

100

0

0

10

3

0

86

aThe remaining 1,248 cases comprises total number of patients in Base Hospitals Nos. 18 and 116 on July 1, 1918, the date the hospital center was established
bSent to other hospitals, replacement depots, regulating stations, etc.
cIn Base Hospital No. 79, the only hospital operating April 30, 1919

Cases completed by hospitals operating independently prior to July 1, 1918: Base Hospital No. 18, 6,411; Base Hospital No. 116, 262; total, 6,673.
Cases evacuated by hospitals ceasing to operate to other hospitals in the center are included in admissions and discharges. Base Hospital Nos. 46, 60, 79, and 81 were so evacuated.
Cases taken over from outgoing units by arriving units are not included in admissions and discharges. Base Hospitals Nos. 18, 42, and 116 were relieved by incoming organizations.
Thirty-two deaths occurring in prisoners of war and allied patients at Base Hospital No. 66, shown in total of 850 above, not included in table for admission and disposition.

AMERICAN RED CROSS

This was the only welfare organization authorized to operate in hospitals after August 31, 1918. Prior to January 1, 1919, the Y. M. C. A. conducted a canteen, religious services, and entertainments.

The buildings erected by the American Red Cross consisted of two very large and two smaller huts, operated by them for officers and nurses.

The representatives of the American Red Cross worked constantly in cooperation with the center and unit commanders, their chief functions consisting in searching for missing men and distributing supplies (Red Cross), writing letters for the patients, sending or procuring information from their homes, or any similar service which would relieve mental or physical trouble. Also they furnished athletic equipment, musical instruments, etc. In the huts were presented opportunity for refreshments, recreation, education, and entertainment. They contained billiard rooms, auditoriums, writing rooms, and rest rooms. There were on the average 8 entertainments and 32 moving-picture shows each week.

CONVALESCENT CAMP

The chief surgeon in a letter of June 21, 1918, ordered that a convalescent camp be operated in connection with the center. The proportion of beds was fixed at one convalescent bed to five of the base hospital capacity of the center, all crisis expansion accommodations being excluded. For this purpose, the number of active beds in buildings was assumed to be 7,000, thus fixing the bed capacity of the camp at 1,400. The site for the camp was selected at Liffol-le-Grand, a village 4 miles west of Bazoilles. This site had been used at one time as a camp hospital and contained a number of small structures and a 14-room château. The personnel of Convalescent Camp No. 2, consisting of 10 officers and 90 enlisted men, arrived on June 10, 1918.

The preparation of buildings and grounds with provision of new barrack buildings, water supply, and roads was begun at once. A satisfactory water supply was not obtained until November, 1918.


546

The medical organization of the camp was quite simple. On admission after the bath, the patient was weighed, stripped. He was outfitted with essential clothing and assigned to a bed in the barracks. At once a physical examination was made, and he joined in the class work the following day. This class work consisted of physical exercise in the morning, followed by a short period of squad drill. After dinner and after an hour's complete relaxation in bed, he was sent on a mile march. On returning, he took part in various games according to his ability. After supper, varying amusements, held in the Y. M. C. A. hut, were available. At the discretion of the medical officer, he was promoted to Company 2, with its increased physical demands, and then to Company 3, where the work consisted of 40-minute setting-up exercises, an hour's squad drill, and a 5-mile march in the afternoon. By the time the patient had successfully passed the physical examination in this company and could successfully perform the strenuous exercises, he was discharged to duty. Men unable to meet these qualifications were reclassified. In the first 5,000 cases, there were less than 10 classified D. But there were probably about 7 per cent who proved unable to meet the tests. It is worthy of comment that these tests were of much greater value as a basis for classification than those heretofore employed; that is, the stethoscope, physician's opinion of patient's statement. Great emphasis was laid on the necessity for military discipline; and although on a patient's status, all convalescents were treated as soldiers training for the front line. Great difficulty was experienced in the lack of standardization of the type of patients received. Thus, one convoy would comprise a case of pneumonia out of bed one day, a mumps patient convalescent three weeks, a patient with flat-foot, gas cases of varying degrees of severity, and superficial gunshot wounds. An occasional valve lesion was discovered, a few cases of pulmonary tuberculosis were found, and not infrequently patients were sent directly from the admitting office to the camp hospital suffering from acute infections, such as bronchopneumonia, influenza, and tonsillitis. Another interesting feature is the fact that promotions were made daily instead of at weekly intervals. This increased markedly the capacity of the camp, and cut down the stay in camp of those physically fit on admission to the remarkably short period of 72 hours. It was this factor that allowed 2,431 admissions and 998 discharges in October, when the camp was in full working order.

A follow-up system was instituted, and the final proof of the success of the camp as measured by the ability of members of the outgoing drafts to perform front-line duty was supplied by the medical officers of units to which the patients were returned.

The constant support and assistance afforded by the American Red Cross carried the camp far beyond the standards obtainable under purely military control. Games and other equipment for the amusement of the patients were all supplied through this organization. A regular representative of that society did not arrive for some weeks after the camp was opened because of the lack of such officers, but thereafter it engaged in numerous activities for the promotion of morale.

The convalescent camp ceased to function on January 25, 1919.


547

DISCONTINUANCE

The Bazoilles center ceased operation May 1, 1919, evacuating on that date all patients remaining in Base Hospital No. 79 to Angers and Nantes. The shipment of all medical property remaining in the center began at once. A large quantity of beds and bedding already had been shipped to Treves. Other property was now shipped to the hospital center at Mars-sur-Allier for storage.

This center was the first to start as an organized center, and after 10 months of very active service was one of the last to close.

COMMANDING OFFICER

Col. Elmer A. Dean, M. C.

HOSPITAL CENTER, BEAU DESERTb

In the late fall of 1917, Beau Desert, in the vicinity of Bordeaux, was selected as the site for a hospital center, and construction was begun in December of that year. The site, about 5 miles west from Bordeaux and near the small village of Pichey, was a nearly level tract of land of approximately 550 acres.

Originally it was planned that there would be 10 base hospital units at this center, each of 1,000 beds, with an emergency expansion to 1,500, but during the summer of 1918 the construction of 7 additional units was authorized.

A railroad track built by the American engineers, which connected with the P. & O. Railway, ran through the center. The hospitals were located on either side of the track, thus affording rapid detraining and entraining of patients. The storehouses and laundry were also situated on this line, so that freight could easily be removed from cars to the loading platform.

Construction was effected by the United States Army Engineers. A large force of men was employed for this work, and during the summer of 1918 more than 4,000 American soldiers, prisoners of war, Chinese, and other laborers were at work. On June 22, 1918, when the first base hospital group arrived, only one unit had been completed. Nine hospital units were eventually completed, in addition to the convalescent camp, steam laundry, and warehouses, making a total of nearly 600 buildings. Twelve miles of gravel walk and 8 miles of board walk were constructed and 4 miles of roads and over 11 miles of railroad track were built.

When the Medical Department took over the center there were available a few old wells, mostly in a dirty condition. Only one of these was in use, furnishing about 50,000 gallons of water daily. This output was barely enough for drinking and a reasonable amount of washing, so that on many occasions the entire center was practically without water for 24 hours at a time and with none whatever for fire purposes. An artesian well, 1,500 feet deep, was sunk, but could not be used for some time through lack of a powerful enough pump. Later this well, connected with a 100,000-gallon cement storage tank, afforded ample supply.

bThe statements of fact appearing herein are based on the "History of The Beau Desert hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


548

FIG. 103.-Airplane view, Beau Desert hospital center


549

Due to the very slight fall in the ground, laying sewers which would promptly carry off the waste water and take care of the drainage proved difficult; however, all the hospital units had a sewer system which emptied into a clarification tank, which in turn emptied into a small stream running through Pichey. The sewer system received only wash and waste water.

Human excreta were disposed of by the pail system. These vessels were emptied by contract with French laborers and buried 18 inches below the surface of the ground. At first an attempt was made to burn feces in Horsfall incinerators, but there were so few of these and the method was so unsatisfactory and expensive that the burial system was resorted to.

FIG. 104.-Beau Desert hospital center, showing railway facilities

Electric power was furnished by the French from Bordeaux. At first the system was very unsatisfactory, as the lights were frequently off and short circuits due to imperfect wiring were the rule rather than the exception. Eventually the powerhouse at Bordeaux was taken over by the Government, and after January 1, 1919, no trouble was experienced.

Early in August, 1918, a motor-transport officer was assigned to the center to organize the service. A motor-transport pool was established and the 312th Motor Truck Company was assigned to Beau Desert for duty. This service had grown from 1 ambulance and 4 trucks to 131 motor vehicles. All motor vehicles were pooled, subject to call from any organization at any time under certain restrictions imposed by orders from center headquarters.
 ORGANIZATION AND ADMINISTRATION

The center was officially organized on July 6, 1918, the staff then consisted of the commanding officer and adjutant, assisted by two clerks. Later, when a large force was available, the center administration was organized as follows:


550

Diagram of central organization at Beau Desert


551

Though only two base hospital units arrived prior to the armistice, the following hospital units eventually were located at this center: Base Hospitals Nos. 22, 114, 104, 106, 111, 121, Evacuation Hospital No. 20, and the convalescent camp.

The sanitary inspector had general supervision of the sanitation of the entire center and was authorized to order the correction of such deficiencies as were in his judgment necessary.

A center chaplain was assigned in July, 1918. It was his duty to supervise the work of all chaplains in the center; also, he was directly responsible for the record of all deaths in the center, for the care of the cemetery, and all funerals.

The office of center chief nurse was not created until March, 1919, when changes in the nursing personnel became very numerous. The incumbent met all the chief nurses of base hospitals periodically, observed the work of nurses in all the hospitals, and recommended transfers in the interests of the service.

Shortly after the establishment of the center an officer of the Quartermaster Corps was appointed center fire marshal. Fire companies were organized in the different units and frequent drills were held. Great difficulty was experienced in obtaining fire-fighting apparatus and the extreme shortage of water in the summer of 1918 made fire hazard very serious. In its whole history the center had but one serious fire. This occurred on the night of February 6, 1919, a ward in one of the units being destroyed.

The center laboratory officer was in charge of all the laboratory activities. The staff consisted of 5 officers and 8 enlisted men. The laboratory made all important examinations, including Wassermann tests and routine examinations of water.

The medical supply depot occupied a building, 150 by 60 feet, with an adequate unloading platform, situated on a spur track. Supplies were received from the supply depots at Cosne, Brest, and Bordeaux. Large quantities of supplies were also purchased in open market.

The center quartermaster office was organized July 22, 1918, when it was divided into the following departments, each under charge of an officer or noncommissioned officer. Subsistence, finance, clothing and miscellaneous supplies, fuel procurement and issue, laundry, salvage and disposal of wastes, corral and stable, Quartermaster Corps detachment and labor troops. The bakery operated in the center for a short time but was then transferred to Camp de Souge, about 7 miles distant. Hospital laundry was at first done by the quartermaster at Bordeaux and by a French laundry, but in September, 1918, a large laundry was completed in the center. This center plant laundered all hospital garments of base section No. 2, and in addition did the bulk of the salvage work for the section. It operated 19 hours a day, with a personnel of 20 officers, 26 enlisted men, and 165 female civilian employees. During March, 1919, the plant laundered approximately 1,300,000 pieces.

The duties of the receiving and evacuating officer were specifically laid down in orders issued by the center. He was charged with meeting all hospital trains, the distribution of patients to the various hospitals of the center, according to their classification or instructions from the commanding officer, as well as the evacuation of all class A patients to the convalescent camps or to their organizations. The evacuation officer kept in touch with the railway 


552

transport officer in Bordeaux as to the time of arrival of hospital trains, and boarded all the trains at Bordeaux. During the trip from Bordeaux to Beau Desert, which occupied from two to three hours, the receiving officer classified all patients. When each patient was classified, he was tagged with a large slip, showing the number of the hospital to which he was assigned. The majority of patients received in the center came on hospital trains; at times two or three trains arrived almost simultaneously. Ambulatory patients were always detrained first. Detraining for a full train occupied, on the average, one hour. These hospital trains were always furnished, when required, all the supplies they needed.

The evacuating officer was also responsible for the efficiency of receiving officers in the various hospitals and of the litter squads effecting reception and evacuation. He was the only officer authorized to give any orders to the train crew relative to switching points, stop, splitting of train, etc. He also kept a chart showing the rapidity of evacuation of each hospital. If it was found that a hospital was slowing up on its evacuation the reason was sought for by him and usually found to be due to failure of the ward surgeons promptly to report cases suitable for evacuation. Experience proved that the evacuation of class A patients from the hospitals averaged about 2 per cent of strength daily. Before the establishment of a convalescent camp, class A patients were evacuated direct from the hospitals to replacement depots. Each hospital was furnished each month with a chart showing the standing of the hospitals with regard to evacuation, thus creating a spirit of competition among them.

Shortly after the armistice began, the Beau Desert center was changed into an evacuation center. Base Hospitals Nos. 114 and 22, because of their experience, were designated as evacuating hospitals and the remaining four as receiving hospitals. Later only Base Hospital No. 22 performed this evacuation duty. In this way all the responsibility of evacuation was placed on one unit, thereby eliminating all differences in method and standards which would have existed if all the hospitals had been charged with evacuation. All patients for evacuation were divided, according to the classification required, into companies of 150 or less, all papers were completed, and five copies of passenger lists made for each company. All patients were examined physically, issued new uniforms, and paid in full. They were inspected when leaving the center and
again while boarding the transport at Bordeaux. The following tables show the number of patients received and their disposition.

Total number of admissions and disposition of patients to April 1, 1919

Admitted by convoy

45,398

Admitted from command

1,840

Total

 

47,238

Transferred to United States

22,880

Returned to duty

12,699

Died

304

Total

 

35,883

Total number of hospital trains received, 84.

From April 1, to the date of closing of the hospital center, on June 25, 1919, 3,681 patients were received, making the total
of cases handled over 51,000.


553

CONVALESCENT CAMP

This camp was organized late in July, 1918, and consisted of 25 wooden buildings and about 200 double hospital-ward tents, giving a capacity of about 4,500 beds, with a possible expansion to 8,000. The largest number ever accommodated was 3,800. No personnel was at first provided, and the hospital furnished the personnel required. Later, personnel was secured from officers and men that were unfitted for combatant service. The patients were divided into companies and battalions and given regular graded drills, exercise, and sports.

WELFARE WORK, SCHOOLS, ENTERTAINMENT, AND ATHLETICS

The welfare societies comprised the American Red Cross, Young Men's Christian Association, Knights of Columbus, and the Jewish Welfare Society. The American Red Cross, in addition to providing entertainment, furnished large quantities of hospital supplies. The Young Men's Christian Association confined its activities to the convalescent camp, providing there athletic entertainments and educational and musical programs. The aid extended by the Knights of Columbus was occasional and was rendered from Bordeaux. The Jewish Welfare Society conducted a clubhouse.

Post School was established on February 1, 1919, where at first only elementary courses for illiterates were given. Later, courses were given in higher mathematics, mechanical engineering, fine and applied arts, government, law, French, Spanish, shorthand, and typewriting.

COMMANDING OFFICER

Col. Harold W. Jones, M. C.

HOSPITAL CENTER, BEAUNEc

This center was located close to the city of Beaune, Department Cote d'Or. Its construction was authorized on December 12, 1917, but did not commence until March, 1918.

A double-track spur from the Paris, Lyon & Mediterranean Railway ran east and west the full length of the center, and the hospital units were placed on both sides of this track. Ten units were planned, but only seven were constructed when hostilities ceased. Hospital construction, varying with the material available, was of brick, tile, concrete blocks, and poured concrete, with fabric cord roofs. One complete unit was of wooden Adrian barracks, but it was occupied throughout by construction personnel and never used as a hospital. Warehouses, laundry, and bakery were of galvanized iron. All units were built on the type A plan, each successive one being somewhat modified in detail, chiefly in the direction of economy of labor and material, with a view of speeding up the work. Special construction included the center laboratory building,
located in unit 2, and a special neuropsychiatric building, which was used as an isolation ward for diphtheria and meningitis was located in unit 7.

cThe statements of fact appearing herein are based on the "History of the Beaune hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


554

Water at first was hauled from Beaune in large wine barrels; and later, about the time when first patients arrived, water from Beaune was piped into the center. Meanwhile the engineers were making efforts to develop an independent supply through driven wells, and were finally successful in locating an abundant artesian flow, from which about 500,000 gallons a day could be secured. Receiving tanks and pumps were installed and about the time the armistice began the water supply was fully provided for. The Beaune and artesian supplies were rather hard, but repeated laboratory tests showed them to be entirely potable at their source. However, the delivery pipes were badly contaminated, as tests showed the water to be dangerous for use as delivered through them, so that chlorination in Lyster bags was always practiced.

The bucket latrine system was used; solid matter was disposed of in Horsfall incinerators, and liquids were emptied through sewers into a septic tank.

One large steam sterilizer was used to disinfect all bedding and clothing. Electric power was brought into the center from Beaune. A permanent transformer was never installed, but only a temporary one of insufficient capacity was available, necessitating the use of a number of oil lamps and candles. An improvised Prest-O-Lite apparatus for emergency use was installed in each operating room. During November, 1918, an accident occurred by which the high-power transmission line became fouled with the lighting wires, resulting in the death by electrocution of 3 patients, 2 Hospital Corps men, and 1 civilian employee.

Laundry was handled at first by Mobile Laundry Unit No. 303, which arrived September 11, 1918; on September 19, the permanent laundry was put into operation by Mobile Laundry Unit No. 321.

The transportation consisted of 3 General Motors Co. ambulances, 3 trucks, 1 touring car, and 1 motor cycle. These were far insufficient, and trucks had to be used late into the night in order to handle the large amount of incoming supplies. Motor Transport Co. No. 477 arrived for duty on November 10, 1918, and took charge of all transportation.

The first base hospital unit arrived on July 31, 1918, and shortly afterwards the center was organized. The following units operated in this group: Base Hospitals Nos. 47, 61, 77, 80, 96; Evacuation Hospital No. 22, Sanitary Squad No. 22, and Hospital Train Unit No. 40; Evacuation Hospital No. 23 (September 19 to October 9, 1918), and Hospital Train Unit No. 45 (August 27 to October 31, 1918). None of the units brought their hospital equipment. The equipment was received from supply depots in various shipments and immediately installed, and as soon as a hospital was prepared to feed and house patients its beds were reported. Each hospital first received medical and minor surgical cases, the more severe ones going to the more completely equipped units. The matter of equipment and nurses chiefly governed the distribution of patients throughout. Special wards for officers, women, contagious and mental diseases were established, but the more detailed classification which was contemplated in the fully developed center was not put into effect.


555

Valuable assistance in the matter of medical supplies was given by the American Red Cross, especially in the way of blankets and prepared surgical dressings. A hut was furnished by this organization in each unit where concerts, dances, moving-picture shows, etc., were given.

CONVALESCENT CAMP

Convalescent camp was opened on October 7, 1918, and operated as such until January 31, 1919, handling approximately 5,000 patients. A disability board was appointed and evacuation began within a few days. The average length of stay of each patient in the camp was 11 days.

FIG. 105.-An operating room, Beaune hospital center

DISCONTINUANCE

The Beaune center was discontinued on March 29, 1919, and the site utilized for the American Expeditionary Forces University.

COMMANDING OFFICER

Col. Clarence J. Manley, M. C.

HOSPITAL CENTER, CLERMONT-FERRANDd

The hospital center, with headquarters at Clermont-Ferrand, was established on September 23, 1918, for the purpose of not only extending hospitalization of that district but also of unifying the hospitalization already established

dThe statements of fact appearing herein are based on the "History of the Clermont-Ferrand hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


556

there. This group included hospitals in the towns of Chatel-Guyon, Royat, Mont-Dore, la Bourboule, and Riom. These towns were composed almost entirely of summer hotels, the capacity of which varied from small villas of 15 to 20 rooms to large hotels of 250 to 300 rooms. Certain public and private buildings in the above places were taken over by the American Army, and plans were formulated for the establishment of six base hospitals with a capacity of 13,600 beds. Two base hospitals (Nos. 20 and 30) were functioning in Chatel-Guyon and Royat, respectively, when the center was organized.

Headquarters were established first at Royat, and on October 1 at Clermont-Ferrand. On October 17, a provisional base hospital was extemporized at Mont-Dore by drawing some personnel, and 100 convalescent patients from the two hospitals already operating. On November 6, 1918, Base Hospital No. 93 arrived and two days later Base Hospital No. 103. Base Hospital No. 103 never functioned as a hospital.

After the signing of the armistice further extension of the hospitalization in section was abandoned and buildings were gradually returned to the French. Discontinuance of the hospitalization in this region was completed about February 20, 1919.

The total number of patients cared for in this center was 17,042. This includes patients admitted prior to the organization of the group.

COMMANDING OFFICER

Col. John S. Lambie, M. C., September 23, 1918, to February 8, 1919.
Lieut. Col. John A. Murphy, M. C., February 9, 1919, to March 10, 1919.

