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Chapter VII

Field Operations, Table of Contents

CHAPTER VII

PRIMARY EVACUATIONS FROM THE ZONE OF THE ARMIES

The transport and hospitalization of the sick and wounded of the American Expeditionary Forces, after these sick and wounded had been evacuated from the zone of the armies, presented difficulties which differed in many respects from those which had confronted the French Army during three and a half years of warfare, and also from those of the British, whose system of evacuation was similar to that of the French though modified by geographical conditions. The French and British systems involved no long lines of communications to home ports. The short route to England made it possible for British wounded to reach home bases rapidly.

The American Army, however, was compelled to hospitalize in France, and to some extent in England, almost all its sick and wounded, since it was impracticable to send home any except a relatively small number, who were permanently (from a military viewpoint) disabled. To meet the needs imposed by this situation and to economize on personnel and matériel, the American Expeditionary Forces had recourse to the use of large hospitals and hospital groups into which patients could be received by the trainload. These organizations necessarily were situated on supply lines of the American Expeditionary Forces.

HOSPITAL TRAINS

The plan in question involved long hauls as patients were moved from the front into variously located base hospitals, and early in the history of the American Expeditionary Forces it was appreciated that ample hospital train service was one of the prime requisites of a successful evacuation service. The method for the procurement of hospital trains for the American Expeditionary Forces has been given briefly in Chapter I. Being sanitary formations, hospital trains were under the general jurisdiction of the chief surgeon, A. E. F., as regards personnel, supply, and maintenance of their equipment, but they were under the orders and immediate control of the regulating officer to whom they were assigned,1 save for those operated in the Services of Supply, which remained under the immediate control of the chief surgeon, A. E. F.

REGULATING STATIONS

Our regulating stations were modeled on those operated by the French when the United States entered the war, and their methods were modified little if any by us. To a degree, one of these stations corresponded to a division point with a train dispatcher according to American railway service practice, and also to a collecting and distributing point for supplies. Each


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of these was a large railway yard, situated preferably at a railway junction where railroads converged from the rear and diverged to the front. Here cars were received and assembled into trains for the divisions, securing to each of these its daily automatic supply and providing for its emergency needs as well. Through such stations passed all the men, supplies, and animals needed by the army which they served, and, in retrograde movement, all men, matériel, and supplies evacuated from it.2 These stations were the funnel,

CHART II


PLATE I.


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CHART III


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so to speak, through which passed everything, or, to change the figure, they were the valves controlling and directing the flow through appropriate channels. They permitted the maintenance of depots and hospitals at a safe distance to the rear, yet secured to troops sufficient supplies to meet daily needs, and relieved them of their sick and wounded. The main purpose was to meet changing conditions at the front and to move speedily backward and forward with the army. Thus, in the early part of the war, during the retreat of the French and the first battle of the Marne, one regulating station on the left of the French Army jumped backward four times and forward twice.3

Only two regulating stations were actually constructed by us, viz, at Is-sur-Tille (Cote d' Or) and at Liffol-le-Grand. The latter was not completed until after the signing of the armistice. In addition to these, however, we used the French stations at Creil and Le Bourget during operations along the Marne, and later those at Nantes, Noisy-le-Sec, St. Dizier, Connantre, Grey, and Dunkerque.2

CHART

IV.-Supply-control installation of French Army in the winter of 1917-18

The subjects of supply and evacuation, in reference to regulating stations, are so intimately connected that the two will be discussed together. Both were under control of G-4, the supply, coordinating, and evacuating section of the general staff, G. H. Q. (See Chart III.)

At the time of greatest activity at the front, when demands upon G-4 for supplies, particularly for ammunition and engineering material, were the heaviest, the demand for hospital trains for evacuation of the wounded also reached its highest point. It was essential, of course, that forward movement of the necessary supplies and rearward movement of the disabled should not result in hopeless confusion. For this reason both these responsibilities were charged on the same division of the general staff, and the regulating office was immediately under its control.2

Chart IV illustrates the supply-control installation of the French Army in the winter of l9l7-l8.3 It was the model we used both for control of supplies and for hospital train service, since both operations necessarily were over railway lines under French control and operation and, in addition, evacuations were conducted to a considerable extent on trains rented from the French.

In this chart Roman numerals represent armies; the Arabic, railroads. Capital letters represent regulating stations. Each small letter represents a


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group of depots. The straight lines represent railroads. The railroad "A"-"G," connecting regulating stations, represents a rocade (shuttle) line.

Operation of this installation can be illustrated as follows: If division No. 1 moves to the position No. 3, the regulator at "A" switches its supply trains to No. 3.

If division No. 1 moves to the position No. 6 while its supplies are at "A," the regulator at "A" sends its supply train over the rocade line to "B," who switches it to No. 6.

In a like manner supplies could be switched from No. 1 to 21.

The rocade line made supply very flexible. By its use any railhead could be reached from any regulating station or from any depot, and this proved a valuable agency for rectifying mistakes, for any shipment missent to a regulating station could be directed to its proper destination by the rocade line. It was especially useful in an emergency.3

Intensive use of railway lines in the zone of the armies made clocklike regularity in their train service essential, and this regularity of movement had constantly to be coordinated with changing battle conditions.2 As intelligent priority also had to be established, the authority for this was vested in the regulating officer, who received all calls from the armies for supplies and transportation and made the necessary requisitions on depots toward the rear. In order that shipments, both front and rear, might be controlled absolutely, they were made to pass through the regulating station yard, where they were checked, recorded, and their destination verified. The regulating station was thus a checking point upon the number and kind of cars and the personnel and freight carried. Being thoroughly conversant with the military situation and needs for supplies and evacuation, the regulating officer could route trains or change their composition as conditions required.2

Under G-4, G. H. Q., the regulating officer was charged with delivery of supplies of all kinds to units at the front and also with the duty of relieving the army of matériel, men and animals no longer in use. Being in close touch with our high command, G-4, G. H. Q., of necessity had full knowledge of all plans and projected operations and was therefore in a position to estimate the approximate number of casualties to be expected in the different sectors of the front, and consequently could allot hospital trains in a way best calculated to meet the situation. In point of fact this was effected through the Medical Department subsection of G-4 (G-4-B) during the entire period of the war. The trains available were apportioned to the different regulating stations and, once assigned, could be changed only by order from General Headquarters. Each having been assigned the number of trains which a particular situation demanded, regulating stations were in a position to meet the requirements of G-4 of the several armies.3

The agencies primarily concerned in evacuation were the evacuation hospital (an army formation), G-4 of the army, the regulating station, G-4, G. H. Q., and hospital trains.3

When American divisions served in French armies in the early part of our participation in the war it was the practice for the officer in charge of


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an evacuation hospital to notify the chief surgeon of the French army in whose zone his hospital was located, that American evacuation was desired. The latter then requested the coordinating officer, at the head of the fourth bureau of the French general staff controlling the zone, to summon a hospital train. When our troops were incorporated in French corps and armies, we necessarily followed their method, but after we organized our own corps and armies, with independent supply and evacuation, it became the duty of an American regulating officer, who was attached to the office of the French regulating officer and allowed to have an assistant to himself solely concerned with the movement of hospital trains.4 The two sets of officers, French and American, worked side by side in the same station, our regulating officer making his requests on the French for the actual movement of trains. The French regulating officer, similarly to the American, had on his staff a French medical officer who was charged with control and supervision of hospital trains movement.

To promote the service of the regulating station the regulating officer divided his duties among several subdepartments, each under an officer responsible for his own department. The chief was responsible for the work of all and for its coordination. To carry out this plan so far as the Medical Department was concerned an officer of the Sanitary Corps was assigned to duty with the regulating officer at Le Bourget and was charged with the movement of hospital trains.5 As requirements increased, it became evident that a medical group should be organized in every regulating station to control the movement of hospital trains and to keep records and other data concerning evacuations. The Medical Department subsection of the regulating office was governed by the following instructions issued by G-4, G. H. Q., August 29, 1918, giving in full the plan of evacuation by train:6

1. Hospital trains are Medical Department organizations. As regards personnel, matériel, supply and maintenance of their equipment and disinfection, they are administered under the direction of the chief surgeon, A. E. F. As railway units they are operated under the direction of the officer to whom they are assigned, and are repaired by the Transportation Service.

