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Chapter XXVIII

Contents

SECTION V

THE ARMY OF OCCUPATION IN GERMANY

CHAPTER XXVIII

THE AMERICAN FORCES IN GERMANY

Immediately after the signing of the armistice, the American Third Army,a was organized as an army of occupation in Germany, in accordance with the armistice terms.1 The territory assigned to the American Third Army was the historic Moselle Valley from the borders of Luxemburg to the Rhine.1 The area contained about 1,000,000 people, with only two large towns-Treves, with 45,000 inhabitants, and Coblenz, with 65,000.1

The maximum number of American troops ever in Germany was in February, 1919, when the number totaled 10,426 officers and 251,833 men.1 On July 1, 1919, the Third Army had been reduced to 5,095 officers and 100,695 men, and its designation was changed July 2, 1919, to the American forces in Germany.1 On October 1 the forces consisted of some 510 officers and 10,556 men.1

MEDICAL SERVICE

Though, as stated above, the change in designation of the Third Army to that of American forces in Germany, was not effected until the summer of 1919, it will be convenient here to consider our medical activities in Germany from the beginning of that year.

The surgeon's office, Third Army, continued to have the same general composition after location of the Third Army in Germany as it had had prior to that event;b however, a department of sanitation, with much broader interests, was established in the first part of 1919, after the army had been stabilized in the area of occupation.2

As army epidemiologist was attached to the office of the sanitary inspector.2 His work was the collection and compilation of data on sickness in the army, the dissemination of this information in the publication of memoranda and a Weekly Health Bulletin, and the formulation of measures for the control of communicable disease. Field work by the epidemiologist was not required, because no extensive outbreak of infectious disease, aside from widespread influenza, occurred.

Territorial sanitation by sanitary squads as army units was not considered necessary after the combat divisions had become stabilized in the areas.2 It was decided by headquarters of the army that the divisions with the usual

    aFor the composition of the American Third Army and its march into Germany, consult Sec. VII, Vol. VIII, of this history.-Ed.
   bConsult Vol. VIII, Sec. VII, Chap. XXXVIII, for details concerning the composition of the office of the surgeon, Third Army.


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divisional medical personnel would be able to carry on continuous sanitary work in their permanent areas without the assistance of a separate army sanitary force. This plan proved satisfactory and, as records of sanitary conditions in the various areas were kept in the office of the army sanitary inspector, no difficulty was experienced in furnishing incoming divisions with the essential information regarding the sanitary conditions of the areas which they were entering.2

In the area of occupation about 10 per cent of the troops were quartered in barracks, while about 90 per cent were billeted with civilians in cities and villages.2 The civil sanitary arrangements varied from crude, primitive methods of water supply and refuse disposal to the fairly well organized sanitary systems of the larger cities. The number of soldiers in this area, at first approximately 250,000, practically doubled the population.2 So severely did this increased density of population tax the general living arrangements, water supplies, and conservancy system, that a considerable part of the sanitary work of the Third Army was concerned with increasing the capacity of these rural and municipal systems. In this work, water supplies were increased, barracks built to obviate overcrowding, and mess halls erected to provide shelter for men at meals.2

Infections diseases, with conditions highly favorable to their transmission to troops, were found to be prevalent among the civilians, the most important widespread epidemic diseases being typhoid fever and diphtheria.2 Arrangements for dealing with the civil phases of the situation were in the hands of the chief sanitary officer, civil affairs, advance general headquarters, at Treves. By a close coordination between the medical organization of the Third Army, the chief sanitary officer of the section of civil affairs, and local German health officials' reports, on infectious diseases among civilians and reports of typhoid fever carriers were obtained systematically.2 Through this system the Army exercised control over disease among the civilians and enforced various measures for improvement of civil sanitation.