HOSPITAL CENTER, COMMERCYe

This center was organized on November 4, 1918, at Commercy, where it occupied the Caserne Oudinot. Barracks were taken over also at Lerouville, a few kilometers northwest of Commercy. The buildings were of stone and in fairly good condition, but a great deal of renovating was necessary to make them suitable for hospital purposes. The windows were torn out, electric wiring was missing, sewers were blocked, and the water was unsafe for drinking. Evacuation Hospital No. 13 had been operating in the Caserne Oudinot since October 30, and was the only hospital in the center during the active period. Base Hospitals Nos. 91 and 90 arrived on November 30 and December 1, respectively. The former relieved Evacuation Hospital No. 13 and the latter took over the caserne at Lerouville, but never functioned as a hospital. During January, 1919, all patients were evacuated to Vichy and Bazoilles-sur-Meuse, and the center was discontinued on January 30, 1919.

COMMANDING OFFICER

Col. William A. Powell, M. C.

HOSPITAL CENTER, JOUE-LES-TOURSf

This center was established in the grounds of a château about 5 kilometers (3 miles) west of the city of Tours. The property was leased by the United

eThe statements of fact appearing herein are based on the "History of the Commercy base hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed. fThe statements of fact appearing herein are based on the "History of the Joue-les-Tours hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


557

States Government from the owners in April, 1918, and two type A units and a convalescent camp were constructed by the United States Engineers. The entire center, including its water supply and sewerage system, was completed in October, 1918. The bed capacity of this group was 4,600 beds, but this capacity was never reached.

The method of handling the sick and wounded followed the usual procedure in base hospitals. The center was operated by Base Hospital No. 7 from July 30, 1918, to the latter part of October, 1918, when Provisional Base Hospital No. 2 was organized. On January 18, 1919, Base Hospital No. 120 took over the activities of Base Hospital No. 7, thereafter, with Provisional Base Hospital No. 2, operating the center until its closure early in June following.

FIG. 106.-A view of part of Kerhuon hospital center

COMMANDING OFFICER

Col. Allen M. Smith, M. C., July 30, 1918, to January 17, 1919.
Col. Edward W. Pinkham, M. C., January 18, 1919, to closure of center.

HOSPITAL CENTER, KERHUONg

The hospital center at Kerhuon was situated 4 miles southeast of Brest and about 1½ miles from the railroad station of Kerhuon. The center was planned to consist of 8 base hospitals, with a total capacity of 8,000 beds, for embarkation purposes; however, only 4,000 beds had been provided when the armistice was signed and further construction was abandoned.

gThe statements of fact appearing herein are based on the "History of the Kerhuon hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


558

The construction of the center, according to the estimate of the Engineer Department, was to be completed by September 15, 1918. However, at that time only about 50 per cent of the buildings were under roof, few of them were entirely finished, the water and sewerage systems still were under construction, and there were no roads or walks of any kind.

The first unit (Base Hospital No. 65) reported on September 16, 1918, and on the 20th the center was organized. Subsequently, the following additional arrived: Base Hospitals Nos. 105, 92, 120. Unlike the other hospital centers of a like capacity, this center always operated as one hospital, this in view of the fact that at least 90 per cent of the activities were devoted to receiving, preparing, and evacuating patients to the United States, and one administration instead of four was desirable.

Approximately 75 per cent of the patients who passed through the center required little or no professional care. Bedridden medical and surgical cases and those requiring professional care were placed in two blocks of wards. The ambulatory cases requiring no professional care were placed in other wards regardless of their physical disability. Medical officers assigned to these wards acted more in the capacity of detachment commanders than ward surgeons; their principal duties were to see that all patients were properly clothed, equipped, and paid preparatory to their embarkation.

The evacuating activities were entirely dependent on space alloted patients on naval transports, on the one hand, and the availability of patients at other hospitals in France, on the other. It might be said that the center coordinated the patients with the vessels so that there was always on hand a sufficient number of patients under the classification demanded by the Navy to fill all space on vessels allotted to them. The Navy was represented by a naval medical officer who furnished the information relative to the dates of sailing and the space allotted for patients. The port of embarkation was represented by a medical officer of the army who, after consultation with the commanding officer of the center, made requisitions on the chief surgeon's office for patients to fill the Navy requirements. The chief surgeon, in turn, ordered patients from hospital centers at Savenay, Nantes, and Beau-Desert to the center at Kerhuon.

When information was received from the naval authorities that a vessel would sail on a certain date and the number and classification of patients required was forwarded, passenger lists of patients were prepared from those available for evacuation and patients tagged with colored tags, each color representing a certain physical classification. These tags were very much cherished by the patients and regarded by them as a ticket home. One-half hour before the evacuations were to begin a bugler sounded "assembly," followed by "overcoats." At this signal all patients who had been tagged repaired to their wards and thence marched to the receiving ward. Here a final inspection of their personnel appearance was made, their records were verified as to completeness, and they were then loaded on ambulances and taken to Pier No. 5, Port du Commerce, Brest. From here they were taken by steam lighters to the transports. This activity was so organized that
frequently 1,100 patients were evacuated in less than three hours.

The following is a detailed outline of the evacuation system as operated in the center.


559

Evacuation Office, Hospital Center, Kerhuon, France

ADMINISTRATION OF RECEIVING, RECORDING, EQUIPPING, AND EVACUATING OF PATIENTS

Evacuation:

Receiving ward.
 Ward surgeon.
  Equipment.
  Statistical department.
  Registrar department.
  Tagging department.
  Liaison.

Function of receiving ward.-To receive patients sent to this hospital center and investigate source of admission as to authority and correctness; to receive papers and data; to assign patients to ward on information from evacuation office; to receive and check baggage and furnish runners to conduct patients to wards, and litter bearers for bedridden patients.

Reception of patients.-When notice is received of train arrivals a noncommissioned officer from this office is dispatched to the station. He represents this center and obtains information relative to convoys, etc., and accordingly makes out report, which is placed on file at this office.

REPORT OF HOSPITAL TRAINS, PATIENTS, BAGGAGE AND EQUIPMENT (ARRIVAL)

Hospital train No. ------  Date of arrival ------------------------------------------------

Number of patients in convoy: Officers, ------; enlisted men,------; total, ------
Embarked at -----------------------------------; time, ---------------; date, ---------------
Arrived at --------------------------------------; time, ---------------; date, ---------------
Detrained at------------------------------------; time, ---------------
Name of train commander ------------------------------------------------------
Seriously ill on train -------------------------------------------------------------
Remarks: -------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------
Condition of men on detraining ------ Time of loading ambulances -----------------------------------------
First ambulance arriving HCK ------ Last ambulance arriving HCK -----------------------------------------
Last patient sent to ward -------------------------------
Number of patients not paid for preceding month --------------------------------------------------------------
Record shortage ---------------------------------------------------------------------------------------------------------
Baggage ----------------------- Number of pieces ------------------- Sent via ------------------------------------
Condition ---------------------------------  Shortage --------------------------------------
--------------  Officers in charge train.  Number of attendants ----------------------
------------------------------------------------------------
------------------------------------------------------------   -----------------------------------------------------
------------------------------------------------------------ Detraining Sergeant.
------------------------------------------------------------
-------------------------------------------------------------   ----------------------------------------------------

Evacuation Officer.

Patients arriving at this center are brought to the receiving ward, lined up and are given a slip of paper with the number of the ward to which assigned written thereon. Passing down the line they are questioned by medical officers who write on the ward assignment slip, data relative to pay, Navy classification and diagnosis taken from field medical and transfer cards; the latter in conformity with the Manual, Sick and Wounded, A. E. F. Patients then have an opportunity, if they desire, of handing over money or valuables to a representative of the registrar's office, for safe-keeping, to be given back when ready to be evacuated to the United States. They then pass on to the clerical room, where a force of about 12 typists fill out the Form 55a complete in quadruple, getting the data from the patient and from the records in his possession. The patients are then sent to the ward to which assigned. This work can be accomplished at a rate of about 175 men per hour.

Ward surgeon.-We depend upon the ward surgeon for the accurate and easy running of the mechanism-first, when patients arrive in the ward, verification of data on the Form 55a, any change in Navy classification, diagnosis or delayed evacuation to be made on form provided.


560

CONTAGIOUS DISEASE-CHANGE OF DIAGNOSIS-CHANGE OF CLASSIFICATION-DELAYED EVACUATION-RELEASES FOR EVACUATION

  Note: ---------------------------------------------------------------------------------------------------------
Chiefs of service.
  --------------------------------------------------------------------------------------------------------------------
Ward --------------------------------------------- Date ------------------------------------------------------
Name -----------------------------------------------------------------------------------------------------------
Serial No. -----------------------------  Rank --------------------------- Organization ------------------
Navy class  --------------------------  Navy class new -------------
Admission diagnosis --------------------------------------------------------------------------------------
Present diagnosis -------------------------------------------------------------------------------------------
Noted by registrar -------------------------------------------------------------------------------------------
Reason for delayed evacuation --------------------------------------------------------------------------
Ward surgeon ------------------------------------------------------------------------------------------------
Approved by chief of service ----------------------------------------------------------------------------
Received by evacuation officer --------------------------------------------------------------------------

This form is sent to evacuation and registrar's office within 24 hours, if possible.

Second, transfer of patients from one ward to another. This should be carefully recorded by use of the following transfer form.
 HOSPITAL CENTER, KERHUON-TRANSFER OF PATIENTS

Request transfer of this patient from ward ---------------to ward ---------------
Name ---------------------------------------------------------------------------- No. ------------------------
Rank ---------------------------------  Organization -------------------------------------------------------
Diagnosis -----------------------------------------------------------------------------------------------------
Navy class ------------------- Navy class, new ------------------
Reason for transfer --------------------------------------------------------------------------------------------
   -----------------------------------------------------,
  Ward No. ----------- Ward Surgeon.

Approved:

  Chief of:
   Medical.
   Service transportation.
   Surgical.

   ------------------------------------,
   Base Hospital No. --------

Approved:

  Chief of:
  Medical.
  Service records.
  Surgical.

--------------------------------------,
  Base Hospital No. -------

The above patient will be transferred to ward -------------------------------------------------------
   Registrar.
Notice to detachment commander to transfer above patient.
  -------------------------------------------------------,
  Detachment Commander.

Received the above patient.
   -------------------------------------------------------,
   Ward Surgeon, ward -----

  EVACUATING OFFICE.
Notice received of transfer.   Date ----------------------------------------------- Time -----------

  ---------------------------------------------,
Evacuating Officer.
Change in file made by --------------------------------------------------------

To receiving officer, to note and return to evacuating officer.
---------------------------------------------------,
Receiving Officer.

The question of diagnosis is carefully considered and any change is immediately reported, through proper channels, to the
registrar and evacuation office.


561

EQUIPMENT

Equipment officer.-The function of this officer is to see that the enlisted patients coming into this hospital are made ready to be evacuated as soon as possible, and that all existing orders relating thereto are complied with. When patients are sent to the ward, a careful inspection of the personal equipment is made by the ward surgeon, and any shortage noted.

The articles to complete the personal equipment are immediately drawn from the quartermaster and supplied to the patients.

After careful inspection of their physical condition, the ward surgeon submits a list of those ready for inspection to the local inspector who notifies the inspector general at base headquarters, and the section inspector comes out and certifies to the equipment, physical condition, and pay of each man.

This certificate is made in duplicate on blanks provided for that purpose, one of which is retained by the patient until he reaches the receiving ward on evacuation, where a final inspection is made. This certificate is retained with the hospital records. The original copy accompanies the patient.

This form is shown below:

General Orders, No. 3, Hospital Center Kerhuon, January 10, 1919.

1. The physical examination of patients and the completion of their equipment must be certified by the ward surgeon within the period of 24 hours after a patient is admitted to the hospital. The certificate will be made in duplicate on the evacuation-inspection slips which have been provided for the purpose.

2. In each case one of the certificates will be retained by the patient until he reaches the evacuation office, where it will be required by the evacuation officer before the patient is allowed to leave the hospital.

3. The other certificate will be transmitted by the ward surgeon through military channels to the section director.

4. The section director each day, at 2 p. m., will supply the representative of the inspector general's office with the certificates of patients who are prepared for inspection.

5. The certificates furnished by the section chiefs will be used by inspection department to compile a list of the patients who are prepared for inspection.

6. These certificates, after having been initialed by the inspector general, will be delivered to the evacuation officer and will be filed in the patient's envelopes with their other records.

7. Upon notification that the inspector general is prepared to inspect the patients in any ward, the ward surgeon will direct that the equipment of the patients concerned be displayed on their beds in an orderly manner so that every article may be easily seen. When physically able to do so, the patient will stand by his bed dressed as when he will embark upon the ship. His identification tags must be worn about the neck and displayed outside his clothing.

HOSPITAL CENTER, KERHUON, BREST-EVACUATION INSPECTION SLIPS

Ward ----- Classification ----- Date -------------------------
Name ---------------------------No. --------------
Rank -------------------- Organization ------------------------------

Complete equipment:

Cap

1

Blankets, olive drab

3

Coat, olive drab

1

Barrack bag

1

Breeches, olive drab

1

Canteen and cover

1

Belt, waist

1

Gloves, pairs

1

Leggins

1

Laces, shoe, pairs

1

Shoes

1

Tags, identification

1

Overcoat

1

Ornaments, collar, cap

3

Shirts, olive drab

2

Toilet kit, complete

1

Undershirts

2

Cup

1

Drawers

2

Knife

1

Socks, pairs

4

Fork (1 spoon)

1

Slicker

1

Meat can

1



562

I have received the articles checked on this list, required to complete equipment as shown on list.

I was paid in full to include month of ----------------------------------- 1919, $ -----------------

I certify that I did not enter the service in Europe.
-----------------------------------------------,
Patient.

I certify this patient's equipment to be complete as shown by above list, except for initialed erasure of articles not available for
issue.

Date ------------------------------------------------ 1919.
(Name) --------------------------------------------------,
  (Rank) Ward Surgeon.

I certify that I have examined this patient and found him free from communicable venereal diseases, from skin and contagious diseases, and vermin infestation.
(Name) --------------------------------------------------,
  (Rank) Ward Surgeon.

Inspection, general:

I inspected this patient immediately before evacuation from the ward and found no evidence of acute infection in eyes, nose, throat, skin, or general condition to contradict evacuation, and has no explosives or combustibles.
(Name) ---------------------------------------------------,
  (Rank)  Ward Surgeon.

Evacuated -----------------------------------------------------  Date -------------------------------------------
S. S. ---------------------------------------------------

The detail of this process is outlined as follows:

Before the sick and wounded are ready to return to the United States a number of conditions must be satisfied, including:

1. The physical condition of the patient must be such as to insure his safe transportation.

2. He must not be suffering from a communicable disease or vermin infestation, thereby endangering the health of his
traveling companions.

3. He must be provided with clothing which will afford him protection and, in the case of ambulatory patients, they must present a neat and military appearance.

4. He must have been paid in full to include the month preceding his embarkation for the United States.

5. His service record must accompany him, if available; and, if not, a supplementary service record must be provided.

6. All foreign money must be exchanged for American money.

EQUIPPING THE PATIENT

Immediately after the reception of the patient in the ward the ward surgeon proceeds with the preparation of the patient for evacuation, and takes the following steps:

(a) The equipment which the patient possesses is orderly displayed upon his bed and checked against the specified list given on page 8 of Embarkation Instructions No. 13, January 4, 1919, headquarters, Services of Supply, A. E. F.

(b) The articles mentioned in the aforesaid list which are not in the possession of the patient are immediately requisitioned from the quartermaster. If the quartermaster is unable to supply any of the articles requisitioned he certifies to that fact.

(c) Inquiry is made of the patient regarding the pay he has received and he is required to state over his own signature the amount and the period of time covered.

(d) Inquiry is made as to whether or not he enlisted in Europe, if so, whether he desires demobilization in the United States, under provision of General Orders No. 40, G. H. Q., paragraphs 1-6. If he so desire, the attached declaration is used and information sent to base commander through military channels.


563

HOSPITAL CENTER, KERHUON,
   BASE SECTION NO. 5, A. P. O. 716,

(Date) --------------------------------, 1919.

Under the provision of General Orders No. 40, paragraphs 1-6, G. H. Q., March 3, 1919, I, ----------------------------------------------------,  hereby
declare that I entered the service of the United States in Europe, at --------------------------------------------------, on (date) --------------------------;
I desire to be retained in the service for the purpose of returning to the United States for discharge. I understand that I am privileged to be discharged in Europe if I so desire. I do not request to be retained in the service for the purpose of returning to the United States for discharge. In consideration of this privilege of being returned to the United States, I waive all claim for travel allowance from the place of discharge to the place of entry into the service, and fully understand that I will be discharged at the demobilization center nearest my home and that I must defray my expenses from the demobilization center at which discharged to my home.

   -----------------------------------------------

Witness:
  --------------------------------------------

(e) The physical inspection of the patient determines whether or not he is suffering from communicable venereal disease, skin diseases, contagious diseases, or vermin infestation.

(f) The requisition upon the quartermaster having been filled and the articles thus acquired having been added to those already in the possession of the patient, the ward surgeon now makes a final check to determine that the patient's equipment is in full accord with the instructions contained in Embarkation Instructions No. 13.

NOTIFICATION BY THE WARD SURGEON

The ward surgeon now requests the chief of the service to verify the findings which he has recorded with regard to the patient's physical condition, equipment, and pay.

The chief of the medical service confirms the findings whenever a patient is reported suffering from vermin infestation, communicable diseases, etc.

A representative of the inspector general's office visits the ward and confirms the fact that the patient is properly equipped for evacuation to the United States, initialing the record in evidence of the fact that this inspection has been made.

The statistical officer verifies the pay status of the patient and prepares his service record for return to the United States.

CERTIFICATION

The correctness of the findings which have been enumerated is attested by proper signature. The patient acknowledges over his signature the correctness of the statement regarding his pay and also that the required equipment for evacuation is in his possession.

The ward surgeon certifies that the patient has been equipped in a proper manner and also signs a certificate indicating that the patient may be transported to America with safety to himself and without endangering his fellow passengers from vermin or communicable diseases.

As a period of a few days may elapse between the time when a patient arrives in the hospital and the time when he is placed upon the passenger list, the ward surgeon makes a final inspection in each case in order that he may give the proper assurance regarding the suitability of every case for evacuation. This final certificate covers the question of acute infection, vermin infestation, and venereal disease.

WOUND CHEVRONS

General Orders, No. 110, general headquarters, A. E. F., July 7, 1918, prescribes the conditions under which wound chevrons may be worn. Many wounded men have been unable to secure authority to wear these chevrons, due to the loss of necessary papers. To obviate this difficulty, telegraphic authority was given to the commanding officer of this center to take the affidavit of any man whose papers were lost or confused. As a matter of practice it is found that greater speed is obtained and better records made available for our own protection if the affidavits are prepared in each case. As soon as the patients are assigned


564

to the ward, the ward surgeon asks for all men to notify him who have never had an order authorizing the wearing of his wound chevron. The ward surgeon prepares an affidavit showing, name, rank, company, organization, number, place of action where wound was obtained, nature of missile or gas, part of body injured, and date of injury. This blank is sent to the adjutant's office. The adjutant sends a commissioned officer, having power to administer an oath, to see the soldier and attest his signature on the affidavit. This affidavit is returned to the adjutant's office, and a special order issued authorizing the individual to wear a wound chevron for the wound specified. Two chevrons are then issued to the men with the order authorizing their use, one for the coat and one for the overcoat. If the patient already has an order but no chevron, a chevron is issued and a notation made on the order. If one chevron only is needed for the overcoat, one is issued for that purpose. In the month of March, about 800 wound chevrons were issued.

HOSPITAL CENTER, KERHUON, FRANCE

A. P. O. 716

  (Date) -------------------------------------------------, 1919.

Personally appeared before me, the undersigned authority, one --------------------------------------------------------, -----------------------------------------
   (Number)
who, after being duly sworn, deposes and sayeth, I was (1) wounded while in action with the enemy; (2) wounded as a result of an act of the enemy; (3) was gassed, which necessitated treatment by a medical officer at ------------------------------------------------------------------------,
(Place)
-----------------------------------. That the wound was due to ---------------------------------------------------- and I was wounded in
  (Date) (Nature of weapon)
-----------------------------------------------; that I am not now wearing a wound chevron for this wound.
   (Part of body injured)

Further deponent sayeth not.
Ward --------------
  -----------------------------------------
  (Name, rank, and organization)

Sworn to and subscribed before me this ------------------ day of --------------------, 1919.
   -------------------------------------------,
   ----------------------------------------
 

HEADQUARTERS, HOSPITAL CENTER, KERHUON, FRANCE

A. P. O. 716

  (Date) -------------------------------------------------------, 1919.

Special Order No. -----------------
 

EXTRACT

* * * * * * *

PAR-- Pursuant to telegraphic authority, headquarters, Services of Supply, 8th February, 1919, the following-named men, having been wounded in action with the enemy, or as the result of an act of the enemy, on the date and at the place specified opposite their names, are hereby authorized to wear the wound chevron prescribed in G. O. 110, G. H. Q., July 7, 1918:

Name   Number   Rank   Organization   Date and place of injury

 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

By order of Colonel Koerper:

FREDERICK THOMAS,
   Major, Sanitary Corps, Adjutant.
Ward----------
Original copy.


565

SERVICE STRIPES

This matter is taken up with every man coming into this center, and handled in a similar manner to wound chevrons. Many men are found who are not wearing service stripes, although entitled to them. In the month of March about 3,000 service chevrons were issued and authorized as per order attached.

HEADQUARTERS, HOSPITAL CENTER, KERHUON, FRANCE

A. P. O. 716

  (Date) -------------------------------------, 1919.