2. Assignments of hospital trains are made by G-4, G. H. Q., to regulating officers and to the T. M. B. at headquarters, Services of Supply.

3. An officer of the Medical Department will be assigned to each regulating station as part of the staff of the regulating officer and as a representative of the chief surgeon to whom commanding officers of hospital trains assigned to that station will be directly answerable in matters pertaining to Medical Department administration. He will be charged by the regulating officer with the duty of seeing that trains are at all times ready to answer calls and are kept properly provisioned and stocked.

4. The chief surgeon, A. E. F., will allot a requisite number of beds daily to each regulating officer, advising him by telegraph as to their number and location. These beds will be reserved for the exclusive use of the regulating officer to whom allotted, and daily notice of any changes in these credits will be furnished him. In all questions arising as to bed credits, their sufficiency, etc., the chief surgeon and regulating officers are authorized to communicate direct. The latter will assign destination to hospital trains, in accordance with the information furnished, as provided for above, and the traffic conditions at the time of evacuation. Information regarding transportation or combat conditions which might affect the allotment or location of beds reserved for him will be promptly communicated to the chief surgeon at headquarters, S. O. S., by the regulating officer.


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5. G-4, Army, will furnish the regulating officer daily with all data bearing upon evacuations in order that the latter may judge the sufficiency of trains and beds at his disposition and take the necessary steps to correct a shortage in either.

6. Evacuation hospitals will report daily, or as often as may be necessary, to G-4, Army, the following information:

(a) Number of evacuable wounded, sitting and lying cases.
(b) Number of nonevacuable wounded.
(c) Number of evacuable sick, sitting and lying cases.
(d) Number of nonevacuable sick.
(e) Number of vacant beds.

EVACUATION FROM ZONE OF THE ARMIES

7. G-4, Army, considering the data furnished him as provided for in paragraph 6, together with such information regarding intended operations as might have a bearing on the evacuation situation, calls upon the regulating officer for a hospital train, giving station and time it is desired to have the train placed. He will at the same time advise the commanding officer of the evacuation hospital concerned of the action taken.

8. The regulating officer upon receipt of a call from G-4, Army, for a hospital train will assign a train and arrange a necessary schedule, advising the evacuation hospital and G-4, Army, of the probable time of arrival and the period of time allotted for loading. The commanding officer of the evacuation hospital will be charged with seeing that the necessary steps are taken in order that the train may be promptly loaded in the time allotted.

9. The regulating officer will notify the commanding officer of the receiving hospital of the contents of each train, showing the number of officers, soldiers, and enemy prisoners; number of sitting and lying patients; the number of contagious cases; together with any other information which would facilitate unloading the train.

10. When American troops are operating in conjunction with French units and not under G-4, Army, information as called for in paragraph 6 will be communicated directly to the fourth bureau of the French army with which the American units are serving. This bureau will call upon the French regulating officer for the necessary evacuation, and the latter will, in consultation with the American regulating officer, arrange the schedule and dispatch the train.

EVACUATION IN ZONE OF THE REAR

11. Evacuation from hospitals in the rear of the zone of the armies will be provided for by the T. M. B. at headquarters, S. O. S., in accordance with requests made upon him for this purpose by the chief surgeon, A. E. F.

Of the foregoing instructions, an especially important item was this notification to the evacuation hospital of the time allowed for loading, for failure to complete this in the time specified prevented the train moving out on schedule and resulted either in disturbing the movement of other trains or in holding the one directly concerned until another schedule could be arranged.

Later, these instructions were modified in some details, but only one need be noted here, the others being of minor importance. It was found that in periods of great activity at the front, communication between evacuation hospitals and G-4, Army, and between the regulating officer was difficult and often much delayed through the urgent demands on the limited telephone and telegraph lines which were available. Authorization was therefore given to modify the mechanism of evacuation by permitting hospitals to communicate direct with the regulating officer.3


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In order to perform the duties with which it was charged, it was necessary that the medical section of the regulating office should know, first, where-i. e., in what evacuation or other army hospital-there were patients to be evacuated, together with the number, and, second, in what hospitals of the Services of Supply there were vacant beds for patients, and the number of beds in each of these hospitals available for the several classes of patients. For the former regulating station received as often as necessary, by telephone or telegraph from the hospitals it served, appropriate information concerning number and classification of those to be evacuated, and the possible moment of all such movements.3 On occasion, the evacuation officer called for extra trains, though a need had not been shown by figures last reported by him. During the Meuse-Argonne operation, trains were sent regularly, irrespective of call, to each evacuation center; e. g., two by day to Vadelaincourt, four by day and two by night to Souilly, Froidos, etc., and these were supplemented by other trains when reports of evacuables showed that additional trains were needed.

The destination of a train was determined as follows: To each regulating station was alloted, according to its needs, a certain number of beds in specified hospitals or hospital centers of the interior. Daily, or twice daily in periods of activity, each of these hospitals telegraphed to the regulating offices the number of vacant beds remaining-medical, surgical, etc.-the telegram giving also the number of the last hospital train received at the particular hospital. This information having been charted, it became a simple matter to deduct from the number of vacant beds shown on the last report the number of patients subsequently sent and thus to determine the number of vacant beds actually available.3

In selecting the destination of a train the medical regulator also considered the kind of cases to be evacuated; i. e., he sent medical cases to a medical base hospital, surgical cases to a surgical base hospital, and so on. To hospital centers he could usually send all the classes of cases.

Preoperative trains were supplied as required to relieve overtaxed evacuation hospitals and then were dispatched to the nearest base hospital. Their use rapidly diminished as operative technique and administrative methods were perfected, evacuation of preoperative cases falling from 11,370 in the first phase of the Meuse-Argonne operation to 293 in the second phase.7 Postoperative cases usually were sent on American trains to base hospitals in the intermediate and base sections. Mixed trains were necessary at times for preoperative cases, but the development of evacuation centers did much to obviate the necessity for resorting to this undesirable expedient.

As soon as trains were called for, destinations and schedules of marches for them were arranged with the railway technician. The regulating officer telephoned the evacuation hospital or evacuation officer concerned, giving the exact load for each train, the number and type of cases, time of arrival and departure of train at loading point, destination and stops at other evacuation points-in case there were any-and directed the number of rations to be put


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on the train when rations were necessary. In case other evacuations were to be made farther along the route, each evacuation point or collecting station was notified in the same manner.8

Ration orders for American trains were usually unnecessary, as these trains commonly carried a supply of 2,000 rations and replenished them as a routine matter; but French trains routed by the American Expeditionary Forces frequently needed rations. When required, they were drawn for the train by the evacuation officer from the railhead officer nearest the loading point.9

The regulating officer confirmed by telegram his telephone call to the hospitals or evacuation officer. He also sent telegrams concerning train movements and evacuations to the following: G-4, hospital evacuations, army; commanding officer of base hospital at destination; other regulating officers through whose areas trains moved; statistical department, adjutant general’s office, G. H. Q., and chief surgeon, A. E. F. A copy of each telegram sent to the evacuation officer or commanding officer of hospital was given to the commanding officer of the train concerned.9

The evacuation sending hospital took necessary measures for loading a train in the allotted time and with only the number of patients and the type of cases prescribed by the regulating officer. If this course was not adhered to closely, considerable delay and probable suffering ensued, as a train sometimes was scheduled to stop for a second or third evacuation convoy and space had to be reserved. Then, were a train to be loaded with other classes of patients than those designated in orders, the base hospital at destination might not be equipped for their care.9

During inactive periods collecting patients from two or more evacuation centers was possible, but the total loading time from all evacuation centers was not allowed, as a rule, to exceed four hours, including time spent en route from one loading point to another.9

The regulating officer kept the chief surgeon, A. E. F., and G-4, G. H. Q., informed daily concerning the number of available beds allotted to him after all his trains were dispatched.8

The army surgeon consulted the regulating officer concerning the location of proposed train evacuation points. Reconnaissance of such points was made by the regulating officer in conjunction with the evacuation officer of the army and the railway technician when an important movement of the army was contemplated.10

