U.S. Army Medical Department, Office of Medical History
Skip Navigation, go to content

HISTORY OF THE OFFICE OF MEDICAL HISTORY

AMEDD BIOGRAPHIES

AMEDD CORPS HISTORY

BOOKS AND DOCUMENTS

HISTORICAL ART WORK & IMAGES

MEDICAL MEMOIRS

AMEDD MEDAL OF HONOR RECIPIENTS External Link, Opens in New Window

ORGANIZATIONAL HISTORIES

THE SURGEONS GENERAL

ANNUAL REPORTS OF THE SURGEON GENERAL

AMEDD UNIT PATCHES AND LINEAGE

THE AMEDD HISTORIAN NEWSLETTER

Chapter XX

Field Operations, Table of Contents

SECTION IV

THE MEUSE-ARGONNE OPERATION


CHAPTER XX

FIRST PHASE

ARMY OPERATIONS

After the St. Mihiel operation, according to Marshal Foch, four things remained to be done to drive the enemy to the Meuse. The Americans were to attack in the direction of Mezieres; the French west of the Argonne to cooperate in the same direction; the British on the St. Quentin—Cambrai front to attack in the direction of Maubeuge, and the combined forces in Flanders toward Ghent.

The American First Army was assigned the entire front from the Moselle to include the Argonne; but for this operation the front of attack was limited to that part of the Meuse. That part east of the Meuse was to be held by three corps—the French Seventeenth, with its left on the Meuse, the French Second Colonial on its right, and the American Fourth extending the line to the Moselle.

Reduction of the St. Mihiel salient had left the lines fairly straight, and the Allies were forced to make frontal attacks. That portion of the line where a break would be most disastrous to the Germans was assigned to the Americans. Success here would deny the enemy the use of the Sedan-Longuyon Railway, which was one of the two principal lines of supply for the German right, drive him out of the Briey country, his main source of iron, and break the great lateral communication line through Carignan and Mezieres. Success farther north would drive the enemy directly back upon his lines of communication, and break direct communication between his right and center; success here would cut off the troops in Belgium and Flanders so that their destruction or capture would be inevitable.

The German strength was so reduced that to meet a serious attack he would be compelled to shorten and thicken his lines. To do this, he must draw in his right, swinging on a pivot at Verdun. If the pivot could not hold, the army was lost. That the enemy realized this danger is indicated by the order issued October 1, 1918, by General von der Marwitz, commanding the German Fifth Army, in which he emphasized the importance of the Longuyon railway and added, "the fate of a large portion of the Western Front, perhaps of our nation, depends on the firm holding of the Verdun front." This

aAbstracted from Major Operations of the American Expeditionary Forces in France, 1917-1918. Prepared in the Historical Section, Army War College.


526

order referred to an expected attack east of the Meuse. The Germans apparently had begun to suspect the attack about September 21, and had made preparation to meet it about the 25th.

At this time the German force was concentrated well to the east. From Clemery, on the Seille south of Metz, to the Meuse, he was believed to have 13 divisions in line and 10 or 12 in reserve about Metz. Between the Meuse and the Aisne he apparently had 5 divisions in line.

The line of contact in the front of the American attack ran from Forges, on the left bank of the Meuse, about 15 km. (9.3 miles) north of Verdun, a little south of west to the southern point of the Bois de Cheppy, thence west to the Aisne, with a bend southward in the Argonne. The country here divides itself into three strips—the valley of the Meuse, the valley of the Aire, and the Argonne forest.

The Meuse, flowing northwest, is the principal stream. Flowing between the opposing lines and emptying into this river is the Ruisseau des Forges, marshy and impassable in wet weather. The commanding height of Montfaucon, about 6 km. (3.7 miles) behind the German front, marks the divide between the Meuse and the Aire. The Aire is a small stream generally parallel to the Meuse as far north as Grandpre, where it breaks through the Argonne ridge and flows west into the Aisne. It has no tributaries of importance impeding an advance north. The principal frontline feature here is the high hill of Vauquois, across which the opposing trenches had lain close together so long that the whole hilltop had been fairly blown away by mining operations.

The Argonne ridge separates the Aire and Aisne Valleys. It is heavily wooded and much cut up by deep ravines, running east or west to the main rivers. The German front line here was on Hill 263, which, with Vauquois, constituted a formidable barrier to any movement down the Aire Valley. Just beyond this line, across the whole front, lay a series of wooded areas.

The German outpost zone was about 1 km. (0.6 mile) wide at the Meuse. It had originally run west from the Meuse to the vicinity of Montfaucon; but an abandoned element of the French defensives had been taken over by the Germans and converted into an advance line running across the reëntrant, increasing the width of the zone to about 2 km. (1.2 miles) at the maximum. The front line was known as the Hagen Stellung; the old front line, now modified and treated as intermediate, as the Hagen Stellung Nord.

Behind this lay the battle zone, 5 km. (3.1 miles) deep at the Meuse, narrowing to 1 km. (0.6 mile) behind the Hagen Stellung Nord, then widening again. Its main line of resistance was the Volker Stellung and lay along the line of crests marked by Montfaucon. The withdrawal zone was about 2 km. (1.2 miles) wide. The total depth of these three zones was about 6 to 10 km. (3.7 to 6.2 miles).

The wooded areas across the whole front were carefully organized as artillery positions, permitting cross fire everywhere. More than this, the guns in the Argonne forest and on the heights across the Meuse enfiladed the lines of any attack and possessed excellent observation.

From 5 to 10 km. (3.1 to 6.2 miles) behind these positions, north of Grandpre gap, lay the final withdrawal position, the Kriemhild Stellung.


PLATE XXV


527

This was a continuation of the Brunnhild position which came down from the northwest to the junction of the Aisne and Aire. It was only partly finished west of the Meuse, but, nevertheless, was very strong. East of the Meuse it was more nearly complete.

The supply system of the whole region was well laid out, each German corps having its own standard-gauge railway line. These led to railheads, where they were continued by a network of narrow-gauge and wagon roads. To facilitate traffic and guard against interruption by shell fire, additional narrow-gauge lines had been built, connecting the forward systems with the standard-gauge lines well back of the railheads and out of artillery range.

The front of the attack of the combined armies was from the Meuse to the Suippe. The direction was Mezieres. The general plan was, first, to throw the enemy upon the line Stenay—Le Chesne—Attigny by attacks on both sides of the Argonne; second, to reach the region of Mezieres, maneuvering from the east so as to overcome the enemy’s resistance on the Aisne and facilitate the advance of the armies farther to the west. The first objective was the line Dun-sur-Meuse—Grandpre— Challerang—Somme-Py; the second, Stenay—Le Chesne—Attigny—Rethel. Surprise was one of the main elements of the plan; this General Pétain emphasized in instructions dated September 6, adding: "Commanders will not hesitate to orient their participants toward eventualities directly contrary to the real plans," and giving examples of such false impressions as might be given out. The Americans, not yet having appeared in force here, French troops were to continue to hold the front line as a screen until the night before the attack.

The mission assigned to the American First Army required a penetration of about 16 km. (9.9 miles) to reach the Dun-sur-Meuse line and 16 more to the Stenay line. Since the Argonne was regarded as impenetrable by direct attack, it was to be flanked out by the two armies. The main American attack, therefore, had to be straight down the Aire Valley, penetrating the German lines there by frontal attack. This attacking force had to be connected with the lines remaining stationary across the Meuse by another force acting as pivot.

