CHAPTER XVII
THE DIVISION OF HOSPITALIZATION (Continued)
MEDICAL DEPARTMENT TRANSPORTATION
HOSPITAL TRAINS
Hospital trains of the American Expeditionary Forces, being MedicalDepartment organizations,1 that department administered thepersonnel as signed to them and was responsible for the maintenance oftrain supplies and equipment.2 As railway units, hospital trainswere operated under the direction of the officer to whom they were assigned,and were repaired by the transportation service, A. E. F.2
Assignments of hospital trains were made by the fourth section, generalstaff, general headquarters, A. E. F., to regulating officers and to thetroop movement bureau, headquarters, Services of Supply.2
An officer of the Medical Department was assigned to each regulatingstation as a part of the staff of the regulating officer and as a representativeof the chief surgeon, A. E. F., to whom commanding officers of hospitaltrains assigned to that regulating station, were directly answerable inmatters pertaining to Medical Department administration.2 Themedical assistant to the regulating officer was charged with the duty ofseeing that trains were at all times ready to answer calls, and, to thisend, that they were kept properly stocked and provisioned.
Briefly, evacuation of sick and wounded from the zone of the armiesby means of hospital trains was effected by trains assigned to regulatingofficers. On the other hand, evacuation from hospitals in the rear of thezone of the armies was provided for by the troop movement bureau at headquarters,Services of Supply, in accordance with requests made upon the bureau forthis purpose by the chief surgeon, A. E. F.2
Prior to the signing of the armistice, most of the hospital trains wereassigned to the control of the chief surgeon's representative at generalheadquarters.3 The remainder, which were engaged in secondaryevacuations-i. e., removal of patients from one base hospital to anotherin the Services of Supply-were under the immediate control of the transportationsection of the hospitalization division, chief surgeon's office, A. E.F., except that certain of these secondary evacuations, the purpose ofwhich was to clear base hospitals in the advance section, A. E. F., wereconducted for a brief period by the regulating station at Is-sur-Tille.3
Since the operation of regulating stations, and primary evacuationsfrom the zone of the armies are discussed in Volume VIII of this history,no further reference will be made to these subjects herein.
The transport and hospitalization of sick and wounded in the AmericanExpeditionary Forces after they had left the zone of the armies, presented
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difficulties which differed in many respects from those which had confrontedthe French Army during three and a half years of warfare, and also fromthose of the British whose system of evacuation was similar to that ofFrench though modified by geographic conditions.3 The Frenchand British systems involved no long lines of communication to home ports.France was hospitalized intensively in each of her military regions, sothat her disabled could be distributed among the many military hospitalsscattered throughout the country, and, when hospital bed space was lacking,in private homes.3 The shortness of the journey to England madeit possible for British wounded to reach home bases rapidly and in largenumbers.
The American Army, on the other hand, was compelled to hospitalize inFrance and in England almost all its sick and wounded, during the periodof active warfare, since it was impracticable to return to the United Statesany except a relatively small number who were permanently disabled.3To meet the needs imposed by this situation and to economize personneland matériel, we had recourse to the use of large hospitals andhospital groups into which patients could be received by the trainload.These organizations necessarily were situated on supply lines of the AmericanExpeditionary Forces. The plan involved long hauls when patients were movedfrom the front into hospital centers in the intermediate or base sections,and early in the organization of the American Expeditionary Forces it wasappreciated that ample hospital train service was one of the prime elementsof a successful evacuation service. The procurement of such trains wasone of the first subjects taken up by the chief surgeon, A. E. F.3
PROCUREMENT
Pending later arrangements, two hospital trains were rented from theFrench Government, the order for them being placed in July, 1917,4delivery for one being effected in December of that year and for the otherin February, 1918.5 Since it was known the French could notfurnish more trains, and as a tentative estimate had been made that 10trains would be needed for every 500,000 troops, contracts for others werelet in England.6 By August 12, 1917, arrangements had been completedfor the procurement of 12 hospital trains from England and the 2 (abovementioned) from France. As the situation developed, an increasing numberof these trains was contracted for to a total of 48 hospital trains and20 corridor trains for sitting patients only.5 Fifteen of theformer had been ordered prior to December 31, 1917, and by the end of August,1918, 17 hospital trains were in use, and orders had been placed in Englandfor 23 others.5 The order for the corridor trains was placedon November 7, 1918.5 Delivery of trains of both kinds was stoppedwhen the armistice was signed.5 At that time 19 hospital trainshad been received from the British and 4 more were ready for shipment.5The cost of each train was approximately $200,000.3 In additionto these trains others, not especially built for the conveyance of casualtiesbut adapted as well as might be to that purpose, were rented from the Frenchto meet emergencies.3
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BRITISH-MADEAMERICAN HOSPITALTRAINS
Each of the British-made trains consisted of 16 coaches. With a fewminor exceptions they were standardized and afforded the following accommodations:71 car for infectious cases, 24 beds (one end used for caboose); 1 staffcar, 8 beds; 1 kitchen and sick officers' (sitting) car, 3 beds for cooks,20 seats; 9 ordinary ward cars, 36 beds each; 1 pharmacy car, 12 beds;1 personnel car, 33 beds; 1 train crew and store car, 3 beds; 1 kitchen,men's mess car, caboose, 2 beds for noncommissioned officers.
The average weight of an empty train, without engine, was about 450tons, and the average length, less the engine, 920 feet.7 Longcoaches, 54 to 56 feet from end to end, were used instead of the short,continental type, in order to insure more comfortable journeys. These trainswere so attractive in appearance that they were frequently placed on exhibitionin England before being shipped to the Continent.
Each train was provided with 360 beds for patients.7 Notinfrequently, however, in emergencies, the train personnel gave their bedsto patients, thus increasing train capacity to 396 beds. Fittings in alltrains (except the one first rented from the French, which accommodated306 recumbent patients) could be so adjusted by folding up the middle tierof beds that the relative number of recumbent and sitting patients couldbe varied from 120 of the former and 480 of the latter-the normal arrangement-to360 of the former and no sitting patients. The crisis load was 120 bedsand 488 sitting patients.6
Special provisions were made for the badly wounded, the slightly wounded,infectious and mental cases, respectively, including arrangements for theirmedical care and for supplying them with proper food.7 Specialcooking facilities were afforded in the two kitchen cars which formed partof these trains.
The forward kitchen car was divided into three sections-kitchens, sittingroom for disabled officers, and a bedroom for cooks.7 In thefirst section was installed an Army range with equipment, together withan apparatus providing an adequate supply of water for cooking purposes.This kitchen was used only when there were patients on board and was supplementaryto the kitchen at the rear of the train. The latter served duty personnel,whether there were patients on board or not.
The staff car, for medical officers and nurses, was provided with sleepingcompartments and a separate dining room for nurses and officers.7Also it was equipped with a shower bath and was made as comfortable aspossible.
Each of the 9 ordinary coaches for recumbent patients was fitted with36 beds, arranged in tiers of 3. Beds were specially designed, were removable,and in case of necessity could be used as stretchers.7 Whenthe car required cleaning these beds could be folded against the sides,and by lowering the middle one flush against the sides of the car the bednearest the floor was converted into a comfortable seat or couch, the topone being still available for a recumbent patient. By thus converting bedsinto seats the less seriously wounded could sit up or lie down as desired.
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These coaches were considered models of simplicity and efficiency.7To expedite loading and unloading double doors were provided on each sideof each ward coach, as near the center as possible. In cases of seriousinjury where it was not advisable to remove a patient from the litter,this could be rested directly on the bed supports, without complicatedadjustments. Ash trays and small racks for holding patients' toilet andother personal articles were provided in convenient places.