The regulating officer was charged with the responsibility of making suitable provision for keeping trains properly stocked and provisioned at all times. When trains were garaged at points distant from the regulating station it was necessary to convey food and matériel to them by trucks from the depot of the station concerned.11

The regulating officer established a hospital train depot at some convenient point where trains stopped in passage. Here they were supplied according to their needs. This depot carried, among other things, special diets, medicines,


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comforts, and the like. Personnel, food, coal, mail, packages, and articles of train equipment arriving at the regulating station for distribution to hospital trains were sent to this depot. When trains were garaged at points where the services of no such depot were available and whence they would not pass a depot, rations were drawn from the nearest railhead officers under the direction of the regulating officer.11

Trains arranged for the exchange of litters, blankets, and other supplies at base hospitals to which they carried patients, as directed by the chief surgeon, A. E. F.12

ORGANIZATION OF MEDICAL SERVICE AT A REGULATING STATION

The following detailed description of the Medical Department organization at a regulating station is derived from the Medical Department historical report of the station at St. Dizier, which handled more patients than did any other, and the history of which is most complete. The general organization of the medical service there will be considered first, before discussing in detail the routing of hospital trains and the office technique by which this was effected.

Personnel of the Medical Department at a regulating station was charged, under the station’s commanding officer, with the operation of hospital trains, maintenance of the station hospital and infirmary and emergency medical supply dump, control of any local Medical Department reserve replacements, care and operation of medical motor transport, and sanitary supervision of the area.

The senior officer of the Medical Department present, known as the medical regulator, was in charge of the movement of hospital trains and supervised other Medical Department activities pertaining to the station. He discharged his most important duty-operation of trains-in conjunction with the railway technician. In order to facilitate this, the train movement bureau which was maintained in the medical regulator’s office at St. Dizier was divided into three parts: (1) Evacuation and movement of hospital trains; (2) record of bed space available at the rear; and (3) personnel and supply service for trains.13 The medical regulator was in constant touch with the army surgeon, the latter conferring with him on the selection of sites for evacuation centers in so far as their railway facilities were concerned. Similarly, he was in liaison with the chief surgeon, A. E. F., who allotted bed credits in various hospitals to the rear, with the commanding officers of hospitals which made evacuations, with the evacuating officers of evacuation centers, and with the railway technician. This medical regulator was responsible for the efficiency of evacuation to the commanding officer of the regulating station, to the Medical Department representative with G-4 (G-4-B), and to the chief surgeon, A. E. F.13

The assistant to the medical regulator also had certain definite responsibilities. While his chief was occupied largely with general supervision and liaison, the assistant’s interests were more local. He received reports from evacuation hospitals and of daily bed allotments in the rear, supervised


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(with the railway technician) the movement of trains, making request of the regulating officer in command of the station for movement of these as needed, and cared for the proper transmission of all orders, telegrams, and instructions, and the formulation of records. He carried out the orders of his chief and his general policies as determined by the strategical situation at the front and hospitalization at the rear. When day and night service was necessary he alternated with his chief in 12-hour shifts. He had as technical assistants a sergeant who was in charge of office routine, a corporal who received, listed, and kept up to date the daily bed allotments, and two army field clerks who attended to telegrams and general correspondence.13

The hospital train supply officer was in charge of the distribution of the matériel shipped to these units in care of the regulating officer and had supervision of the medical supply depot if one were organized at the station. Such a depot was stocked with rations, special diets, blankets, and miscellaneous medical supplies, and met emergency calls for supplies from the hospital trains and from sanitary formations in the regulating station district. This officer also had charge of the laundry exchange for trains operated by the depot, distributed mail for hospital train personnel, and issued proper orders concerning individuals on duty with trains. In short, his duties were similar to those of an adjutant, personnel and supply officer combined. He was assisted by a supply sergeant, two privates, and details as required from the casual camp. He delivered by Medical Department truck all supplies required by trains and the mail of those on duty with them.14

The total personnel on duty with the hospital train movement bureau at St. Dizier was 3 officers, 2 field clerks, 3 noncommissioned officers, and 5 privates, including a chauffeur who drove the supply truck and the motor car assigned to the chief of medical service for his use in visiting hospital trains garaged at a distance from his office and depots established at railhead for hospital trains.13 This personnel dispatched 528 hospital trains carrying 196,018 patients from September 5 to December 1, 19l8.15

The station hospital constituted a small evacuation unit for the hospitals of the district, and provided needed accommodation for those on duty at the station. It was located near the railroad and the casual camp. Usually its personnel was small-3 officers, 2 nurses, 4 noncommissioned officers, and 10 privates-and it accommodated only 100 patients. An infirmary was operated in connection with it, which received from hospital trains patients unable to continue the journey and sent them to hospitals in the district. At St. Dizier the infirmary had 106 beds and a personnel of 2 medical officers, 4 nurses, 4 noncommissioned officers, and 16 privates; it also treated casuals and detachments in the regulating district but not attached to the station.15

A Medical Department replacement depot for the Army, the regulating station, and the train service was considered advisable, this to be located in the regulating area, but no record has been found showing that such a depot was established.

The motor transport of the station consisted of 1 touring car, 4 ambulances, and 1 one and one-half ton truck.15


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One or more sanitary squads attached to the station supervised sanitary conditions, including the establishment of prophylactic stations, care of water supply, construction and maintenance of disinfecting stations, refuse-disposal plants, and kindred activities.16

ROUTING OF TRAINS

Supplied with information concerning bed credits, the medical regulator could make immediate choice of routes, the greatest latitude being allowed him in this matter and in the selection of the destination of patients subject to bed credits. It was greatly to his advantage to have hospital credits widely scattered geographically, as this arrangement allowed the use of the least congested routes and the fastest schedules, but this advantage had to be weighed carefully against possible disadvantage to patients. The problem was thoroughly worked out by the medical regulator, who took into consideration the type of sick and wounded; that is, whether the cases were preoperative or not, the length of time which must elapse before they could be got to a hospital, and the hospital accommodations at destination. Consideration was given also to the hospital personnel available-whether or not it was adequate to meet the situation and also whether it was being overworked. Unless the number of such personnel justified the eight-hour shift system, the arrival, one after another at close intervals, of hospital trains carrying sick and wounded, would break down any hospital, regardless of its bed space.17

Another consideration in routing trains and in selecting their destination was their adequacy in number. In times of great emergency at the front, e. g., during the Meuse-Argonne operation, hospital trains were always short of the number needed. If, under these circumstances, the medical regulator had beds available at Bazoilles and Bordeaux and at several intermediate points, he first sent his trains to hospital at the former place because it was nearest, the round trip to Bazoilles taking less than 24 hours, while the round trip to Bordeaux consumed several days. French trains were more commonly used near the front, as they could be garaged more easily, did not need such long loading quays, and their accommodations were more suitable for short trips; while the heavier, larger American trains carried patients farther toward the rear. As a matter of fact, in the early part of the Meuse-Argonne operation, prior to October 15, American trains were employed chiefly in moving patients from hospitals in the advance section to those in the intermediate and base sections.

The strain upon hospital train service was aggravated by the fact that large numbers of slightly sick and wounded men who should have been retained in the army zone were sent to the rear. They had slipped through triages and field hospitals at a time when pressure was so great that they could not be given more than the most casual examination there and had been given the benefit of any doubt as to their condition. Then, when these patients once reached evacuation hospitals there was no place to which to send them except to the base hospitals.17


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During the Meuse-Argonne operation, when a constant succession of supply trains was moving through the regulating station at St. Dizier, and when 67 hospital trains were in constant service, there was never a time when rearward movement of the latter was obstructed by railway congestion, although there were many occasions when the shortage of engines and hospital cars caused the deepest anxiety. So heavy were the demands made upon hospital trains that at this time the French complained that their technical railway personnel had no opportunity to inspect or to oil and make minor repairs to the rolling stock borrowed from them, and that they feared breakdown of the evacuation service if demands did not lessen soon. Fortunately, the armistice followed very shortly.3

In the following discussion the term "train" is sometimes used in the sense of a train trip; that is, its round trip from the garage to the front to the destination in the rear and return to the garage. Whenever used in this sense the exact meaning is made clear by the context.