Three corps, then, were placed on the front between the Meuse and the Argonne. The Fifth Corps, in the center, from Malancourt to Vauquois, was to reduce the Bois de Montfaucon and the Bois de Cheppy, outflanking them from both sides, and to take the line of heights of which Montfaucon itself was the key. The First Corps, on the left, was to swing forward its right, keeping in touch with the Fifth Corps, then attack the Argonne ridge from the east; its left, in the forest, to follow up the enemy’s withdrawal and keep in touch with the French west of the Argonne. The Third Corps, on the right, was to hold a pivot on the Meuse and swing its left forward, bringing the whole corps to the river line and keeping touch with the Fifth Corps; to penetrate the German second line promptly and turn Montfaucon, thus assisting the operations of the Fifth Corps; and organize its front on the Meuse for defense.


528

Each corps had, at the outset, three divisions in line and one in reserve. These were the following, counting from right to left: Third Corps—33d, 80th, and 4th Divisions in line; 3d Division in reserve; Fifth Corps—79th, 37th, and 91st Divisions in line; 32d Division in reserve; First Corps—35th, 28th, and 77th Divisions in line; 92d Division in reserve. Including the organic divisional artillery, each corps had about 600 guns of the divisional types and from 140 to 200 heavy guns and trench mortars. The Air Service was represented by 4 balloon companies and 4 aero squadrons in each corps, except the Third Corps, which had 1 additional squadron. The First Corps had 3 battalions of tanks, light and heavy; the Fifth Corps had 11 battalions; and the Third Corps had none. The army artillery consisted of something over 350 long-range heavy guns of various types, more than a brigade of light guns, and a strong force of anti-aircraft artillery.

The line of corps objectives extended along the Meuse from Forges to Dannevoux, thence to Nantillois, Cierges, Epinonville, Charpentry, Montblainville, and finally looped southward through the Argonne and northward again to Binarville, which was to be taken by the French. Each corps was to advance to its objective without regard to the others; when all had arrived, they were to resume the advance, regulating on the center corps, to the American army objective. This followed the Meuse to Brieulles, then passed along the northern edge of the Bois de Foret to Romagne, Exermont, and Apremont, and through the forest to Binarville.

Meanwhile the French were to make a corresponding advance, bringing their line to face northeast, with the Argonne in a pocket. A combined movement was then to be made, after which the American line was expected to run from the Bois de Foret to the north edge of the woods about Bantheville, then southwest through St. Juvin to the northern tip of the Argonne.

The troops east of the Meuse were to make demonstrations along the entire front, joining in the artillery bombardment and making deep raids into the enemy’s lines.

The artillery preparation was to last for five hours, and include neutralization of the heights east of the Meuse, Montfaucon, and the eastern edge of the Argonne. A rolling barrage was to follow along the whole front. Gas was to be used in the preparation, persistent on the heights east of the Meuse, nonpersistent elsewhere. Front-line wire was to be cut by trench mortars and torpedoes. A mixed group, consisting of a detachment from the French 38th Corps and a regiment from the reserve division (92d Division) of the American First Corps, was to maintain connection between the Americans and the French Fourth Army.

Besides the divisions assigned to the corps, there were three in the army reserve—the 1st, 29th, and 82d.

The troops came in from all directions from the British front to Belfort, moving by train, by truck, or by marching, and chiefly at night. The concentration was complete by the 25th. Marching troops were supplied en route from designated railheads; the others carried rations from their last stations.


529

During the operations, the regulating stations of St. Dizier and Is-sur-Tille were used. At the outset there were nine railheads on and south of the line Verdun—Les Islettes. Later, refilling stations were established on 60-cm. railways, and supplied from railheads.

The operations in the Meuse-Argonne really formed a continuous whole, but they extended over so long a period of continuous fighting that they are considered in three phases: The first, from September 26 to October 3; the second, from October 4 to 31; and the third, from November 1 to 11.1

On the night of September 25-26 the screen of French troops in the American front was withdrawn and the American divisions definitely took over the line. At 5.30 a. m., on the 26th, the advance began on a front of 33 km. (20.4 miles). Wire had been well cut and troops generally found little difficulty in passing the enemy’s front line. By night the Third Corps was on its objective; so also were the left division (77th) of the First Corps, and part of the center division (28th) of the same corps; and the left elements of the 91st Division, Fifth Corps.

The center of the line, however, had failed to break the enemy’s position south and west of Montfaucon. This was due in part to the strength of the positions themselves, in part to the cross fire of the artillery in the Argonne and across the Meuse, and in part, doubtless, to the inexperience of many of our staffs and troops, which interfered with full development of power and with mutual cooperation.

On the left, connection with the French was lost. The 368th Infantry, the American part of the connecting group, failed to connect up with the French part; the group was thus disrupted and could not accomplish its mission.

The attack was continued on the next three days. On the 28th the limit objectives were dropped and the corps directed "to advance within their zones of action * * * without regard to objectives." Montfaucon was captured on the 27th, and on the 29th the right of the First Corps advanced as far as Exermont, but was forced to retire. On the night of the 29th the line ran along the Meuse to the Bois de la Cote Lemont, thence by Nantillois to Apremont, south along the edge of the Argonne and west across it to Binarville.

While the plans of the First Army were not fully carried out, yet a very considerable measure of success had been attained, and the sudden strong attack had caused the enemy to weaken other parts of his line by sending reserves to this, the critical section. But our troops had suffered severely, and a defensive line was selected and occupied to permit reorganization for the renewal of the attack.

At this stage of the operations three points in the enemy’s lines presented serious tactical problems. These were: (a) Cunel Heights, flanked on the east by the hostile artillery fire from the Meuse, and on the west by fire from the wooded area of Romagne-sous-Montfaucon; (b) the heights of the Bois de Romagne (the wooded area just mentioned), flanked on the


530

east by fire from Cunel Heights, and on the west from the edge of the Argonne; (c) the east flank of the Argonne, especially in the vicinity of Chatel Chehery and Cornay.

These three localities formed strong, mutually supporting points. In addition, the hostile position extending from the heights of the Bois de Romagne to Fleville prevented infiltration between these heights and the Aire River, and any extended flank attack against Cornay and Chatel Chehery.

In preparation for a new general attack, the 35th, 37th, and 79th Divisions were relieved by the 1st, 32d, and 3d, respectively. The 91st Division was withdrawn to corps reserve. The corps boundary was shifted so as to give to the Third Corps all the Cunel Heights, narrowing the front of the Fifth Corps. The 92d Division was placed at the disposal of the French Thirty-eighth Corps, the right element of the French Fourth Army.

MEDICAL DEPARTMENT ACTIVITIESb

The office of the chief surgeon of the army remained at Neufchateau until September 26, when it moved to Ligny-en-Barrois. Its personnel consisted at that time of 13 officers and 19 enlisted men (including 3 hospital sergeants, 3 sergeants, first class, and 5 sergeants) of the Medical Department. Officers’ assignments were as follows: Army chief surgeon, medical supply officer and three assistants, sanitary inspector, directors of motor, correspondence and statistical services, representative of the chief surgeon at the front, director and assistant director of the ambulance service, and superintendent of evacuation hospitals.2

DIVISIONAL TRIAGES

Division surgeons were instructed to arrange their field hospitals in such way that one or two of these, as circumstances required, would be placed near the battle line to serve as triages and to receive nontransportable cases, including the gassed and badly shocked. The remaining divisional field hospitals, conveniently located at the rear of these hospitals, received and treated transportable cases.3 Divisional triages were located as follows:

        Third Corps:4
                33d Division—Glorieux, near Verdun.
                80th Division—Fromereville.
                4th Division—Sivry-la-Perche.

        Fifth Corps:5
                79th Division—Les Clairs Chenes.
                37th Division—Brabant.
                91st Division—Brabant.

         First Corps:6
                35th Division—Neuvilly.
                28th Division—La Croix de Pierre.
                77th Division—Florent.

bIn this connection, as will be noted, the arrangements made pertain to the Meuse-Argonne operations as a whole rather than to the first phase.