The pharmacy car was placed near the center of the nine ward coaches.It was well equipped with drugs, linen, medical and surgical necessities,and had an office where records were kept. It also had a room containinga collapsible operating table for minor operations or for changing dressings,a 12-bed ward, and a morgue.7
The car for infectious cases was divided into four compartments forpatients and one for attendants.7 Each compartment for patients(used also for mental cases, as required) accommodated six patients.
The personnel car, provided for the enlisted force, was designed onthe same lines as an ordinary ward coach, so that in emergencies it couldbe utilized as a patients' car.7 Accommodation for patientswas also increased at such times by the insertion of litters wherever thesecould be placed.
The second kitchen car had dining-room accommodations for noncommissionedofficers and enlisted men and was equipped with facilities for cookingand for heating water similar to those installed in the forward kitchencar.7
The last coach on the train furnished ample storage space for generalsupplies such as food and drugs for seven days and, in a section partitionedoff from the rest of the car, afforded additional accommodations for thetrain crew.7
Trains were electrically lighted throughout and were capable of generatingcurrent when running at any speed.7 Storage batteries were placedunder the bodies of the cars to furnish current when the train was notin motion, but orders were enforced that current be economized. Hurricaneoil lamps and an ample supply of candle holders were provided for emergencyuse in case the electrical connections became disordered. Material forgas lighting was supplied at some stations, but in times of battle pressuretrains were not held to have this supply.7 If this materialwas refused at any of these stations, the fact was reported to the transportationsection of the chief surgeon's office.
Our British-made hospital trains were steam heated throughout, the ratioof heat-radiating surface being higher in them than in any other railwaycoaches on the Continent.7 Staff and personnel coaches wereprovided with a special self-heating equipment for use when detached fromthe engine. As the personnel lived on board, this was a necessary provision.When trains carrying patients were garaged on sidings and their enginesdetached, the train commander was authorized to request French authoritiesor the railway transportation officer to have an engine attached if weatherconditions were severe.
An ample supply of water for drinking and other purposes was providedon all coaches, the amount per train being about 2,500 gallons.7Drinking water was supplied in 6-gallon tanks throughout the train, andit was ordered that these tanks be filled as opportunity offered, due noticebeing given the railway transportation officer, who was charged with makingnecessary arrange-
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ments. All drinking water was sterilized. Water for washing trains wasobtained from the station supply.
Special attention was given to ventilation of ward and other cars andof lavatories.7 Trains were equipped with large electric fans,and small portable ones were used in the treatment of gassed cases. Lavatoryaccommodations were ample.
TRAINS OBTAINEDFROM THE FRENCH
The acute need for hospital trains arose first in May, 1918, at Cantigny,and was intensified during the operations in the Marne area.3It continued throughout July and late into August in the last-mentionedsector and in that of the Champagne. A large number of American woundedwere evacuated by trains procured from the French during operations infront of Paris in July and August, though we then had 9 trains, from Pantin,in service.3 From 4 to 6 of these were sent daily to entrainingpoints and were routed into Paris or through it to other destinations.Arrangements had also been made with the French to furnish us other hospitaltrains and trains for patients. In the same way 45 French trains were borrowedfor use during the St. Mihiel and Meuse-Argonne operations.3These were additional to the 2 specially prepared trains rented from theFrench in July and the 19 built in England.
FIG. 82.-Hospitaltrain obtained from the French, at Base Hospital No. 9, Chateauroux
French trains obtained for the Meuse-Argonne operation were of threemain types:9 (1) Permanent trains made up of corridor cars.(2) Permanent sanitary trains made up of cars specially constructed forthe transportation of bed patients. These were comparable to our hospitaltrains except that they were smaller, carrying 120 recumbent patients.Heating, as a rule, was central. Patients were unloaded through side doors.(3) Improvised hospital trains
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made up of ordinary passenger cars fitted with racks for holding stretchers.Only recumbent patients were carried in these, 12 to a car. Cars were heatedby a small stove in each, and there was no communication between them.One enlisted man of the French Medical Department traveled in each car.
In addition to these hospital trains there were the mixed or semipermanenttypes, made up of the ordinary French day coaches (second and third class)with lateral corridors. Certain of them were equipped for carrying recumbentcases.9 Some of these trains were made up of corridor cars only;others only partially so. Two stretchers, one above the other, were placedin one-half of each compartment, leaving room for 3 sitting cases on theopposite seat; that is, each compartment carried 5 patients, 2 lying and3 sitting. According to the number of compartments (6, 7, or 8), cars carried12, 14, or 16 recumbent cases each, and 18, 21, or 24 seated; a total of30, 35, or 40.
FIG. 83.-Frenchhospital train, with continental type of carriage
The method of supporting stretchers varied somewhat, according to thetype of train and also whether it belonged to the Midi or Paris-Lyons-MediterraneanCo.9 In cars of both these lines the interior handle of thestretcher rested against an iron frame fixed to the side of the compartment.In the Paris-Lyons-Mediterranean type of train the external handle of thestretcher rested on the end of the same frame, while in the Midi type oftrain it was suspended by a chain from the roof of the car.
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Carrying capacities of these French trains varied considerably.9Some accommodated an average of 70 recumbent and 300 sitting patients;others from 70 to 280 recumbent and no sitting patients. Some carried 108recumbent and from 230 to 250 sitting patients, and so on.
Toward the end of the Meuse-Argonne operation a few trains of largecapacity, carrying from 1,000 to 1,500 were utilized for the exclusiveuse of sitting cases.9 It was thought that box-car trains wouldbe used only during periods of intensive evacuation. In point of fact weemployed them frequently during the Meuse-Argonne operation, because thewhole front line from the sea to the Vosges was continually evacuating,and every available kind of transportation was needed.
Except the two trains obtained at first, those leased from the Frenchwere operated as arranged for by them, but their destination was controlledby the American Army.3 They were not used exclusively, however,for American wounded. French wounded carried on these trains were caredfor and taken to American hospitals just as were American patients. DisabledGerman prisoners, too, were carried in the same way, no difference beingmade with them in accommodations, treatment, or disposition. During theSt. Mihiel and Meuse-Argonne operations, approximately 2,000 wounded Germanprisoners were carried on trains belonging to the American evacuation service.3
It had been contemplated that box cars would be fitted up in such away that they could be used for transporting patients from the front, and,by the readjustment of fittings, for transporting supplies from the rear.5These fittings, consisting of metal posts supporting tiers of litters,could be screwed in to the floors and tops of cars and easily removed.Though these fittings arrived in France, they were never used, for whilethe idea appeared sound there was delay in cleaning trains and adjustingfittings. Moreover, cars were not always available when needed for thispurpose. The French and the British Governments both had attempted to usethe plan but soon abandoned it.
SUPPLIES
Initial supplies and equipment for hospital trains were procured fromthe American Expeditionary Forces medical supply depot, Cosne, upon whichrequisition was made direct.10 After being placed in operationthese trains obtained their supplies from the hospital train store establishedat the central depot for hospital trains and from supplementary depotsestablished as necessity arose. In times of pressure, hospital trains disembarkingcasualties at base hospitals where there were not hospital train depots,sometimes had to return direct to railhead areas without stopping for anyprolonged period. Under such circumstances the commanding officers of thesetrains obtained supplies, if possible, from these base hospitals or fromthe quartermaster depots located there. Notice of stores drawn under suchcircumstances was sent to the central depot against which these supplieswere charged, so that this depot could check the issue.