Provision of facilities for disinfestation and bathing were urgent sanitary problems during January, 1919.2 At that time approximately 90 per cent of the men were infested with lice, consequent upon the lack of bathing and delousing facilities in the zone of combat and on the march. Upon the stabilization of troops in this area energetic efforts were made to free the command of these vermin. Only one Foden-Thresh machine was available, and the facilities for bathing were inadequate. Much improvised apparatus was constructed by division medical establishments and by the engineers; Serbian barrels, Canadian hot-air disinfestors, cave disinfectors, and steam barrels, supplied with steam from tractor engines or factories, were set up throughout the area. By these means, augmented later by standard steam disinfestors and portable shower baths, louse infestation was rapidly reduced, until by May 31, 1919, the degree of infestation as determined by inspection, was not above 1 per cent.2

During the first three months of 1919 the general camp sanitation of organizations of the Army was greatly improved.2 The problems depending for solution upon the supply of lumber and other materials were efficiently


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handled by divisions and the Corps of Engineers.2 Improved construction of kitchens, screening of food receptacles, fly-proofing of latrines, and removal of manure piles and other breeding places of flies had progressed well toward completion before the commencement of the season when flies might prove prevalent. Supplies of clothing were ample; food supplies were sufficient, of good quality, and generally handled with cleanliness during transportation. Efforts to provide men with amusements which give them facilities for sports and other recreation were extensive and very beneficial.

The water-supply service was found to be the only sanitary work requiring a definite Army organization as distinct from that of the divisions.2 The organization of the water-supply service was begun in the surgeon's office in January, 1919, when it was found that purification of water supplies at their sources would be necessary. Many of the towns in the area of occupation were supplied by water systems carrying tap lines to the houses. A number of these supplies were found on examination to be polluted, particularly in the towns in valleys of the Rhine, Moselle, and Ahr Rivers.2 Since chlorination of water in water sterilizing bags was an inadequate control of drinking water for men who had free access to water from taps in houses, a water-supply service was organized under officers of the Sanitary Corps, with one section in the surgeon's office and another section in the office of the army chief engineer.2 The section in the surgeon's office was engaged chiefly in conducting surveys and examinations of water supplies and recommending the installation of apparatus for systematic chlorination of water at suitable points. In this work the division field laboratories were being utilized as extensively as possible and proved of great value. The section in the chief engineer's office was concerned primarily with the assembling, construction, and installation of apparatus and the training and provision of personnel to operate the plants.

The first evacuation hospitals which operated in Germany were Evacuation Hospital No. 3, which reached Treves on December 3, 1918, and Evacuation Hospital No. 12, which arrived at the same city on December 4.2 The former relieved a Fourth Corps field hospital which had taken over a German hospital on December 1.

During the week ending December 15, when the divisions reached their final areas, additional evacuation hospitals arrived. It was planned to have these evacuation hospitals function as base hospitals in order that as many patients as possible might be retained in the Army and returned to duty. To this end these hospitals were staffed and equipped as completely as possible with well-trained personnel and with adequate supplies.2 Without exception, they were unusually well housed in suitable buildings, a few of which had been constructed for hospital purposes; others were in large schools and military barracks previously used by the Germans to care for the sick.2

It was the policy, as far as possible, to group the hospitals in centers so that special services could be more highly developed.2 The large area over which the Third Army spread made it necessary, however, to place a few isolated hospitals at outlying points. The largest center was situated in Coblenz.2 Here Evacuation Hospital No. 6 was established in a splendidly


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equipped German military hospital. This was used for surgical and orthopedic cases and for sick officers and nurses. Evacuation Hospital No. 2 had a urological and contagious service. Evacuation Hospital No. 4, located in a schoolhouse on Oberwerth Island, had the eye, ear, nose, and throat cases, as well as medical service. Evacuation Hospital No. 14 took over the Bruderhaus hospital and, later, a military hospital in Ehrenbreitstein. This included neuropsychiatric and medical services and in addition was used as the triage to which all patients received in Coblenz were sent and thence distributed to other hospitals.

The second center, at Treves, consisted of Evacuation Hospitals No. 3 and No. 12.2 In the former, surgical, orthopedic, eye, ear, nose, and throat, and medical services were developed; in the latter, urological, neuropsychiatric, contagious, and medical services.