531

Triages of the Third and the First Corps were on an average fully twice as far from the front as were those of the Fifth Corps. The distance from the divisional triages to the nearest evacuation hospitals varied from 5 to 12 km. (3.1-7.4 miles). Terrain occupied by the Fifth Corps offered no points directly accessible to the rear in the sector of that corps where evacuation hospitals could be located, for which reason it evacuated obliquely to Varennes, to the southwest; a poor route, but the only one available.7 All evacuation points except Vaubecourt and Revigny were within 20 kms. (12.5 miles). Rest stations were established by the Red Cross on evacuation routes, enlisted men of the Medical Department being assigned to assist, and at these stations all patients were given an opportunity to warm themselves, to dry their clothing, to obtain food, and to sleep if they so desired.7 Corps hospitals for the reception of patients returnable to duty within a few days were established at suitable points, as nearly as possible midway between the divisional and army hospitals.8 Ambulances and busses were assigned to the corps, as indicated below, to evacuate divisional units. This provision of corps hospitals and transport plus divisional, by making an elastic system, capable of great extension without manifest injury to the wounded, met an emergent need, for it was utterly impossible to advance army hospitals pari passu with the troops until roads and railways were repaired and motor trucks released for hospital service.9

The following named ambulance companies arrived in this area:10

Souilly, Meuse: Evacuation Ambulance Company No. 1; arrived September 21.
Fontaine Routon: Evacuation Ambulance Company No. 2; arrived September 14.
Froidos, Meuse:

Evacuation Ambulance Company No. 5; arrived September 24.
Evacuation Ambulance Company No. 10; arrived September 23.

Rarecourt, Meuse: Evacuation Ambulance Company No. 11; arrived September 24.
Vaubecourt, Meuse: Evacuation Ambulance Company No. 12; arrived September 23.
Fleury-sur-Aire: Ambulance No. 132; arrived September 22 (personnel only) to serve with American Red Cross Hospital No. 114.
Souilly: Ambulance Company No. 318; arrived September 21.
Villers-Daucourt:

Ambulance Company No. 310; arrived September 21.
Ambulance Company No. 120 (personnel only); arrived September 26.

Fleury-sur-Aire: Ambulance Company No. 42 (personnel only); arrived October 29.

Of these, the following were returned to duty with their divisions:10 33d Division, Ambulance Company No. 132, September 30; 78th Division, Ambulance Company No. 310, October 1; 80th Division, Ambulance Company No. 318, October 1.


532

Ten Service de Santé sections, 15 cars each, were loaned us by the French and were assigned to divisional sanitary trains. These were supplemented by 30 sight-seeing busses, with a seating capacity of 30 per car.11 Ambulances of the French Service de Santé sections each carried 5 recumbent and 10 sitting patients, while G. M. C. amubulances carried 4 recumbent and 10 sitting patients.12

All available vehicles, including those of evacuation ambulance companies detached from evacuation hospitals, trucks, motor cycles with side cars, etc., were pooled for use in corps and army areas.11 This transport pool functioned under an officer who was attached to the office of the army surgeon and who was charged with control of the evacuation ambulance service. In comparison with the size of the army, there was a deficiency of 750 ambulances, a circumstance which, in conjunction with the large number of casualties, subjected the evacuation service to a severe test which was met only by increased effort and protracted hours of labor on the part of the personnel.11

Remedy of the shortage of division and corps ambulances was considered a preferred need, and the army strained every nerve to meet their deficiencies. This was accomplished by temporarily loaning extra ambulance sections to the corps, which in turn assigned them to divisions while they were in action. By this plan, instead of being assigned to a particular division, ambulances were controlled by the army through the corps; and when an emergency arose they were readily shifted to the point of greatest need.11 As an illustration of the inadequate ambulance transportation with which some of the divisions entered the army for this offensive may be mentioned the fact that one division in the First Corps arrived for combat at the last moment with only 4 Ford and 8 G. M. C. ambulances; that is, a total carrying capacity of 44 litter patients. Another division came in with an ambulance carrying capacity of less than 32 patients. Pioneer regiments had no ambulances.11

On the night of Septemuber 25 the army and corps had transport for 1,829 recumbent and 1,200 sitting patients, exclusive of divisional ambulances and corps trucks.12

Shortage of motor ambulances necessitated the use of returning ration and ammunition trucks to transport slightly wounded and gassed patients.11, 5

The plan of transporting patients by ambulances for the operation was as follows: Wounded, sick, and gassed from battle line to triage and field hospitals by divisional ambulance companies, thence to evacuation and special hospitals by the corps ambulances, the army furnishing extra ambulance companies and 10 sight-seeing busses in addition to those already assigned the corps, and the corps in reciprocity evacuating any army troops in the corps area which required this service; the army to provide for evacuation of special, mobile, gas, and evacuation hospitals.13

For the purpose of carrying out the movement of patients, the army territory was divided into seven evacuation areas according to railheads available, viz, Vadelaincourt, Souilly, Froidos, Fleury-sur-Aire, Villers-Daucourt, Vaubecourt and Revigny.13


533

One United States Army ambulance section was stationed at Fontaine Routon to evacuate the Vadelaincourt area, two at Evacuation Hospital No. 6 to evacuate the Souilly area, one at Evacuation Hospital No. 10 to evacuate the Froidos area, one at Red Cross Hospital No. 114 to evacuate the Fleury-sur-Aire area, one at Red Cross Hospital No. 110 to evacuate the Villers-Daucourt area (this section also established liaison with Revigny), and one section at Troyon-sur-Meuse for the 26th Division, which was with the French Seventeenth Corps.14

The following disposition of vehicles (other than divisional) was made by the chief surgeon of the First Army:15

        Right flank, Third Corps:

United States Army Ambulance Sections Nos. 560, 571, 599.
French Sanitary Section No. 63—15 ambulances (5 recumbent patients).
French Sanitary Section No. 85—13 ambulances (5 recumbent patients).
10 French sight-seeing busses.

Total, 64 ambulances and 10 sight-seeing busses.

        Center, Fifth Corps:

United States Army Ambulance Sections Nos. 542, 602, 603, 604.
French Sanitary Section No. 131—13 ambulances (5 recumbent or 8 sitting patients).
10 French sight-seeing busses.

Total, 61 ambulances and 10 busses.

Left flank, First Corps:

United States Army Ambulance Sections Nos. 520, 570.
United States Army Ambulance Company No. 41.
Evacuation Ambulance Company No. 11.
10 French sight-seeing busses (seating capacity 20 to 30).

Total, 48 ambulances and 10 sight-seeing busses.

        Army Reserve:

First echelon, one hour from the line, French Sanitary Sections 5, 89, 145.
Second echelon, two hours from the line, United States Army Ambulance Sections 554, 586, 639, 634, and 30 trucks fitted to carry the slightly wounded (capacity 20 each).

        Summary:

Army, 114 ambulances.
Army,c 12 cars.
Corps, 175 cars and 30 sight-seeing busses.
Army reserve, 99 cars and 30 trucks fitted with seats.

Total, 400 cars and 60 busses and trucks.

The foregoing list does not include the following United States Army Ambulance Sections:16 569th, loaned to the 78th Division; 590th, loaned to the

cTwenty-sixth Division was with the French Seventeenth Corps.


534

80th Division; 600th, loaned to the 33d Division; Army Ambulance Sections 578 and 611, loaned to the 77th Division; Army Ambulance Sections 593 and 640, loaned to the 91st Division; Army Ambulance Section No. 647, loaned to the 82d Division.