It was intended that property accountability should be taken care ofby these depots and that hospital trains were to obtain their suppliesfrom them on memorandum receipt, but until such depots were establishedit was neces-
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sary for the trains to keep a property account.10 As soonas depots were established, orders were issued for hospital trains to invoicethe property to depots but to retain the same on memorandum receipt. Whenemergency issues were necessary, a telegram was sent to the base hospitalor quartermaster storehouse, giving train number, time of arrival, andname and quantity of articles wanted so that these would be available onarrival. When absolutely necessary for supplies to be drawn at the railhead,notice of what had been drawn was sent to the central depot for hospitaltrains.10
A list of the standard equipment for each train was furnished the regulatingofficer and was kept for his reference.7 He was authorized tocheck this equipment whenever he deemed this necessary, and the commandingofficer of the train was ordered to check it frequently, verify its condition,and make suitable provision for its care. Hospital trains were suppliedwith adequate material to effect exchange of all property brought by patientsfrom evacuation hospitals, such as pajamas, splints, crutches, litters,air pillows, and dakinization tubing; when such matériel was deliveredwith patients at base hospitals it was similarly replaced. Also, a sufficientsupply of litters and blankets was kept at the hospital centers to permitan exchange, thus avoiding transfer of patients from one litter to another.When reserve supplies were not sufficient for the exchange of item foritem, either the commanding officer or the supply officer of the trainwas given a receipt for matériel not replaced.
Red Cross comforts for patients were obtained at any train depot.3Blankets were checked frequently, were obtained from depots when needed,and were disinfected at the central sterilizing plant.3 Reserveblankets were turned over to the railhead depot when required, and othermedical supplies carried as reserve when asked for. When the train returnedto a depot these reserve blankets and supplies were replaced. Similarlyclothing and shoe repairs for personnel were obtained at the hospital traindepots. Splints and suspension bars were carried in reserve to replacethose brought with patients from the zone of the advance. Arrangementsfor dental service of train personnel were made at the depots.
PERSONNEL
Each American train carried, at first, a personnel of 3 medical officers,3 nurses, 1 sergeant, first class, or hospital sergeant, 2 sergeants, 2cooks, and 31 other enlisted men of the Medical Department, including 1engineer-mechanic.3 Later it was found that two medical officerswere sufficient, the third being replaced by an additional nurse. Trainpersonnel was housed and fed on board whether in transit or in garage.3
ADMINISTRATION
The commanding officer of a train was charged with several correlatedduties, exercising military jurisdiction and professional control.10He was responsible for discipline, exercising control over personnel andpatients, for which reason he appointed a summary court officer. He wasalso charged with the thorough instruction of his personnel. When patientswere being entrained or detrained, the entire train personnel was on duty,and only the
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officer in charge of the movement and the necessary enlisted help wereallowed off the train.11 Furloughs were granted only on approvalof the regulating officer or of the transportation section of the chiefsurgeon's office if the train was under the latter's immediate control.Passes to leave a train were granted with discretion. No such passes weregranted in the advance zone, and nurses were not permitted to be away froma train longer than two hours. Such of the train personnel as became incapacitatedwere left at the nearest base hospital. If anyone on duty missed his trainhe reported at once to the railway transportation officer of the stationit, being forbidden to travel without orders on any train; all absenceswere reported to higher authorities. Ward orderlies were not sent out ofthe train for any purpose whatever. At night at least one medical officer,one trained nurse, and one orderly for each ward remained on duty. Precautionsagainst fire were enjoined, and appropriate orders, including assignmentsin case of such emergency, were issued. The train commander permitted noone to travel on his train except its authorized personnel, men whose namesappeared on the evacuation lists, and those authorized by the chief surgeon,A. E. F., or by the regulating officer to whom the train was assigned.10,11 Armed guards who had accompanied such a train from the zone ofthe advance were forbidden to return on it except as so authorized.10,11
The train commander kept a war diary in which he made note of all mattersof importance to its service.11 He reported to the regulatingofficer or to the chief of the transportation section, chief surgeon'soffice, all cases of slight sickness and of the wounded who should havebeen retained in the advance area, and all cases of death, giving fullparticulars. (The regulating officer, in turn, transmitted this informationto G-4, general headquarters, and to the Army surgeon.)12 Hesupervised the treatment of patients and made provision for their care,kept up the records of sick and wounded, and sent to the chief surgeonA. E. F., to the commanding officer of the base hospital to which he wastaking patients, and to the regulating officer, telegrams stating the numberof recumbent and sitting patients in his total trainload, and the sameinformation covering each class of patients on board: Wounded, sick, andgassed.11 His telegram to the regulating officer, confirmedby mail, gave complete detailed information concerning the trip. To thechief surgeon, A. E. F., and to the regulating officer he sent copies ofhis train report and of his "detraining state." A telegraphic report ofany accidents, confirmed by letter giving full particulars, was sent tothe regulating officer, who was charged with the responsibility of sendingimmediate relief, with a wrecking crew, and with report of the facts inthe case to the chief surgeon's office.11, 12
Accidents causing damage to coaches, or derailments, were reported bytelegraph to the transportation section, chief surgeon's office, A. E.F., and repeated to the Railway Transport Service, general headquarters.10Demand for repairs, was handed to railway transport office representativesat bases where such repairs were possible and were authorized, but exceptin cases of great emergency no such demands were made at a railhead orother unauthorized station.
Suggestions concerning minor alterations in structure which appearedto be desirable, or notes on general conditions of trains, were sent bymail to the transportation section in the chief surgeon's office, A. E.F.11
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Trains were loaded as nearly as possible according to the instructionsof the regulating officer and were routed as he directed, no trips beingmade except upon his authorization.2 Upon completion of evacuationthe train was sent back to the regulating area and garaged there.11
If coaches were removed from or added to a train, notification withtime, place, and cause, was telegraphed to the chief surgeon, A. E. F.,or to the regulating officer concerned, who altered his record of the carryingcapacity of such train and arranged his load for it accordingly.11Changes in the composition of hospital trains were authorized only by thechief surgeon. If the regulating officer found that conditions requiredsuch changes, he consulted the chief surgeon's office. If through accidentor emergency cars were detached, the regulating officer endeavored to havethem returned as soon as possible if in his area; if outside it, he madeappropriate request upon the transportation section, chief surgeon's office.Use of cars except for their designated purposes was forbidden.11
Careful classification of evacuable patients before loading was of vitalimportance, for the following reasons:11 The rate of distributionamong hospitals in the rear was proportionately as rapid as classificationat loading points was correct. Retention of patients of the same classificationin the same part of the train expedited their removal.
Evacuation officers of hospitals where patients were received gave especialattention to the classification of outgoing patients into such groups as"Seriously wounded," "Gassed," "Ordinary sick," "Infectious cases," "Mentalcases."11 The commanding officer of the train verified thisgrouping of cases according to classification. If several places were scheduledfor detrainment, the patients were grouped according to their destinationas far as this was possible.11
The evacuation officer gave the train commanding officer his evacuationsheet, on which appeared nominal lists of all cases-classified-to be evacuated,and the latter prepared his train for the load.11
When it was possible to do so the evacuation officer inspected eachman as he was placed on board, noting the condition of clothing and dressings,the patient's field card, record of antitetanic injections given, and sawto it that no helmets, arms, or packets were carried. Only personal belongingswere allowed to be retained by the patient.11
The following reports were rendered for each journey:10, 11
Detraining state: 2 (1 to detraining medical officer atdestination; 1 to transportation section, chief surgeon's office, A. E. F.)
Report of train journey: 1 to transportation section,chief surgeon's office, A. E. F.
List of documents received: 1 to detraining medical officerat destination.
Nominal roll of officer patients: 2 (1 to detraining medicalofficer at destination; 1 to transportation section, chief surgeon's office,A. E. F.)
Death reports: 2 (1 to adjutant general's office, generalheadquarters; 1 to transportation section, chief surgeon's office, A. E.F.)
Nominal list of patients detrained en route: 1 to detrainingmedical officer at detraining station.
Telegram of French sick and wounded on train: 1 to commandantdes Armees Francaises at destination.
Diet accounts: 1 to transportation division, chief surgeon'soffice, A. E. F.
War diary: 1 monthly to adjutant general's office, throughtransportation section, chief surgeon's office, A. E. F.