In view of the fact that regulating stations were newin our service, and also because of the great exactitude with which trains schedules had to be arranged, the most important details in the operation of the medical regulator’s office are given below.18

Control of evacuations by railway transport was essentially technical and required minute attention to details. Close liaison was necessary between army sanitary formations, railway authorities and the hospitals of the advance, intermediate, and base sections. To carry out its purpose in the simplest and most effective manner, the medical regulator’s office at St. Dizier instituted a daily routine and a system of special form and records. While a copy of each of the forms which will now be mentioned was made a part of the historical report of that office, these are not reproduced here, a mere statement of their designation and a very brief description of their purport being considered sufficient.18

    GROUP 1. Preparation for evacuation:

            Form 1. Daily evacuation chart.
            Form 2. Daily garage list.
            Form 3. Trip slate.
            Form 4. Area map.
            Form 5. List of trains regulated.

    GROUP 2. Choice of destination:

            Form 6. Daily average bed allotments.
            Form 7. Individual hospital bed records.
            Form 8. Current vacant bed list.
            Form 9. Load and destination sheet.
            Form 10. Daily report of beds allotted, used, remaining.

    GROUP 3. Dispatch of trains:

            Form 11. Request for movement of trains.
            Form 12. Telegrams from regulating officer.
            Form 13. Dispatching slate.


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    GROUP 4. Reports:

            Form 14. Telegrams from commanding officer of train.
            Form 15. Detraining slate and train report.
            Form 16. Ten-day report.
            Form 17. Permanent record book, by months.

    GROUP 5. Filing system:

            Memorandum.

As noted above, each evacuation hospital reported twice daily, or oftener if necessary, by telephone or telegraph, the number of recumbent and sitting cases evacuable, classified as follows: Preoperative, postoperative, sick, gassed, allies, prisoners, contagious cases, and neurological. From all these reports an "evacuation chart" (Form 1) was made up. Hospitals were then evacuated as the chart indicated, without requests on their part. If any evacuation hospital had special need for a train, request was made to the regulating officer, with the information as above. A train would be sent, the number of evacuations deducted, and the chart balanced.19 A large map also was used, and each day the evacuable cases, recumbent and sitting, were indicated for each evacuation hospital. This map showed also trains in garage as per daily garage list. A new map was needed daily, showing location of all railheads, evacuation hospitals, railways and garages.20 The central idea was that the medical regulator should keep evacuation hospitals clear of evacuables without waiting for requests for their removal. With him the service became rather routine, an accumulation of evacuable cases calling automatically for evacuation. A daily garage list was made up and corrected every morning. It showed the location of trains actually in garage, at what points they were, and trains expected in during the day. These trains were then indicated on the area map. Trains en route were shown on what was called a "trip slate," loaded trains in red, returning trains in blue. All trains in advance of the regulating station ran at the same speed and became part of a continuous stream. Hospital trains could move no faster than freight trains, each having to keep its place in line.21

The destination of trains required another set of reports. Every morning-and oftener during active periods-the regulating officer received a telegraphic statement of the number of vacant beds in each base hospital or hospital center at the disposition of the regulating station. The chief surgeon, A. E. F., sent this information, consolidated, concerning hospitals in the base sections, but the hospitals and hospital centers in the advance and intermediate sections telegraphed it direct to the regulating officer, giving the number of beds available for the next 24 hours, medical, surgical, and contagious, also the number of the last train arriving with patients. An officer had charge of this "bed space" and kept a chart for each hospital, deducting subsequent arrivals from the last report. He was prepared to give the bed status of any hospital at any hour of the day.22 A combined chart showed at a glance the status of all the hospitals, and the net balance gave the total beds available. Before asking the railway authorities for a train it was necessary to give its


275

destination. In rush times, when minutes had to be saved, the train department merely asked the bed space department for a destination for a train carrying a certain number of medical and surgical cases, specifying whether a point in the advance, intermediate, or base section was preferred. A daily report of beds allotted and evacuations made was sent to the chief surgeon, A. E. F., and to G-4, G. H. Q., A. E. F., at Chaumont. A permanent record book with complete records of each day’s evacuations was kept.23

When patients were to be evacuated a request was made to the technical service (French) of the railway company, showing places to be evacuated, train desired, number of recumbent and sitting patients and destination. This request was made on French blank, Form No. 11. If approved, notice was given to the evacuation hospital concerned, so that loading could commence as soon as the train reached the platform. When the train schedule was furnished a telegram was sent immediately to each of the following: Chief surgeon’s office; troops movement bureau of section concerned; commanding officer of train; commanding officer of hospital to be evacuated; commanding officer of receiving hospital; regulating officer of area through which train was to pass; and G-4, G. H. Q., statistical bureau. These telegrams followed established forms and gave the number of the train, the place of loading, date and hour of departure, destination and hour of arrival, number of patients, recumbent, sitting, wounded, gassed, medical, insane, and so on, number of rations to be furnished, and instructions as to whether patients were to be fed before loading or at certain points en route.24

The commanding officer of a hospital train en route sent a telegram to his regulating officer, confirming it by mail, giving complete detailed information regarding the evacuation. The blank 15-A gave detailed information as to classes of cases, nationality, rank, hours of movement and time of detraining. A separate slate was kept for each day’s evacuations, showing every train sent and giving exact information in detail concerning each movement. Every ten days a report was sent from the regulating officer to the chief surgeon, A. E. F., to G-4, G. H. Q., and to G-4, Army, showing the trains moved each day and the patients carried. A complete daily record for statistical purposes was also kept of each day’s evacuations.25

When the St. Mihiel operation was projected, the chief surgeon, First Army, had estimated that our casualties would be 33,000. In point of fact there were less than 7,000 during the actual operation. In anticipation of this operation, garage and entraining points and supply agencies were established, and 45 French trains of different types were obtained similar to those used later in the Meuse-Argonne operation (see description in earlier portion of this chapter), for French trains to this number were considered adequate in view of the short hauls necessary to base hospitals in the advance section.26 After these hospitals were filled, secondary evacuations were made from them to hospitals farther in the interior, the better equipped but more unwieldy American trains being used for this purpose. The latter trains were also used for long hauls from the front into the interior. Trains


276

evacuating the army area were routed by the regulating station at St. Dizier, others by the regulating station at Is-sur-Tille. Bed credits given the former, however, could not always be used, for during this period all railways were so badly congested that there was very little choice of routes. This resulted in an unequal distribution of patients, some hospitals being overcrowded, while others had considerable empty bed space.17

Similar arrangements were made during the Meuse-Argonne operation, but casualties were so numerous then that transportation facilities were taxed to the utmost. During this operation, 154,898 casualities from the American First and Second Armies were transported on American trains and on those rented from the French.4 Until October 14, Is-sur-Tille regulating station was charged with only secondary evacuation. On and after the 15th it participated in evacuations from the front.27 During this operation, 11 American trains made 114 evacuations in 47 days; each train averaged a round trip in four and one-half days.28

The time in hours required for trains to make runs from evacuation points in the Meuse-Argonne operation to the various hospitals is shown in the following table:

TABLE 5.Number of hours required for trains to make runs from evacuation points to
hospitalization points, Meuse-Arqonne operation
28

Evacuation point

Hospitalization point

Chaumont

Vittel

Dijon

Allerey

Paris

Mesves

Vichy

Clermont

Blois

Nantes

Angers

Limoges

Perigueux

Bordeaux

Toul

6

10

12

---

20½

---

---

27

24

---

19

---

25½

Froidos

10

14

14

16½

15

18½

---

26

---

---

---

---

---

---

Souilly

14

14

18

15½

20

23½

---

21½

32½

29

24

22½

30

Argonne front

8

12½

13½

16¾

15½

17¾

22

25½

21½

26½

27½

23½

26¼

30¼

The following tables and notes pertain to evacuation from the front only and do not take cognizance of "secondary" evacuations, i. e., evacuationswhich cleared advanced base hospitals into hospitals farther to the rear:

TABLE 6.-Evacuations by hospital trains, regulating station, Creil, Oise, February 17 to July 18, 1918, 1st and 26th Divisions

Month

Officers

Enlisted men

Total

French trains

Limits of evacuations

Total

French trains

Effectives

Position

February, March

---

a394

394

10

Feb. 17-Apr. 7.