Special Order No. ------

EXTRACT

* * * * * * *

PAR -- Pursuant to the provisions of G. O. 110, sec. 1, Hqrs., A. E. F., July 7, 1918, as amended by G. O. 147, sec. 3, par. 4, Hqrs., A. E. F., Sept. 2, 1918, permission is hereby granted the following-named members of the American Expeditionary Forces, now at this hospital center, to wear ----- war service chevrons.

Name  Number  Rank  Company Organization  Date of arrival

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

By order of Colonel Koerper:
  FREDERICK THOMAS,
  Major, Sanitary Corps, Adjutant.

Ward --------
Original copy.

EVACUATION

The evacuability of a patient is indicated when the ward surgeon forwards, through military channels, the evacuation-inspection slips, which contain the certificates referred to above. This slip is made in duplicate, one of which is taken up by the inspector; when all are collected a list is made and handed to evacuation department, which thereupon releases the equipment check of patient, kept on file at evacuation office. The duplicate slip is kept by patient, who brings it to the receiving ward and when he is checked on the passenger list he hands the slip to the inspector, who examines it once more to insure correctness and then places it in the patient's envelope. This envelope is then given directly to the detachment commander. At this point the patient is given the final inspection as to neatness and military appearance.

FORMATION INTO DETACHMENTS

Prior to evacuation, patients are grouped into detachments of 75 to 150 and placed in the charge of a medical officer, who receives the records relating to the patients and conveys them to the United States.

STATISTICAL

The function of this department is to see that the service records are complete; or if not and not obtainable, to provide supplemental service records, and to see about pay for every man. A roster of detachments of men to be evacuated, which is the passenger list of the evacuation office, is submitted to this department, and 12 copies of passenger list made from the data contained thereon. Two copies of the twelve contain red-ink notations concerning the absence of service records. These copies are disposed of as follows:

5 copies for personnel adjutant, United States port of debarkation.
2 copies to central records office.
1 copy to headquarters, Services of Supply.
1 copy to be retained at port of embarkation, A. E. F.
1 copy for executive officers on board ship.
1 copy to The Adjutant General of the Army.
1 copy to detachment commander.


566

REGISTRAR

The registrar accepts one of the Forms 55a, places it in live file; when passenger list is called for and patient ready to go out the Form 55a is taken out, stamped with proper date, and placed in dead file.

TAGGING

This department receives a copy of passenger list, and fills out the tag, form shown below:

  P. L. No  --------- Detachment ---------- Class -------------------------
  Name --------------------------------------------------------------------------
  Rank ------------------- Serial No ------------------------------------------
  Company -------------- Organization ------------------------------------
  Diagnosis --------------------------------------------------------------------
  Home State --------------- Ward No -------------------------------------

The patients are tagged in the wards, and made readily distinguishable and ready to go to the receiving ward for final inspection and loading when called for.

Tags are colored, denoting classifications:

White-Walking, no dressing ------------------------------------------------------------------------------------------- (WND a, b)
Green-Walking, dressing ------------------------------------------------------------------------------------------------ (WD a, b, c)
Yellow-Tubercular --------------------------------------------------------------------------------------------------------  (TB a, b, c)
Red-Mental -----------------------------------------------------------------------------------------------------------------  (Ment a, b)
Blue-Bedridden ------------------------------------------------------------------------------------------------------------  (BR a, b)

Barrack tags.-Tags are made in duplicate, one part is tied on the barrack bag and the other the patient keeps in his possession.

Det. 278. No. 50

Det. 278. No. 50.

John Doe

John Doe

Pvt. 1/cl.

Pvt. 1/cl.

OFFICE SURGEON, BASE SECTION NO. 5, A. P. O. 716,
   (Date) March 24, 1919.

To: C. O., Hospital Center, Kerhuon, France.
Requisition for classified patients for evacuation to transport:
Transport: S. S. Mount Vernon.
Date of sailing: March 28, 1919.
Hour for ambulance loading: 8:00 a. m.
 

 

Bed ridden

Walking, dressing

Walking, no dressing

T. B.

Mental

Total

A

B

A

B

C

A

B

A

B

C

A

B

Officers

---

---

---

---

---

---

---

---

---

---

---

---

---

Enlisted men

---

10

---

---

---

50

750

---

---

---

---

---

810

Nurses

---

---

---

---

---

---

---

---

---

---

---

---

---

Total

---

10

---

---

---

50

750

---

---

---

---

---

810

(Signed) --------------------------------------------,
   Captain, M. C., Assistant Adjutant.


567

LIAISON

The duty of this department is to keep in touch with the base evacuation officer and other points that send patients to this center for evacuation to the United States; to arrange for their reception and requisition through office when needed; to keep live statistics on the general information board as to movement of patients and nurses, and expected arrivals of ships. In other words, to coordinate all outside information that has to do with the reception and evacuation of patients, and to maintain a sufficient number of patients at all times to fill the requisitions made by the Navy.
 * * * * * * *

The physical function of evacuating patients is as follows:
When the passenger list is completed the following form is made out:

   EVACUATION OFFICE,
  HOSPITAL CENTER, KERHUON, A. P. O. 716,

Memorandum:  ---------------------------------------------, 1919.

1. Loading from the S. S. ------------------------------------------------------------------------------------------- will start at -------------------------------- M.
------------------------------------------------------------------, 1919.
The following detachments will load:

Detachment No. ------------------------------------- In command of --------------------------------------------------
Detachment No. ------------------------------------- In command of --------------------------------------------------
Detachment No. ------------------------------------- In command of --------------------------------------------------
Detachment No. ------------------------------------- In command of --------------------------------------------------
Detachment No. ------------------------------------- In command of --------------------------------------------------
Detachment No. ------------------------------------- In command of --------------------------------------------------
Detachment No. ------------------------------------- In command of --------------------------------------------------
Detachment No. ------------------------------------- In command of --------------------------------------------------

2. Evacuation will take place from the following wards:
----------------------------------------------------,
  Evacuation Officer.

Copies to-

Commanding officer, Base Hospital No. 65.
Chief of professional services.
Chief of medical service.
Chief of surgical service.
Chief nurse.
Detachment commander.
Receiving officer.
Mess officer.
Baggage sergeant.
File.

These are sent to officers that are in any way connected with the process that they may be informed and have patients designated to go at appointed hour. To the receiving officer is sent, first, a "ward check," that he may know the wards from which the patients are to be called, their number, and classification:

Detachment No. 136:

Enlisted men-

   BRb ---------------- J2   J4   J5   J6
   3   10   34   1

WNDb ------------Y7   Y4
  45  5

Detachment No. 137:

  Enlisted men-

WNDb -------------Y7  Z1  X2  D7
   30  22   2   1

TBc ---------------- A3  E5  X2  A4
   31   19   2   17


568

Detachment No. 138:

  Enlisted men-

TBa ---------------- A3   A4   A6   J1   ES   E6
   8 3 16   12   7 4

TBc ---------------- A6   J1   E6
   16 3 1

WNDb -------------Z1 Z2   Y7   C6   H10   H9   F3   D5
   1  1 9 1 3 1 3   2

Cl E4 E3   E2
2  4 1 1

Detachment No. 139:

  Enlisted men-

WNDb -----------D3   D4
  34 36

WDa ------------ C5 C4 H2 Al   C2
  2  11 1 26   10

Detachment No. 140:

  Enlisted men-

WNDb --------- D4 D5 D6
  4 38 28

WDb ------------Z1 C6 Y3   C2   Z2   Y2
  4  2 3 3 2   1
 

Detachment No. 141:

  Enlisted men-

WNDb -------- J7 Cl A8   Al   X2   A2   Z2   Z3
29 13  21 4 8   1 20   53

Detachment No. 142:

  Enlisted men-

Mentb -------- A9   Al0 P2 P6
24 38  4  6

Detachment No. 143:

  Enlisted men-

                WNDb ----- Z1           Z3             H9             D3             D2
                                    62             44             19                 1               24

Detachment No. 144:

        Enlisted men-

                WNDb ------ H9         H10             C5             C6
                                        21          37                 29             38

Detachment No. 145:

        Officers-

                WNDb ------- B2         Al             B3            B4             B5             B6
                                        16             1             11             8                 4                1

                WNDa -------  B4         B5
                                            1            1

                TBc ----------- B2
                                           1

                WDc ----------- B5
                                         2

                WDb --------- B4         B5
                                         1             2

                WDa --------- B4         B5
                                        1             1

Detachment No. 146:

        Nurses-

                WNDb ------- K4
                                        22

Detachment No. 147:

        Mental officers-

                Mentb --------- B7
                                     32 or 33


569

Second, an office detachment sheet showing how each detachment is to be made up. An office detachment sheet is given below, showing the make-up of the passenger list of the Steamship Leviathan. This list, as will be noted, calls for most of the sick and wounded classification. It will be noted that the detachments are made up in "splits"; that is, not all are of the same class, the reasons for which are: First, evacuating facility; second, part of the detachment in the class are able to help the others, which tends to shorten the transportation time; third, it does not load up a detachment commander with a lot of one class of patients who might be sick and require a lot of attention and care.
 OFFICE DETACHMENT SHEET STEAMSHIP "LEVIATHAN" 

In command of convalescent detachment No. 138, Capt. ----:

 

(1) TBa (patients), 49 enlisted men, 1 civilian

50

TBc (patients) 

20

WNDb (patients)

29

Total

99

In command of convalescent detachment No. 136, Maj. ----:

 

(2) BRb (patients)

49

WNDb (patients)

50

Total

99

(Supplemental 101 to 110.)

 

In command of convalescent detachment No. 137, First Lieut. ----:

 

(3) TBc (patients)

69

WNDb (patients)

55

Total

124

In command of convalescent detachment No. 142, Maj. ----:

 

(4) Mentb (patients)

58

Attendants

6

Total

64

In command of convalescent detachment No. 139, Capt. ----:

 

(5) WNDb (patients)

69

WDa (patients)

49

Total

118

In command of convalescent detachment No. 140, Capt. ---:

 

(6) WNDb (patients)

70

WDb (patients)

49

Supplemental list, WNDb (patients)

12

Total

131

In command of convalescent detachment No. 141, Capt. ---:

 

WNDb (patients)

148

In command of convalescent detachment No. 143, Maj. ---:

 

WNDb (patients)

150

In command of convalescent detachment No. 144, Capt. ---:

 

WNDb (patients)

125

In command of convalescent detachment No. 145, Lieut. Col. ---:

 

Officers-

 

TBc (patients)

1

WDa (patients)

2

WDb (patients)

3

WDc (patients)

2

WNDa (patients)

2

WNDb (patients)

40

Total

47

In command of convalescent detachment No. 146, Capt. ---:

 

Nurses-

 

WNDb (patients)

22

Attendants

3

Total

25

In command of convalescent detachment No. 147, Lieut. Col. ---:

 

Officers-Mentb (patients)

32


570

When there are many bedridden patients to be evacuated, the ambulances are run right down to the wards where they are located, where a temporary evacuating shelter is set up and the patients checked there instead of in the receiving ward. The burden of transporting is practically nil, the patient being taken out of his ward and almost into the waiting ambulance, and thence directly to the ship. The ambulatory patients go through the receiving ward. Thus the evacuation can be carried on in two places at the same time. It might be interesting to note that the passenger list of the Leviathan, calling for 1,162 patients, a somewhat complicated one, calling as it does for bedridden, ambulatory, mentals, and attendants, was loaded from this center in 3 hours and 15 minutes.

OFFICE ADMINISTRATION

A file, made up of Forms 55a, a copy of which was obtained from clerical room on the reception of the patients, is arranged according to the classification of sick and wounded as required by the Navy, and under which the Navy calls for patients to be transported. Form 55a contains all information necessary to make out a passenger list, and since they are filed in order of arrival, they thus establish a priority list.

This file is also kept in subdivision by wards, so that the number in each class and also the number in each ward of each class can be readily determined. For a daily report the following form is used: 
 Morning situation report of patients, hospital center, Kerhuon-Navy classification 

OFFICERS

 

Bedridden

Walking, dressing

Walking, no dressing

Tubercular cases

Mental cases

Total

A

B

A

B

C

A

B

A

B

C

A

B

Remaining

---

---

---

---

---

---

---

---

---

---

---

---

---

Admitted

---

---

---

---

---

---

---

---

---

---

---

---

---

Total

---

---

---

---

---

---

---

---

---

---

---

---

---

Disposed of:

 

 

 

 

 

 

 

 

 

 

 

 

 

Lost by reclassification

---

---

---

---

---

---

---

---

---

---

---

---

---

Gained by reclassification

---

---

---

---

---

---

---

---

---

---

---

---

---

Died

---

---

---

---

---

---

---

---

---

---

---

---

---

Remaining

---

---

---

---

---

---

---

---

---

---

---

---

---

Available

---

---

---

---

---

---

---

---

---

---

---

---

---

ENLISTED MEN

Remaining

---

---

---

---

---

---

---

---

---

---

---

---

---

Admitted

---

---

---

---

---

---

---

---

---

---

---

---

---

Total

---

---

---

---

---

---

---

---

---

---

---

---

---

Disposed of:

 

 

 

 

 

 

 

 

 

 

 

 

 

Lost by reclassification

---

---

---

---

---

---

---

---

---

---

---

---

---

Gained by reclassification

---

---

---

---

---

---

---

---

---

---

---

---

---

Died

---

---

---

---

---

---

---

---

---

---

---

---

---

Remaining

---

---

---

---

---

---

---

---

---

---

---

---

---


571

P./L --------------------------------------------------------------------------------------------------------------------------------------------------------------

P./L --------------------------------------------------------------------------------------------------------------------------------------------------------------

P./L --------------------------------------------------------------------------------------------------------------------------------------------------------------

Temporarily held ---------------------------------------------------------------------------------------------------------------------------------------------

Available -------------------------------------------------------------------------------------------------------------------------------------------------------

    Total ----------------------------------------------------------------------------------------------------------------------------------------------------------

Local patients --------------------------------------------------------------------------------------------------------------------------------------------------

    Grand totals -------------------------------------------------------------------------------------------------------------------------------------------------

The distribution of the Form 55a is made either immediately following the completion of its typing in the receiving ward, or as soon as the patients have passed through it, and sufficient time has been had to make a careful check as to diagnosis, etc., and to make comparison with the transfer card from the forwarding hospital and other papers which will come in on the convoy, but not in the possession of the patient. The original of the Form 55a which is retained in the receiving ward is filed according to wards, and the patient remains unavailable for evacuation until such time as he has been released from all checks. The Form 55a is transferred from the "hold-over" file to the "available" file, and there arranged according to the Navy classification and by wards.

A patient to be made evacuable must be equipped, paid in full to include the month preceding his evacuation to the United States, have his service record completed, not be awaiting trial by court-martial, be free from orthopedic complications and temporary illness. In other words these are six points which have to be considered and checked.

When this office is called on for a certain number of patients in the various classifications required by the Navy, the Forms 55a are "pulled" from the "available file" and blocked out and given the serial numbers to be used in making the passenger list. Typists prepare the passenger list. Approximately 10 per cent more names, if available, in each classification as called for by the Navy are placed on the passenger list and service records for this number called for. As the system works out we find that in practically every list there are a number of "hold-ups" at the last moment, so that as a name is scratched one of the other names is used to fill in. Those that are not needed are scratched. After the passenger list is complete, the Forms 55a are kept in their respective order, to be accessible, in case anything arises requiring their use for reference, until the patient is actually evacuated. For instance, if at the last minute a patient for evacuation is found too ill to travel, change will be made. When the evacuation is accomplished and the patients have gone to the ship, final disposition is made of the Form 55a by marking each copy with the number of the special order and paragraph which authorizes the patient's evacuation, giving date and ship on which he travels. They are then filed alphabetically as a permanent record of this office.

Seventeen copies of a passenger list are made by the evacuation office; disposition a follows:

    4 to transport surgeon for use at port of debarkation.
    1 to chief surgeon, A. E. F. (through base surgeon).
    1 to base surgeon.
    1 to statistical and registrar departments.
    8 to Army and Navy medical authorities.
    1 retained for tagging and permanent file.
 RED CROSS HUT ACTIVITIES

Previous to arrival of a convoy the American Red Cross is notified by the receiving department. When the patients arrive and are awaiting registration, hot chocolate is served, and cigarettes are passed.

When patients go out, representatives of the Red Cross are present and supply each patient as he passes by the desk with a cigarette, giving him a light and a parting word before he gets into the ambulance. This detail, while small in itself, is important, as it serves to leave a good impression in the minds of the patients.


572

COMMANDING OFFICER

    Col. Clyde S. Ford, M. C., September 20, 1918, to February 11, 1919.
    Col. Conrad E. Koerper, M. C., February 12, 1919, to discontinuance of center.

HOSPITAL CENTER, LANGRESh

This hospital center was situated about three-fourths of a mile to the east of the city of Langres. Construction of the center began during the early part of the summer, 1918, but delay in receipt of building material and the shortage of labor prevented its completion until after the armistice began. The original plans for this center contemplated four base hospitals and a convalescent camp; however, buildings for only two base hospitals, a convalescent camp, and for the center administration were constructed.

To the wooden buildings were added later, 36 marquee tents, crisis expansion, to each base hospital, and 72 to the convalescent camp. This addition gave each hospital a capacity of 1,500 and 1,000 to the convalescent camp, a total of 4,000 available beds for the entire center.

The center was organized on August 15, 1918. At this time the permanent buildings were partially completed, most of the roads and a few walks laid, the electric plants in operation, and water and sewer pipes laid.

The administrative staff of the center was organized into the following divisions: Adjutant, evacuating officer, sanitary officer, medical supply officer, laboratory officer, and quartermaster.

The following units comprised the center: Base Hospital No. 53; Evacuation Hospital No. 18 (temporarily, September 15 to October 26); Base Hospital No. 88; Hospital Unit I, which arrived on January 10, 1919, and was incorporated with Base Hospital No. 53.

One of the greatest handicaps under which the center operated was its distance from the detraining point, necessitating the transportation of all patients a distance of more than 2 miles by ambulance and truck over rough narrow roads. There never was sufficient ambulance transportation available, and the majority of patients were transported by trucks. At the time the armistice began, plans were under way providing for a railway track to be built directly into the hospital area.

Water was obtained from the Marne River. It was treated with alum for coagulation, and then with free chlorine. Because of the heavy pollution, it was necessary to chlorinate again in Lyster bags all water used for drinking purposes.

The sewerage system handled only liquids, which passed through a septic tank, and after purification were discharged into a branch of the Marne River. The bucket system latrines were in operation and proved fairly satisfactory. One Horsefall destructor was installed. This proved effective, but proved rather expensive in the matter of fuel. One steam sterilizer was adequate for all the work for the center.

hThe statements of fact appearing herein are based on the "History of the Langres hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


573

CONVALESCENT CAMP

The camp consisted of 72 marquee tents and 17 portable wooden barracks. The patients were classified and divided into several grades, according to physical strength, and were given graduated exercises, drills, and walks.

The American Red Cross constructed a large hut where amusements in the form of motion pictures, athletic exhibitions, and games were held. During its three months' existence the camp received about 3,500 patients.

DISCONTINUANCE

On January 13, 1919, Base Hospital No. 88 was ordered to Savenay, leaving only one base hospital in the center. As the central administrative staff was no longer necessary, it was discontinued on January 22, 1919.

COMMANDING OFFICER

    Col. William R. Davis, M. C., August 27, 1918, to November 21, 1918.
    Col. Conrad E. Koeper, M. C., November 22, 1918, to January 22, 1918.

HOSPITAL CENTER, LIMOGESi

The hospital center at Limoges was organized July 22, 1918. Several hotels, schools, and other buildings were leased from the French; in addition, type A barracks were constructed by the United States Engineers. The hospitals were widely separated in different parts of the city. The entire group was planned to accommodate 5,500 patients, but this number was increased so that on November 13, 1918, 9,093 beds (including the convalescent camp) were reported as available.

Three base hospital units, Nos. 13, 24, and 28, arrived and were functioning some time before the center was established. Ambulance Company No. 347 arrived September 25, 1918, and was used in the evacuation of patients. Sanitary squad No. 79 reported September 29, 1918, and performed the sanitary work in the center. During January, 1919, Evacuation Hospital No. 32 and Base Hospital No 98 arrived, relieving Base Hospitals No. 13 and No. 28, respectively.

Laundry was handled by local contract, but facilities were inadequate and a center laundry was authorized, but due to the signing of the armistice it was never completed.

Laboratory work of the center was distributed among the three hospitals, one performing the Wassermann tests, another the survey work, and a third the paraffin section work. Each laboratory operated independently, making its own routine examinations, with the exception of meningococcus typing, which was assigned to one hospital.

Beginning December, 1918, the bed capacity of the center was gradually reduced, until on February 28, 1919, all buildings but one were returned to the French. During its activity, this group admitted 23,592 patients.

iThe statements of fact appearing herein are based on the "History of the Limoges hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


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CONVALESCENT CAMP

The camp was opened September 21, 1918, and occupied a tract of land of about 10 acres, on which 50 tents and 12 frame buildings were erected. The initial capacity of the camp was to be 1,000 beds, but during November this was found insufficient and barracks were rented from the French Government, increasing the bed capacity to 2,200. The largest number of patients in camp at any one time was 2,165; total number cared for was 3,077.