Return of journeys: 1 monthly to transportation section,chief surgeon's office, A. E. F.
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A correspondence book was kept on each train, and a reserve supply ofofficial labels in the office of each train, as follows:11 (1)Casualty; (2) description; (3) patient's kit; (4) red labels (affixed topatients too sick to be transported farther and therefore put off at intermediatehospitals); (5) white or ship labels; (6) specification labels. These weresupplied to trains as soon as obtainable by the depots.
The "detraining state" was a report given by the commanding officerof a hospital train to the detraining medical officer, and contained thefollowing items:11 (1) Train number; (2) army from which entrained;(3) time and place of departure; (4) destination; (5) gross number of patientson board; (6) numbers classified as "lying" and "sitting" in accordancewith the following category: Infectious cases (disease to be specified);mental cases; Carrel cases; venereal cases; any other special cases; civilianpatients (including Y. M. C. A. and Red Cross men); labor contingents;French, Belgian, Portuguese, etc.; German.
When patients were entrained at base hospitals for ports of evacuation,the entraining medical officer sent this information by telegram to thedetraining medical officer of the port. When trains were loaded with patientsfor hospitals located at seaports and not intended for ships, the word"Hospital" was noted on the telegram to specify destination. Patients carriedonly between stations-as, for instance, for dental treatment-were not includedin the telegram to detraining station, as this telegram was intended tonotify base hospital authorities concerning the amount of bed space whichwould be needed for patients then en route.10, 11
The commanding officer of the train and the evacuation officer checkedthe loading of patients and verified the number evacuated.11When loading was completed the commanding officer of the train advisedthe railway transportation officer, who furnished him with an order oftransport, showing destination, stops and load. The commanding officeradvised the former of his readiness to leave, and verified the transmissionof his several telegrams.
It was important that advance notice be sent of the expected arrivalof a train, so that the receiving officer could arrange for prompt unloadingand for sufficient transportation for the removal of sick and wounded tohospitals.11 In order to expedite matters, announcement of prospectivearrival of the train was made to the commanding officer of the receivinghospital by telegram from the regulating officer. It was also made by telegramfrom the commanding officer of a train as soon as loading was completed.
As promptly as possible after a train was loaded its commanding officermade inspection, again examining field cards and clinical records, verifyinginformation regarding the administration of antitetanic serum and, whennecessary, ordering it to be given.11 He instructed ward carorderlies how to care for patients, and the orderlies prepared for hima list of the patients in their care. These lists formed the basis of thecommanding officer's reports and of his telegrams to the chief surgeonand to the regulating officer making final records for the train trip.
In so far as the British-built American hospital trains were concernedthe following scheme was adopted for a balanced load when it was desiredto carry
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600 or more patients:11 Top berths were used for litter cases,the middle berths being folded, and lower berths for sitting patients,so that each car provided accommodations for 12 recumbent and 48 sittingpatients. Serious cases requiring much attention were placed in the pharmacycar in order that their wounds might be redressed if necessary or the patientsbe otherwise cared for on the operating table installed in this car. Unlessit was necessary to do so, wounded men were not removed from one car toanother or from one litter to another. In times of stress the capacityof ward cars was increased by placing litters, in tiers of three each,across the car doors. These were secured by hooks attached to the end rodsof the bunks, and by straps.
FIG. 84.-Interiorof one of our hospital trains (British built)
Bodies of patients who died en route were left at the larger stationswhere stops were made, and full details regarding each body were givenin an envelope to the officer taking charge of it, with notice that thecommanding officer of the train had signed the official telegram notifyingthe central records office, A. E. F., of the patient's death.10, 11Personal effects of such casualties were disposed of in accordance withArmy Regulations. The transportation section of the chief surgeon's office,A. E. F., was notified by letter of all deaths occurring on trains, withfull particulars, and a telegram was sent thereto at the same time as thatsent to the adjutant general's office, A. E. F. Very serious cases weresometimes detrained en route, at the larger places, but only when thiswas absolutely necessary.11
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PROFESSIONAL ACTIVITIES
Serious cases were cared for at once. Orthopedic cases and those thatwould require dressing en route, if not placed in the pharmacy car, wereplaced in the middle and lower bunks, with injured parts next the aisle.11Slightly wounded, recumbent patients were put in top berths and injuredparts immobilized before the train started.11 Mental cases weresearched before being placed on board (all patients were disarmed beforebeing entrained) and were taken to a separate compartment the windows anddoors of which were closed, ventilation being provided by electric fansand roof ventilators. These patients were kept under constant surveillance.Contagious cases also were carried in special compartments.
Chest cases bore transportation badly. Empyema cases usually drainedfreely. When there was danger of secondary hemorrhage, new amputationswere dressed while a stop was being made. A few operations, including ligationsof arteries, were performed on trains, but professional activity was limitedusually to redressings-generally performed in the pharmacy car-and symptomatictreatment.11 Conditions causing the greatest concern were injuriesof head and abdomen, and pneumonia cases. Cases of the first two classeswere prone to secondary hemorrhage; pneumonia patients did not endure wellany movement before convalescents. Gassed cases were carried recumbentwhen this was possible, and they were not allowed to smoke. If their eyeswere injured and sensitive to the light, they were placed on the lowestberths if these were not needed for seriously wounded patients. If a patient'ssplint was so adjusted that it obstructed the car aisle, he was placedat the end farthest from the toilet and a chair put under his splint toremind passers to make a detour around him. Headboards of berths, especiallyon train No. 55, were placed at the end farthest from the car door, andpatients were entrained head first and placed in berths without being turnedaround.13 This arrangement facilitated supervision by the wardmaster stationed at the center of the car. Upon completion of loading,this attendant examined all his patients and their medical cards, makingappropriate entries in a notebook, noting the need of Carrel-Dakin solution,the administration or nonadministration of tetanus antitoxin and morphia,the presence of contagious or venereal diseases, abdominal wounds necessitatingliquid diet only, and other items of professional importance.
SUBSISTENCE
Hospital trains drew rations and supplies at base hospitals if thisplan was found to be more convenient.11 Drawing of commutedrations was found difficult. Sales commissaries in advance zones were notin convenient locations for the 30 or 40 stations at which trains weregaraged, and even when available they had not sufficient stock on handto supply organizations in addition to those to which they had been assigned.11Nor were these sales commissaries open at all hours of the day and night.
French hospital trains in American service were furnished with rationsby railhead officers upon request of the evacuation officer.12Patients on these French trains were fed at station infirmaries at regularfeeding points and stops were arranged for in the schedule.12
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MESSING OF PATIENTS ON REGULAR HOSPITAL TRAINS
Immediately upon entrainment patients were given hot drinks, soups,or other light nourishment. As the patients were to be on board only arelatively short time, meals were standardized on a number of trains-e.g., train No. 53, with the result that waste was minimized, the accumulationof unsuitable food prevented.11
On train No. 58 patients were served a thick soup containing ingredientsthat otherwise would have been served as separate dishes-such as beef,potatoes, beans, hominy, and the like-and were given sandwiches.14This method expedited service and facilitated the feeding of bed patientsand at the same time conserved stove space needed for special diets. Onother trains-e. g., No. 59-patients received the garrison ration, exceptthat special cases were given light, soft, or liquid diets.15
MESSING OF PATIENTS ON EXTEMPORIZED HOSPITAL TRAINS
As previously stated, patients on most of the trains rented from theFrench were fed by station infirmaries while en route, at regular subsistencepoints, and stops were arranged for in the schedule.12 Whenthere was intercommunication between ward cars these stops were unnecessary.Certain of these trains were equipped with kitchen cars where patient'smeals were prepared en route and served at certain stops specified in theschedule, and these trains were rationed accordingly. All French trainswhich the United States employed were rationed at railheads by local evacuationofficers.12
DETRAINING PATIENTS
Each of our large hospitals or hospital groups had a railway transportationofficer, one of whose duties was the arrangement of priorities for thestopping of hospital trains at proper detraining points.3 Ateach such detraining point detraining parties were organized, charged withthe proper unloading of trains and with the duty of assisting train crewsin the work of cleaning and disinfecting the cars, as well as in the properexchange of blankets, litters and other supplies which might be unloadedwith patients. This exchange was made through the train commander.