To serve the more remote areas, Evacuation Hospital No. 8 was located in Mayen and Evacuation Hospital No. 7 in Prum.2 In order to care properly for the 42d Division, at the extreme left of the area, evacuation on Hospital No. 26 was established at Neuenahr in a large hotel providing 1,000 beds.2

The Sixth Corps was attached to the Third Army during the first two weeks in April, 1919, and with it Evacuation Hospital No. 13, at Wolferdange, near the city of Luxemburg.2 This hospital remained attached to the Third Army after the disbanding of the Sixth Corps. It was established in a château affording 150 beds. Additional beds to the total of 500 were provided in tents. Because of its limited capacity the hospital continued to function more as an evacuation hospital, sending many of its cases to the center at Treves.2

Some of the divisional and corps field hospital were put in operation, but retained only those cases which could be returned to duty in a few days. An exception was made in the case of the 90th Division, which occupied a large area.2 Here it was considered advisable, because of the long distance to Treves, to equip a field hospital at Cues with female nurses and a good medical staff in order that pneumonia cases might be hospitalized.

During March, 1919, certain of the evacuation hospitals which had been longest in the American Expeditionary Forces were relieved by others with a shorter term of service overseas, as follows: No. 2 by No. 49, No. 6 by No. 27, No. 4 by No. 22, No. 8 by No. 30, No. 7 by No. 29, and No. 3 by No. 19.2 Evacuation Hospital No. 16 relieved Evacuation Hospital No. 14 on April 3.2 The retention, with one exception, of the commanding officers and of some of the medical directors of the relieved hospitals resulted in a continuity of policy. The decrease in the size of the Third Army led to the closing of the following evacuation hospitals in May:2 Evacuation Hospital No. 9, Coblenz; Evacuation Hospital No. 12, Treves; Evacuation Hospital No. 29, Prum. None of the special services in these hospitals was discontinued, however, each being carried on in one of the hospitals remaining. It was assured that with the contraction of the medical activities coincident with that in the size of the army, the character and adequacy of the service did not suffer.

The epidemic of respiratory infections during January and February necessitated frequent evacuations to the services of supplies.2 Occasionally the congestion of the hospitals in the Coblenz center was lessened by sending con-


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valescent patients to Treves. Following the stabilization of the army in the occupied area, however, patients to be evacuated to the services of supplies were collected at the hospital centers.

Subsequent to the early part of March, 1919, the steady decline in the hospital admission rate made it possible to retain a much larger number of patients in the army until they could be sent to duty or it could be demonstrated that they should be returned to the United States. This policy created the necessity for convalescent sections in the hospital centers.2 One of these was organized at Evacuation Hospital No. 19, Treves; one at Evacuation Hospital No. 9, Coblenz; and one at Evacuation Hospital No. 26, Neuenahr.

The Third Army laboratory service consisted of 2 Army laboratories, 10 evacuation hospital laboratories, 7 divisional laboratories, and limited laboratory facilities in isolated field hospitals, with 47 commissioned officers.2 The laboratories were so distributed and their work so divided and coordinated that the entire army had immediate access to excellent pathological, bacteriological, chemical, and serological facilities. In addition to the routine work of the service, extensive bacteriological surveys of the water supplies in the Third Army area and surveys for chronic carriers of typhoid, paratyphoid, and dysentery bacilli among the troops were made. Several research problems were taken up, one on the earliest evidence of tuberculosis infection; another on the pneumonias; and still others, prompted by the interest of interested officers.

The major part of the professional work in the hospitals and divisions of the army fell upon the internists, due to the fact that by far the greater number of cases admitted to hospital were for medical, rather than surgical, conditions.2 Since the evacuation hospitals had been organized principally for surgical work, it was appreciated that their personnel and equipment would not be adequate for the type of cases now to be treated, consequently in January, 1919, the staffs were supplemented with a number of internists.2 A medical service under a competent chief was maintained in each hospital, and much shifting of personnel was done to put each service on the most efficient footing possible.

As the Third Army was reduced in size, more particularly during the release of the final divisions, the various evacuation hospitals were closed and returned to the United States, until Evacuation Hospital No. 27 alone remained. This occupied the buildings of the former German military hospital at Coblenz, which, as will be referred to below, became the base hospital for the American forces in Germany.

When the office of the surgeon, Third Army, became that of the chief surgeon, American forces in Germany, this difference obtained:2 Whereas, the Third Army was a part of the American Expeditionary Forces, the American forces in Germany were subordinate only to the War Department, consequently there was now no intermediate officer between the chief surgeon and the Surgeon General, in so far as matters purely medical were concerned.