Movement of the Medical Department vehicles into position was not completed until the early morning of September 26. Many of the ambulance companies and seven sections were employed in bringing up nurses, operating teams, and other necessary medical personnel from the Toul and other centers and distributing them to their respective hospitals, and as these were widely scattered this proved to be a time-consuming process.17 The army ambulances transported 4,307 passengers (other than casualties), with baggage. One ambulance section alone, stationed at Souilly, carried 728 passengers during the period of this operation, September 26 to November 11.18 The burden was further increased by the excessive amount of baggage carried by many of the medical officers and nurses.17

In order to conceal from the enemy the intended offensive, it was ordered that no nurses be brought into the area until the last moment, and that those already in the area remain concealed during the day.17

On September 30, French Sanitary Section No. 50 was attached to the First Corps and No. 84 of the same service was attached to the Fifth Corps. Nine trucks were assigned to the Third Corps. The policy was maintained of attaching an ambulance section from the army reserve for temporary duty only with a corps according to need, thus enabling these reserves to be readily shifted from one corps to another as circumstances required. In order to keep the sections in good working order, those having had hard, active duty were withdrawn for short periods of rest and repair, their places being filled from the reserves.12

Evacuation Ambulance Company No. 5 was removed from the First Army on September 30, reducing by 12 the number of first ambulances.12

On October 3 five ambulances of French Sanitary Section No. 63 were shelled, one being completely destroyed. On the same day French Sanitary Section No. 84 was subjected to severe machine-gun fire and six of its cars were disabled temporarily.19

During the early part of this operation it was impossible through lack of reports to maintain an accurate check on the activities of the army ambulance companies, but later the daily reports of these organizations became satisfactory and provided a more accurate index of work accomplished.18 These daily reports did not tell the whole story, however, for figures were not furnished to cover all patients transported. As a result, the total number of cases which they reported they carried does not correspond with the actual number of sick and wounded transported during these operations. Their reports, did not include those of (1) divisional ambulances, which frequently worked in corps and army areas, (2) army ambulance companies (with dressing station personnel) assigned to corps sanitary trains, and (3) a part of the


535

ambulances working behind the French Seventeenth Corps and the French Second Colonial Corps.18

Passengers carried, other than casualties, were for the most part individual medical personnel and surgical teams changing stations.18

During the operation the United States Army Ambulance Service sections transported individual medical personnel, teams, and baggage, furnished a supply truck service for the army hospitals, and maintained a courier service for liaison purposes. Their trucks also assisted in moving army hospitals. Many of the evacuation hospitals came into the zone of the army with truck transportation entirely inadequate for the work it was called upon to do. Most of the recently arrived units had no trucks, and the combined gas hospitals could muster but one of these vehicles. This condition, however, was improved later. In order to meet this serious situation the United States Army Ambulance Service sections pooled their trucks and redistributed those of the evacuation hospitals. In this way such transportation was made as mobile as possible and the army ambulance service was able to provide truck service for gas, neurologic, contagious, and certain evacuation hospitals, supplying them with food, clothing, wood, the needed quartermaster supplies, and, in addition, to carry the water supply of two hospitals. So far as it was possible to do so, this service was run on a definite schedule.20

On several occasions, because of the shortage of medical personnel, ambulance personnel was withdrawn temporarily from the transport service to relieve overworked and undermanned gas hospitals. The following ambulance companies were employed in the army hospitals until called for by their respective divisions: Nos. 41, 108, 110, 120, 310, and 318.21

Ambulance service was successfully maintained under the most trying conditions, and this was largely due to the splendid work of ambulance mechanics and the hearty cooperation of the Motor Transport Corps. For this operation the latter established a forward auto repair and supply depot at Ferme Longues-Roies, on the Triaucourt—Souilly road, 2 km. (1.2 miles) east of Triaucourt. This depot was well placed, ably administered, and proved to be a potent factor in the maintenance of the G. M. C. ambulances.22 For French ambulances the main supply and repair depot was at Parc Bailly, Bar-le-Duc; while overhauling and minor repairs were made at Parc Fretty, 2 km. (1.2 miles) from Souilly. The echelon American Parc C, Haute Jure, 4 km. (2.4 miles) south of Bar-le-Duc, supplied spare parts, tubes, tires, etc., for the Ford ambulance sections of the French Service de Santé. Later a motor transport park at Sampigny was used for more extensive repair work.22 Maintenance of the ambulance road service, save for ordinary wear and tear and minor repairs, was extremely good. Five of the ambulance sections went through the entire operation without laying up a single car. The daily average for effective G. M. C. ambulances during the Meuse-Argonne operation was 11.25 cars per section of 12, which of itself speaks for the energy of commanding officers and for the spirit and skill of drivers and mechanics. The record


536

for Ford cars was not satisfactory, owing in part to the fact that these cars were used on bad roads, where in fact the rough terrain made the use of the heavier cars difficult; yet this did not altogether account for the difference in their ability to meet service requirements.23

Owing to the acute shortage of ambulances, some patients were evacuated by the 1-m. and 60-cm. railways, their lines being convenient for the purpose. On the first-mentioned line, which traversed the entire zone south of No Man’s Land, three trains were operated, each with a personnel of 1 officer and 12 enlisted men from Evacuation Hospitals No. 6 and No. 7. These trains carried 1,120 patients from Souilly to Base Hospital No. 83, at Revigny.24

When it was possible to do so, evacuations by the army and the divisions were made over the 60-cm. railway.

In the forward areas on these railways litters were simply placed on racks fitted on flat cars, a method which proved very satisfactory. An attempt was made to operate a train of box cars each specially fitted with conveniences, e. g., an oil stove and a marmite for hot coffee or other liquids; but the high center of gravity and the poor roadbed caused such frequent derailments that this attempt was discontinued.25 Each train was manned by 1 medical officer and 5 enlisted men and ran on a regular schedule. During the period November 1-5 all trains were preempted for the movement of rations and munitions.25

Two routes were employed for the 60-cm. line: (1) Fromereville to the Souilly railhead. This line was well ballasted and in good condition. Eight trips were made and 510 patients removed, the average time per trip being about three hours. (2) Montzeville terminal to Souilly railhead, the line passing over the Verdun battle field. Here the road was rough and ballasting poor, so that after two trips, when 145 patients had been carried, the service was discontinued because of derailments.25

Increased hospitals for the operation being necessary, the commanding general of the French Second Army turned over the following for use of the American forces, in addition to those which had been similarly transferred for the St. Mihiel operation:2

French evacuation hospitals at Villers-Daucourt, Brizeaux-Forestieres, Revigny, Froidos, Fleury-sur-Aire; gas hospital, Julvecourt; neurological hospital, Nubecourt; fracture hospital, Deuxnouds-devant-Beauzee; hospital locations at Verrieres, Chateau de Salvange, La Grange-aux-Bois, Les Placys, Les Clairs Chenes, Fontaine de Routon, and a large triage at Glorieux, near Verdun.26

To insure sufficient bed space for the casualties expected, additional evacuation, mobile, and other hospitals were transferred to the area, while still others were provided from local resources. These hospitals were located as follows, but certain of them did not arrive during the first phase of the operation and certain others were moved from one point to another, as indicated below:10


537


Arrived—

 

Arrived—

Evacuation Hospital No. 3:

 

Mobile Hospital No. 1:

 

Fleury-sur-Aire, Meuse

Sept. 21

Les Clairs Chenes, Meuse

Sept. 24

French Army (Mont Frenet, Marne)

Oct. 2

Fromereville, Meuse

Oct. 9

Fontaine de Routon, Meuse

Nov. 10

Esnes, Meuse

Oct. 27

Evacuation Hospital No. 4:

 

Bethenville, Meuse

Nov. 12

Fontaine de Routon

Sept. 14

Mobile Hospital No. 2:

 

Fromereville, Meuse

Oct. 29

Château de Salvange, Meuse

Sept. 24

Evacuation Hospital No. 5:

 

Mobile Hospital No. 4:

 

Ville-sur-Cousances, Meuse

Sept. 16

Villers-Daucourt, Marne

Sept. 18

French Army (La Veuve, Marne)

Oct. 3

La Grange-aux-Bois, Marne

Sept. 29

Staden, Belgium

Oct. 24

Cheppy, Meuse

Oct. 27

Evacuation Hospital No. 10:

 

Mobile Hospital No. 5:

 

Froidos, Meuse

Sept. 21

Les Placys, Meuse

Sept. 24

Evacuation Hospital No. 11:

 

Mobile Hospital No. 6:

 

Brizeaux Forestieres, Meuse

Do.