On arrival at a base hospital the commanding officer of a train hadin readiness his "detraining state," which he turned over to the detrainingofficer of the hospital, together with all documents pertaining to patients,including any X-ray plates.11 These were duly receipted for.The detraining medical officer informed the train commander of the orderin which his patients were to be removed; whereupon an officer of the trainsupervised the unloading, taking care that patients' kits went with them.Officer patients' baggage was turned over to a noncommissioned officerdetailed by the detraining medical officer to receive and receipt for it.Any articles whose ownership could not be traced were turned over to thecentral hospital train depot, with full particulars regarding them.11
The train commander informed the railway transport officer of any gas,repairs, or water required and also gave the time when his trains wouldbe ready to proceed.11 Unnecessary delays were carefully avoided,as even a few minutes' delay might mean the loss of a schedule, resultingoften in a halt of three or four hours before a new schedule could be obtained.
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SANITARY SUPERVISION OF TRAINS
The sanitary condition of these trains required constant supervision,as patients were often received at the front with badly soiled clothing.3Many of them harbored vermin, and many suffered from infectious diseases.One of the greatest difficulties experienced in train service was the provisionof any adequate supply of water under sufficient pressure for flushingout all cars, though trains carried many lengths of garden hose to makedistant water connections.3 The French offered the use of theirdisinfecting apparatus employed on their own trains, but their processdid not utilize the methods and agents which American authorities preferred.3It was the American practice to flush out trains from end to end as theyreturned to the front, walls being washed with formaldehyde solution andfloors scrubbed with strong cresol. Blankets were shaken, mattresses turned,and latrine buckets cleansed and deodorized with chloride of lime. Frenchtrains placed at the disposal of the American Army invariably had beendisinfected with formaldehyde, though this measure consumed time whichthe American service employed in returning trains to the front.3One reason for our method was the shortage of trains. When ours were heldin garages or on sidings for any length of time, galvanized-iron cans wereplaced under all waste and toilet discharges and were emptied by trainpersonnel into proper places before the train started. This was alwaysa troublesome process, especially in large freight yards such as at Pantin,near Paris, where many trains of all kinds were placed on tracks so closetogether that passage between them with these iron cans was almost impossible.3
FIG. 85.-Hospitaltrain at Base Hospital No. 27, Angers
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LAUNDRY
Laundry was exchanged either at replenishment depots, including thatof the regulating station, or at hospitals to which patients were taken.11
TRAIN MOVEMENTS
As stated above, train movements were determined by the Railway TransportService, which made the necessary traffic arrangements.7 Americantrains were not allotted to any particular line but were interchangeableand were operated according to Medical Department needs and traffic facilities.
Immediately upon requisition of the first train, arrangements were madefor garage points and for routing and rates of speed on French railways.3Through areas in advance of regulating stations it was never possible toroute hospital trains any faster than freight.3 This correspondedto the slow freight train of America, but the disadvantage was not so greatas might be supposed, the distance between entraining points and regulatingstations usually being short. In routing trains from the latter stations,however, to points far in the interior, and even to base ports, the transportationof patients at such low speed was inadvisable, though the French used itfor their hospital trains.3
Our need for a faster schedule arose from the fact that hospital trainshad to travel long distances to reach our base hospitals.3 Afterseveral conferences on this subject, held in Paris with the fourth Frenchbureau, the French Government gave orders to the French director generalof transportation that American hospital trains traveling from regulatingstations toward the interior be given the advantage of passenger-trainschedules.3 In point of fact the speed was that of militarytrains, but on lines in the interior a faster schedule was followed whenevertechnical conditions permitted. In cases of emergency trains were dispatchedon fast schedules for the entire journey, provided this did not interferewith the schedule of military trains having priority. All express scheduleswere authorized by the fourth bureau, general staff, which arranged theintercommunicating schedules with the railway management. These authorizationsfor rapid movement were transmitted immediately to the regulating officersconcerned, showing the advanced notice required for dispatching trainsand the proper railway authorities to be notified in each case.11
Constant liaison was necessary between the regulating officer and traincommanders, as the former could usually give the latter information concerningthe approximate time of the next trip.12 Especially was thistrue when trains were in one garage and where train trips followed consecutively;that is, where the last train in was also the last train to go out. Trainswere often moved up to the loading points as trains already loaded pulledout. In such cases it was difficult to determine the time of movement.It was important, therefore, under such circumstances that trains alwaysbe fully prepared to be called on to move at a moment's notice.
Trains were routed so as to reach their destinations in the shortestpossible time.11, 12 They did not make stops en route even onsidings, if this could be avoided, and only after previous consultationswith the railway authorities,
333
if this was possible. Long stops at railway stations were permittedonly where tracks allowed loading or unloading without blocking the mainline. Trains were ordered not to halt on main lines for more than the briefestpossible time. At small stations unloading had to be done within a specifiedtime, and so far as possible these places were avoided. Trains were splitonly in case of absolute necessity.
Night service was not often organized on branch lines, and notice hadto be given in advance when trains were due to arrive at night.l2
The regulating officer selected new loading stations in the army zoneat points most convenient to the evacuation centers designated by the armysurgeon.12
When a hospital train garaged at a regulating station was asked forby the army, the regulating officer proceeded to route the empty train,fully equipped, to an entraining point farther toward the front, wheresick and wounded were received from evacuation or mobile hospitals.3The regulating station then routed the train back, generally through theregulating station and then farther on into the interior to base hospitalsin the advance, intermediate, or base sections designated to receive thepatients.
The train made this journey under more difficulties than are at firstapparent.3 In all forward areas, railways were constantly congestedby traffic, and all rolling stock was routed on a priority schedule fromwhich no deviation could be made without causing great confusion. For example,bread trains, passing forward daily through the regulating station, hadpriority over everything except moving troops, and empty hospital trainsgoing forward from regulating stations had to take their chances for prioritywith all other railway transportation loaded with army necessities. Ifone train at an entraining point fell behind its schedule for startingon the return journey this might for the next 24 hours throw out the schedulesof other trains carrying all kinds of supplies, for after loading, thehospital train proceeded back toward the regulating station and it becameone of a stream of empty trains passing to supply bases over the same route.After arrival at the regulating station, another schedule had to be arrangedfor it by the regulating officer to get it through to its destination ordetraining point in the interior. Little outside assistance could be giventrain commanders along this entire route, for which reason full equipmenthad to be issued before the train could begin its journey. In additionto this, excess equipment, rations, and supplies had to be carried, toprovide for the numerous emergencies and delays which might occur beforeit could reach its destination.