Also, certain changes in the Medical Department units were effected. As finally organized the Medical Department of the American forces in Germany was as follows:2

    Chief surgeon's office.
    Attending surgeon's and dental surgeon's office.
    Medical supply depot.


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    Base hospital, including-
        Convalescent camp.
        Field Hospital No. 13.
        Evacuation Ambulance Company No. 26.
        Hospital Train No. 70.
        Field Hospital No. 6.
        Field Hospital No. 8.
        Ambulance Company No. 6.
    Provisional Sanitary Train, 2d Brigade.
    Port surgeon's office, Antwerp.
    Port hospital, Antwerp.
    Medical Department personnel on duty with the various organizations operating infirmaries and prophylactic stations.
    Veterinary service (chief veterinary officer in office of chief surgeon and veterinary officers on duty with mounted organizations).
    Polish typhus relief expedition (attached).

With the replacement of troops of the army of occupation by regular troops, the plan of hospitalization necessarily changed.2 Instead of evacuating to the United States each patient not expected to return to duty within a short period, a practice hitherto obtaining, all except surgeon's certificate of disability cases were to be retained and treated in Germany. Accordingly, a base hospital was established, and the sick from the various organizations were collected daily and treated in this hospital.2

The base hospital, American forces in Germany, was located in the western section of the city of Coblenz.2 It occupied a group of buildings which at one time comprised the Germany garrison hospital of Coblenz, and was used by the Germans in part as a hospital and in part as a medical supply depot. There were 13 two-story concrete buildings, with whitestone foundations, stone-lined entrances and windows; they all were of modern type and in good repair, and had a normal bed capacity of 460.

Collecting daily and treating sick in the base hospital not only assured the proper segregation of cases of contagious disease, but also gave the patients the benefit of the best modern diagnostic methods and treatment by specialists.2 But as the base hospital soon became overcrowded, it had to be enlarged by building a number of temporary frame wards.2

At first, five temporary buildings were added. These, with 152 beds, were located across the street from the hospital. Subsequently nine additional wooden frame buildings, of the Adrian type, were constructed. These buildings were heated by stoves, illuminated by electricity, and had modern sewerage connections and flush latrines. A series of wooden buildings (Adrian hut type) which were a part of the hospital was used as quarters for the detachment, Medical Department, and for the supply depot of the base hospital.

The increase in the activities of the base hospital also necessitated the establishment of a convalescent camp in connection with it.2 Such a camp, with a bed capacity of 500, was opened on September 24, 1919. It was established primarily for the treatment of convalescent venereal patients, and throughout the period under consideration was utilized to its full capacity.2

Antwerp being a supply base for the American forces in Germany, it was necessary to provide for the local hospitalization of our troops there.2 Early


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arrangements were effected with the Belgian military authorities by which any members of the United States Army in Antwerp, when in need of medical or surgical attention, might be taken care of at the Hôpital Militaire d'Anvers. This arrangement worked very well, but had several drawbacks, among which may be mentioned the fact that any soldiers so treated were not under the control of the United States Army from the time that they were admitted to the Belgian hospital until they were discharged. There was also always more or less difficulty about getting men discharged on time and in some cases fraudulent release occurred through the Belgians not being familiar with the United States Army procedure. Ultimately a small port hospital of 75 beds was opened.2

Hospital Train No. 70 was turned over to the American forces in Germany and placed in use, evacuating disability cases to Antwerp, Belgium, for return to the United States.2

The amount of sickness among the American troops in Germany was never excessive.2 Taking into consideration that these forces were made up mostly of recruits, the sick rate for communicable diseases was very low, although some of the contagious diseases, such as diphtheria, measles, and scarlet fever, were at times above the normal pre-war rate. No serious epidemics occurred. The good health of the command was attributed to the mild, equable climate of the Rhine Valley; to the good health and sanitation of the civil population; to the excellent housing conditions of the troops, most of them being in comfortable barracks; and to the careful supervision of sanitation by medical and line officers. With the exception of the control of venereal diseases, no difficult health problems presented themselves.

REFERENCES

(1) Annual Report of the Chief of Staff, U. S. Army, 1920, 239-41.
(2) Annual Report of the Surgeon General, U. S. Army, 1920, 368-91.

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