FIG. 107.-A view of part of Limoges hospital center

The camp was operated by a section of Convalescent Company No. 5, consisting of 7 officers and 45 enlisted men. Patients were also used, especially in the offices and in the kitchen. Incorporated in the daily schedule of the camp operation were regular hours for physical exercises, drills, and outdoor games, patients being formed into graded companies which were allotted schedules based on the physical possibilities of its members. The camp was evacuated on January 2, 1919, and turned over to the Engineers on January 13.

COMMANDING OFFICER

    Col. William B. Bannister, M. C.


575

HOSPITAL CENTER, MARS-SUR-ALLIERj

The construction of this center was authorized in the fall of 1917. It was located about 2 miles from Mars-sur-Allier and was to have a capacity of 43,000 beds, including crisis expansion and convalescent camp. This capacity was never reached. At the time of the armistice the center had 30,000 available beds.

Actual construction began in February, 1918, but at first it was comparatively slow through lack of material. The work was under the direction of United States Army Engineers. Railroad sidings ran into the center and the hospital units were grouped on either side, thus making it possible to stop the train in front of any hospital designated to receive patients. When the commanding officer of the center arrived, on July 19, 1918, two units were fairly well toward completion. After August 2, 1918, the development of the center was very rapid. Material came in by trainloads almost every day. By November 11, 14 units had been completed and were functioning; 3 were almost completed, and material was on hand for 3 other units.

The following organizations formed the center and arrived in the order named: Base Hospitals Nos. 68, 48, 35, 14, 62, 131, 123, 107, 110; Evacuation Hospitals Nos. 31 and 37. Some of these did not arrive until after the armistice began.

At first, water for the center was derived from a spring, being pumped into a large concrete tank, located at the highest point in the center. This supply was ample in the early stages of development, but when the population increased to about 10,000 it proved to be insufficient, so additional water was drawn from the Allier River, some 4 miles distant. The water from both of these sources was fairly good, but too uncertain in quality for use without chlorination.

The sewerage system disposed of only the liquid waste. The pail system was used in connection with the latrines, the pails being collected once or twice a day and their contents burned. A few of the earlier units to arrive were equipped with Horsfall incinerators, but the later units used improvised crematories which seemed to work equally as well. These crematories were fairly satisfactory, but required a great deal of fuel and were not entirely free from odor.

All laundry work was done at Nevers, the nearest city of any size. A laundry was under construction in the center when the armistice was signed.

Bread at first was obtained at Nevers. Later a bakery company established a bakery, which proved very efficient and adequately met all demands.

The headquarters of the center were organized into the following departments: Commanding officer, chief of staff, adjutant, professional staff, sanitary staff, medical supply department, quartermaster department, receiving department, evacuating department, motor transport, railway transport, personnel adjutant, central purchasing agent, signal corps, central records office, engi-

jThe statements of fact appearing herein are based on the "History of The Mars-sur-Allier hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


576

FIG. 108.-General view of Mars hospital center, looking northeast from tower at west end of center


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neers, headquarters detachment and band, post office, fire department, provost marshal, welfare organization, judge advocate department, chief nurse. These departments were developed to fit the needs of various organizations, and with slight modification proved very efficient in hospital administration. As an example, the professional staff at headquarters, consisting of the surgical, medical, genitourinary, neuropsychiatric, orthopedic, X-ray, eye, ear, nose and throat, laboratory and dental consultants, were responsible for the coordination of the professional work of the center. Another important department was the central purchasing agency, a development made necessary by the large amount of supplies purchased and the tendency of independent organizations to bid against each other, thus raising the price of supplies. This was overcome by having all purchasing for the entire center made through one department and distributed to the various organizations as required.

FIG. 109.-One of the operating rooms, Mars hospital center

The central records office was established at the beginning of the center. In this office an effort was made to keep a duplicate record of every person that came into the center. Thus it was possible within a very few moments to locate any individual in the hospital. This department was a great timesaver and proved its value as the center grew.

As frequent calls came in for operating and special teams for duty at the front, many of the hospitals were reduced to an actual minimum of working personnel. It became necessary to centralize the various departments of the hospital. The central laboratory was first to be organized, and here the bulk of laboratory work was performed, but each hospital maintained sufficient equipment to do routine urinalysis and simple blood work. Similarly the


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X-ray and eye, ear, nose, and throat departments were centralized. As the center grew, it proved advisable to classify all cases and assign them to special hospitals. Some of the special hospitals were concerned largely with bone work, some with chest, and others with general medicine and surgery. A complete contagious hospital was in the process of organization when the development stopped. A central dental clinic was in active operation at the time the armistice was signed.

Prior to the influenza epidemic, in the fall of 1918, the medical service was not very active. With this epidemic, however, came a great number of pneumonia cases, with resultant complications of empyema. This made specialization of chest work necessary, and most of this surgery was handled by one unit. Each hospital maintained a contagious department of its own for each particular class of disease. One hospital cared for mumps, another for measles, another for scarlet fever, and so on. Medical cases were almost entirely confined to two hospitals. In addition to those mentioned, there was the orthopedic hospital and one for neuropsychiatric cases.

Owing to the unfamiliarity of the new personnel of the hospitals with Medical Department records, it was necessary to install some system of instructing the new organizations on these particular subjects as soon as they arrived. Two of the units were utilized as school of instruction. When a new hospital unit arrived its adjutant, registrar, mess officer, sanitary officer, senior noncommissioned officers, and clerks were distributed for instruction to one of these hospitals and remained there until they were fairly familiar with the records and their own hospitals were ready to receive patients.

All notices regarding the arrival of hospital trains were sent by telegram from regulating stations. Upon arrival of the trains the ambulant cases were removed first, all patients as a rule being taken directly to the receiving sheds of the hospital to which they had been assigned. At first, class A patients were evacuated direct to duty; later all evacuations were made from the convalescent camp.

A Red Cross hut was established at each hospital, where refreshments were served every afternoon, and practically every night some form of entertainment was given. In addition to these huts, a central theater was operated by the Red Cross.

The center organized a complete symphony orchestra of about 60 musicians, and a band of 36. It had an excellent vaudeville troupe, glee club, and several male quartets.

The convalescent camp occupied an area of about one-half mile square and comprised 100 tent units, with 301 tents (299 marquee and 2 Denry), 38 wooden buildings, 4 wooden latrine groups, 3 sheds, and 4 feces destructors. All tent units, buildings, and roads had double ditches.

Patients were admitted to this camp not only from the Mars center, but also from the Vichy center, Chatel Guyon, and Chaumont. On August 18, 1918, there were 130 patients in the camp, and on October 1 there were 1,796. This number steadily increased until the maximum of 4,565 was reached on December 5, 1918. The greatest number ever received in one day was 435. The largest evacuation was 1,336, made on December 18, 1918. Up to January 1, 1919, 11,497 men had been received and 9,638 evacuated.


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The policing of camp was a large problem, necessitating a guard of approximately 210 men. The guard was partially armed during the day and completely so at night. An officer of the permanent personnel always acted as police officer, while the officers of the day were drawn from the convalescent line officers. The institution of formal guard mount very much improved the discipline and behavior of the guard. The center sanitary officer did not exercise jurisdiction over the sanitation of the camp, therefore a sanitary squad of from 50 to 100, headed by one of the permanent officers and assisted by a number of noncommissioned officers, was organized.

The military discipline was splendid, largely due to a greater percentage of military ceremonies and drills than usually occurs in establishments of that nature. The camp maintained from 4 to 10 companies of convalescents, numbering from 150 to 520 each. The medical officer in charge of each company was not only responsible for the records and the health of the men, but also for their military instruction. All phases of military work were taken up, including the school of the soldier, company, battalion, and regiment, and special ceremonial formations as well.

FIG. 110.-View of convalescent camp (east end), looking north from water tower, Mars hospital center

Next to military discipline and drill there was nothing that contributed so much to the physical and mental welfare of convalescents as agreeable work. Ten shops were established, 2 tailor shops, 2 barber shops, 1 electrical-repair shop, 1 cobbler shop, 1 cot-repair shop, 1 carpenter shop, 1 disenfecting shop, and 1 sign-painting shop. When a patient was discovered who had any particular training or inclination, industrially or artistically, he was given every opportunity to work.


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Athletics were encouraged in all forms, and intercompany competition in baseball and football was very keen. The convalescent camp closed on February 1, 1919. The hospital center at Mars-sur-Allier was discontinued on May 20, 1919.

COMMANDING OFFICER

    Col. George A. Skinner, M. C.
 

HOSPITAL CENTER, MESVESk

CONSTRUCTION FEATURES

Construction of the Mesves hospital center, located between the villages of Mesves and Bulcy, in the Department of Nievre, was approved by the general staff, A. E. F., in December, 1917. This site was selected because of its location on the Paris, Lyon & Mediterranean Railroad, its rolling and slightly elevated contour and its accessibility to the Loire River for water supply.

FIG. 111.-A view of part of Mesves hospital center during the construction period

The original plan for the center embodied 10 base hospital units, each of 1,000 beds, with space for crisis tent expansion of an additional 1,000. Each unit was to consist of 55 buildings apportioned to administration, receiving and evacuating, bathhouses, quarters for personnel, recreation hall, morgue, X-ray and operating, supply storehouses, garage, and disinfection.

In July, 1918, additional plans were approved to increase the construction of this center to 20 base hospital units. These additional units were somewhat modified; the number of ward buildings was reduced by half, and each ward building made twice the size of the earlier ones.

kThe statements of fact appearing herein are based on the "History of the Mesves hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


581

The construction of the center was left to a firm of contractors in Paris, on January 31, 1918, and under the terms of the contract they were to furnish all material which could be obtained in France and all labor possible. The actual construction was to be done under the direction of an engineer officer, American Expeditionary Forces. The construction work was begun on February 7, 1918, but progressed very slowly during the first three months. In fact, so slowly, that on June 15, 1918, when the commanding officer of the center arrived, the only buildings completed were 6 wooden barracks in unit No. 10, and 5 barracks in unit No. 1, partially completed. At this time about 20 hotels and other buildings in Pouges-les-Eaus, about 11 miles from the Mesves center, were taken over by the center and converted into a base hospital.

FIG. 112.-A row of wards, Mesves hospital center, during construction period

This delay in construction was largely due to difficulties in receiving building material and transportation. A standard-gauge railroad siding was built and numerous roads were constructed throughout the center before any construction of barracks was begun. The first units to be partially completed were Nos. 1 and 5, closely followed by 6, 10, 2, 3, 4, 7, and 8. Patients began to arrive before the hospital buildings were completed, and many of these were occupied with only a floor, walls, and a roof; there were no windows, doors, plumbing, lighting, and heating facilities. However, they served the purpose of shelter, which was a point of paramount importance. During the last six months of 1918 the construction work progressed fairly satisfactorily, and by December 1 the first half of the center was practically 100 per cent completed, and in the second half, units 15, 16, 12, 13, and 11 were partially completed, were occupied, and cared for a full quota of patients. The construction of the five remaining units was stopped with the signing of the armistice.


582

The water supply at first was obtained from a well, which soon dried, necessitating the use of water from the highly contaminated Mazon Creek, which required the utmost care and supervision as to proper chlorination before using. This continued until the latter part of October, 1918, when the supply was augmented from the Loire River. In the latter part of November all water was supplied by the pumping station on the Loire, with chlorination at the source.

The sewerage system emptied into a clarification tank, constructed of reinforced concrete, on the banks of the Loire about 2 miles from the center. The construction of the sewerage system was very slow, and it was late in November before any of the units in the first half of the center had sewerage connections.

FIG. 113.-Rock quarry, used in construction of Mesves hospital center

The latrines of the center were operated on the pail system. Five Horsfall destructors and a central destructor were in operation until January, 1919, when each hospital unit was supplied with a brick feces destructor. Some garbage and wastes were disposed of by contract to civilians; the remainder being destroyed in the central destructor. Later a type A hospital incinerator was constructed in each unit.

At first only one disinfector, American Sterilizer Co. type, was available; however, in August, 1918, two Thresh disinfectors were received, and these by constant use took care of all disinfections. In December there were 4 portable and 4 Thresh disinfectors in use.

The lighting system consisted of two 25-kilowatt General Electric sets and one 50-kilovolt-ampere steam-driven plant. A
permanent lighting system


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was installed December 10, 1918, furnishing current of 110 volts to all buildings throughout the center and 220 volts to X-ray and operating buildings.

UNITS

On June 15, 1918, the commanding officer of the center arrived. On June 23 the crew of Hospital Train Unit No. 26, consisting of 2 officers and 31 enlisted men, arrived, and were immediately assigned to work on unit 1, making it ready for the reception of patients. On June 26, 6 officers and 60 enlisted men, comprising Convalescent Hospital Unit No. 2, arrived at Pougues-les-Eaux and were assigned to the newly leased hotels at that place. On this date Convalescent Depot Unit No. 1 (the only one ever organized), consisting of 2 officers and 5 enlisted men, also arrived. This constituted the Medical Department personnel until July 18, when the Sanitary Squad No. 2, consisting of 1 officer and 26 men, reported for duty. On the 23d the crew of Hospital Train Unit No. 35 arrived.

The following organizations constituted the Mesves Hospital Center:

MEDICAL

Sanitary Squad No. 44.
Sanitary Squad No. 50.
Sanitary Squad No. 78.
Sanitary Squad No. 80.
Hospital Train Unit No. 35.
Provisional Base Hospital Unit No. 3.
Provisional Base Hospital Unit No. 8.
Base Hospital Unit No. 44.
Base Hospital Unit No. 50.
Base Hospital Unit No. 54.
Base Hospital Unit No. 67.
Base Hospital Unit No. 72.
Base Hospital Unit No. 86.
Base Hospital Unit No. 89.
Base Hospital Unit No. 108.
Evacuation Hospital Unit No. 24.
Evacuation Hospital Unit No. 27.
Evacuation Hospital Unit No. 29.

ENGINEERS

Detachment 109th Engineers.
Engineer Train Unit No. 109.
Detachment 521st Engineers.
Detachment 529th Engineers.
Casual Engineers Detachment.

QUARTERMASTER CORPS

Quartermaster Detachment.
Detachment Bakery Company No. 2.
Detachment Bakery Company No. 314.
Detachment Butchery Company No. 328.
Detachment Laundry Company No. 323.
Detachment Laundry Company No. 324.
Pack Train Company No. 329.

ARMY SERVICE CORPS

Administrative Labor Company No. 2.
Administrative Labor Company No. 26.
Administrative Labor Company No. 28.
Administrative Labor Company No. 90.
Administrative Labor Company No. 91.
Administrative Labor Company No. 134.
Administrative Labor Company No. 182.

MOTOR TRUCK COMPANY

Motor Truck Company No. 543.

MILITARY POLICE

Military Police Company No. 223.
 

ADMINISTRATION

HEADQUARTERS

The commanding officer established his headquarters in a set of buildings known as the central administration group, and from here the entire administration of the center was accomplished. The work was, as rapidly as possible, divided into departments, and an officer assigned in charge of each.


584

The officers composing the staff of the commanding officer and many of their assistants, were taken from the various organizations within the center. This personnel lived in buildings provided for this purpose in the administration group. The enlisted men composing the headquarters detachments were secured from various sanitary squads, hospital train units, and casuals, ordered to the center. These organizations, upon arrival, immediately lost their identity as such and were amalgamated into the headquarters detachment.

Each organization in the center was allowed absolute freedom in administering its own internal affairs, subject to existing regulations. Policies affecting the entire command were controlled by the commanding officer of the center.

SANITARY OFFICER

In addition to the center sanitary officer, each unit had a sanitary officer, who was directly accountable to his unit commander but cooperated with the center sanitary inspector. The center sanitary officer maintained a shop where sanitary appliances were made and repaired

QUARTERMASTER

The office of the center quartermaster was established July 13, 1918, with 1 officer and 5 enlisted men. The personnel was augmented gradually until early in January, 1919, when it reached maximum strength of 500 officers and enlisted men and 600 laborers. The office eventually comprised the following divisions: Personnel, finance, property, subsistence, bakery, laundry, and salvage sections, and center purchasing agency.

MEDICAL SUPPLY DEPOT

This depot was organized in August, 1918. The major portion of the medical supplies was received in carload lots from base storage stations and the larger central depots, ranging from 10 to 15 cars per day. A spur track permitted placing cars of supplies alongside the warehouse.

RAILROAD TRANSPORTATION SERVICE

This office was inaugurated on August 1, 1918. In addition to numerous clerks and messengers, an engineer, fireman, conductor, and two brakemen were added to operate the center switch engine. During its existence this office handled 3,500 cars. In addition, 86 hospital trains were handled between August 1, 1918, and January 1, 1919, and 1,600 transportation orders were issued.

MOTOR TRANSPORTATION DEPARTMENT

This department was organized in the latter part of September, 1918, when all transportation of the center was placed in a pool under direct control of the motor transport officer. The transportation consisted of 127 trucks, ambulances, and other vehicles.

RECEIVING AND EVACUATION SERVICE

On arrival of a train at the Mesves station, the center receiving and evacuating office was so notified by the railroad transportation office. Messages, stating the number and kind of cases, were sent immediately to hospitals


585

of the center that were to receive patients. The motor transport officer was also notified as to the number of the train and the prospective disposition of the patients in hospitals. The assignment of patients to hospitals was gauged by the kind of cases being received.

Up to January 1, 1919, 86 hospital trains arrived at the center, with a total of 31,912 patients. Seventy-two of these trains came directly from the evacuation hospitals at the front, arriving in an average time of 28 hours. In addition to these patients brought by the hospital trains, a great many convalescents and slightly sick and wounded were received from near-by hospitals. Upon arrival, patients were classified into class A, B, C, or D.

Prior to October 1, 1918, all evacuations, except class D, were made from the convalescent camp, transfers to the camp taking place informally by returning men to duty status from the hospital in which they had been treated. After October 1, all class A and permanent class C men were evacuated directly from hospitals, and class B and doubtful class C cases were sent to the convalescent camp. Class D patients were transferred to the base ports. Up to January 1, 1919, the center evacuated a total of 28,456.

MEDICAL INSPECTOR

This department was opened December 20, 1918. Its object was constructive criticism and the rendering of assistance in the various departments of hospitals. Particular attention was directed toward the administration work of the organizations.

MILITARY POLICE

As regular military police were not available, a company was formed from class A patients, and an officer for them was detailed from the Engineer regiment. In addition to this company a traffic police detachment was organized, consisting of 70 men under the direction of the fire marshal. The latter were employed in policing, fire prevention, and as watchmen over quartermaster and medical supply depots.

PROFESSIONAL SERVICES

MEDICAL SERVICE

The original conception of the center called for 20 hospitals, with a crisis expansion capacity for a total of 40,000 beds. Such an immense plant necessarily presented broad opportunities for classification of cases, and although but little over half the number of patients originally intended were sent there, the scheme of differentiation of the medical cases was maintained throughout. The patients with pneumonia and severe infectious diseases were sent to specified units; patients with influenza, gastrointestinal diseases, and gas poisoning to another group, while in a third group the slightly ill were collected.

The distinctively influenza hospitals were cubicled. When shortage of sheets was imminent, newspapers were employed most usefully to replace them. Isolation was carried out, and incipient cases of pneumonia were transferred promptly to the near-by pneumonia units.

The usual group of contagious diseases was divided between two hospitals. Diphtheria, scarlet fever, measles, and mumps were treated in one, and epidemic


586

meningitis and typhoid fever in another. The grouping of other diseases gradually took place.

An organization for control of diseases at the hospital center at Mesves was a board consisting of the chiefs of medical and laboratory services and the sanitary inspector, who met informally from time to time and devised preventive measures, as required.

OPHTHALMOLOGY AND OTOLARYNGOLOGY

A consultant in otolaryngology was appointed in October, 1918. Each hospital in the center had on its staff a qualified specialist in these branches, who cared for the cases within his own unit.

MAXILLOFACIAL SURGERY

In October, 1918, a consultant for the center was appointed. He had direct supervision over all maxillofacial cases and determined whether or not the personnel of the hospital where these cases were under treatment was capable in every way to care for them, and ordered the transfer of any cases that needed special care to the unit particularly designed for that purpose. A central dental laboratory was established and operated under the direction of the consultant. All available material and apparatus for the construction of splints and appliances was grouped in this laboratory.

ORTHOPEDIC SERVICE

A consultant in orthopedic surgery for the center was appointed the latter part of August, 1918. At this time two hospitals were selected for the reception of orthopedic cases, but later it proved necessary to take over certain wards in all other hospitals. The admission of fracture and joint cases was so great in October that it became necessary to establish 16 fracture wards in various hospitals. Owing to the fact that it was necessary to change dressings on all these cases on admission, it was impossible for the ward surgeon to adjust splints, erect Balkan frames, and apply extensions, so a splint team was organized, consisting of 1 medical officer, 1 sergeant, and 1 private. As soon as a ward began receiving
orthopedic patients this team was set to work erecting frames and suspending the cases. Usually this work would be done for all the urgent cases in a day.

In a latter part of October a curative workshop combined with a splint shop was opened. During its existence 658 special splints were manufactured. At this time six reconstruction aids in physiotherapy arrived and were assigned to duty in the fracture wards.

LABORATORY SERVICE

The center laboratory was opened August 3, 1918, its work being outlined as follows: (1) Special pathology (gross and microscopic); (2) special bacteriology (pneumococcus typing, typhoid and dysentery); (3) serology (agglutination and complement fixation reactions); (4) general board of health for center (water analysis, carrier work); (5) preparation of media, purchase and requisition of supplies.