PROVISIONS FOR REPAIRS
It early became apparent that provision must be made for minor repairsfirst, and major repairs later, which could not be made by the mechanicon duty with each train unit; consequently, immediately upon acquisitionof the first trains, arrangements were made with the French fourth bureaufor garage and repair at the American car shops at Nevers.3Necessary repairs always began within an hour after the arrival of hospitaltrains at the shops, whether by day
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or by night. Facilities were also provided at regulating stations inthe army zone for garage of hospital trains, minor repairs, reception ofwater, rations, medical supplies, and the distribution of mail.3,12
SECONDARY EVACUATIONS
For secondary evacuations the 2 trains constructed by and leased fromthe French at the outset of our activities and the 19 trains built by theBritish were those chiefly employed, for they were in effect rolling hospitals,self-sustaining, and much better equipped for the care of patients duringlong hauls than were the smaller trains rented from the French.3The latter were therefore used for primary evacuations.16 Secondaryevacuation effected by the chief surgeon's office pertained chiefly tothe movement of patients from base hospitals to ports of embarkation andthe collection of certain types of cases-e. g., maxillofacial-at hospitalsdesignated for their special treatment. Patients sent to ports of embarkationwhere those whom disability boards in the various hospitals had reportedunfit for further military service in France (class D) and those who wouldrequire at least six months' hospital treatment before they could becomemembers of class A; that is, fit for any military duty. Because of theirserious wounds or their chronic illness, these class D patients requiredthe most careful attention during transport, and, being widely scatteredthroughout France, their systematic collection and treatment en route presenteda very serious problem to the transportation service. While many such patientsmade the necessary journey on ordinary passenger trains to hospitals atbase ports, whence they were to be transferred to the United States, mostof these were collected on hospital trains so routed as to impose the leasthardship through unnecessary handling and delay in transit. The successof this secondary evacuation depended largely upon the cars used by disabilityboards at hospitals in the advance and intermediate sections in selectingsuch cases as were plainly able to bear both the journey on hospital trainsand the subsequent transfer to ships at the base ports. If cases were selectedat base hospitals for transfer to the United States which upon arrivalat base ports were found unable to continue the journey to the United States,they had to be retained at port hospitals until such time as their conditionwarranted their embarkation and the long sea voyage. If such retentionwas protracted, there was danger of overcrowding hospitals at base ports.3
Prior to the armistice the collection of class D patients (i. e., thoseto be returned to the United States) for evacuation to the ports was adifficult problem, for these were cases of chronic illness or mutilatingwounds, many of which required great care while in transit.3
As already stated, certain of these cases which were not in need ofextraordinary care made the journey to base port hospitals by ordinarypassenger train.3 Among such categories were cases of incipienttuberculosis and mental defectives of certain types; also some of thosesuffering from healing wounds or other injuries of the upper extremitiescould properly be sent in small parties accompanied by the necessary attendants.Larger groups of such cases were sent in special coaches furnished by thelocal railway transportation officer at hospital entraining points. Veryoften this method imposed hardship on certain types of cases sent, formany times it happened that changes of cars not anticipated by the
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railway transportation officer were ordered by the French en route,accommodations sometimes being substituted which were inferior to the standardwhich the American service strove to maintain. But, whenever possible,patients were carried to the ports on hospital trains, for on the wholethe system described above did not work well. It was resorted to only whenhospital trains could not be spared for the purpose and hospitals had tobe emptied to make room for fresh increments of the sick and wounded.
The movement of insane patients and mental defectives, including psychoneuroticspopularly known as "shell-shocked," was always attended by difficulty andembarrassment.3 The laws of France prohibited the transporton French trains of men declared insane, but as a matter of fact this regulationwas sometimes disregarded, for mental cases developed in regular, smallincrements, making it impracticable to hold these patients for the accumulationat hospitals of a sufficient number to warrant the routing of hospitaltrains to collect them.3 Unless mental cases needed the closestsupervision, or unless they were such as to excite comment en route, manyof these were sent, accompanied by proper attendants, on ordinary passengertrains as "observation cases."3 We never had cause to regretdispatching these cases in this manner, since they were chosen carefullyfor this method of transportation, and the procedure prevented the accumulationof mental cases at hospitals which could not maintain specially trainedpersonnel for their care, observation, and classification.3
FIG. 86.-Entraining class D patients at BaseHospital No. 30, Royat
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When occasion demanded, hospital trains made periodic visits to collectingpoints such as the hospital center at Bazoilles on call of the psychiatricservice to transport cases accumulating there.3 Some complaintsarose from various causes concerning the transportation of mental cases,but these were invariably investigated by the evacuation service of thechief surgeon's office and no instances were found in which such patientswere subjected to conditions which jeopardized their safety or ultimaterecovery.3
Similarly, difficulties confronted the assembling of maxillofacial casesat Vichy, where special apparatus and personnel were provided to care forthem.3 These cases were received at base hospitals all overFrance, but their number never warranted the use of hospital trains fortheir collection at one point.3 Though it is true that manyof these cases were ambulant and were able to make journeys on ordinarypassenger trains, the French were very insistent that mutilated patientsbe not routed on such trains, where the sensibilities of the travelingpublic would be distressed.3 Aside from this issue, it was verydifficult for attendants to feed such cases en route from one hospitalto another. Transport of selected cases to the maxillofacial center atVichy was therefore a matter of exceptional difficulty, for their widedispersion in hospitals throughout France, and the paucity of cases ina given hospital did not warrant the frequent use of a hospital train fortheir collection and conveyance.3 To a degree the same difficultyapplied to the assembly and evacuation of the blind.3
After the beginning of the armistice, and after battle casualties hadbeen cleared from field units, most of the hospital trains were engagedin evacuations from hospitals in the advance or intermediate section toothers near base parts, but a few continued to serve the Third Army, makingprimary evacuations from the area of occupation, until arrangements weremade for shipment of casualties down the Rhine.3
SUITABILITY OF HOSPITAL TRAINS
During our active military operations of 1918 American hospital trainsproved excellently suited to our needs, except as noted below.3When once a patient was started on the journey on one of these trains,food, warmth, and necessary treatment en route were assured. Patients senton trains rented from the French (other than the two first obtained) werenot so conveniently served, for these trains had limited kitchen facilities,or none at all, and routes taken to American base hospitals were not providedwith the rest and refreshment stations found all along French evacuationlines. The American Expeditionary Forces had no personnel for the operationof such stations. This was one reason why French trains were used preferablyfor short hauls from the front hospitals in the advance section and Americantrains on longer trips to hospitals farther to the rear. Though excellentin other respects, American trains were so long and so heavy that Frenchrailway officials found difficulty in laying them on sidings and in providingspace for them at garages and entraining points. In about 50 per cent ofinstances where trains were placed on sidings it became necessary to dividethem into two or sometimes even three sections. In cold weather this wasa great disadvantage, for the reason that it disconnected part of a trainfrom its circulating steam line.
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AMBULANCES
Ambulances comprised two kinds of vehicles: Animal-drawn and motor.The Medical Department made use of both kinds of ambulances for the transportationof patients in the American Expeditionary Forces; transportation of patientswas a responsibility with which that department was charged throughout.
PROCUREMENT
In the American Expeditionary Forces, the use of animal-drawn ambulanceswas very restricted. These ambulances were assigned only to Medical Departmentunits serving with combat troops; that is, one ambulance company of eachdivisional ambulance section was animal-drawn.17 Both animal-drawnambulances and animals for them were supplied by the Quartermaster Corps;17their procurement was not a responsibility of the Medical Department.
The procurement of motor ambulances, on the other hand, was a directresponsibility of the Medical Department for the greater part of the war.5In discussing this question it must be considered from both sides of theAtlantic, motor ambulances, though classed as Medical Department matérielwhen we entered the World War, became Motor Transport Corps matérielsome months prior to the armistice. Since this change was effected considerablyearlier in the American Expeditionary Forces than it was in the UnitedStates, there was a period when, as will be explained, the Medical Departmentin the United States was purchasing motor ambulances and shipping themabroad on Motor Transport Corps tonnage.