Deuxnouds-devant-Beauze, Meuse

Sept. 29

Evacuation Hospital No. 14:

 

Varennes, Meuse

Oct. 17

Villers-Daucourt, Marne

Do.

Mobile Hospital No. 8:

 

Les Islettes, Meuse

Oct. 7

Deuxnouds-devant-Beauzee, Meuse

Oct. 15

Varennes, Meuse

Nov. 6

Exermont, Ardennes

Nov. 3

Evacuation Hospital No. 15:

 

Neurologic Hospital No. 3:

 

Revigny, Meuse

Sept. 21

Nubecourt, Meuse

Sept. 20

Glorieux, Meuse

Oct. 13

Field Hospital No. 41:

 

Evacuation Hospital No. 16:

 

Villers-Daucourt, Marne

Sept. 21

Revigny, Meuse

Oct. 15

Varennes, Meuse

Nov. 4

Army Red Cross Hospital No. 110:

 

Villers-Daucourt, Marne

Sept. 24

Army Red Cross Hospital No. 114:

 

Fleury-sur-Aire, Meuse

Sept. 18

Army hospitalization as it existed in the Meuse-Argonne region on September 26 was as follows:27

Evacuation Hospital—

No. 3, Fleury-sur-Aire (in reserve).
No. 4, Fontaine de Routon (for seriously wounded).
No. 5, Ville-sur-Cousances (in reserve).
No. 6, Souilly (for seriously wounded).
No. 7, Souilly (for seriously wounded).
No 8, Petit Maujouy (for seriously wounded).
No. 9, Vaubecourt (for seriously wounded).
No. 10, Froidos (for seriously wounded).
No. 11, Frizeaux-Forestieres (seriously and slightly wounded).
No. 14, Villers-Daucourt (seriously and slightly wounded).
No. 15, Revigny (sick patients).

American Red Cross Hospital—

No. 110, Villers-Daucourt (seriously and slightly wounded).
No. 114, Fleury-sur-Aire (seriously and slightly wounded).

        Mobile Hospital—

No. 1, Les Clairs Chenes, near Blercourt (nontransportables).
No. 2, Chateau de Salvange (nontransportables).


538

No. 4, Le Grange-aux-Bois (nontransportables).
No. 5, Les Placys (nontransportables).
No. 6, Deuxnouds-devant-Beauzee (for head and facial injuries).

Base Hospital No. 83, Revigny (sick).
       
Army Field Hospital No. 41, Villers-Daucourt (for gassed cases).

Neurologic Unit—

          No. 1, Benoite Vaux.
          No. 3, Nubecourt.

Gas hospitals:

Rambluzin, Gas Hospital No. 1, operated by Ambulance Company No. 108, with mixed personnel, including some from Evacuation Hospital No. 10.
Julvecourt, Gas Hospital No. 2.
Verrieres, Gas Hospital No. 3, operated by Ambulance Company No. 108.
Rarecourt, Gas Hospital No. 4, operated by Ambulance Company No. 108.

Infectious diseases and gassed:

          La Morlette, annex to Evacuation Hospital No. 8.

Infectious diseases:

          Verrieres, Infectious Hospital No. 1, mixed personnel.
          Benoite Vaux, Infectious Hospital No. 2, French.

Between October 1 and 27 the personnel of Evacuation Hospitals Nos. 20, 21, 22, and 23 arrived and was distributed among the other hospitals, which were being taxed to their utmost.28

Personnel of Base Hospital No. 83 arrived on September 20 and was assigned to other hospitals. Later it cared for the sick at Revigny, but did not function as an independent unit until November 14.29

All the units above mentioned taken together afforded a front hospitalization of 18,000 beds. This was far too small for the forces engaged, but it represented the full resources of the Medical Department then available for the purpose; for the Medical Department was still experiencing critical shortages in equipment, personnel, hospitalization, and ambulances.

Evacuation Hospitals Nos. 1, 2, 12, and 13 and Mobile Hospitals No. 3 and No. 39 remained in the Toul sector to serve the Fourth Corps and the newly formed Sixth Corps.30 They were detached, however, from the First Army and assigned to the Second when this was organized, October 12.31 Evacuation Hospitals No. 3 and No. 5 were transferred, their ambulances accompanying them, on October 1 from the area to Mont Frenet and La Veuve, respectively, to serve the 2d and 36th Divisions, which had been detached from the First Army for service with the French Fourth Army in the Champagne sector. Mobile Hospital No. 7 from Paris went also to Mont Frenet.32

The character of the terrain in No Man’s Land and the effect of artillery fire upon the few roads necessitated the retention of these army hospitals at the points indicated, despite the advance of troops, until repair of roads and railways had reduced traffic congestion. In prevision of this condition, mobile


539

hospitals were placed as far forward as possible, as already indicated, in order to receive the seriously wounded. The army hospitals were placed as near as possible to railway sidings and were expanded to their fullest capacity.8

Assignments were made to the several corps of hospitals for severely wounded, slightly wounded, gassed, and sick according to corps evacuation lines. Each corps was given an equal number of these units, with the exception of the French Seventeenth Corps, which was to be a holding force at first, its sick and wounded to be cared for in French hospitals already in existence.33

The First and Fifth Corps had contagious diseases hospitals each run as an annex of the nearest evacuation hospital and operated by its personnel. The Third Corps was served in this particular by a preexisting French unit at Benoite Vaux.33

The only attempt at surgical specialization by way of a special hospital was the use of Mobile Hospital No. 6, at Deuxnouds-devant-Beauzee, for cranial and facial injuries; these cases sustained transportations well before operation but badly subsequent to it. Though this unit performed excellent service, it was found that this method of specialization—a relic of trench warfare—was unsound. Specialization was actually accomplished by assigning operating teams trained in head surgery to each mobile and advance evacuation hospital.9

Food stations were established at the receiving wards and on loading platforms of the evacuation hospitals, and hot drinks were served to patients as they entered and departed from the hospital.7

EVACUATION CENTERS

In order to clear evacuation and special hospitals which were not on railroads, and to facilitate the making up of full trainloads of cases of the same kind, it was found advisable to collect cases from these hospitals into hospitals located on the railroad. Thus were created the evacuation centers. At each of these centers a representative of the evacuation office of G-4 of the army was stationed to effect evacuation of the group of hospitals in the particular area. These officers had preferred telephone wires to the regulating station at St. Dizier. An evacuation center was established at Souilly for the Souilly, Vaubecourt, Revigny, and Vadelaincourt groups, to serve the right or Third Corps front, and another at Fleury for the Fleury, Froidos, Villers-Daucourt, and Varennes groups, to serve the center and left or Fifth and First Corps front.34 The hospitals at Souilly, Fleury, Froidos, Villers-Daucourt, and Varennes were provided with loading platforms accommodating entire hospital trains.34

Evacuations by ambulance were necessary to empty into the evacuation centers the hospitals not having railway facilities. An effort was made to prevent the accumulation of more patients in the nonrailway hospitals than could be cared for by the operating teams on duty. If greater accumulation occurred, some of the patients were transferred and evacuated on preoperative trains.34