All laboratory supplies arriving in the center (except those of Base Hospital No. 44, at Pougues-les-Eaux) were invoiced to the central laboratory officer and issued by him on memorandum receipts to the several unit laboratories.


587

CONVALESCENT CAMP

On July 17, 1918, a temporary convalescent camp was established in the crisis expansion tents of one of the base hospital units. The first convalescent patients were received on July 19. The construction of the permanent convalescent camp began on July 28, near Bulcy, northeast of the center. The camp was occupied on August 7, before any of the permanent buildings were completed.

The personnel at this time consisted of commanding officer, adjutant, mess and supply officers, 2 medical officers, commanding companies, 1 convalescent line officer, and 35 men from Hospital Train Unit No. 35. By August 30, there were 1,030 convalescents in camp, and 131 tents had been erected, each accommodating 16 men on cots. The administration building, officers' quarters, and mess and kitchens were partially completed and occupied. On September 19, Convalescent Camp Unit No. 4, consisting of 9 officers and 90 men, arrived, and the patients, now numbering 1,800, were organized into 6 companies. One medical officer was assigned to each company.

Admission and evacuation to the camp occurred almost daily, the admissions always being larger, leaving an increasing balance in camp, until November 10, 1918, when the greatest number (2,859) was reached.

THE AMERICAN RED CROSS

In the early days the work of this organization consisted of distribution of extra comforts in the wards, letter writing for patients, and searching work. Later, 10 recreation halls were opened, equipped with stages, furniture, and canteens. In addition to these, an especially large hall was equipped at the convalescent camp. Also, halls were opened for the Red Cross personnel, nurses, and others. Daily entertainments were furnished by six moving-picture machines and various theatrical productions.

YOUNG MEN'S CHRISTIAN ASSOCIATION

The Young Men's Christian Association provided a number of lectures, musicians, and vaudeville artists. Baseball outfits, footballs, and basket balls were also furnished.

CLOSURE

The center ceased operating in April, 1919, and was closed in May, 1919.
 COMMANDING OFFICER

    Col. Henry C. Maddox, M. C., June 15, 1918, to August 16, 1918.
    Col. William H. Moncrief, M. C., August 17, 1918, to January 30, 1919.
    Col. Guy V. Rukke, M. C., January 31, 1919, to closure of center.

HOSPITAL CENTER, NANTESl

The hospital center at Nantes was organized July 29, 1918, at Doulon, a suburb of Nantes. One base hospital unit (No. 34) was located at Nantes, about 3 miles from the center proper. The group originally consisted of three

lThe statements of fact appearing herein are based on the "History of the Nantes hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


588

base hospitals, Nos. 34, 38, and 11, and to these, on November 2, 1918, was added Base Hospital No. 216, which had been organized from personnel in the center. During January, 1919, Evacuation Hospitals Nos. 36, 31, and 28 relieved the three original base hospitals. In addition to the above units, the following organizations served in the center: Sanitary Squads Nos. 39 and 59 and Ambulance Company No. 346.

Water was obtained through the city of Nantes from the River Loire, and proved to be of good quality. Sewage was emptied into the River Loire, after having first passed through a septic tank. Waste material was disposed of in two type A incinerators constructed by the engineers.

The laundry at first was handled by contract, but as this proved unsatisfactory, small hand laundries were installed in each unit and operated by civilian laundresses.

ADMINISTRATION

The headquarters staff comprised the following divisions: Adjutant, quartermaster, sanitary inspector, evacuating officer, laboratory officer, fire marshal, medical supply officer, and guard officer. The commanding officer in no way interfered with the internal administration of the units; his relations with the hospitals concerned chiefly matters which were outside the jurisdiction of the hospital commanders. The office of the group quartermaster was established on August 15, 1918, and a subsistence and sales commissary on October 15. Supplies were easily procured as the quartermaster depot of base section No. 1 was within 4 miles of the center, and all requisitions were promptly filled. The medical supply depot was not fully established until October 15, 1918. Supplies were usually received from intermediate medical depot No. 2, Gievres, and base medical storage depot, St. Nazaire. The center laboratory occupied a type A barracks and a subsidiary laboratory building, 20 by 40 feet. The addition, connected with the main laboratory building, contained an ice chest and autopsy and tissue rooms.

The duties of the evacuating officer comprised: (1) Receiving all patients arriving at the hospital center, and by the use of bed reports from the various hospitals directing them to the proper hospitals for admission; (2) file and rendition of reports showing the number and nature of cases of patients in the various classes in the center; (3) receiving and executing through the unit evacuating officers, the regulations and orders relative to the evacuation or final disposition of all cases.

Prior to the arrival of a hospital train the evacuating officer was invariably notified by telegram or telephone. Sixteen ambulances were kept available at the center for the evacuation of patients from hospital trains. These trains were sidetracked at the Doulon station, less than five minutes' drive from the center. The patients on arrival at receiving wards were served hot chocolate and other nourishments by the American Red Cross.

Evacuations to the United States were made through one hospital unit (Base Hospital No. 216) which was designated as the embarkation or evacuation hospital for the center. Certain wards of that unit were set aside as embarkation wards, and an embarkation office was opened, in charge of an officer, assisted by an experienced clerical force. Each day this office notified


589

the various hospitals of the center the exact number of patients expected from them on the following day. Before transfer to the embarkation department these cases were paid, their records completed, they were equipped as for transfer to any other hospital, furnished with wound and service chevrons and certified as free from venereal or contagious diseases and vermin. Upon admission to the embarkation department, they were organized immediately into convalescent detachments of 50 or more, all their records checked and corrected, their money exchanged for United States currency, and the passenger lists prepared.

Upon receipt of requisition for convoy of certain numbers of patients the center evacuating officer made arrangements with the local railway transport officer as to the hour of loading, necessary baggage cars, etc., and also notified the local representative of the inspector general's office of the number of patients to be evacuated and the time that patients' records and equipment would be ready for final inspection, which was held not more than 24 hours prior to entraining. After the final inspection, detachment commanders receipted to the evacuation officer for the patient's records and equipment, and patients were again checked on board the hospital train by passenger lists.

CONVALESCENT CAMP

The camp was opened on November 7, 1918, and was operated by Convalescent Company No. 5. Seventy-two marquee tents, with a bed capacity of 1,000, were provided for the housing of patients. The camp functioned from November 7, 1918, to January 9, 1919, during which time it admitted approximately 1,500 patients. About 30 per cent of these were restored to class A and returned to their organization.

CLOSURE

The hospital center was abandoned and ceased to function on June 8, 1919.

COMMANDING OFFICER

    Col. Thomas J. Kirkpatrick, M. C., July 29, 1918, to March 16, 1919.
    Col. Ralph C. DeVoe, M. C., March 17, 1918, to June 8, 1919.

HOSPITAL CENTER, PAUm

A hospital center at Pau was authorized on September 3, 1918. It was planned that this would be located in hotel buildings in several widely separated towns in the Department of Basses-Pyrenees, near the Spanish border. Nearly a month was required for inspection of the properties offered by the French, and not until October 16, 1918, were headquarters of the center opened at Pau. Personnel and supplies had begun to arrive at the time the armistice was signed.

Four hospitals reported to the center during December, 1918. These were located as follows: Base Hospital No. 71, Pau; Base Hospital No. 98, Lourdes; Evacuation Hospital No. 20, Dax; Evacuation Hospital No. 29, Bagneres-de-

mThe statements of fact appearing herein are based on the "History of the Pau hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


590

Bigorre. These hospitals never functioned, as orders were received on December 30, 1918, to abandon the center and the various organizations were ordered to other stations.

COMMANDING OFFICER

    Col. Adam E. Schlanser, M. C.

HOSPITAL CENTER, PERIGUEUXn

The hospital center at Perigueux was located in the valley of the Isle River on both its banks, about 1½ miles above the city of Perigueux and about 90 miles east of Bordeaux. The center was organized on September 16, 1918, and the following organizations were attached: Base Hospital No. 84, Base Hospital No. 95, Administrative Labor Companies Nos. 147 and 148, Motor Truck Company No. 523, Sanitary Squad No. 75, Regimental Band, 136th Infantry, Bakery Company No. 316, and half of Convalescent Company No. 12.

The roads in the neighborhood of this center were excellent. Buildings occupied consisted of new construction distributed according to the type A plan for base hospitals. Construction was of concrete throughout except nurses' and enlisted men's barracks, which were built of wood. Five units were planned for this group, two on the south side and three on the north side of the river, but only the two units on the south side of the river were completed and occupied when hostilities ceased.

Water was obtained from the Perigueux city supply, and was chlorinated at the pumping station, two enlisted men being stationed at the pumping station to supervise chlorinating the apparatus. In general the supply of water was abundant, though occasionally difficulty was experienced for a few days at a time. Separate lavatories and baths were provided for patients, personnel, officers, and nurses connected with the sewerage system through a septic tank. Garbage was readily disposed of to farmers, but it was found more profitable to buy pigs and feed them the garbage. Two Horsfall destructors were erected. They proved ample and satisfactory and were economical of fuel.

The operating pavilion was heated by steam; all other buildings were heated by stoves. Coal was shipped from Bordeaux and there never was a shortage. Wood was also provided in sufficient amount. Until November 20, 1918, all electricity was furnished by a local generator and after that date, from the city supply.

The various messes of the center were coordinated under the management of a center mess officer. This permitted various economies and a more intelligent use and division of the supplies which were obtained by the quartermaster from Bordeaux. A central butcher shop was installed from which all organizations drew their meat, properly cut. A bakery company was established in tents and made excellent bread. After this organization left, the source of bread supply was Bordeaux, but this was not dependable. A laundry was constructed early, but machinery was not obtained until after the armistice
 

nThe statements of fact appearing herein are based on the "History of the Perigueux hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


591

began. Until then it was necessary to send laundry to the Beau Desert hospital center in trucks and ambulances, a circumstance which did not allow frequent changes of linen.

The first hospital train arrived October 18, 1918, and up to March 1, 1919, 4,558 patients were received from 9 trains. Early in January the center was designated as an orthopedic center, and 10 orthopedic surgeons reported for duty. Evacuations were made by Hospital Train No. 68 to the Beau Desert hospital center. This group was discontinued in May, 1919.

COMMANDING OFFICER

Col. Edward G. Huber, M. C.

HOSPITAL CENTER, RIMAUCOURTo

The hospital center located at Rimaucourt, Haute-Marne, occupied new structures consisting of five type A base hospital plants, supplemented by buildings to house the center staff. A railroad spur of three tracks was built into the center, and hospital units were aligned along both sides of this spur.

The normal bed capacity of the wards was 5,000, but by erection of Marquee tents this was more than doubled. On November 11, 1918, the center reported 10,338 available beds for patients and 1,675 personnel. A convalescent camp and five additional sections were under construction when hostilities ceased.

The water supply was excellent and ample. A 50,000-gallon reservoir was built on a cliff about 1,000 yards from the camp, and two electric engines pumped all the water that could be used. A system of plumbing conducted this supply into nearly every building of the group.

A sewer system emptied all kitchen and bath wastes into a canal about 2,000 yards distant. Bucket type latrines were used in connection with Horsfall incinerators.

Electricity for illumination was obtained from a local French plant, supplemented by a small gas-operated electric machine that was provided for each unit.

One bakery capable of baking for 20,000 men and one laundry able to care for a like number were also provided.

The following organizations composed the center: Base Hospitals Nos. 52, 58, 59, 64, 238; detachments, Quartermaster Corps, bakery company, butchery company, laundry company, Motor Transport Corps, and labor battalion.

The headquarters were organized into administrative and professional staffs. The administrative staff consisted of the adjutant, quartermaster, medical supply officer, sanitary officer, assistant provost marshal, post-office officer, food conservation and kitchen technique officer, and railway transport officer.

The professional staff consisted of a staff consultant, consultants in general surgery, neurosurgery, orthopedics, oroplasty, urology, ophthalmology,

oThe statements of fact appearing herein are based on the "History of the Rimaucourt hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


592

otolaryngology, X ray, dentistry, neuropsychiatry, dermatology, laboratory, and pathology. The staff consultant had no administrative power. His duties were (1) to coordinate with the visiting consultants and to present his recommendations to the center commander; (2) to advise and keep the center commander informed about every professional question and to act as his medical inspector; (3) to advise changes in personnel so as to group specialists where their services were needed, and to report any excess of personnel; (4) to arrange through base hospital commanders, by mutual consent, such transfer of patients and personnel as might be desirable without the necessity of issuing orders to accomplish this result. Upon receipt of notification of the arrival of a hospital train, the staff consultant requested all hospital commanders to require such officers as were desired to report to him for orders. The staff consultant and evacuation officer then decided where to "spot" the train and gave necessary instructions to the rail transportation officer. As soon as the train arrived the staff consultant assigned to each of three or more cars, suitable teams of medical officers. These officers decided to which hospital each patient was to be sent and gave him a slip of paper bearing that number. The litter-bearer section followed the officers and evacuated the train. Walking cases were not permitted to walk from the train to the hospitals, but were transported in trucks.

Each commander of a base hospital kept two wards open for receiving purposes. All beds in these wards were cubicled and all persons on duty therein wore masks. As soon as admissions began, the surgeons in these wards began the secondary triage, sending to the registrar and the disinfecting station all cases ready for final disposition. At this triage, if it was found, for example, that a man had been admitted to the respiratory infection hospital when he should have been admitted to the gas hospital, the staff consultant was notified and transfer was effected.

The number of patients admitted to the center from date of opening on September 14, 1918, to January 28, 1919, was 18,308. The center was discontinued in May, 1919.
 COMMANDING OFFICER

    Col. Henry Page, M. C.

HOSPITAL CENTER, RIVIERAp

The origin of the Riviera hospital center was an urgent need for a location for hospitals that would give the maximum hours of sunshine and clear skies, even temperature, and the most stimulating atmospheric conditions within practicable distance of the advanced areas. This was found in that strip of coast line extending from Marseille to Menton, called the Cote d 'Azure, or Riviera, about 180 miles in extent, 5 to 10 miles in depth, facing the Mediterranean Sea and sheltered by the Maritime Alps. Rainfall was limited and the climate mild rather than hot. Aerial bacteriology was low and the general atmospheric condition partook of the mingling of marine and mountain air. It

pThe statements of fact appearing herein are based on the "History of the Riviera hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


593

was too far from the scene of active operations to receive cases of recent injuries or acute illness, and therefore all cases received were patients who had so far recovered as to be able to stand a long journey. The center comprised all the hospitals along the north coast of the Mediterranean from Toulon to the Italian border, and functioned as a group of convalescent hospitals. The number of these hospitals was 29.

The hospitals established by the American Expeditionary Forces were located at Tamaris, Hyeres, St. Raphael, Cannes, Nice, Cap d 'Ail, and Menton. In each of these places commodious hotels were leased and changed to hospitals fully equipped as regards both personnel and furnishings for the accomplishment of the most modern work in medicine and surgery. A certain number of acute medical and surgical cases developed among those who were on leave or stationed in the area, and hospital equipment took cognizance of that fact. All hospitals were established in hotels and no new construction was attempted. Garage and warehouses were rented for purposes of supply.

Acquisition of hotel properties began in July, 1918. By September 1, accommodations for 9,000 beds had been secured and by November 1, 1918, 12,000. On November 11, requests for locations for 6,000 other beds which previously had been made were canceled.

The geographical location of hospitals made it advisable to establish five groups, with one hospital in each group for acute medical and surgical cases, and the remainder in each group for ambulant cases requiring but little treatment or professional observation. Each group was organized as one hospital for purposes of admission, transfer and discharge, and general administration. Each building had its own personnel with a responsible administrative officer under the group commanding officer.

Group 1.-Hyeres, Department of Var (including Tamaris), consisted of 9 hotels, with a total capacity of 3,600. This group was first designated Convalescent Hospital No. 1, but on arrival of Base Hospital No. 99, on November 26, 1918, the designation was changed to that of the base hospital.

Group 2.-St. Raphael (including Agay Var) consisted of 3 hotels, with a total of 800 bed capacity. It was known as Convalescent Hospital No. 2 and was staffed by casual personnel. It opened January 4, 1919, and closed January 31, 1919.

Group 3.-Cannes (including Antiles) consisted of 5 hotels, with 1,450 beds, and was known as Convalescent Hospital No. 3. On December 22, 1918, this group was taken over by Base Hospital 93.

Group 4.-Nice (including Cap d'Ail) consisted of 3 hotels, with 2,300 beds, and was known as Convalescent
Hospital No. 4.

Group 5.-Menton consisted of 9 hotels, with 2,700 beds. This group was first started with casual personnel and was known as Evacuation Hospital No. 5. From December 23, 1918, to February 13, 1919, Evacuation Hospital No. 49 operated this group. The headquarters of the entire center were located at Cannes, A. M., the organization being as follows: Commanding officer, adjutant, personnel adjutant, urologist, historian, medical supply officer, group supply officer, and motor transport officer.


594

The records of the Riviera center embodied the daily, weekly, monthly, and quarterly reports received from each unit commander throughout the center. Reports were transmitted daily by the various units by a system of couriers on motor cycles. This system, in conjunction with the telephone and telegraph, was the main factor in the administrative control of the area and made it into a compact unit, reducing the 220 km. which separated the farthest situated groups from each other into a center linking all the groups together. Under its efficient service the great distances were minimized, and daily contact was maintained by headquarters with each group and by all groups with one another.

FIG. 114.-Base Hospital No. 99, Hyeres, Riviera hospital center

Patients were received from November 7, 1918, to April 1, 1919, a total of 13,975 cases being admitted during this period. Patients were classified by a disability board appointed for each unit by the commanding officer of the center. Hospital trains were provided for transporting discharged patients. Those for home ports were shipped direct to embarkation ports, others to duty or special hospitals, as the case called for.

The exercise and training of men partially disabled through wounds received in battle were under the supervision of the commanding officers of the various units. Voluntary movements were insisted upon, which, with the aid of massage and use of electrical instruments, greatly aided in restoring parts, the use of which would have otherwise been lost.


595

Railroad transportation officers were assigned to Hyeres, Cannes, and Nice on December 15, 1918, and handled all transportation for the personnel, patients, and supplies for the hospitals. Men from the different rail transportation offices met the incoming and outgoing trains and did all that was possible to assist members of the American Expeditionary Forces while traveling on the Riviera. Practically all patients were handled on regular United States Army hospital trains. Thirty-four of these trains arrived during the period the center was open. These trains parked at La Bocca, just west of Cannes, where they were resupplied. When receiving patients, they were "spotted" at Cannes, and patients from Menton
and Nice were transferred to that place for evacuation. The trains for Base Hospital No. 99 were switched at Toulon and "spotted" directly to Hyeres.

FIG. 115.-Base Hospital No. 93, Cannes, Riviera hospital center

Medical supplies for the center were received on requisition from the supply depot at Cosne, Maramis, and the depot of base section No. 3. At first, because of congestion of railroad transportation, supplies were often delayed (the opening of this center had been delayed by inability to procure supplies), but in February, 1919, a medical supply depot was established at Cannes, and thereafter local requisitions of hospitals were filled promptly.

The Quartermaster Department began to function on October 29, 1918, with headquarters at Cannes. A suitable warehouse was leased at the latter place and a depot established. Later, four subdepots were established for the needs of the entire hospital center. At the beginning of the center the quarter-


596

master operated the post office and railway transportation until these activities increased to such a great extent that a regular post office and a rail transportation office were established. Repairs and improvements to hotels were made under the engineer officer.

The American Red Cross attached workers to all the groups, where they promoted the welfare of all persons in the center.

After November 11, 1918, properties were gradually returned to their owners or made into accommodations for leave areas. No patients were received after April 1, 1919, and evacuation began May 1, 1919, the personnel leaving the whole area June 1, 1919.

FIG. 116.-Evacuation Hospital No. 49, Menton, Riviera hospital center

COMMANDING OFFICER

    Col. Haywood S. Hansell, M. C., September 12, 1918, to April 28, 1919.
    Lieut. Col. Leopold Mitchell, M. C., April 29, 1919, to June 2, 1919.

HOSPITAL CENTER, SAVENAYq

The hospital center of Savenay was located in the city of that name, about 18 miles northeast of St. Nazaire. Its construction was authorized by the commander in chief in February, 1918, and was to consist of 15 type A base hospital units and 1 base hospital in the normal school of Savenay, which had

qThe statements of fact appearing herein are based on the "History of the Savenay hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


597

been in operation since August 21, 1917. A convalescent camp, the so-called type C hospital, was also authorized, with a capacity of 5,200 beds. The center was organized on August 5, 1918, when the commanding officer of Base Hospital No. 8 was also appointed commanding officer of the Savenay center. On that date his staff consisted of an adjutant, quartermaster, evacuating officer, and a sanitary officer. Later the organization of the center headquarters was as follows: Commanding officer, executive officer, adjutant's department (2 assistant adjutants), evacuation officer (1 assistant), receiving officer (2 assistants), personnel adjutant (1 assistant), service record division, inspector (3 assistants), maintenance officer, sanitary inspector (4 assistants), center laboratory officer (3 assistants), medical supply officer (1 assistant), motor
transport officer, hospital train replenishment depot, orthopedic consultant (2 assistants), dental supervisor, historical officer, athletic director, entertainment director, disability board, quartermaster (8 assistants). Adequate elements of the center staff were kept on duty during the night so that there was no interruption of its central service.