401

12

26th Division

Soissons (Aisne) area.

April

---

71

71

10

 

Apr. 18-July 17.

3,325

83

1st Division

Cantigny, Picardy, area

May

22

1,287

1,309

28

---

---

Two divisions

On detached service with French Army.

June

32

1,580

1,612

37

---

---

---

July

---

a340

340

10

---

---

---

Grand total


54


3,672


3,726


b95


----


3,726


95


---

aClassifications as to officers and enlisted men not given in French reports; therefore monthly totals carried as enlisted men to balance totals.
bForty-nine of these trains carried less than 25 Americans.


277

NOTE ON TABLE 6, BY MEDICAL REGULATOR29

All evacuations by hospital trains regulated by the medical regulator, American regulating station at Creil, were made on French hospital trains. The medical regulator worked in liaison with the "Service de Santé" French regulating station, by whom the records contained herein were furnished. The records are complete in the period from May 18 to June 18, when careful record was kept by the regulating officer. After June 17 the French and American regulating stations for the Picardy area moved from Creil to Nantes, Seine, due to the severity of the nightly air raids, and as the medical regulator remained at Creil as regulating officer until the end of the month, the records furnished later by the "Service de Santé," Nantes, were not complete as to classification, entraining, and detraining stations. Before May 17 the records in the same manner are incomplete, as the American regulating station, a new function of the Army, was not fully organized. Several hundred American wounded from the 1st Division were discharged from French evacuation hospitals and sent by passenger trains to the replacement depot at Noyers and St. Aignan. Of these, records were unavailable. Upon completion of duty at Creil (the end of June) the medical regulator was assigned to Le Bourget (Seine) regulating station in charge of evacuations by hospital trains from the army known as the "Paris Group."

During the Cantigny offensive, the American wounded and sick on leaving the divisional (1st Division) sanitary formations were hospitalized in French evacuation hospitals at Beauvais, Poix, Crevecœur, etc., whence they were evacuated in French hospital trains to French base hospital centers in the rear. In so far as possible, trains carrying American and French patients were directed to hospital centers containing American and French base hospitals. As often as railroad conditions permitted, trains were directed through St. Germain, Seine (near Paris), where they were stopped, and the district surgeon (Paris) transported by ambulance such cases as were transportable to American hospitals in Paris. The Paris surgeon hospitalized in Paris, 1,880 Americans, regulated through Creil on 32 French trains.

In order to hospitalize American patients in American hospitals, plans were made to install an American evacuation center at Beauvais to receive American divisional wounded from the area, from which center American hospital trains might evacuate the wounded direct to American base hospitals. As the division was temporarily on detached service with the French Army and as the Chateau-Thierry operation started about the time the plans were formulated, they did not materialize.

TABLE 7.-Evacuations by hospital trains, regulating station, Connantre, Marne, October 4 to November 5, 1918, 2d and 36th Divisions

Month

 

Cases (unclassified)

French trains

Limits of evacuations

Effectives

Position

October

8,367

34

Oct. 4-Nov. 5.

2nd Division; 36th Division.

Champagne sector.

November

75

1


Total


8,442


35

NOTE ON TABLE 7, BY REGULATING OFFICER30

The 2d and 36th Divisions were on detached service with the French Fourth Army and were in the lines in front of St. Etienne above Suippes (Marne). The limits of operations refer to the evacuations only, for although both divisions were moved to the Argonne area after a successful operation ending about October 16 the evacuations continued to November 11. The attack started October 2.

The evacuations were all made on French hospital trains loaned to the American regulating officer at Connantre by the French (Service de Santé, Regulatrice) Connantre.


278

The records (unclassified), as shown herewith, were furnished by the French. Hospitalization in the "bases" was furnished (by telephone) by the regulating station, St. Dizier, which at that time received all the available bed space in the advance, intermediate, and base section hospitals for trains dispatched from the front. No American trains were available for the Connantre evacuations, as the need in the Argonne section was so great.

TABLE 8.-Evacuations by hospital trains, regulating station, Dunkerque, Nord, October 29 to December 25, 91st and 37th Divisions

Month

Officers

Total officers and enlisted men

French trains

Limits of operations

Effectives

Position

October

38

647

2

Oct. 29-Dec. 12

91st Division; 37th Division.

Ypres sector.

November

39

2,953

10

December

12

1,011

2

Total


89


4,611


14

NOTE ON TABLE 8, BY REGULATING OFFICER30

These divisions were on detached service with the French Army in Belgium. Although all fighting had ceased on November 11 (the armistice), the evacuations continued through December 24, as shown by the attached records. The evacuations were made on French trains loaned by the French regulating station, Dunkerque. The French furnished these reports for the American regulating officer, Dunkerque, and they are included herewith to make the figures of all evacuations by hospital trains from the front complete.

TABLE 9.-Evacuation by hospital trains, regulating station, Le Bourget, Seine, June 4to October 25, 1918, Paris Group Army

Month

Wounded

Sick

Gassed

Grand total

Allies

Enemy prisoners

American officers

American enlisted men

American total

American trains

French trains

Total trains

June

2,577

763

607

3,947

0

0

11

3,936

3,947

11

3

14

July

25,483

4,813

2,049

32,345

105

103

592

31,545

32,137

56

84

140

August

13,672

3,716

1,186

18,574

0

0

507

18,067

18,574

45

55

100

September

2,445

317

1,002

3,764

0

0

42

3,722

3,764

4

34

38

October

28

0

0

28

0

0

0

28

28

0

5

5


Total


44,205


9,609


4,844


58,658


105


103


1,152


57,298


58,450


116


181


297

Classification (per cent)

78

15

7

100

¼

¼

2

97½

99½

---

---

---

TABLE l0.-Separate operations in the Chateau-Thierry operation


Limit of evacuations


Effectives


Position


Total


French trains


American trains


Total trains

French trains carrying less than 25 Americans

July 17-Aug. 28

1st Division; 2d Division.

Soissons area, Aisne

10,456

117

8

125

75

Aug. 28-Sept. 14

32d Division

Juvigny, Aisne, Soissons area

2,295

31

5

36

24

June 4-Oct. 14

Paris group army

Chateau-Thierry, Soissons area

58,658

181

116

297

121

Total Chateau-Thierry evacuations, including ambulances, 71,409.

NOTE ON TABLE 10, BY REGULATING OFFICER31

At the beginning of June, when the 2d Division went out into the lines, west of Chateau-Thierry, a large number of divisional wounded were hospitalized in evacuation


279

centers at Juilly and Meaux (Seine et Marne) and in French evacuation hospitals in that area. The chief surgeon (Paris district) relieved the pressure at the evacuation center, Juilly, by evacuating in ambulances 2,177 cases to the Paris hospitals, a distance of 26 kilometers. Other ambulance evacuations were made to French hospital centers, the figures for which are not available.

The official limits of operations differ from the limits of evacuations in that evacuations usually commenced the day the operations started, but continued until the evacuation centers closed, which was sometimes several weeks after operations had ceased. For example, the 1st and 2d Divisions started their offensive near Soissons about the 17th of July and were out of the lines within five days. The evacuations from that area started the day the offensive began and continued until August 27, a great many Americans having remained in American and in French hospitals in that locality, although the divisions had moved to another area. Likewise, the 32d Division started operations at Juvigny (Aisne) near Soissons on August 28 and evacuations continued until September 15, although the division was taken out of the lines after the first week. A large number of French trains during the whole Chateau-Thierry operation carried only 1 to 25 Americans from French evacuation hospitals. They are reported herewith to make reports complete, but should not be counted as full trainloads of Americans.