540

As a rule mobile hospitals were located in advance of evacuation hospitals, to care for the seriously wounded or nontransportable cases. At other times they were used to reinforce the operating departments of evacuation hospitals. Their evacuation was usually made by ambulance to the evacuation hospitals.34

If the line advanced, the hospitals which were located off the railroad were sent forward, either complete or as tent sections, the more permanent railhead hospitals remaining in place to care in part for evacuations from hospitals in advance of them.34

EVACUATION AREAS

As stated above, in the consideration of the First Army ambulance service, evacuation areas for that army were designated. In determining these areas the following facts were taken into consideration: The railhead facilities, the character of casualties which the hospitals within the area would receive, the number of trains per day assigned to hospitals in the area, and, finally, the practicability of routes of evacuation from outlying hospitals to the railhead.35

The Vadelaincourt area (1,110 beds) evacuated by Evacuation Ambulance Company No. 2, stationed at Fontaine de Routon, included the following hospitals:35

 

Beds

Mobile Hospital No. 1 at Les Clairs Chenes

250

Mobile Hospital No. 5 at Les Placys

250

Evacuation Hospital No. 4 at Fontaine de Routon

600

The Souilly area (4,130 beds), evacuated by United States Army Ambulance Sections No. 521 and No. 530, stationed at Souilly, included the following hospitals:36

 

Beds

Evacuation Hospitals Nos. 6 and 7, Souilly

2,400

Gas hospital at La Morlette

450

Gas hospital at Rambluzin

280

Evacuation Hospital No. 8, Petit Maujouy

1,000

The Froidos area (1,340 beds), evacuated by Evacuation Ambulance Company No. 10, stationed at Froidos, included the following hospitals:

 

Beds

Evacuation Hospital No. 10 at Froidos

440

Mobile Hospital No. 2 at Chateau de Salvange

250

Gas Hospital No. 2 at Julvecourt

300

Gas Hospital No. 4 at Rarecourt

350

The Fleury-sur-Aire area (2,050 beds), evacuated by Evacuation Ambulance Company No. 8, stationed at Fleury, included the following hospitals:36

 

Beds

Army Red Cross Hospital No. 114 at Fleury-sur-Aire

1,200

Evacuation Hospital No. 11 at Brizeaux-Forestieres

600

Camp Raton

250

The Villers-Daucourt area (2,180 beds) was evacuated by United States Army Ambulance Section No. 601, stationed at Army Red Cross Hospital


541

No. 110, which also established liaison with Revigny. The area included the following hospitals:36

 

Beds

Army Red Cross Hospital No. 110 at Villers-Daucourt

1,620

Contagious hospital at Verrieres

310

Mobile Hospital No. 4 at La Grange-aux-Bois

250

The Vaubecourt area (3,060 beds), evacuated by Evacuation Ambulance Company No. 12, stationed at Evacuation Hospital No. 9, included the following hospitals:16

 

Beds

Evacuation Hospital No. 9 at Vaubecourt

2,000

Neurological Hospital No. 3, at Nubecourt

210

Mobile Hospital No. 6, at Deuxnouds

250

French Contagious Hospital, at Benoite Vaux

300

Neurologic Hospital No. 1, at Benoite Vaux

300

The Revigny area (1,670 beds) included following hospitals:16 Base Hospital No. 83, functioning with Evacuation Hospital No. 15, at Revigny. (Two ambulances from Evacuation Ambulance Company No. 12, to maintain liaison between Vaubecourt and Revigny.)

Evacuation Ambulance Co. No. 6 was stationed at Troyon-sur-Meuse to provide additional evacuation for the 26th Division, which was with the French Seventeenth Corps.16

Until roads and railroads were repaired and motor trains freed from the incessant transportation of ammunition, it was utterly impossible to advance an evacuation hospital beyond No Man’s Land. It was believed that unless possessed of a multitude of motor ambulances—which the First Army lacked—an evacuation hospital would prove useless unless located near a railroad with loading facilities, and in spite of opposing arguments this theory was adhered to rigidly. Otherwise, these units would speedily have become congested and, having no outlet, the result would have been a backing up into corps and divisional hospitals successively.9

During trench warfare it had been noted that the demand for rapid transport of wounded and shocked cases to a point where definitive treatment could be given had been responsible for many unnecessary deaths, the shock of operation being added to that of trauma and exhaustion incident to rapid transport. The army surgeon’s office was insistent that this procedure should not be permitted, and divisional and corps units were directed to be prepared for shock treatment and for the proper care of all cases before they were operated or evacuated. When this system had been developed, it was observed that many cases which otherwise would have died were received at evacuation hospitals in astonishingly good condition, though some of them, on account of terrible road and traffic conditions, had been three days en route.9

The sudden incidence of influenza, with pneumonia as a complication, threatened completely to disrupt the evacuation system, and it was necessary to triage cases of this disease as carefully as those suffering from battle casualties. This epidemic was much more prevalent during the second phase of this operation than during the first or third phases.9


542

SUPPLY DUMPS

Large, well-stocked medical supply dumps were established at Vaubecourt, Varennes, and Fleury, while that previously established at Souilly was enlarged.33 Later, a dump was established at Les Islettes and a supply unit was proposed at Verdun.37

CORPS REGULATING OFFICER

It was necessary for the surgeon of each corps to maintain close liaison on the one side with his divisional hospitals and on the other side with the evacuation hospitals draining them in order that they might work together. In each corps, therefore, a corps regulating officer was designated to represent the corps surgeon in this important duty. In order to expedite action, the regulating officers were stationed at places having direct trunk-line telephone communication with the chief surgeon of the army. In the First Corps the officer so selected was the commanding officer of the corps sanitary train; while in the others, other officers were designated for this service.38 An officer of the corps sanitary train detailed to assist the corps regulating officer was placed on duty with each divisional triage and kept his chief informed concerning the number and kind of patients requiring evacuation. As the corps regulating officer was also kept constantly informed by the army evacuation officer of the number of vacancies in army hospitals and was furnished other data concerning them, he was enabled not only to determine which divisional hospitals were in greatest need of evacuation but to route corps ambulances from them to the evacuation hospitals best prepared at the moment to receive patients. This routing was changed as occasion required by traffic signs, couriers, and military police. Routing was by no means an easy task, for it was influenced not only by the location and bed capacity of the army hospitals concerned but also by changing traffic conditions.38 These in fact necessitated certain departures from the general plan.

The evacuation problem of the Third Corps differed from that of the First and Fifth. In the rear of the Third Corps area, army hospitals were more scattered and presented more possibilities of readjustment and shifting of the wounded than did those of the First and Fifth Corps.39

In the Third Corps the corps surgeon was made responsible for evacuation from divisional triages and field hospitals, the army assuming a coordinating control. The army furnished the corps surgeon with information regarding the number of empty beds in the different hospitals, the corps surgeon in turn furnishing estimates of the probable number of wounded. These reports were not limited to daily returns, but were furnished by courier and by telephone as often as circumstances demanded.39

The problems of the First and Fifth Corps were very similar. The principal army hospitals serving these two corps were grouped about two main highways, the Clermont—Froidos—Fleury road and the Ste. Menehould—Villers—Daucourt road. The former was the more active and congested. For the first 10 days of this operation it was possible for the corps to shift ambulances to the desired hospitals by placing directing officers in control of


543

roads. Then as the advance progressed, the control problem was simplified and a single control post was established on the Grandpre—St. Juvin—Varennes—Clermont road, a short distance above Varennes and close to the Third and Fifth Corps rest and relay stations. At this time practically all wounded of these corps were coming down this road, and a mutual arrangement was made for the purpose of avoiding duplication of personnel. The First Corps assumed control of this control post, the army keeping the ambulance director of the First Corps informed concerning the bed capacity of evacuation hospitals. At this post a large, illuminated box showed, through removable lettered sheets inserted in its front, to which hospital ambulances should carry each class of cases. This post was under control of the commanding officer of the corps sanitary train, who maintained liaison, by the use of motor cycles, with the director of corps ambulances.39