FIG. 117.-Airplane view, Savenay hospital center

The following Medical Department units formed the center: Base Hospitals Nos. 8, 29, 88, 100, 113, 118, 119, 214, Hospital Unit F, field hospital company, Ambulance Company No. 345, 87th Division. The eventual capacity of the center was to be 25,000 beds. This program was never fully realized because of the termination of hostilities.

All the unit buildings which were built by the United States Engineers consisted of demountable sectional barracks and plaster-block structures. To build and maintain the unit shops were established, a garage, stable, and two large freight yards were built. Several miles of standard-gauge track were


598

constructed and spur tracks laid to connect the various units of the center. About a mile and a half of roads were built in the units. Each unit was connected by telephone with a central exchange, installed by the Signal Corps.

Electric power was obtained from a French producer at St. Nazaire. Each unit of 1,000 beds had a 50-kilowatt capacity, the convalescent camp 25-kilowatt, and the tuberculosis camp 5.

During the early days of the center most of its important work was carried on by Base Hospital No. 8, which was the first unit assigned to this center. As each new hospital unit was constructed and made ready for patients, it was given a number as a unit of Base Hospital No. 8, and its activities were carried on that hospital's records until personnel of a base hospital arrived from the United States to continue its functions. Thus, when a new unit reported for duty it was assigned to take over some provisional hospital already operated by Base Hospital No. 8.

The shortage of water was very serious until a dam was constructed. This dam, of reinforced concrete, was built across a small valley between two hills, forming a reservoir, which had a total capacity of about 140,000,000 gallons. It was completed April 10, 1918. An additional reservoir was planned and built, but due to the signing of the armistice was never used.

Sewerage for the service of three units was taken care of by an Imhoff type tank. In the units not having sewerage connections the contents of latrine pails were collected each day in cans by prisoners of war, and carried by truck to a gravel pit.

Clothing and equipage were difficult to obtain during active operation, but after the armistice this shortage was relieved. An excellent laundry was in operation, which averaged 450,000 pieces of laundry per month. A modern bakery was constructed which supplied all bread for the center. From October, 1918, to March, 1919, this bakery produced 5,094,438 pounds of bread.

The medical supply depot was instituted on September 12, 1918. This organization completely equipped and maintained all the hospital units in the center, served as a base of supply for all hospital trains entering that area, and furnished medical supplies for prisoner of war companies and engineers doing duty near the center.

The location of Savenay, within one hour by rail of the port of St. Nazaire, and only seven hours from Brest, made it particularly important as an evacuation center.

The problem of receiving and admitting patients to the hospitals of this center was at first handled by a receiving officer from each hospital in rotation, each assuming the work for a definite period of one or two days, and then being succeeded by the receiving officer of the hospital next on the list. Since the functions of certain of the hospitals of this center were of a special character (e. g., Base Hospital No. 88 cared for all venereal cases, Base Hospital No. 118 all cases of tuberculosis, and Base Hospital No. 69 the very seriously wounded litter cases), it was always necessary that a classification of the patients be made upon arrival of each hospital train. A more satisfactory system was finally developed when a center receiving officer, with 2 junior officers and 8 enlisted men, was appointed. The receiving officer met the incoming trains, with such


599

a number of men that one could be assigned to each car. The receiving officer went through the train, inspected the field medical card of each patient, and decided to which hospital he should be sent. With the officer a sergeant was in attendance, carrying a box of tags of various colors, each color representing a different hospital. When the officer decided to which hospital a patient should be assigned, the sergeant tagged him accordingly.

While this work was going on, the men assigned to the several cars of the train made a nominal list of every patient, showing rank, serial number, diagnosis, hospital of origin, and hospital to which assigned at Savenay. These lists were then turned in to the records office of the hospital center in order that admission cards might be made for file and other purposes of record. The greater percentage of patients arriving at the Savenay hospital center came on hospital trains, but there was always a certain number coming by way of trench trains of the regular passenger service type, and also some who came by  motor transportation. Also some were admitted from the personnel of the center. All of these patients, no matter from what route admitted, were required to pass through the center receiving office in order that they might properly be classified and
assigned, and in order that record might be made of their admission in the center records office.

Each hospital of the center also maintained its own receiving office, but the receiving officer of any of these hospitals was not allowed to accept a patient until he had been through the regular channel of the center receiving office. 

In the early days of the hospital center, all evacuations made from Savenay were handled through Base Hospital No. 8 and passed through the records of that hospital.

Prior to November 11, 1918, all American Expeditionary Forces patients returned to the United States on surgeon's certificate of disability were evacuated through Savenay. Until that date efforts of the Medical Department were directed to sending men back to duty where possible, and large numbers of evacuations were made to the convalescent camp and from that camp back to duty.

After November 11, 1918, instructions were so modified that many patients who under previous rules would have been sent to duty in class B, were returned to the United States.

The evacuation service at the hospital center, Savenay, increased after the armistice began to such an extent that the simple measure theretofore employed proved insufficient, and the work was centralized under the direction of a center evacuating officer. Each hospital, however, retained its own evacuating officer also, and the center, together with the individual units, combined to form one great evacuation hospital. The operation of the system of evacuation now adopted was as follows:

A representative of the base surgeon at St. Nazaire, or at Brest-for evacuations from Savenay were made through both of these ports-on learning that a vessel was ready for hospital service and able to accommodate a certain number of patients, would telephone to the center evacuating officer to the effect that accommodations were in readiness for a specific number of patients of certain types which he specified. He might designate, for instance, that there were


600

accommodations for 30 litter cases, 60 ambulatory surgical requiring dressings, 210 medical and surgical patients in standees, 590 medical and surgical cases not requiring attention, and 20 mental cases requiring restraint. The evacuation officer of the center would call upon the evacuating officers of the various hospital units telling them how many and what class of patients he would require from their respective hospitals. In order that he might know just what he reasonably could call for, a morning report was supplied by each hospital, showing the number and classes of patients ready for evacuation. From these reports the center evacuation officer would know the number and character of patients in each unit ready for evacuation.

As soon as they had received the patients, the evacuation officer of units sent the patients' records to the central evacuation office of the center, in order that passenger lists might be prepared. These lists carried the patients in consecutive numbers for the entire center, giving the quota from each hospital on a separate sheet, and showing at the head of that sheet the organization from which each patient came. It was the duty of the evacuating officer of each hospital to see that the patients whose names were sent in on the passenger lists were fully prepared ready for evacuation in every respect. In order to insure uniformity in evacuation, the following method of procedure was prescribed:

PROCEDURE OF EVACUATION OF PATIENTS FOR EMBARKATION FROM HOSPITAL CENTER, SAVENAY

1. When the number of patients for Brest or St. Nazaire is known, the capacity blank is filled out, apportioning cases to the various hospitals according to the classified morning report of evacuable cases.

2. Determination of number of detachments of ambulatory sick and wounded.

3. Determination of number of officers and attendants needed for officers, nurses, litter cases, and mentals (not formed in detachments).

4. Requisitions:

(1) Records of patients from various hospitals (Form E-l).

(2) Detachment commanders and attendants to be furnished by personnel adjutant (Form E-4).

(3) Hospital train from regulator of hospital trains and supplies, a copy of the requisition to R. T. O., Savenay, also for baggage car (Form E-5).

(4) Requisition patients (Form E-2).

5. Record envelopes to be brought to evacuation center by evacuation officers of several hospitals, and histories and records checked at this time. Check passenger list.

6. Send copies of passenger list to various hospitals and tag patients.

(1) Duty of "taggers" from center to note any colored men tagged and not so marked on passenger list.

(2) To check patients requiring dressings, and see that they are properly tagged. (Exception: Passenger list will be delivered to Base Hospital No. 214, but the patients are not checked or tagged by evacuation center.)

7. Submit data for special orders to orders department.

(1) Patients, officers, nurses, enlisted men.

(2) Data of attendants and detachment commanders to orders department from personnel adjutant at same time it is sent to evacuation center.

8. Notify quartermaster of several hospitals by phone and memo to commanding officers of several hospitals of number of car and place of loading baggage (Form E-3). No baggage to be loaded unless checker is present from the evacuation center.

9. Block out convoy for the several trains on block (Form E-6).

(1) Confer with commanding officer of train as to any reasons for not loading as blocked.


601

10. Loading of train:

(1) (a) Evacuation officers will instruct ambulatory patients before coming to evacuation center to entrain to look for the corresponding number of their little tag, on the block at each stall in the evacuation center; for example, Car A-l, Nos. A-l to A-36. This stall would include all patients numbered A-l up to A-37.

(b) That when they are placed in the stall, to remain there. When going aboard the train remain in the same numerical order to facilitate detraining.

(c) To remain in line and not wander about or lean on rail during inspection, but to cover off in column of twos and stand at attention while being inspected.

(d) To be quiet and orderly and assist in hastening their departure.

(e) That there will positively be no smoking while waiting to entrain.

(2) Load.

11. Record check.

(1) Pull out record envelopes of cross-offs.

(2) Correct Navy copy.

(3) Correct base surgeon's copy.

(4) Correct train commander's copy.

(5) Correct commanding officer of detachment's copy.

(6) Send 16 uncorrected copies of port personnel adjutant with memorandum of serial number of cross-offs on St. Nazaire convoy. (Send only 6 corrected copies to Brest with memorandum to commanding officer, hospital center, Kerhoun, of serial number of cross-offs.)

(7) Send memorandum to Navy officer on second train, giving serial number of cross-offs, if part of a detachment has gone on a previous train.

(8) Place aboard all records of complete detachments loaded. (If a part of a detachment is loaded, all records will go on train on which remainder of this detachment is completed.)

(9) Complete train commander's block of train.

(10) Complete detraining officer's block of train.

(11) Complete senior detachment commander's block of train.

(12) Furnish all information required by inspectors as to detachments and number of patients loaded.

12. Report to orders department exact number of cases leaving on train for telegram when convoy goes to Brest. Call Brest by telephone.

* * * * * * *

The work of the hospital center, instead of decreasing after the armistice began, was greatly augumented because of the closure or contraction of base hospitals farther forward and the evacuation of casualties toward base ports with a view to their return to the United States. Hospitals composing this center were therefore filled. This condition continued until the month of March, 1919, when there began to be some diminution in the number of patients. This center was in effect an evacuation hospital for the American Expeditionary Forces and cleared a much larger number of patients than did any other formation which was engaged in this service.

The following table gives the number of patients evacuated from the hospital center at Savenay, to and including July 31, 1919.

 

St. Nazaire

Brest

Bordeaux

 

St. Nazaire

Brest

Bordeaux

1917

 

 

 

1918

 

 

 

November

3

---

---

January

1,172

2,571

---

1918

 

 

 

Do

3,531

4,205

---

January 

234

---

---

Do

6,410

989

---

Do

83

---

---

1919

 

 

 

Do

239

---

---

January

5,022

3,885

---

Do

350

---

---

February

5,092

5,332

124

Do

202

---

---

March

4,449

6,048

---

Do

384

---

---

April

4,518

4,807

---

Do

90

692

---

May

5,019

3,578

---

Do

35

1,590

---

June

3,140

4,731

---

Do

510

2,680

---

July

60

251

---

Grand total of 82,026 patients to the United States. To duty and replacement through this center, 8,696.


602

The chief consultant of the medical service, under date of letter of June 6, organized teams for treatment of gassed cases. These were designated gas teams and consisted of 1 medical officer, 2 nurses, and 2 enlisted men. August 17 it was decided to use these permanently for treatment of surgical shock and should consist of 1 medical officer, 1 nurse, and 1 enlisted man. On September 5 this designation was changed to emergency medical teams.

Surgical teams were furnished for the front and for hospitals in the center. Infected cases were isolated in tents; also suspects and observation cases. Tent colony plan was for infected cases. Laboratory and X ray was used and many patients were returned to duty. Class D cases were evacuated to the United States. A tuberculosis camp was erected and taken over by Base Hospital No. 118, on January 25, 1919.

ORTHOPEDIC DIVISION

The designation of Savenay as a center through which all orthopedic patients must be sent from the American Expeditionary Forces to the United States had a considerable effect in determining nearly all of the activities in that specialty in this area. An orthopedic department of the surgical division was established in this center in February, 1918. At the beginning Base Hospital No. 8 was called upon to perform such hospital duties as ordinarily fell to a base hospital. In making the first response to demands for convoys to the United States, patients were evacuated in much the same way as from other base hospitals. It was soon discovered, however, that special preparation would be necessary in the case of patients with battle casualties who were to travel to the United States-that at least certain types of treatment must be given beforehand, and that certain provision must be made against discomfort and danger of complications on the way across.

Because of the character of the wounds and the condition in which patients arrived at a point as far from the front line as Savenay, it was subsequently decided by the chief surgeon that special responsibility for these patients should be given to the orthopedic department. The entire policy was not determined at once, but after about August 1, 1918, a detailed scheme was worked out in which the Savenay hospital center had a principal part. Thereafter patients received the treatment necessary and were prepared in such a way that many thousands were transferred with comfort and safety from Savenay to hospitals in the United States.

During August a more comprehensive plan than that which had been in operation theretofore for orthopedic cases was established. A change in policy with regard to classes of patients to be evacuated to the United States was inaugurated. Changes in staff were effected, and it was directed from headquarters, August 20, 1918 (Circular No. 46, office of the chief surgeon, A. E. F.), that the orthopedic department should be responsible for the surgical treatment, corrective and otherwise, of all bone and joint injuries, amputations, tendon injuries or inflammations, flat feet, spine injuries, and general bad posture. The bone and joint injuries included fractures. The orthopedic department was made responsible for the necessary treatment, but more particularly for the adjustment and splinting of all such cases, so that the patients could be transferred to the United States.


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During the first two weeks under the new régime about 400 orthopedic patients had to be splinted and consigned to convoys for transfer.

One effect of this was to exhaust at once the supply of splints available in Base Hospital No. 8. Splints were almost impossible to obtain at the moment, and improvised splints and plaster of Paris had to be used. The situation was greatly ameliorated by the voluntary efforts of a number of the patients who, under the direction of two of the enlisted men of the Medical Department, made hundreds of hand cock-up splints, splints for the support of drop-foot and even the more complicated finger extension and flexion splints and airplane splints.

These splints were made mostly of wood, but the salvage department was called upon to furnish shoes and other necessities. The iron bars of mosquito-bar supports which had been condemned were converted into splints, entirely satisfactory in every way, except that they lacked the finished appearance of the usual article.

Base Hospital No. 8 now accommodated about 3,000 patients. Immediate segregation of orthopedic patients being apparently impossible, one of the first requirements of the department was a system by means of which all such patients could be located and cared for. This was undertaken both for the benefit of the patient and to avoid delay in making up passenger lists for convoys. The four features found necessary to establish in this connection were as follows: (1) The cataloguing and inspection of every orthopedic patient as he entered the hospital; (2) the written opinion of every medical officer on the patients that he saw; (3) the centralized splint and plaster-of-Paris room, to which walking patients were brought for treatment; (4) a card index catalogue with a follow-up system by which recommendations made by medical officers were checked up and controlled until the patient was pronounced fit for transfer.

The first centralized splint room or dispensary, established about September 1, 1918, proved one of the most helpful features. In the course of a few days it reached a capacity of from 30 to 50 patients daily. On one Sunday, after receiving a large convoy, over 100 patients were splinted and had plaster casts applied during the day. Walking patients principally, but also a few cot cases, were brought to the splint room from all the wards and cared for by the surgeons in attendance, as in any dispensary clinic. At this time the number of new orthopedic patients arriving at Savenay was about 70 per day.

From the beginning, patients were rechecked as they were sent to the trains leaving the hospital. Occasional defects in splinting were in this way caught up and remedied as the patients departed. After the first fortnight practically every patient in each convoy had been carefully and adequately splinted, whether for the needs of immediate treatment or for protection during the journey to the United States.

Also, by way of suggestion to medical officers and nurses into whose hands the patients passed on their way home, tags were printed and attached to the splints on the patients' departure from the hospital. The following are given as illustrations:


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Tag 1, for Thomas humerus traction splints:

The arm is to be kept securely bandaged into splint at all times. Only the bandage immediately over the wound is to be removed for dressings. The hand is to be kept in supination and dorsiflexed. The elbow is to be kept at or slightly beyond a right angle.

Tag 2, for Thomas femur traction splints:

Please do not release the traction or lift the leg out of the splint for dressings. Remove bandages only immediately over the wound and keep all others and the traction tight and neat.

The exact methods employed in dealing with patients on admission may best be illustrated by quoting from a circular which was published from the headquarters of the orthopedic department October 15, 1918. The circular was published following the completion of a plan by which an extensive segregation of patients according to diagnosis had been made and the patients placed in groups in special wards. The first special wards to be provided were those for fractures of the femur and for amputations. These were provided during September. The obvious advantages of this plan led to the approval by the commanding officer early in October of a larger plan, by means of which more than 1,400 beds were set aside in Base Hospital No. 8, with special wards for leg fractures below the knee (64 beds), battle injuries of the knee-joint (32 beds), gunshot wounds and fractures of the upper extremities (256 beds), gunshot fractures of the femur (196 beds), and amputations (250 beds), etc.

The following is the plan outlined in the circular issued October 13, 1918, to be used in receiving patients:

(a) Patients will be admitted from the receiving room to wards A-1 to A-15 and to ward 5 in the following groups.

(b) No patients are to be admitted to the B wards. These will be reserved for patients who are ready for transfer to the United States.

A-1 (64 beds): Miscellaneous (for cases in regard to the diagnosis of which the receiving office is in doubt).

A-2 and 3 (98 beds): Amputation cases.

A-4 (32 beds): Knee-joint injuries.

A-5 (64 beds): All injuries of the upper extremities, including shoulder injuries.

A-10, 11, 12 (196 beds): Fractures of the femur. (Femur cases will be evacuated direct from these wards to the train.)

A-15 (64 beds): Foot injuries.

Ward No. 5: Will remain, at present, a ward for miscellaneous orthopedic cases.

On the morning following the patients' admission to Savenay, special buff cards for the orthopedic service will be distributed. They will contain the patient's name, number, unit, date of admission here, and diagnosis. They are to be completed in the manner indicated by the following:

[Sample card]

"Yes" or "No"

    Name, Doe, John. Rank, Pvt.

    Date, Oct. 15/18. No. 1,000,000. Unit, Co. I, 10 Inf.

    Diagnosis G. S. W. left leg with F. C. C. femur and injury to sciatic nerve. (Diagnosis number) 27-31.

    Condition 1, 2, 3, (4). (Notes) No splint. A. B. C, (D). Treatment: Thomas splint.

    (Initials of medical officer.)

    Hospital: 1     2     3.         B. H. 4.

    Condition as to readiness for transfer is indicated by writing on the margin of the card, as follows:

    "Yes," if no treatment is required and case is ready for immediate transfer.


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"No," if splinting is required and case will be ready for immediate transfer after the required splinting is completed.

"No," if prolonged treatment is required to prepare case for evacuation.

Diagnosis numbers are entered in accordance with charts of diagnosis numbers already prepared (an arbitrary code).

Condition: (1) No splint required and wearing none; (2) wearing satisfactory splint; (3) wearing unsatisfactory splint; (4) wearing no splint, but needing one.

A, B, C, D: Classification as to nature of disability.

Hospital: Number of hospital through which patients have successively passed should be entered here, space (3) being for hospital from which cases have been transferred to this center. These slips must be finished and returned to the orthopedic office before noon of the same day. There must be no exceptions to this rule.

Patients admitted during the preceding 24 hours, who are found to require radical changes of splint or other application of new splints, may be sent at once or during the afternoon from 1.30 to 4.30 to the plaster of Paris and splint room, where special medical officers will be on duty to deal with them. The splint or plaster cast recommended should be indicated on the special splint prepared for this purpose and should accompany the patient. In case of doubt, regarding the exact operation or procedure to be used in the treatment of any patient, it is expected that the services of the orthopedic consultant or some one designated by him will be called for. Certain standard methods have been evolved for dealing with these conditions; but in this center, particularly with both treatment and evacuation in mind, careful judgment must be used in order that the best interests of the patients may be served.

During the period of waiting for evacuation for most of the patients and during the stay in the hospital, extensive use is to be made of the services of the reconstruction aides. Walking patients are to have exercise and massage in groups and must be sent to the orthopedic department with special notes as to treatment suggested, at certain hours, as indicated in the following schedule:

(a) Patients with median, musclospiral, and ulnar nerve injuries, 10.30 to 11.30 every morning.

(b) Patients with knee-joint injuries for knee-joint, thigh, or leg massage, 1.30 to 2.30 p. m.

(c) Patients with sciatic, external popliteal, or other nerve injuries of the lower extremities, 2.30 to 3.30 p. m.

(d) Patients with elbow injuries for forearm, hand or finger exercises, 3.30 to 4.30 p. m.

Other reconstruction aides (occupational) will be available for directing the employment of bed patients. Any note directed to the consultant in orthopedic surgery on this subject, as to dealing with the individual patients or wards as a whole will receive prompt attention.

These points with regard to the records of these patients must be strictly complied with:

(a) The admission cards must be completed before noon of the day following the patients' arrival at the hospital, and the cards must be sent to the orthopedic office.

(b) The patient's condition, when admitted, and the first recommendations must be entered the same day on the field medical card so that the field medical cards, as the patients proceed from admitting wards to the evacuating wards, will be complete in so far as Base Hospital No. 8 is concerned.