The records on French trains were furnished by the French medical regulator, at Le Bourget, who generously loaned French trains during the intensive period of the Soissons operation, at which time there was a shortage of American trains and a pressing need for French trains for French evacuations. The 17 American, 3 British, and 35 French trains on duty at the Le Bourget regulating station were in constant circulation for several weeks, and on several occasions the supply of trains on hand was exhausted. From September 7 to October 14, all evacuations from the Chateau-Thierry area were made on French trains, every American train having been dispatched to the St. Mihiel area pending the attack by the First Army. The French generously provided French trains to take their place at Le Bourget.

During the Chateau-Thierry-Soissons operation, the wounded for the most part were transported on American hospital trains. Up to July 17, 7 American trains were garaged in 1 central garage, Pantin, near Le Bourget, and 10 more with the 3 British trains arrived shortly after. Trains were dispatched from Pantin to the evacuation hospital centers as indicated by G-4, Army (Paris group) who placed the calls for trains. This system of calling for trains through G-4, Army, was unsatisfactory, in that trains were called for in anticipations of loads at the evacuation centers which sometimes never arrived. For example, two trains called for at Coulommiers (Marne) and one at La Ferte Gaucher (Marne) were dispatched from those points only half filled, the hospitals not having enough to complete the loads. The trains left on the scheduled time as designated, for the railroad traffic was very heavy and could not be blocked pending the arrival of more patients. Furthermore, every available bed space on trains was in urgent demand and several hundred wounded from the 1st and 2d Divisions needing transportation were lying without cover at Crepy-en-Valois (Oise). In one day during this period, as many as 49 French and American hospital trains were dispatched by the regulating station, Le Bourget, on French and American evacuations. These with troops, supply, and ammunition trains created stupendous traffic on the railroad lines.

The difficulty was chiefly in faulty telephone connections between the evacuation centers, which were some distance from (G-4, Army) La Ferte-sous-Jouarre, Marne, and between (G-4, Army) the regulating station, Le Bourget. It took so long to transmit calls that conditions at the evacuation centers oftentimes changed and trains already dispatched could not be diverted. G-4, Army, had no telephone connections at the beginning of the attack with the evacuation centers (1st and 2d Divisions) located in the vicinity of Crepy-en-Valois, so that the medical regulator prepared his evacuations direct with the evacuation centers and received the necessary information on evacuables with greater efficiency and in shorter time. The same system was finally used for the evacuation centers at Coulommiers, La Ferte Gaucher, and Chateau-Thierry and proved more satisfactory.


280

Daily available bed space (5,000) at base hospital centers in the rear was furnished by telegram from the chief surgeon’s office, S. O. S., and the medical regulator thus coordinated the evacuations from the evacuation centers at the front direct to the rear. At first, bed spaces were furnished by the chief surgeon, Paris district, and the primary and secondary evacuations from the Paris Group area were coordinated through his office. They worked well, the telephone conditions being good, but the system required at best the passing of necessary information through another bureau and necessitated further delays. The bed reports (base hospitals) were finally telephoned direct to the regulating officer after July 24, so that with number of evacuable cases, the bed reports at the bases and the regulation of trains in one bureau, the regulating officer was enabled to direct the evacuations with greater efficiency and in shorter time.

TABLE 11.-Evacuation by hospital trains, regulating station, St. Dizier, Haute Marne, September 5 to December 1, 1918, (First Army)32

Month

Wounded

Sick

Gassed

Grand total

Allies

Enemy prisoners

American officers

American enlisted men

American total

American trains

French trains

Total trains

September

22,907

15,619

1,083

39,609

380

928

889

37,412

38,301

52

54

106

October

55,568

38,712

16,079

110,359

739

1,019

2,669

105,932

108,601

72

228

300

November

17,434

25,745

2,871

46,050

234

753

970

44,093

45,063

40

83

123


Total


95,909


80,076


20,033


196,018


1,353


2,700


4,528


187,437


191,965


164


365


529

Percentage

48.9

40.9

10.2

100

.7

1.4

2.3

95.6

97.9

---

---

---

TABLE l2.-Operations in the St. Dizier, regulating station figures32

Limits of evacuations

Effectives

Positions

Totals

September 12-26

First Army

St. Mihiel sector

21,009

September 26-November 12

…do…

Meuse-Argonne sector

150,350

October 10-25

Second Army

Toul sector

4,548

September 5-December 1

First Army, Second Army

St. Mihiel, Meuse-Argonne sectors

196,018

NOTE ON TABLE 12, BY REGULATING OFFICER32

The Second Army was formed October 12 and occupied the Toul sector. The regulating station, St. Dizier, continued to make evacuations from the Second Army evacuation center, Toul, until October 25, after which these were made by the regulating station. Is-sur-Tille.

TABLE 13.-Record of evacuations made by trains regulated at St. Dizier28

Operations

United States trains

French

Total

Daily average

St. Mihiel (Sept. 12-25)

29

28

57

4

Argonne (Sept. 26-Nov. 11)

114

304

418

9

Before St. Mihiel (Sept. 5-11)

6

0

6

1

After Argonne (Nov. 12-30)

15

33

48


Total evacuations (Sept. 5-Nov. 30)


164


365


529


---

During the St. Mihiel operation 7 United States trains were on duty during 14 days, making 28 evacuations. One train made 7 trips. The average number of trips per train was 4; the average length of round trips, 3½ days.

During the Argonne operation 11 United States trains were on duty during 47 days, making 114 evacuations. One train made 14 trips. The


281

average number of trips per train was 10.36; the average length of round trips, 4½ days.

The average load for French trains was about one-half that of American trains. For this reason the latter, in the St. Mihiel operation, made more evacuations than were made by French trains, but they made short trips into the zone of the advance, just as did the French. On the other hand, in evacuations from the Argonne, American trains were used on long trips into intermediate and base sections, while French trains were used for short trips, the numbers carried thus balancing more nearly those carried on French trains.28

One of the essential features which made for the success of evacuation through St. Dizier during the Meuse-Argonne operation was the excellence of telephone communication between that station and the evacuation points, on the one hand, and the office of the chief surgeon, A. E. F., on the other, thus enabling it, with the least possible delay, to coordinate evacuations direct to bases from the front. An officer from G-4, G. H. Q., and the evacuation officer representing the army surgeon, at Souilly, controlled movement of evacuables from evacuation centers and coordinated them through an officer at every such center charged solely with control of evacuations and loading of patients on trains. These officers represented both the army surgeon and the fourth section of the general staff. This system obviated the necessity for sending calls through another bureau.33

In order to avoid the mistake of calling for hospital trains when they were not actually needed, or of dispatching trains not fully loaded, and for the purpose of furnishing more accurate information for the evacuation department so that equipment at the disposal of the regulating officer could be used to the maximum advantage, the system of evacuation, as outlined herewith in brief, was adopted at St. Dizier in preference to that used during operations in the Chateau-Thierry sector.32

Evacuation centers at Souilly, Toul, Fleury, Vaubecourt, Froidos, etc., telephoned the regulating officer daily (8 a. m. and 8 p. m.) or as often as necessary, the number of patients to be evacuated, classified. They did not call for any specific number of trains, simply giving the number and type of patients to be evacuated. Supplied with these data the medical regulator arranged for a sufficient number of trains completely to evacuate all transportable patients, telephoning the evacuation centers information as to the marche of trains, the time allowed for loading, and the number and types of patients to be loaded. Trains best equipped for carrying particular loads were chosen. This was important because the equipment of the station consisted of 43 French trains, varying in carrying capacity from 86 to 700 places, besides 14 American trains. Officers at the evacuation centers saw to it that trains were loaded within the allotted time, though the personnel engaged in this work often labored 48 hours without rest. Each train was loaded with the type of patients specified and was dispatched to hospitals prepared to care for the kind of patients delivered to them. Upon completion of evacuations, trains were immediately ordered back to garage.32


282

TABLE 14.-Daily record of trains sent from each evacuation center, served by St. Dizier regulating station, St. Mihiel and Meuse-Argonne operations34