In December, 1917, what was then the Motor Transportation Service wascreated a part of the American Expeditionary Forces.18 Its purpose,in part, was the technical supervision of all motor-drawn vehicles; theirreception, organization, and assignment (except vehicles belonging to organizedunits); and the organization and operation of repair and supply depotsfor motor vehicles. Until May, 1918, motor ambulances in the American ExpeditionaryForces were not included in the classes of vehicles controlled by the MotorTransport Service, A. E. F.;19 however, they were maintainedin a state of repair by that service. From May, however, all motor ambulancesarriving in the American Expeditionary Forces were turned over to whathad now become the Motor Transport Corps, A. E. F., but being classed asspecial vehicles, motor ambulances were held by that corps subject to theorders of the chief surgeon, A. E. F.19 Between this time andthe following August, though the Medical Department procured motor ambulancesin the United States, they were shipped overseas on Motor Transport Corpstonnage.20 Subsequent to August, when the Motor Transport Corps,in the United States, took over the procurement of motor ambulances fromthe Medical Department,21 their shipment overseas became a responsibilityof the Motor Transport Corps. Thereafter shipments were based on estimatesfurnished by the Medical Department, A. E. F.
338-339
ESTIMATES AS TO NUMBER
On September 22, 1917, the following memorandum was submitted by thechief surgeon, A. E. F., to the chief of staff:
1. The following motor vehicles of all classes will beneeded by the Medical Department to meet the demands of the forces whichit is estimated will be here on July 1, 1918: Motor ambulances, 1,446;motor trucks, 905; motor cars, 338; motor cycles, 557.
2. The motor vehicles should arrive per month as follows,based upon the contemplated program of the arrival of troops:
Motor ambulances | Motor trucks | Motor cars | Motor cycles | |
October | 145 | 91 | 34 | 56 |
November | 145 | 91 | 34 | 56 |
December | 73 | 46 | 17 | 28 |
January | 290 | 181 | 68 | 112 |
February | 145 | 91 | 34 | 56 |
March | 73 | 46 | 17 | 28 |
April | 217 | 136 | 51 | 84 |
May | 217 | 136 | 51 | 84 |
June | 141 | 87 | 32 | 53 |
| Total | 1,446 | 905 | 338 | 557 |
On November 27, 1917, the following more explicit estimate of the needsof the Medical Department in motor transport was submitted:23
Re reply to memorandum from chief of staff, dated September18, 1917 (corrected to November 27, 1917).
The following motor vehicles of all classes will be neededby the Medical Department to meet the needs of the forces which are estimatedwill be here by the 1st of July, 1918:
1. For the Army: | |
| (a) Chief surgeon's office- | |
| Motor cars | 2 |
| Motor cycles | 2 |
| (b) Central laboratory. | |
| (c) Army laboratories (3 laboratories), each laboratory- | |
| Motor car | 1 |
| Motor cycle | 1 |
| Motor truck | 1 |
| (d) One sanitary train (combat division)- | |
| Motor cars | 7 |
| Motor cycles | 17 |
| Motor ambulances | 36 |
| Motor trucks | 42 |
| Total for the Army- | |
| Motor cars | 14 |
| Motor cycles | 24 |
| Motor ambulances | 38 |
| Motor trucks | 48 |
| Special bacteriological cars | 6 |
2. For each corps (5 corps): | |
| (a) Office of each corps surgeon- | |
| Motor cars | 2 |
| Motor cycles | 2 |
| (b) Corps laboratories, each- | |
| Motor car | 1 |
| Motor cycle | 1 |
| Total for 5 corps- | |
| Motor cars | 15 |
| Motor cycles | 15 |
3. For each division (30 divisions, including 10 replacement divisions): | |
| (a) Each division surgeon's office- | |
| Motor car | 1 |
| Motor cycle | 1 |
| (b) Division laboratories (1 each)-Motor cycle | 1 |
| (c) Evacuation hospitals (2 per division)- | |
| Motor car | 1 |
| Motor cycle | 1 |
| Motor trucks | 3 |
| (d) Evacuation ambulance companies (1 per division)- | |
| Motor car | 1 |
| Motor cycle | 1 |
| Motor ambulances | 20 |
| Motor trucks | 2 |
| (e) Motor ambulance companies and field hospitals (3 per division)- | |
| Motor cars | 7 |
| Motor cycles | 17 |
| Motor ambulances | 36 |
| Motor trucks | 42 |
| Total for the division (30)- | |
| Motor cars | 330 |
| Motor cycles | 660 |
| Motor ambulances | 1,680 |
| Motor trucks | 1,500 |
4. Line of communications: | |
| (a) Chief surgeon's office- | |
| Motor cars | 2 |
| Motor cycles | 2 |
| (d) Surgeons at base ports (3 bases)- | |
| Motor cars | 3 |
| Motor cycles | 3 |
| (e) Base port transportation (3 bases; 1 motor ambulance company at each base)- | |
| Motor cars | 3 |
| Motor cycles | 9 |
| Motor ambulances | 36 |
| Motor trucks | 9 |
| (f) Medical supply depot (2 at ports, 1 in intermediate section, 3 in advance section; total, 6 depots), for each depot- | |
| Motor cycle | 1 |
| Motor trucks | 2 |
| Motor car | 1 |
| (g) Base hospitals; to July 1, 1918, 130 will be needed and each hospital must have- | |
| Motor car | 1 |
| Motor cycle | 1 |
| Motor ambulances | 3 |
| Motor trucks | 3 |
| Total for line of communications (exclusive of 10 replacement divisions)- | |
| Motor cars | 148 |
| Motor cycles | 182 |
| Motor ambulances | 426 |
| Motor trucks | 411 |
| Special bacteriological cars | 4 |
| * * * * * * * | |
Grand total: | |
| Motor cars | 507 |
| Motor cycles | 881 |
| Motor ambulances | 2,144 |
| Motor trucks | 1,959 |
| Special bacteriological cars | 10 |
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Before December, 1917, there had already developed an acute shortageof ambulances, and shipments from the United States, because of procurementand tonnage difficulties, were under our estimated need.5 Althoughcable after cable was dispatched setting forth our emergency needs alongthis line, the shortage continued to increase. The problem of estimatingour requirements was made more difficult by the lack of tables of organizationin Services of Supply, corps, and army units;5 existing tablesindicated transportation for divisions only. By April 24, 1918, the followingfurther-developed estimate, concerning the motor transportation requiredby the various elements of the Medical Department, A. E. F., was formulated:23
1. For the Army: | |
| (a) Chief surgeon's office- | |
| Motor cars | 2 |
| Motor cycles (side cars) | 2 |
| (b) Central laboratory (1 laboratory)- | |
| Motor cars | 2 |
| Motor cycles (side cars) | 4 |
| Motor ambulances | 2 |
| Motor trucks | 3 |
| Special bacteriological cars | 6 |
| (c) Army laboratories (3 laboratories), each laboratory- | |
| Motor car | 1 |
| Motor cycles (side cars) | 3 |
| Motor truck | 1 |
| (d) One sanitary train (combat division) complete motor equipment- | |
| Motor cars | 10 |
| Motor cycles (side cars) | 22 |
| Motor ambulances | 48 |
| Motor trucks | 53 |
| Trailmobiles, kitchen, and water carts | 16 |
| Repair trucks | 4 |
| (e) Dental service-special dental cars | 2 |
| (f) Evacuation ambulance companies (1 per division)- | |
| Motor car | 1 |
| Motor cycle (side car) | 1 |
| Motor ambulances | 20 |
| Motor trucks | 2 |
| (g) Evacuation hospitals (2 per division), each hospital- | |
| Motor car | 1 |
| Motor cycle (side car) | 1 |
| Motor trucks | 3 |
| (h) Mobile hospitals (20 units), each unit- | |
| Motor cars | 2 |
| Motor cycle (side car) | 1 |
| X-ray truck | 1 |
| Motor trucks | 2 |
| Motor trucks (cargo, for moving only) | 18 |
| (i) Mobile surgical unit (20 units) each unit- | |
| Motor car | 1 |
| Motor cycle (side car) | 1 |
| Motor trucks (cargo) | 3 |
| (j) X-ray service, motor-X-ray trucks. | |
2. For each corps (5 corps): | |
| (a) Office of each corps surgeon- | |
| Motor cars | 2 |
| Motor cycles (side cars) | 2 |
| (b) Corps laboratories, each- | |
| Motor car | 1 |
| Motor cycle (side car) | 1 |
| (c) Dental service-dental car | 1 |
3. For each division (30 divisions, including 10 replacement divisions): | |
| (a) Each chief surgeon's office- | |
| Motor cars | 3 |
| Motor cycles (side cars) | 2 |
| (b) Divisiona laboratories (1 each)-Motor cycle (side car) | 1 |
| (c) Field hospitals (4 per division)- | |