(d) The orthopedic office must be supplied at 9 o'clock each morning by the medical officer or the nurse in charge of each ward with names, identification numbers, and organizations of all patients admitted to or discharged from the wards, above mentioned, during the 24 hours up to midnight of the day preceding. Lists of the wards will be checked every morning in the orthopedic office as to whether or not these reports have been received, and the reports must be sent before 9 o'clock without fail.

The care of patients with battle injuries was always so large a problem, especially at this center, that it was important to lay aside all personal and departmental considerations. To a large extent this was so successfully accomplished that it was considered one of the principal reasons for much of the work done at Savenay.


606

One of the earliest, as well as one of the most important features of the orthopedic service at Base Hospital No. 8 was the installation of the amputation service. Three principal features were to be noted in the inauguration and development of this service: (1) The treatment of all unhealed stumps by skin traction devices in an effort to preserve the length of the existing stump. This plan did away immediately with many reamputations and contributed greatly to the comfort and welfare of patients with stumps that were not healing properly. (2) The organization of physical training classes. In these men were taught balancing to strengthen the remaining portions of the amputated extremities, and to protect themselves against the tendency toward contracture deformities. (3) The application of provisional artificial limbs to accomplish the immediate replacing of a man on his feet, the exercise and shrinkage of stumps, and the preparation in all other ways of the men for the permanent prosthetic device to be applied upon his return to the United States.

In undertaking to provide provisional artificial limbs for all the patients with leg amputations, the American Expeditionary Forces took an advanced position. The amputation department of Savenay hospital center undertook to apply to every man with leg amputation a provisional artificial limb before he left for the United States. Such limbs were prepared in a manner first popularized by the Belgians more than two years previously and since extensively used by the British. In American hospitals, however, these artificial limbs were fitted earlier and more universally. Ready-made devices were supplied for both above and below knee amputations. These were fitted to the stump by the construction of a plaster-of-Paris bucket. This was made on the patient himself and the mechanical devices were built into the bucket as it was applied. In the case of amputation above the knee, the artificial extremity had a crude knee joint, which enabled the man to bend the leg when he sat down. This was locked without removing the clothing when he arose from a sitting position. During September about 75 of these artificial legs were applied. About October 1, however, the number had grown to average about five a day, and in every convoy a very considerable number of men were being sent with these temporary artificial limbs, upon which they were walking very well.

During the first four weeks of the operation of the orthopedic service, 1,904 patients passed through the department. These were received from about 50 base hospitals, camp hospitals, and other medical organizations throughout France. Thirteen hundred were splint patients, of whom a few more than one thousand had splints readjusted or applied for the first time at Base Hospital No. 8. Five hundred and eighty-one had their splints applied for the first time at this hospital. Twelve hospitals sent more than 100 patients each to Base Hospital No. 8 on their way home to the United States.

Of the 1,904 patients, about 500 had wounds of the upper extremity and about 350 wounds of the lower extremity. These consisted chiefly of compound fractures, although a considerable number had wounds of the soft parts including nerve injuries without bone damage. There were about 100 with injury of the median, musculospiral, or ulnar nerves and about 50 with injuries of the sciatic and external popliteal nerves.


607

The conditions most commonly presenting themselves for operative or splint treatment were in general as follows: (1) Adduction deformity in upper arm and shoulder injuries; (2) fixation of the elbow, usually with the arm in extension; (3) drop-wrist in musculospiral injuries; (4) fixation of the hand and fingers, usually in extension in gun-shot wounds of the wrist and carpus; (5) femur shortening (in a number of cases as much as seven or eight cm.); (6) malunion of both femur and leg fractures; (7) drop-foot due both to nerve injuries and to leg, ankle and tarsal injuries; (8) flexion contractures of all sorts due to soft part wounds.

Separate wards, about 180 beds, for compound femur fractures and 160 for amputations were set aside. Other orthopedic conditions were treated in other wards as they came. Staff meetings of the entire surgical staff and the hearty cooperation of other departments made improvement in the care and transfer of the patients rapid and fairly easy. In the case of some of the larger convoys, surgical officers were detailed to accompany patients to their port of debarkation for the United States or even to the other side.

The attitude of the orthopedic service at Savenay hospital center toward convoys of its patients going to the United States were largely determined by the visit of the chief consultant in orthopedic surgery to certain convoys leaving Brest about the middle of August, 1918.

During September, at the request of the commanding officer of the center, one of the transports leaving St. Nazaire was visited and inspected. The following letter is a report of that visit:

AMERICAN EXPEDITIONARY FORCES,
BASE HOSPITAL NO. 8,
September 15, 1918.

From: Chief of the orthopedic service.

To: The commanding officer.

Subject: Condition of patients for transfer to the United States.

Reporting on the condition of patients on board the --------- , visited on your instructions this afternoon, the following is respectfully
submitted:

1. Patients leaving the hospital at 10 p. m. last evening were placed on the boat between the hours of 0 and 10 this morning. Splints and apparatus were in good condition. No surgical dressings had been done since the patients left the hospital.

2. All splints had tags of instructions attached. The medical officer on the boat had deferred the surgical dressings until our arrival. He was in doubt as to the method of dealing with surgical dressings for patients in splints (samples of tag instructions are attached hereto for your information).

3. A number of the bed patients should have been dressed this morning. The ambulatory patients were all in good condition.

4. No medical officer or Hospital Corps men were found who had previous experience in dealing with this class of patients, a considerable number of whom were elaborately splinted and required daily surgical dressing. For these patients to travel in comfort and safety it is necessary that the dressings be done without disturbing the splints and that the staff of surgeons and orderlies be adequate even under unfavorable conditions.

5. It is suggested that hereafter a medical officer accompany these patients until they are on board the boats, and at least until they have had their first surgical attention. Also that arrangements be made so that in the case of larger convoys a medical officer from the hospital, with special experience in dealing with this class of patients, should accompany them to their destination.


608

Thereafter medical officers, one or more, were assigned to almost every convoy. During January, 1919, instructions from headquarters provided that every 150 patients must be accompanied by a medical officer in charge.

When other hospitals were located in the Savenay hospital center, the lessons that had been learned by the experiences of Base Hospital No. 8 were applied to the new organizations. Admission slips were completed in the same way. Patients were examined promptly and as far as possible dealt with immediately. Tab reports upon the condition of patients as they arrived at the boats for transportation and even the reports upon the condition of patients as they landed in the United States were studied for suggestions as to the best methods of treatment, splinting, etc., to be employed in dealing with these patients during the period which they spent in Savenay preliminary to departure.

In the meantime, also, statistics had been compiled with a view of determining particularly the incidence of the different casualties and the condition in which they presented themselves at Savenay. It was found that considerable numbers of patients, in some instances as high as 40 or 50 per cent, required extensive alterations of position, with new splinting, or even operation, by way of preparation for transfer to the United States. This was due, of course, to the extraordinarily difficult conditions under which many of the base hospitals were compelled to operate, but it also served to emphasize the importance of just such an organization as had been built up at Savenay for dealing with these patients at the stage and in the condition in which they arrived.

The service of reconstruction aides had been planned in the United States during 1917, but none reported for duty in France until the end of the summer of 1918. As an active part in the Savenay hospital center, however, they fortunately arrived fairly early. Three principal forms of activity were employed by this service, massage and occupational therapy in the wards, a massage clinic in dispensary fashion, and an occupational (curative) workshop. The combination of these three has regularly exercised an influence upon from 500 to 1,000 men per week in the Savenay hospital center. The amount contributed by these activities to the more rapid recovery of stiffened, contracted, and slowly recovering extremities can hardly be measured. The results are more rapid in the case of hands and fingers, which often under the influence of such treatment make more progress in a few days than had been made in weeks preceding.

NEUROPSYCHIATRIC SERVICE

Until November 6, 1918, the neuropsychiatric service at Savenay was under the direction of the commanding officer of Base Hospital No. 8. It functioned separately, with a chief of service, medical staff, and special personnel. For the first six months relatively few cases were admitted, from January 1 to June 1, 1918, the admission being 369. Two wooden barracks of 90 beds each were used during this period, but inmates had their meals with other patients. One ward was partitioned off, one end being used for disturbed patients.

After June 1, 1918, the admission rate rapidly increased and additional wards became necessary. Three more wooden barracks were used as required


609

for this service, providing accommodations for about 500 patients. In the meantime, wards of special construction, designed by the chief surgeon, had been erected for this service in a locality some distance from the main hospital. These 11 wards, situated on a slight elevation of ground, consisted of the administration building, a ward for officer patients, a mess hall, a barracks for enlisted personnel, and a ward for disturbed patients, the remaining wards being of uniform type, with a large day room, shower baths, and running water. This unit was occupied the latter part of August, 1918. There were accommodations for something less than 200 patients, but by using officers' barracks and enlisted men's barracks, the capacity was expanded to over 250. During this period, however, the barracks connected with Base Hospital No. 8 were still retained.

In October, 1918, 4 additional buildings of concrete block were added to the 11 wards above mentioned. When these were completed, the original barracks of Base Hospital No. 8 were relinquished. No diminution in the admission rate after the cessation of hostilities occurred, and therefore the unit as finally constructed proved inadequate. Indeed, in the late fall of 1918, admissions were so rapid that the commanding officer of the center found it necessary temporarily to designate wards from two adjacent units-i. e., Base Hospital No. 69 and Base Hospital No. 113-for the use of the neuropsychiatric service.

On November 6, 1918, the neuropsychiatric service was organized as an independent unit, taking over the quarters already occupied. The former chief of service was designated as commanding officer.

During the latter part of December, evacuation had been so rapid and admissions delayed to such an extent that for a short time there were but 65 patients in the hospital. Admissions, however, soon increased so that early in January, 1919, the population exceeded 700 patients, including 40 officers. This was quite in excess of the capacity, especially since, except as a temporary expedient, the use of the wards of adjacent units was not feasible. Under these circumstances the commanding officer of the center gave directions that one of the new 1,000 bed units be taken over as a neuropsychiatric hospital.

During the period that this organization was changed from the neuropsychiatric service of Base Hospital No. 8 to an independent unit and during the transfer subsequently of the hospital to its present site, considerable administrative work was necessary. The responsibility of this reorganizing, and of the subsequent transfer of the patients and property, as well as opening and equipping the new unit, rested particularly with the chief of the service, the quartermaster, and the officer in charge of administrative details.

The new unit was occupied January 21, 1919. The construction was not completed and special construction was necessary, this being done chiefly by patients. A sitting room was made in one end of the officers' ward, and furnished by the American Red Cross. A similar sitting room for nurses was arranged in another ward. A staff conference room was constructed in the officers' barracks. A diet kitchen, furnished by the American Red Cross, was installed in the building used for occupational therapy. Four wards were constituted closed wards, with screened windows, and in these wards parti-


610

tions were constructed in such a way as to make patients' day rooms. One ward building was utilized for a Red Cross recreation hut and appropriately furnished.

The large building adjacent to the mess, used in other units for surgery and dressings, was fitted up for a workshop. This workshop was especially well equipped. It had the advantage of the use of material formerly used at Base Hospital No. 117, consisting of brass-work tools, lathes, carpentering sets, and an acetylene welding apparatus. Looms for weaving were made by the patients, and woven bags, belts, and mats were manufactured. A forge was made by one of the patients. A supply of salvage material for use in the shop was secured from the salvage department at Tours. Six aides, under a director, were engaged in giving instruction. The average number of patients engaged daily was 42. A large amount of material of various kinds was manufactured in this shop. Much of this material, such as benches, tables, chairs, cabinets,
and office furnishings, was used to equip the administration buildings and wards of the unit. In the metal department rings, trays, and other souvenirs were made in great number. Much of the material made was taken home by the patients.

Personnel.-Prior to June 1, 1918, the neuropsychiatric service at Base Hospital No. 8 was under the direction of a chief of service, who had from two to three assistants. He succeeded in securing the services of nurses and enlisted men with special training in this work. On June 8, 1918, Base Hospital No. 117 arrived at Savenay from the United States, en route for la Fauche. A part of the personnel, namely, 3 medical officers, 28 nurses, and 33 enlisted men remained at Savenay to take charge of the service.

After June 1, 1918, the admission rate increased rapidly. In June, 256 cases were admitted; in July, 405; in August, 588; in September, 887; in October, 658; in November, 809; in December, 412; in January 1919, 885; and in February, 824.

The organization received the cases, classified them, afforded appropriate care and treatment and furnished medical officers and personnel to transport them to the United States. Moreover, the trained personnel was sent to convoy patients to Savenay from other centers and organizations.

For purposes of classification all patients were admitted to one large admitting room of 90 beds. A special nursing force was maintained here, and observations for classifications were made at once. All patients, upon admission, were seen by the receiving officer and assigned to proper wards. The acute psychoses, cases of chronic alcoholism, and the delinquents were sent at once to closed wards. Mild psychoses, epileptics, and mental defectives were kept in open wards under supervision. Cases of psychoneuroses were sent to separate wards and, as soon as space was available, to the specially constructed wards mentioned above.

By examining and classifying at once every case administrative difficulties were reduced to a minimum. During this period but two serious accidents occurred, although delinquents of every description came through the service. At the same time patients were given as much liberty as possible-indeed, liberties which in civil life would have been considered impossible.


611

There was no separate mess for many months, patients going to the general mess. The center American Red Cross recreation hut was used by all, and the convalescent patients from the neuropsychiatric service often contributed very considerably to the entertainments.

As previously stated, supervision of transportation of these cases to America was rendered by this organization to the extent of furnishing medical officers and enlisted personnel. The convoys consisted as a rule of from 50 to 200 cases and occasionally more. They went by train to Brest or St. Nazaire for embarkation, patients being loaded in cars especially designated, with acute cases loaded in one special car. The number of attendants sent varied according to the type of patients. The train left the hospital under charge of a designated medical officer, who exercised supervision until patients were delivered to their destination in the United States. Since such conveys drew heavily upon the personnel, this work could not have been carried on had not the personnel been supplemented from the hospital center.

BLIND PATIENTS

All of the blind patients whose blindness resulted from battle casualties in the American Expeditionary Forces passed through Savenay and were handled in its hospitals, where they received a certain amount of training. The general nursing care was given by the ward nurses, while the social and educational part of the treatment was given by trained teachers. Certain of the American Red Cross workers who were here for the special purpose of looking after blind patients also gave special instruction.

A school was established in the rear of ward A-15 of Base Hospital No. 8. In the morning the program included work in the schoolroom and the teaching of Braille and typewriting. In the afternoon on fine days the patients were taken for walks, or else games and readings and other forms of entertainment were conducted in the schoolroom or ward. This program was also continued during the evening, varied usually by the reading of the evening paper. On Sundays the men were conducted to church in the morning.

A pleasant variation of the work as conducted by the women of the American Red Cross was the arrangement of parties for the blind patients, the invitations to which were written in Braille, and a considerable part of the enjoyment of the party consisted of the reading of the invitation and the pleasant anticipation.

Patients who were unable to go to the schoolroom were taught at the bedside, and there were also bedside readings and games.

LABORATORY SERVICE

Each unit in the center had a laboratory which was subsidiary to the center laboratory. Supplies for these laboratories were issued by the center laboratory officer on memorandum receipt. The center laboratory performed the more technical and nonroutine work, such as serology, histology, autopsy, bacteriological type determinations, and surveys in epidemiology.


612

The center laboratory was divided into the following departments:

 

Officers

Noncommissioned officers or technicians

Private or privates, first class

(a) Administration and supply:

a1

b1

c1

(1) Administration

---

1

---

(2) Supply

---

1

1

(3) Media preparation and sterilization

---

---

3

(4) Glassware preparation and fatigue

1

2

c1, d1

(b) Pathology

1

1

c1

(c) Bacteriology (general)

1

1

---

(d) Wound bacteriology

1

1

---

(e) Epidemiology

1

1

---

(f) Serology

1

1

---

(g) chemistry (and water analysis)

---

1

---

 

Total

6

10

8

aMajor.
bSergent, first class.
cClerk.
dUndertaker.

CONVALESCENT CAMP

A convalescent camp was in operation at Savenay as early as April, 1918, in connection with base hospital No. 8, where 50 beds were set aside for convalescent patients.

On August 21, 1918, orders were received from the chief surgeon's office to establish a convalescent camp as a unit separate from the hospital. In compliance with this, a site was selected where the parade ground measured something like 1,800 by 1,600 feet. Fifty pyramidal tents were put up and 300 French beds placed in the tents for use of the men. This change from hospital to convalescent camp was made in one day, the patients being transferred from hospital to camp, and returns made from the camp as a separate organization. The duty personnel consisted of 1 officer and 1 enlisted man. From the first, patients were selected to act as noncommissioned officers, selection being made with care in order to get men who were responsible and who took an interest in the work.

Under Circular 11-A, 1918, chief surgeon's office, A. E. F., all patients in convalescent camps were placed on a duty status, and consequently returns were those of line organizations. This was changed after a few weeks and patients were again put on a hospital basis, necessitating again a change in forms.

In fair weather the following schedule was adhered to: The entire battalion participated in the morning exercises. These were ordinary setting up exercises and lasted for 15 minutes. Then the medical officer of each company made an inspection of his company; patients who were found not fit for further exercise were required to fall out and return to their quarters. The exercises were then continued for 30 minutes and another inspection was made, with the same procedure. After this, games were played for 5 to 10 minutes and then the companies were dismissed. At 10 o'clock the entire battalion was drilled in squads, platoons, or companies, depending upon the advancement of the soldiers. This drill lasted until 10:45.

At 2 o'clock all men were required to be on the athletic field for games, football, basket ball, indoor baseball, and volley ball, which were played until 3.45. Regimental parade was held every afternoon at 4.30. The schedule was


613

so arranged that each enlisted man was required to take a routine march once or twice a week; four companies going on consecutive days until Friday when the entire battalion formed and marched for an hour and a quarter to band music. Each Saturday afternoon competitive games, consisting of tugs of war between companies, baseball, obstacle races, potato races, relay races, boxing contests, and battle royals were held on the athletic field. For each event prizes were given varying from 3 pounds of candy to 1 or 2 cartons of cigarettes, the company winning most events being given a pennant. These games were always enthusiastically attended and competitors showed great interest in them.

Schools were established in connection with the camp, preliminary for the education of illiterates, but after the armistice began classes soon increased. All classes were voluntarily attended, but once a man volunteered for a course, he was required to be present at all classes of his course unless evacuated. Those who volunteered for courses were excused from other duties which interfered with their work. Teachers were detailed and the subjects taught ranged from those suitable to an illiterate foreigner to those for a high-school graduate. Instruction was given in arithmetic, reading, spelling, writing, grammar, United States history, civil government, geography, physical geography, European history, and French. The following schools also were established: Tinsmithing, motor mechanics, commercial branches, woodworking, sign painting,
and dramatics.

The hours for each subject extended from 8.30 to 11 a. in., and from 1 p. m. to 4.30 p. m. A man worked the whole day on a course until he completed it. Many made astonishing progress; some men, unable at first to write their names, were able within 12 days to write short letters home. The classes were kept small, the largest number taking a course numbering 90. A total of 200 men were enrolled in the tinsmithing course and averaged six hours daily.

THE CENTER FARM

The center farm consisted of 98 acres of land leased by the American Red Cross, through which agency also were obtained implements necessary to start work. The farm proved not only of value as an adjunct to the mess facilities of the center, but also monetarily; during the summer of 1918 the sale of produce each week exceeded the farm rental for a full month. In addition, the farm proved of great benefit in the reconstruction work.

WELFARE

The American Red Cross assisted in giving surgical dressings, clothing, personal equipment of nurses and secretaries, games, novels, and a portable laundry, and huts including a nurses' and officers' hut and an auditorium for 1,650 people. It leased and equipped an experimental farm, maintained a staff of searchers, published a local newspaper, promoted recreation, distributed personal gifts such as socks, scarfs, helmets, etc., and conducted a library.

The Young Men's Christian Association conducted religious services and entertainments, including moving pictures, and gave canteen service.


614

COMMANDING OFFICER

    Col. Wibb E. Cooper, M. C.

JUSTICE HOSPITAL CENTER, TOULr

This group of hospitals was organized primarily for the purpose of taking care of the casualties in the St. Mihiel operation (April 12-16,1918). A number of base and evacuation hospitals were ordered to Toul, where they took over permanent military barracks, just west of the city. The group consisted of the following barracks: Caserne Lamarche, Lamarche Annex, Caserne Perrin, Brichambault, Caserne Tavier, Caserne A. R., and Caserne Luxembourg. With the exception of the last, these barracks were situated very close together, on Rue de Justice, about a mile from the center of Toul. The buildings were of stone and concrete construction and the rooms were fairly well suited for purposes of hospitalization. There were no bathrooms, no means of disposing of waste in the buildings, and running water was to be found in but one or two rooms in each building.

There were two sources of water, one being individual wells and the other the Moselle River. The water was apportioned to the various hospitals at daily periods and regulated through a system of valves. It was impossible, however, to furnish any storage, as any irregularity in apportionment interfered with the supply of the other areas. The sewerage system consisted of a series of pipe lines and drains, which received the liquids from kitchens and baths.

The latrines were of the can type and none were in the buildings themselves. All the excreta of the bed patients had to be carried to these latrines, and these were often located at some distance from the wards. In the same manner all the waste liquids, bath water, etc., had to be carried from the buildings and emptied into the sewers.