Evacuation centers

September

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Toul

1

--

--

1

1

--

1

3

4

3

3

4

4

4

4

--

1

2

1

4

1

--

1

--

--

1

Sorcy

--

--

--

--

--

--

--

--

1

--

1

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

Trondes

--

--

--

--

--

--

--

--

--

--

1

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

Vadelaincourt

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

1

Souilly

--

--

--

--

--

--

1

--

1

--

1

--

1

--

1

--

1

1

1

3

1

3

2

2

3

4

Vaubecourt

--

--

--

1

--

--

--

--

--

--

1

--

1

--

2

--

1

--

1

1

1

2

2

5

2

2

Froidos

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

2

1

Fleury

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

1

3

2

4

Villers-Daucourt

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

1

1

1


Total loadings


1


0


0


2


1


0


2


3


6


3


7


4


6


4


7


0


3


3


3


8


3


5


6


11


10


14


Evaluation
centers

October

November

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

1

2

3

4

5

6

7

8

9

10

11

Toul

--

--

--

--

--

--

--

--

--

2

1

1

--

--

--

--

--

--

--

--

--

1

3

--

1

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

Vadelaincourt

1

--

1

--

--

--

--

--

--

1

--

--

--

--

1

--

2

1

--

2

1

--

--

--

--

1

2

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

Souilly

5

4

5

3

2

3

5

2

3

3

5

3

3

4

5

5

5

4

4

3

4

1

3

2

5

3

3

2

3

2

2

3

2

4

2

3

3

3

2

3

2

3

Vaubecourt

2

3

1

6

3

2

4

2

2

4

3

3

--

3

2

2

2

3

2

2

2

2

2

1

1

2

3

2

1

3

--

3

1

3

2

1

2

1

2

1

1

1

Foridos

2

2

2

1

3

1

1

2

1

1

1

2

2

1

1

1

1

2

1

2

1

--

--

--

2

--

2

1

1

1

--

--

--

1

--

--

2

1

1

--

--

--

Fleury

4

3

3

2

4

2

2

2

2

3

4

2

2

2

2

3

2

1

1

3

--

2

1

--

2

2

3

2

1

2

1

2

2

3

1

2

2

1

1

1

1

1

Villers Daucourt

1

2

--

1

1

2

2

--

1

--

--

1

--

1

1

--

2

1

1

--

1

1

1

--

1

--

--

1

--

1

--

1

1

1

1

2

1

--

2

--

1

--

Revigny

--

--

--

--

--

--

--

--

--

--

--

1

--

--

--

--

1

1

1

1

--

1

--

--

2

1

--

1

--

--

--

--

--

--

1

--

--

--

1

--

1

--

Varennes

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

--

1


Total loadings


15


14


12


13


13


10


14


8


9


14


14


13


7


11


12


11


15


13


10


13


9


8


10


3


14


9


13


9


6


9


3


9


6


12


7


8


10


6


9


5


6


6

TABLE 15.-Number of trips made by hospital trains in the performance of evacuation35

Regulating station

American trains

French trains

French trains carrying less than 25 Americans and included in total trains

Total

Creil

0

95

49

95

Le Bourget

116

181

121

297

St. Dizier

164

365

0

529

Connantre

0

34

0

34

Dunkerque

0

16

0

16


Total


280


691


170


971

TABLE 16.-Summary, classified by officers, enlisted men, and types of patients evacuated4

 

Chateau-Thierry

St. Mihiel

 

Argonnea

Total

Per cent

Evacuations

Per cent

Evacuations

Per cent

Evacuations

 

Per cent

Evacuations

Officers

2

1,001

400

2

3,752

2

5,153

Enlisted men

97½

43,385

96

19,865

96½

148,157

96½

211,407

Others

½

209

744

2,989

3,942


Total


100


44,595


100


21,009


100


154,898


100


220,502

Wounded

78

34,741

53

11,246

51

79,415

60

125,402

Sick

15

6,913

45

9,501

36

56,015

32

72,429

Gassed

7

2,941

2

262

13

19,468

8

22,671


Total


100


44,595


100


21,009


100


154,898


100


220,502

Between operations (covering all evacuations not included in above operations)

---

---

38,700


Grand total


---


---


---


---


---


---


---


259,202

aSecond Army evacuations from Toul, October 10 to 25, 4,548. Total Argonne First Army evacuations, 150,350 on 409 hospital trains.


283

TABLE 17.-Hospital trains employed4

 

Chateau-Thierry

St. Mihiel

Argonne

Total

Between offensives

Grand total

American

78

29

114

221

42

263

French

135

28

304

467

119

586


Total


213


57


418


688


161


849

TABLE 18.-Evacuations by trains from First Army, September 5 to December 1 (including both. St. Mihiel and Meuse-Argonne operations)4

Month

Wounded

Sick

Gassed

Total

Allies

Prisoners

American officers

American enlisted

Total American

French trains

American trains

September

22,907

15,619

1,083

39,609

360

928

889

37,412

38,301

52

54

October

55,568

38,712

16,079

110,359

739

1,019

2,669

105,932

108,601

72

228

November

17,434

25,745

2,871

46,050

234

753

970

44,093

45,063

40

83


Total


95,909


80,076


20,033


196,018


1,333


2,700


4,528


187,437


191,965


164


365

NOTE ON TABLE 184

The incidence of influenza in the last week in September, the rising curve in October, and the fall in November are indicated by the column of "sick." This epidemic was responsible for a large number of evacuations, as the First Army lacked a convalescent camp within its area and possessed small hospitalization in its immediate rear; the converse holding for the Second Army, based upon Toul, with its numerous barracks.

TABLE 19.-Summary of evacuations from the front by hospital trains35

Regulating stations

Departments

Positions

Troops

Time of evacuations

Creil

Oise

Soissons and Picardy.

26th Division, 1st Division.

Feb. 17-July 10.

Le Bourget

Seine

Chateau-Thierry sector, Soissons sector.

Paris group army

June 4-Oct. 26.

St. Dizier

Haute Marne

St. Mihiel

First Army


Sept. 5-Dec. 1.

Meuse-Argonne

Second Army

Toul Sector

…doc

Connantre

Marne

Champagne Sector

2d Division, 36th Division

Oct. 4-Nov. 4.

Dunkerque

Nord

Ypres Sector

91st Division, 37th Division.

Oct. 29-Dec. 25.


Regulating stations


Wounded


Sick


Gassed


Grand total


Prisoners


Allies


Enlisted men


Officers


Total Americans

Creil

a3,726

---

---

3,726

---

---

3,672

b54

3,726

Le Bourget

44,205

9,609

4,844

58,658

103

105

57,298

1,152

58,450

St. Dizier

95,909

80,076

20,033

196,018

2,700

1,353

187,437

4,528

191,965

Connantre

a8,442

---

---

8,442

---

---

8,442

(b)

8,442

Dunkerque

a4,611

---

---

4,611

---

---

4,522

b89

4,611

 

156,893

89,685

24,877

271,455

2,803

1,458

261,371

5,823

267,194

Percentages by classes (approximate)


60


32


8


100


1


½


96½


2


98½

aSecond Army evacuations from Toul, October 10 to October 25,  4,548 on six American and three French trains, included. With American grand total, 267,194 and 2,177, transported by ambulance to Paris in June, gives grand total of 269,371 Americans.
bClassified as wounded (battle casualties from front). Records of sick, wounded, and gassed, unclassified, in French train reports.
cRecords of officers incomplete in French train reports. Records of allies and prisoners unclassified, as wounded, sick, and gassed, and as to officers and enlisted men in French train reports. Thus officers and enlisted men refer to Americans only.