The designation of certain army hospitals to receive the wounded from the individual corps facilitated evacuation, but it was sometimes necessary to make a rapid readjustment in this respect in order to meet exigencies of the moment.39

MEDICAL REPRESENTATIVES, GENERAL STAFF

A representative of the medical department section of the fourth section of the general staff remained at headquarters of the First Army, at Souilly, for the purpose of coordinating Medical Department activities of the general staff, A. E. F., with those of the army. Other representatives of that section were also frequently at the front.40

EVACUATION OFFICER

Regulation of the flow of casualties into evacuation and mobile hospitals was directed in detail by an assistant of the army surgeon who was designated as evacuation officer. He also was stationed at Souilly, and under direction of the chief surgeon of the army directed army ambulances and supervised and coordinated the evacuation of casualties by hospital train. In order to promote coordination he was attached to the office of G-4 of the army—not to G-4, General Headquarters, A. E. F. He received twice daily the casualty reports of division, corps, and army troops and the classified reports of hospitals in the army zone, which gave the number of empty beds and the number of cases in the following categories: Sick, wounded, gassed, and evacuables. The last named were further classified as sitting, prone, preoperative, and postoperative.41 The hospitals in the army zone also reported, at first twice daily, and later every four hours, whether patients were or were not coming in rapidly, whether they could or could not care for patients coming in, and whether they would or would not have to be evacuated within the next few hours. In times of greatest activity even more frequent reports were made by the evacuation hospitals concerning vacant beds and the number of operating teams, in order that the flow of casualties from the various corps might be changed accordingly. In this service the hospitalization officer


544

acted as a representative of the evacuation officer in liaison with the corps and the various hospitals.41

Train evacuations during the first phase of this offensive from the several evacuation points of the First Army (including Toul, which served troops to the east of the Meuse-Argonne sector) are shown in Chapter XIX.

COURIER SERVICE

The Souilly office of the chief surgeon, First Army, had established courier service with evacuation hospitals, mobile hospitals, contagious and gas hospitals of the army area on September 5, 1918. At that time one route was sufficient and motor cycles were then supplied by Sections 521 and 530, United States Army Ambulance Service. During the preparations for the Meuse-Argonne operation it became necessary to establish three routes for official mail and one additional route for special reports which were submitted by hospitals of the western half of the area to the assistant director of ambulance service. Until the corps headquarters moved north of the Clermont—Verdun road, couriers visited also the First, Third, and Fifth Corps headquarters. After corps headquarters moved north, corps mail was sent through the First Army message center.42

To keep four motor cycles actually on the road it was necessary, because of traffic and road conditions, to have eight on duty. Four of these machines reported from Toul and the other four belonged to ambulance companies. Sections 521 and 530, United States Army Ambulance Service, had three machines on duty at all times, and Sections 520, 570, 599, and 603, United States Army Ambulance Service, had machines on duty for variable periods.43

Couriers called at the message center, Souilly, three times a day, and mail was left there for the trunk line of the army courier service. Couriers from the evacuating office took all Medical Department mail for units of the army and corps, thereby relieving the message center of that work. Not only was mail from the office of the chief surgeon, First Army, taken care of, but also all mail addressed to hospitals was cared for by the couriers of the evacuation office of the army.43

Courier routes averaged 60 km. (37.2 miles) in length. During September each hospital was visited twice daily by courier. Then because of traffic conditions it became impossible to make two trips in the daytime, and thereafter each hospital was visited once a day. The total distance traveled by courier from the army evacuation office was approximately 14,160 km. (8,793 miles) between September 5 and November 11, l9l8.43

SURGICAL REPORTS

In order that both the surgical and the evacuation services might be better controlled, efficiency reports from surgical hospitals, surgical directors, and operating teams were required by the army surgeon. Daily reports of surgical activities were also sent by the director of surgery in each hospital to the army consultant in surgery.44 These reports called for the number of amputa-


545

tions, the deaths without operation and subsequent to it, and the number of cases, as follows: Gas gangrene at time of operation, fractures admitted without splinting or improperly splinted, tourniquets applied, wounds which had not been operated in 24 hours. In addition, patients improperly treated before arrival were specifically reported. It was required that the name, number, regiment, field hospital, and name signed to the field card of every case be made of record in order that the surgical consultant should receive detailed information, and this especially concerning this last class of patients.

An excessive number of amputations indicated faulty triage, delayed45 transportation, abuse of the tourniquet, undue surgical zeal, or they might be due to uncontrollable conditions. An excessive number of deaths before operation at a receiving hospital indicated faulty and unwarranted forwarding of nontransportable cases. From the number of gas gangrene cases at the time of operation, it was possible to discover if there had been defects in transportation and needless detention of patients in the advance areas. From the number of improperly splinted or unsplinted cases could be measured the efficiency of the division orthopedist and the degree of cooperation given him by the division surgeon; cooperation between these officers was reflected in the care which fracture cases received. By the number of cases received whose wounds were of more than 24 hours duration could be checked delays in transportation and unnecessary retention of patients in field hospitals.46

Under the caption "Cases improperly treated before arrival," the surgical directors could give much valuable information concerning the bad condition in which patients were received. This information in turn was passed on up through corps surgeons to the divisions. A consultant’s daybook was kept in the office of the army surgical consultant and consultants entered in this the work done by them and each of the results accomplished. Investigations assigned to consultants were entered on one page of the book in question and on the opposite page the action taken and results obtained.47

Reports showed considerable differences between the various divisions in the length of time elapsing after a patient was wounded and his arrival at an army hospital. Experience showed that the best results in reducing infection and in saving life were in those divisions which, in spite of all difficulties, managed to get their wounded to the rear in good time. The marked difference between divisions was due to a tendency in certain divisions to hold cases for operation. Road conditions alone did not account for the marked discrepancy between divisions. Certain divisions, from the moment they entered the army area until they left it, managed to get their wounded promptly to the rear, some of them making especially fine records.48

The following pertains to the activities of the Medical Department during the first four days of the Meuse-Argonne operations:49

* * * * * * *

Sanitary troops — In general the services of attached sanitary troops were satisfactory, except as affected by deficiency in numbers and difficulty and delay in bringing up the battalion combat equipment, due to the broken terrain and roads and improper transportation. Mistaken zeal was shown in some cases by making long-distance evacuation


546

of single patients by litter when the majority of patients would have fared better if the battalion litter bearers had been used for the collection of the many patients in groups, to be cared for by the ambulance company personnel on its arrival, and later evacuated by wheel transport. Dressings were generally well applied, but complaint was heard of damage done by unnecessary use of the tourniquet. Medical Department soldiers were not greatly used as litter bearers in the advanced positions. Combat troops or infantry litter bearers were doing much carrying, which fact, with other less legitimate depletion, took many rifles from the firing line. In one case, eight riflemen were noticed accompanying one wounded man to the rear. The provisions of the regulations prohibiting combat troops taking wounded to the rear should be rigidly enforced. Supplies were generally adequate in the advance positions owing to the small ratio of casualties on the first day.