The center was organized on August 27, 1918. At this time the following units had arrived: Base Hospitals Nos. 45 and 51, American Red Cross Military Hospital No. 114, and Evacuation Hospitals Nos. 3 and 14. Later, Base Hospitals Nos. 82, 55, 78, 87, and 210 arrived and Evacuation Hospitals Nos. 3 and 14 were relieved from the center. In addition to these, gas, contagious, and neurological hospitals were organized. When completely organized the center had a capacity of 15,250 beds.

The center staff was organized into the following divisions: Adjutant, consultants in medicine and surgery, quartermaster, evacuation officer, laboratory officer, sanitary officer, transport officer, medical supply officer, and chaplain.

The supply depot was established on September 8, 1918, in one of the permanent barracks of the center. Prior to this time all supplies had to be obtained from the First Army depot.

The office of the Quartermaster Department began functioning on September 8, 1918, when the first carload of supplies was received. During the
 

rThe statements of fact appearing herein are based on the "History of the Justice hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


615

month of September, the work of this department was very much handicapped on account of the difficulty in obtaining supplies. This was due to the congestion at the railhead during the activities in the St. Mihiel sector. A large riding hall in one of the barracks was used as a warehouse and afforded ample space. On November 20, 1918, Bakery Company No. 11 was established, and for the first time the bread supplied to the center was made at that port.

The greater part of the laundry work was done at the large laundries in Toul and Nancy. Each unit had one or more French hand laundries, but the amount of work these could do was too small to be of material help. A group disinfecting plant, consisting of three steam disinfectors, was operated for all the hospitals.

Evacuation Ambulance Co. No. 7, which arrived on August 28, 1918, handled all transportation until September 21, 1918, when a center motor transport service was established.

The office of the group chaplain was organized on September 21, 1918. In addition to the regular duties of a chaplain, this officer also had charge of all the entertainments furnished through the cooperation of the Y. M. C. A. A post school was established by the chaplain on March 10, 1919, with a class of about 28, but due to the many changes occurring in the personnel it soon became extinct.

Surgical cases usually were treated in Base Hospitals Nos. 45, 51, 82, 55, and 78; however, in October and November these hospitals received medical cases also. During the St. Mihiel operation and immediately after, this center received a large percentage of the total casualties for the First Army. During the period September 12-25, 8,340 surgical cases were admitted, and the base hospitals temporarily functioned as field and evacuation hospitals. After September 26, the group did not receive any considerable number of battle casualties direct. The surgical services suffered, especially during the early active period, from lack of surgical instruments and trained personnel. In January, 1919, all surgical cases were transferred to and cared for in Base Hospital No. 45.

The medical service did not receive many patients until the latter part of September, 1918. After this time, however, the influenza epidemic assumed large proportions and the service soon became overcrowded. A contagious hospital was opened, with a bed capacity of 600. All cases were held here until over their infectious period.

A neurological hospital was opened on September 7, 1918, with a bed capacity of 1,000. It was well outfitted, in large part by the American Red Cross. The hospital was designated Neurological Hospital No. 2. It acted very much in the manner of an evacuation hospital, with an equipment and staff of an elaborate base for nervous cases. Of 259 cases treated there during the first month, 63 per cent were returned to duty. Other evacuations were made by ambulance to Base Hospital No. 116, at Bazoilles, and to Base Hospital No. 117, at La Fauche.

A large center laboratory was established in Caserne Lamarche on September 23, 1918. It occupied excellent quarters and consisted of six rooms. This laboratory made all the special bacteriological examinations, Wasser-


616

mann tests, colloidal gold tests, and dark field examinations, made cultures, and prepared media, solutions, and sera. The individual hospitals made post-mortem examinations, routine clinical, pathological, and bacteriological examinations.

The majority of patients were transported to the center from the front by ambulances. Prior to November, 1918, there was no central triage, and the hospitals were designated to receive cases arbitrarily as regards location, personnel, and equipment. This caused considerable difficulty and confusion. About the middle of November a center triage was organized, consisting of 10 Bessonneau tents. All incoming ambulances were directed to this central point by road signs and guides. Two officers, two noncommissioned officers, and twenty privates, selected from the various hospitals, were on duty at all times. It was the duty of the triage officer to have the ambulances unloaded, examine all patients and field cards (and if necessary make a provisional change in diagnosis), and direct patients to designated hospitals. This system necessitated a change in the staffs of the various hospitals so that they more readily might treat the types of cases sent to them. Evacuation of all patients was made from the hospitals, as there was no convalescent camp in this center. Evacuation of class A patients was made either through replacement battalions or regulating stations, though some class A patients were evacuated directly to their organizations. Reclassified patients were sent to the 1st Depot Division at St. Aignan, with the exception of class D patients, who were sent directly to the hospital center at Savenay. All mental and neurological cases were sent in ambulance convoys to Base Hospitals Nos. 116 and 117. All patients evacuated to the rear were transported in American and French hospital trains. A consolidated list of patients to be evacuated was telephoned to the regulating officer at St. Dizier twice a day, who, in turn, dispatched trains as necessity called for them. The evacuating officer usually received from 2 to 12 hours' notice as to when a train would arrive at the center and made requests for litter bearers on the hospitals which were to evacuate lying cases.

The American Red Cross furnished the center large quantities of instruments, drugs, and hospital equipment. It also distributed literature and many special articles not furnished by the Army to the patients. To each hospital was assigned a searcher whose duty it was to trace soldiers reported missing, and perform special services for patients, such as writing letters, sending telegrams, etc.

Recreation rooms for nurses and enlisted men were established in each hospital, where theatricals, concerts, and moving-picture shows were produced.

COMMANDING OFFICER

    Col. Henry C. Maddox, M. C., August 27, 1918, to November 13, 1918.
    Col. Robert M. Thornburgh, M. C., November 14, 1918, to discontinuance of center.


617

HOSPITAL CENTER, VANNESs

This center came into existence officially on November 3, 1918, when 1 officer and 50 men of the Medical Department arrived and took over certain buildings requisitioned from the French. Geographically the center embraced Vannes, Auray, Plouharnel, Carnac, and Quiberon, covering an area of 30 miles.

Headquarters of the center were organized November 11, 1918, at Vannes. Here large barrack buildings, known as the Quartier Senarmont, were taken over. This caserne, following the general plan of the French Army barracks, was surrounded by a wall inclosing a compound measuring 760 by 860 feet. Within this area were three large four-story barracks, kitchens, guardhouse, stables, veterinary hospital, and other buildings. It was planned that 2,300 patients could be cared for in this inclosure. The buildings were in very poor repair, and the only advantages provided were ample space, a site free from mud, and an abundant supply of good water. Considerable construction was effected in this caserne, such as extending water pipes to the upper floors, placing of sinks, etc.

In Carnac the United States Government leased a hotel and five villas. The hotel, which accommodated about 200 patients, was at the beach of Baie de Quiberon, about 2 miles from Carnac. It was used for convalescent respiratory cases, who rapidly improved in health at this point.

In Quiberon the hospitalization consisted of 12 small hotels and villas, only 2 holding more than 100 beds. The hotels were not modern and lacked adequate facilities for light, heat, and bathing. The distance of this group from headquarters of the center made difficult its supply and control; therefore, the properties were given up on January 18, 1919.

Near Plouharnel, a large three-story monastery, the Abbey St. Michiel, with a bed capacity of 500, was taken over, but was used only once for patients, and then for a short time only.

Hospitalization at Auray consisted of 2 hotels with a capacity of 350 beds. These were unsatisfactory and were never used for patients, leases on them being given up in December, 1918.

Base Hospitals Nos. 136 and 236 operated in this center and up to March 1, 1919, admitted a total of 3,224 patients.

In February, 1919, Base Hospitals Nos. 4, 5, 10, 12, and 21 were ordered to this center for quarters, awaiting transportation to the United States. This hospital center was discontinued in June, 1919.

COMMANDING OFFICER

    Col. Robert M. Blanchard, M. C.

sThe statements of fact appearing herein are based on the "History of the Vannes hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


618

HOSPITAL CENTER, VICHYt

The hospital center at Vichy, though planned early in 1918, was not organized officially until August 12, 1918. Two base hospital units, Nos. 1 and 19, were then operating. The French Medical Department had been using many of the larger hotels in Vichy as hospitals since the beginning of the war in 1914. Twenty-eight of these were turned over to the United States Army, and later additional hotels were leased from private owners, so that eventually 86 hotels, large and small, were utilized by the center, the total bed capacity of the center at its maximum being 19,000. In addition, 13 garages, and laundries were taken over for use.

The following units operated in the Vichy center before the armistice: Base Hospitals Nos. 1, 19, 115, 76, Hospital Train Unit No. 41, and Hospital Unit D. After the armistice began the following units arrived: Base Hospital No. 109, Evacuation Hospitals Nos. 25, 33, and Convalescent Camp Co. No. 9. The latter organization never functioned as a convalescent camp.

Vichy had many advantages as a hospital center. The location, although apparently somewhat distant from the battle lines, was well chosen owing to favorable railroad connections. Patients were received in some instances within 24 to 36 hours after receipt of injuries, and frequently they arrived with their original dressings, although a very large proportion of the patients had passed through evacuation or base hospitals.

Vichy, being a famous watering resort, established for many years, was a well-developed small city. The streets were well paved and well lighted, thus greatly facilitating the handling of patients arriving on trains at night. There also was an excellent water supply; gas and electric current were obtainable in abundance.

The Grande Établissement Thermal et Physiothérapeutique, which we used, was well equipped with electrical, X-ray, and orthopedic appliances that were of value in the treatment of orthopedic and nerve injuries during our occupancy. The hotels on the whole were well adapted for hospital use, the larger, first-class ones being well equipped with bathing facilities and modern kitchens. On the other hand, the smaller hotels were not so well suited, but were used to great advantage for the walking cases and the less seriously wounded.

The Quartermaster Department was divided into finance, subsistence, property, clothing, and miscellaneous sections. Another officer was assigned to the building department, which was charged with maintenance and repair of approximately 90 buildings. A force for this last purpose was organized from among the different base hospital units. Requests for repairs averaged 70 a day. As the center grew a railway transport officer, a motor transport officer, and an engineer officer were assigned to the center. A quartermaster officer was assigned to the bakery and another to the laundry.

Motor transport of various types and makes was provided. Part of the personnel to operate this was furnished by the motor transport officer and part was composed of convalescents and other personnel at the center.

tThe statements of fact appearing herein are based on the "History of the Vichy hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


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FIG. 118.-Hotel des Bains, part of Vichy hospital center


620

The problems connected with the mess arrangement for the center were most difficult. By the end of October 15,000 persons were being subsisted. During the period of greatest stress there were 36 messes in operation. Though each hospital unit had its own mess officer, a group mess officer, assisted by 10 clerks, managed the messes from the beginning of the center until its closure. In this way a central purchasing department was maintained and the messes throughout the center were coordinated. The central mess office procured and issued not only food supplies but also mess equipment. The walking patients, who occupied many of the 86 buildings, were marched under a noncommissioned officer to a close-by mess.

FIG. 119.-Hotel Lilas, part of Vichy hospital center

For a time, bread was made by local French bakers, who were furnished American flour; however, on July 10, 1918, three units of Bakery Company No. 12 arrived with complete equipment and thereafter baked all bread required by the center. During the period November 1 to 10, 1918, this organization produced 11,050 pounds of bread daily.

Laundry was done, prior to the organization of the center, by a civilian laundry. This arrangement soon proved inadequate, and on August 20, 1918, the Quartermaster Department leased a laundry in Bellerive, near Vichy, and Laundry Company No. 302, consisting of seven men, was placed in charge. This company supervised a day and night shift of French civilian help. When this laundry proved inadequate another, the Les Bains, was leased and placed in charge of Laundry Company No. 509. In order to avoid any danger of infection, all underclothes, uniforms, and linen which had been in contact with incom-


621

ing patients were sent to the Les Bains laundry, all other hospital linen being sent to the Bellerive laundry. A salvage department was inaugurated in conjunction with the laundry.

A bathing establishment was secured on October 14, 1918, by contract from the French, to provide proper bathing facilities for the patients upon admission. All walking cases were taken there immediately from the train and bathed. New clothing was issued to them before they were sent to a hospital; their old clothing was sent to a delousing station. In this way it was possible to keep practically every one of the 86 buildings in operation free from infection. This establishment was used also for the walking cases and the personnel of the center. The heating system was excellent, allowing over 200 baths a day to be given. The number of baths given at this establishment from October 14, 1918, to January 15, 1919, was 61,854.

FIG. 120.-A ward, Base Hospital No. 1, Vichy hospital center

Each of the base hospital units in the center occupied on the average of over 20 buildings, each building being in charge of a medical officer who was responsible to the commanding officer of his unit for the professional service, both medical and surgical, and the discipline and police of the building of which he was in charge. The commanding officer of the unit was in turn responsible to the commanding officer of the center.

Maxillofacial and neurosurgical cases were sent to this center, especially after September 6. Base Hospital No. 115, which then arrived, was soon charged with the care of such cases as well as general surgical cases.

Evacuation of patients was made as soon as the patients were reported ready. They were classified and reported as in various classes fit for evacua-


622

tion. Each week the commanding officer of each hospital was sent a statement of the percentage of patients evacuated in each of these classes, by the center and by each base hospital, in order that the commanding officer might know whether his ward surgeons were taking advantage of all evacuations possible.

The American Red Cross at Vichy provided a warehouse for materials and distribution, a canteen, including a hall for dancing, a theater, reading and writing rooms, and a diet kitchen and a serving room for French. An officers' club, a noncommissioned officers' club, a nurses' club, and a gymnasium were provided. It leased a building for a nurses' club over which a representative of the Y. W. C. A. presided. The Red Cross furnished hundreds of cases of supplies, provided many entertainments, and conducted, through searchers, a home-communication service.

FIG. 121.-Officers' mess at the Hotel Sevigne,Vichy hospital center

Beginning on February 1, 1919, some of the hotels were returned to their owners and the center was discontinued in April, 1919.

COMMANDING OFFICER

    Col. Walter D. Webb, M. C.


623

HOSPITAL CENTER, VITTEL-CONTREXEVILLEu

The hospital center at Vittel-Contrexeville was located in the small towns of Vittel and Contrexeville. Vittel is about 60 kms. east of Chaumont and about 90 kms. west of the Alsace border. Contrexeville is 4 kms. southwest of Vittel.

Both towns had been well-known watering places, situated in the foothills of the Vosges Mountains. Being at a considerable altitude, they had a cold, rigorous climate, with winter coming early and remaining long, accompanied by much snowfall. All industries of both places were connected with the service of their hotels and springs. The waters in no way influenced the selection of this location for hospitals, and they were not used in the hospitals of the center, except by those who desired to do so.

FIG. 122.-Casino used as the officers' club, Vichy hospital center

Vittel has an excellent water supply derived from the springs in the hills above the town, which, though at times taxed to the utmost, was beyond suspicion as to purity. A total of 100,000 gallons per day was allowed for the hospitals, which, with proper care, was sufficient. Contrexeville was not so fortunately situated with respect to its water supply. No large springs were available and each hotel had its own more or less shallow well. Being intended only for summer use, all piping was exposed, causing endless trouble from freezing during cold weather. Practically all water in Contrexeville was determined to be nonpotable.  

uThe statements of fact appearing herein are based on the "History of the Vittel-Contrexeville hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.


624

FIG. 123.-Building used as the noncommissioned officers' club, Vichy hospital center


625

Both towns had fairly satisfactory electric lighting plants, of sufficient capacity both for lighting purposes and for the operation of X-ray equipment.

There was also a well-defined park system, especially so in Vittel. This, together with the privilege of the tennis courts and golf links, made a very valuable adjunct to the center.

FIG. 124.-Two small hotels used for the enlisted men, Vichy hospital center

Prior to the arrival of the Americans and for a short time after the establishment of our hospitals at Vittel and Contrexeville, in the winter of 1917—18, the French occupied some of the hotel buildings for hospital purposes. These buildings were turned over to us by the French. All other buildings were leased from their owners; in case of refusal on the part of the owner, they were requisitioned. In this way, by November 17, 1917, buildings for 5,500 beds had been acquired; and eventually 74 hotels, villas, and other buildings were occupied by the hospital units. The bed capacity at its height was 11,075, including crisis expansion and beds in the convalescent camp, which, however, were never occupied. In compensation for beds allotted us at other points, 2,700 beds were reserved for French patients. Villas were leased for officers and nurses, the casino for enlisted men; garages were provided for the military police, storeroom, and medical supply. All buildings were of concrete and stone construction and more or less fireproof in some cases; in others, especially in Contrexeville, veritable firetraps. The hotels were from three to five stories high, with from 40 to 300 rooms, some of which were reserved for storage. No buildings had heating plants that were adequate. Heating was very unsatis


626

factory, and it was early realized that proper heating was not to be obtained. Seven thousand French stoves were received shortly after the arrival of the units and were installed. The labor involved in caring for this number of stoves, the carrying of the coal and ashes, four to five flights, was enormous. Practically every hotel building had its own kitchen range installed and in fair working condition.

All buildings were piped for water, and had a sewerage system that was wholly inadequate for the number of patients in each during crisis expansion. Cesspools were situated under the kitchen floor, and whenever the capacity of the cesspool was exceeded the inevitable result was a flooding of the floor of the kitchen. By continually pumping over the cesspool this was reduced to a minimum.

Four base hospital units were assigned to Vittel and Contrexeville. These were Base Hospitals Nos. 23, 36, 32, and 31 to Contrexeville, the first one arriving December 17, 1917, and the last one January 1, 1918. On March 13, 1918, three hospital units, B, R, and G, arrived and reinforced the hospitals. Prior to the organization of the center, each unit had its own quartermaster and medical supply officer, submitted its own requisitions, and controlled its own transportation.

On January 27, 1918, one officer of the group was placed in command of all four hospital units, thus inaugurating the hospital-center system of coordinating the activities of several hospital units grouped together. The organization of the center at the height of its activity was as follows: Commanding officer, adjutant, quartermaster, evacuating officer, sanitary officer, medical supply officer, assistant provost marshal, air raid officer, motor transport officer, railway transport officer, laboratory officer, professional consultants in surgery, medicine, neuropsychiatry, orthopedics, and ophthalmology.

To a great extent the headquarters staff was organized by detailing officers from several units. Each headquarters staff in organizing his department chose personnel from the organizations which he knew were capable. It was realized that these units were well supplied with especially qualified men, therefore no request was made for an additional force to form a headquarters detachment. The headquarters detachment was formed by details from the constituent organizations, especially the base hospitals.

Certain special and technical units were organized as follows: Sanitary squads, one in each town. A provisional ambulance company was organized from personnel and ambulances belonging to the base hospitals. It was under the control of the evacuation officer, who was responsible for the movement of all patients. This arrangement was found more satisfactory than to have the ambulances under the motor transport officer.

A laboratory was established in each town, under the control of the center laboratory office. Each hospital, however, retained enough laboratory equipment to perform routine clinical examinations.

As all organizations were well equipped with nonexpendable property, a medical supply depot was not established A center storehouse was maintained, and all requisitions were made out by the center supply officer.


627

A laundry plant was leased in a town about 4 km. from Vittel, which, after being remodeled by the Army engineers, was satisfactory. A laundry company of 1 officer and 16 men operated the plant.

At first bread was obtained from Is-sur-Tille. Later a section of a field bakery was obtained, with two ovens. This, with another oven belonging to one of the units, was sufficient to supply fresh bread to all organizations. During quiet times the extra oven was used for pastry and other extras.

The quartermaster storehouse occupied two large garages at Vittel, centrally located, and a small branch was established at Contrexeville. A well-stocked sales commissary was kept, and organizations in surrounding towns were supplied. There never was a shortage of subsistence articles.

An air raid officer was appointed who drew up such regulations as were necessary for the protection of patients, personnel, and property. Windows were kept screened at night, which was an extremely difficult matter, with the thousands of windows in a single building, some of them so large and so situated as to be almost impossible to cover. For some time the French kept a railroad artillery train parked in the city, and considerable time was required to get it removed. It was not considered in keeping with the provisions of the Geneva convention to construct a cross for protection while these combat organizations were within the city, but after they were ordered away the cross was constructed. Although surrounding towns were repeatedly bombed this center fortunately escaped.

During the winter of 1917-18 and spring of 1918 patients were admitted principally from the surrounding training areas, and from Baccarat and Luneville, where our troops were in the trenches. Numerous gas cases were admitted to the center at this time.

The admission of French patients required a duplication of records and necessitated a providing of the French ration, but was an excellent experience for all the units at a time when there were not sufficient American patients to keep the personnel busy. During this period of adjustment not many patients were arriving and the keenest rivalry developed in obtaining patients. Later a receiving office was established and all arriving ambulances were required to report there. All distributions were made by direction of the commanding officer of the center.

During the month of September steps were taken to establish a convalescent camp of 1,200 capacity. This camp was ready for occupancy when the armistice was signed, whereupon the project was abandoned.

A Red Cross hut was constructed at both Vittel and Contrexeville for the enlisted men, and a well-stocked canteen was maintained at both places. A hut for the nurses also was constructed and furnished in Vittel and a theater leased in the Casino, where moving pictures and other entertainments were provided. This organization also leased a bathing establishment, where hot and cold baths were available for personnel and patients at all times.

The Vittel-Contrexeville center was discontinued in January, 1919.

COMMANDING OFFICER

    Col. Guy V. Rukke, M. C.

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