284

The most important facts concerning the activities of the regulating station at Is-sur-Tille are given in Tables 20, 21, and 22. The first evacuations made by hospital trains operated by this station occurred in March, 1918.27

The number of hospital trains at the disposition of the regulating officer was at first considered inadequate to meet anticipated demands, but, as it proved, evacuations during the active four days of the St. Mihiel operation were far less than had been expected. The Meuse-Argonne operation, however, during the first, second, and third weeks of October, together with the epidemic of influenza, which spread rapidly throughout the army at the time, caused double the number of evacuations which would have been required with a normal sick rate.32

From September 26 to October 14, 1918, the regulating station at Is-sur-Tille controlled many of the secondary evacuations, by which is meant evacuations from base hospitals in the zone of the advance to others nearer base ports.27 It was the practice during that period to send patients by train from evacuation hospitals to base hospitals in the zone of the advance, whence, as opportunity offered, other trains took them farther to the rear. Hospital train equipment at this time was inadequate and it was only by the utmost care and by the narrowest margin that trains were able to keep the evacuation hospitals cleared. Hospital trains were sent preferably to forward base hospitals, because of the shorter hauls, and then, during lulls in fighting, they cleared those hospitals in turn, in preparation for later short hauls from the front when heavy fighting was resumed. A round trip between the front and the hospitals in the advance section required some 24 hours or less, while between the front and the hospitals in the base sections a round trip required about a week. Had trains been employed frequently in the first instance for the long hauls congestion in evacuation hospitals would have been inevitable. Only during intermissions in the conflict and when casualties diminished in the latted part of October did long hauls become practicable. After October 14, when the demands for hospital trains at evacuation hospitals diminished, it became possible to move patients direct from the front to base hospitals well toward the rear, and then the former system, with the secondary evacuations incident thereto was discontinued.27

In selecting garages for hospital trains, four considerations were taken into account by the Is-sur-Tille regulating station: Sufficiency of siding space, engine terminals, location of base hospitals, and base of supply. The following garages were used by the Is-sur-Tille regulating station for trains assigned to it:27

TABLE 20.-Hospital train garages

Location

Capacity
(trains)

Capacity

Capacity
(trains)

Foulain

1

Bourmont

1

Liffol-le-Grand

2

Vittel

1

Bazoilles

1

Damblin

3

Hymont

1

Rosières-sur-Mouzon

1

Harréville

1

Breuvannes

1

Remoncourt

1

Is-sur-Tille

6

Aulnois (Vosges)

1


285

The following evacuations were effected from base hospitals in the advance section to hospitals in intermediate and base sections:27

TABLE 21.-Evacuations from base hospitals in advance section, A. E. F.

 

Month 1918

French trains

American trains

Patients

 

 

 

March

---

3

1,128

 

 

 

April

---

4

1,396

 

 

 

May

---

3

1,080

 

 

 

June

---

3

1,300

 

 

 

July

---

2

610

 

 

 

August

---

16

5,780

 

 

 

September

9

36

16,552

 

 

 

October

56

33

31,777

 

 

 

November

16

7

8,198

 

 

 

Total, patients

---

---

67,821

 

 

TABLE 22.-Evacuations effected by regulating station at Is-sur-Tille27


Types and locations of hospitals concerned in the evacuations

Number of trains used

Kind of train

Patients

Patients evacuated from evacuation hospitals to hospitals in the advance section from Sept. 26 to Oct. 14, 1918, inclusive

26

American

11,125

84

French

28,806

Patients evacuated from evacuation hospitals to base hospitals in the near intermediate section (Dijon, Beaune, Allerey, Mesves, and Mars)

28

American

12,472

56

French

17,947

Patients evacuated from evacuation hospitals to distant intermediate and base section hospitals

3

American

1,260

Patients evacuated from evacuation hospitals in the advance section from Oct. 15 to Nov. 11, inclusive

42

French

15,282

Patients evacuated from evacuation hospitals in the near intermediate section

127

…do…

39,074

Patients evacuated from evacuation hospitals to hospitals in the far intermediate section

5

American

2,453

Patients evacuated from evacuation hospitals to hospitals in the base section

52

…do…

26,246

Number of secondary evacuations from base hospitals in the advance section to distant hospitals in the intermediate section base

49

---

15,110

Secondary evacuations from base hospitals in the advance section to hospitals in the base section

16

American

7,945

2

French

560


Total


293


---


106,770


TABLE 23.-Assignment of hospital trains to regulating stations, September 26 to November 11, 1918

Dates

Regulating station

Kind of train

Number

1918

 

 

 

Sept. 26-Oct. 14

Is-sur-Tille

American

8

…do…

French

11

St. Dizier

American

7

…do…

French

34

Oct. 15-Nov. 11

Is-sur-Tille

American

5

…do…

French

7

St. Dizier

American

10

…do…

French

a40

aThe report of St. Dizier states that its equipment consisted of 14 American and 43 French trains.

While the station at Is-sur-Tille was concerned for a brief period with secondary evacuations from the zone of the advance, other secondary evacuations were conducted directly by the office of the chief surgeon, A. E. F., at Tours. Trains operated in the zone of the armies were assigned by G-4, G. H. Q. to the several regulating officers; on the other hand, those assigned and operating in the Services of Supply were directly under the jurisdiction of the chief surgeon and were controlled by his office.27


286

REFERENCES

(1) Report of the activities of the chief surgeon’s office, A. E. F., to May 21, 1919; compiled by the chief surgeon, A. E. F., undated, 104. On file, Historical Division, S. G. O.

(2) Report of the fourth section, general staff, G. H. Q., A. E. F., prepared by the assistant chief of staff, G-4, June 1, 1919, 65-70. Copy on file, Historical Division, S. G. O.

(3) The French supply control installation for the field forces, by Lieut. Col. J. W. Beacham, Inf.; The French control of evacuation, by Lieut. Col. S. H. Wadhams, M. C. (Remarks delivered at the General Staff College, Washington, March 23, 1921.) Copy on file, Historical Division, S. G. O.

(4) The evacuation system in the Zone of the Armies, by Col. A. N. Stark, M. C., undated. On file, Historical Division, S. G. O.

(5) Report on activities of G-4-B, medical group, fourth section, general staff, G. H. Q., A. E. F., by Col. S. H. Wadhams, M. C., chief of section, December 31, 1918, 59. On file, Historical Division, S. G. O.

(6) Exhibit "U" to report on activities of G-4-B, medical group, fourth section, general staff, G. H. Q., A. E. F.: Evacuation of sick and wounded, from the commander in chief G-4, G. H. Q., A. E. F., to all regulating officers, August 29, 1918. On file, Historical Division, S. G. O.

(7) Evacuation of the wounded in the Meuse-Argonne operation, by Col. H. H. M. Lyle, M. C., May 10, 1921, 25. On file, Historical Division, S. G. O.

(8) Exhibit "S" to report on activities of G-4-B, medical group, fourth section, general staff, G. H. Q., A. E. F.: Report of hospital evacuation section, Regulating Station "B," St. Dizier, undated, Part III, 55. On file, Historical Division, S. G. O.

(9) Ibid., Part III, 56

(10) Ibid., Part III, 58

(11) Ibid., Part III, 53

(12) Ibid., Part III, 54

(13) Ibid., Part I, 1

(14) Ibid., Part I, 2

(15) Ibid., Part V, 2

(16) Ibid., Part V, 4

(17) Evacuation of wounded into fixed formations, by Col. R. M. Culler, M. C., undated. On file, Historical Division, S. G. O.

(18) Exhibit "S" to report on activities of G-4-B, medical group, fourth section, general staff, G. H. Q., A. E. F.: Report of hospital evacuation section, Regulating Station "B," St. Dizier, undated, Part 1, 3. On file, Historical Division, S. G. O.

(19) Ibid., Part II, 5

(20) Ibid., Part II, 11

(21) Ibid., Part II, 7

(22) Ibid., Part II, 16

(23) Ibid., Part II, 20

(24) Ibid., Part II, 28, 29

(25) Ibid., Part II, 35

(26) Medical activities in the Zone of the Armies, by Col. A. N. Stark, M. C., chief surgeon, First Army, February 15, 1919. On file, Historical Division, S. G. O.

(27) Exhibit "S" to report on activities of G-4-B, medical group, fourth section, general staff, G. H. Q., A. E. F.: Report of hospital train evacuation, American regulating station, Is-sur-Tille, undated. On file, Historical Division, S. G. O.

(28) Exhibit "S" to report on activities of G-4-B, medical group, fourth section general staff, G. H. Q., A. E. F.: Report of hospital evacuation section, Regulating Station "B," St. Dizier, undated, Part IV, 5. On file, Historical Division, S. G. O.

(29) Ibid., Part IV, 31

(30) Ibid., Part IV, 36

(31) Ibid., Part IV, 20, 21

(32) Ibid., Part IV, 7

(33) Ibid., Part IV, 8

(34) Ibid., Part IV, 4

(35) Ibid., Part IV. 2