Ambulance and dressing stations or triages — In these open operations the establishment of a general dressing station for the entire divisional zone was the rule. Here patients were collected, dressed, sorted, and evacuated as road conditions permitted. As these establishments were necessarily large, they required much shelter and cover. As there was usually only one to the division, stations were considerable distances from battalion and regimental collecting points or aid stations. They were frequently established on congested roads (always targets for artillery fire) and consequently were unnecessarily exposed to fire and caused long carriage of patients to them. In open operations, difficult terrain and bad or congested roads will be the rule, and consequently evacuation from the dressing station by ambulance will be difficult and slow. The measures to be taken to secure best care of the wounded are to move up at least two or three dressing stations by pack mule, or by bearer detachment carriage, and distribute them over the divisional zone in such a manner as to secure cover on lines of covered evacuation from the front, away from shell-threatened villages and crossroads and near the collecting points of wounded of the brigades or regiments they are to cover. Here the casualties can be collected, dressed, and cared for until the roads are repaired and ammunition train congestion has ceased. Such action will secure early clearing of the field and collection, and the best possible care of cases until evacuation can be accomplished. Here primary sorting can be done, and if necessary a secondary triage can be done at an establishment located farther to the rear on a route of sanitary evacuation. While such procedure does not bring the patient to the evacuation hospital sooner, it does permit early clearing of the field, collection, dressing and antitetanic prophylaxis, feeding, warming, shelter and care, and relief of the attached sanitary troops for further duty with their organizations, and maintains the patient in better condition for his evacuation trip.

The dressing stations, particularly those under canvas, worked efficiently in general after patients had been received. Those established in dugouts, cellars, or buildings were cramped for room, and in many cases had not cleared out obstacles and débris sufficiently to permit economy of effort.

Ambulance detachments - Work excellent, in so far as spirit, interest, care, and driving were concerned. Evacuation was much delayed in forward areas by destroyed roads and jams.

Field hospitals - Owing to the existence of fixed hospitals in rear areas, evacuation was made from the triage direct to hospitals designated for special types of cases, and the field hospitals were used in some cases to equip and man the triage, for slight cases, or held in reserve.

Corps and army sanitary troops and establishments - Generallyheld in reserve for future use, a correct procedure, or were designated for special types of cases.

Evacuation - Except as limited by road conditions, evacuation satisfactory. Cases arriving at evacuation and surgical hospitals were held, cared for, and cleared in a satisfactory manner in accordance with a well-ordered scheme. Some of the fixed establishments were at considerable distances owing to the necessity of using buildings built by the French for the sanitary service of intrenched positions. Several of these units had not completed establishment until late owing to the fact, as stated, that sufficient trans-


547

portation was not furnished for rapid movement of equipment and because of the prohibition of erection of tentage at night before H hour.

Military police - Military police were not noted at the sanitary establishments to the rear. It is necessary to have at least a small squad of military police at triages and evacuation and surgical hospitals in order to hold slightly wounded, malingerers, and skulkers, able to return to their command, who are evacuated or wandering to these establishments.

Salvage - Owing to transportation difficulties and the absence of salvage troops, considerable amounts of ordnance material brought in with patients collected at dressing stations and hospitals. If properly cleaned and cared for at once this material would be immediately available for reissue. The sanitary troops by themselves are insufficient to care for this material, and to put it under shelter makes considerable demands on the cover which should be reserved for personnel. It is deemed advisable to assign one enlisted man of the ordnance or salvage department to each ambulance company, field hospital, evacuation hospital, and mobile surgical unit or hospital for the care and preservation of salvaged property.

REFERENCES

(1) Final Report of Gen. John J. Pershing, September 1, 1919

(2) Final report of the chief surgeon, First Army, November 20, 1918, 6. On file, Historical Division, S. G. O.

(3) Ibid., 10

(4) Annex No. 5, F. O. No. 18, Third Army Corps, September 21, 1918

(5) Report of Medical Department activities, Fifth Army Corps, by Col. W. R. Eastman, M. C., corps surgeon, December 10, 1918. On file, Historical Division, S. G. O.

(6) Annex No. 9, F. O. No. 57, First Army Corps, September 22, 1918

(7) Final report of the chief surgeon, First Army, November 20, 1918, 12. On file, Historical Division, S. G. O.

(8) Ibid., 10

(9) lbid., 11

(10) Report of Medical Department Units, First Army, from the chief surgeon, First Army, to the assistant chief of staff, G-3, First Army, February 6, 1919. On file, Historical Division, S. G. O.

(11) Evacuation of the wounded in the Meuse-Argonne operation, by Col. H. H. M. Lyle, M. C., May 10, 1921, 7. On file, Historical Division, S. G. O.

(12) Final report of the chief surgeon, First Army, November 20, 1918, 16. On file, Historical Division, S. G. O.

(13) Ibid., 13

(14) Ibid., 14

(15) Ibid., 15

(16) Evacuation of the wounded in the Meuse-Argonne operation, by Col. H. H. M. Lyle, M. C., May 10, 1921, 11. On file, Historical Division, S. G. O.

(17) Ibid., 12

(18) Final report of the chief surgeon, First Army, November 20, 1918, 18. On file, Historical Division, S. G. O.

(19) Evacuation of the wounded in the Meuse-Argonne operation, by Col. H. H. M. Lyle, M. C., May 10, 1921, 18. On file, Historical Division, S. G. O.

(20) Ibid., 30

(21) Ibid., 32

(22) Ibid., 33

(23) Ibid., 34

(24) Ibid., 26

(25) Ibid., 27

(26)  Final report of the chief surgeon, First Army, November 20, 1918, 7. On file, Historical Division, S. G. O.


548

(27) Evacuation system of a field army, by Col. C. R. Reynolds, M. C., not dated, 31. On file, Historical Division, S. G. O.

(28) Medical activities in the Zone of the Armies, by Col. A. N. Stark, M. C., undated, 15. On file, Historical Division, S. G. O.

(29)Report ofMedical Department activities, Base Hospital No. 83, A. E. F., prepared under the direction of the commanding officer, undated. On file, Historical Division, S. G. O.

(30) Medical activities in the Zone of the Armies, by Col. A. N. Stark, M. C., undated, 12. On file, Historical Division, S. G. O.

(31) Final report of the chief surgeon, First Army, November 20, 1918, 8. On file, Historical Division, S. G. O.

(32) Medical activities in the Zone of the Armies, by Col. A. N. Stark, M. C., undated, 14. On file, Historical Division, S. G. O.

(33) Ibid., 13.

(34) Evacuation system of a field army, by Col. C. R. Reynolds, M. C., undated, 32. On file, Historical Division, S. G. O.

(35) Evacuation of the wounded in the Meuse-Argonne operation, by Col. H. H. M. Lyle, M. C., May 10, 1921, 9. On file, Historical Division, S. G. O.

(36) Ibid., 10.

(37) Medical activities in the Zone of the Armies, by Col. A. N. Stark, M. C., undated, 16. On file, Historical Division, S. G. O.

(38) Evacuation system of a field army, by Col. C. R. Reynolds, M. C., November 20, 1918, 36. On file, Historical Division, S. G. O.

(39) Evacuation of the wounded in the Meuse-Argonne operation, by Col. H. H. M. Lyle, M. C., May 10, 1921, 19. On file, Historical Division, S. G. O.

(40) Report on activities of G-4-B, medical group, fourth section general staff, G. H. Q., A. E. F., December 31, 1918, 57. On file, Historical Division, S. G. O.

(41) Evacuation system of a field army, by Col. C. R. Reynolds, M. C., undated, 37. On file, Historical Division, S. G. O.

(42) Evacuation of the wounded in the Meuse-Argonne operation, by Col. H. H. M. Lyle, M. C., May 10, 1921, 32. On file, Historical Division, S. G. O.

(43) Ibid., 33.

(44) lbid., 38.

(45) Ibid., 39, 40.

(46) Ibid., 40.

(47) Ibid., 41.

(48) Ibid., 64.

(49) Notes on Recent Operations No. 3, (Confidential Document No. 1376, G-5, G. H. Q., A. E. F.), October 12, 1918. On file, Historical Division, S. G. O.