| Motor cars | 4 |
| Motor cycles (side cars) | 10 |
| Repair trucks | 4 |
| Motor trucks | 44 |
| Trailmobiles | 8 |
| (d) Motor ambulance companies (4 per division)- | |
| Motor cars | 6 |
| Motor cycles (side cars) | 12 |
| Motor ambulances | 48 |
| Motor trucks | 9 |
| Trailmobiles | 8 |
| (e) Field signal battalion-motor cycles (side cars) | 2 |
| (f) Dental service-Dental car | 1 |
Services of Supply: | |
| (a) Chief surgeon's office- | |
| Motor cars | 6 |
| Motor cycles | 4 |
| Motor cycles (side cars) | 3 |
| Bicycles | 5 |
| (b) Divisions of specialists (laboratory service excepted)- | |
| The administration office- | |
| Motor car | 1 |
| Motor cycle (side car) | 1 |
| Chief of groups (2 main groups), each- | |
| Motor car | 1 |
| Sectionsb (9), each section-Motor car | 1 |
| One section-Motor cars | 3 |
| (c) Advance section- | |
| Surgeon's office | 2 |
| Motor cycles (side cars) | 2 |
| (d) Intermediate section, surgeon's office- | |
| Motor cars | 2 |
| Motor cycles (side cars) | 2 |
| (e) Base laboratories, (4 laboratories), each laboratory- | |
| Motor car | 1 |
| Motor cycle (side car) | 1 |
| Special bacteriological car | 1 |
| (f) Base laboratories, central for hospital groups (28 laboratories), each laboratory-Motor cycle (side car) | 1 |
| (g) Surgeons at base ports (5 bases)- | |
| Motor cars | 5 |
| Motor cycles (side cars) | 5 |
| (h) Base port transportation (3 bases), 1 motor ambulance company at each base- | |
| Motor cars | 3 |
| Motor cycles (side cars) | 9 |
| Motor ambulances | 36 |
| Motor trucks | 9 |
| Trailmobiles | 6 |
| (i) Medical supply depot (3 at ports; 2 in intermediate section; 1 in advance section; total, 6 depots), for each depot- | |
| Motor car | 1 |
| Motor cycle (side car) | 1 |
| Motor trucks | 6 |
| (j) Hospital centers (10 centers) each center- | |
| Motor cars | 2 |
| Motor cycles (side cars) | 2 |
| (k) Base hospitals (130), each- | |
| Motor cars | 2 |
| Motor cycles (side cars) | 2 |
| Motor ambulances | 10 |
| Motor trucks | 3 |
aMedical supply unit (attached to divisionalheadquarters), each unit, 1 motor car, 4 motor cycles (side cars), 2 motortrucks.
bRecommended that G. U. section laterhave 3 cars and other 8 sections 2 each.
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EVACUATION AMBULANCE COMPANIES
The Manual for the Medical Department, United States Army, 1916, containedprovisions for the organization of evacuation ambulance companies. Sincethese were to be organized only in time of war, it is needless to statethat no such companies existed when we entered the World War.
They were to be in the proportion of one for each division at the front,and their primary function was to be the evacuation of division hospitals,and the care and transportation of patients therefrom to evacuation, base,or other hospitals on the line of communications, or to points with trainor boat connections for rail or water transport to such hospitals. Theywere to be field army organizations, and their personnel and equipmentwere to be that provided for a division ambulance company with such modificationsas might seem warranted.
On November 12, 1917, the Surgeon General notified the chief surgeon,A. E. F., that the organization of three evacuation ambulance companieshad been begun and that the personnel of each would be two officers and60 enlisted men, and that its equipment would be that of a motor ambulancecompany less dressing station equipment.24 To this the chiefsurgeon replied requesting that vehicles for these units be increased from12 to 20.25
Independently, the chief surgeon, line of communications, on November27, 1917, recommended that ambulance personnel and transport within hisjurisdiction be organized into evacuation ambulance companies, each consistingof 5 sections with 20 ambulances each.26 He also urged thatif it were possible 30 sections of the United States Army Ambulance Servicethen in the United States but ready for shipment should be secured forthe American Expeditionary Forces in order to avoid the complete breakdownwhich he considered immi-
343
nent.26 He remarked that the need of evacuation ambulancecompanies was becoming more and more apparent.26 The need formotor ambulance companies, conveniently located to meet current needs,instead of ambulances distributed among many combat and other organizationsand the special need for such an organization (under the control of theadvance section, Services of Supply) in the vicinity of the training areaswas emphasized.26 Others as needed were to be located at otherplaces on the line of communications. It was anticipated that personneland matériel might ultimately be supplied from the sections of theUnited States Army Ambulance Service but until that service's resourceswere more than enough to meet its own needs, our evacuation ambulance companiesmight be developed quickly though temporarily by drawing in from variousbase and other hospitals all available transport and personnel.26Even though such an organization might lack symmetry it would meet thesituation temporarily until units of the United States Army Ambulance Servicecould be made available.26 The memorandum further remarked that88 sections of that service in the United States not yet assigned, mightbe considered available for requisition for service on the line of communications.The necessity of a maintenance department with ample spare parts and otherequipment was noted and the necessity for the immediate establishment ofan ambulance park in the vicinity of the training areas was emphasized.26
The same date (November 27, 1917) the chief surgeon, A. E. F., initiateda cablegram to the Surgeon General to the effect that evacuation ambulancecompanies should be organized from the equipment and personnel of sectionsof the United States Ambulance Service, which had not yet been sent toFrance.27
Under date of December 8, 1917, a memorandum for the chief surgeon,A. E. F., emphasized the need for organizing on a large scale transportationfor casualties, noted the limited amount of transport and inadequate spareparts available at camp and base hospitals, and requested that the chiefof United States Army Ambulance Service loan to the United States Armyone ambulance company section.28 It was further recommendedthat a cable be sent to the War Department requesting shipment of the necessarytransport.28 A few days later (December 13) the chief surgeon,A. E. F., received a report, from one of his subordinates who had beenordered to investigate transportation requirements, in which emphasis waslaid upon the need for evacuation ambulance companies; the wasteful resultsof assigning ambulances to small scattered commands; the difficulty ofmaking evacuations in training areas, and suggesting number and locationsof companies, sources of personnel and matériel, facilities forrepairs, etc.29
On January 14, 1918, the chief surgeon, line of communications, reportedthat it was imperatively necessary to make provision for more motor ambulancetransport in the advance section in order to evacuate the field hospitals,and recommended that a provisional motor ambulance company be organizedfrom the resources of the 41st (the first depot) Division.30This recommendation was approved and the organization of this provisionalcompany ordered January 17, 1918.31 This unit, first designatedthe 116th Evacuation Ambulance Company and later Provisional EvacuationAmbulance Company No. 1 was the first evacuation ambulance company of theAmerican Expeditionary Forces. It was located at Toul.32
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In converting sections which had been organized in the United Statesfor the United States Army Ambulance Service (to serve with the FrenchArmy) to evacuation ambulance companies, A. E. F., some complexities arose,shown best in the following correspondence.
In a letter which the Surgeon General wrote The Adjutant General ofthe Army on January 30, 1918, he stated:33
1. In cable from the commanding general, American ExpeditionaryForces, No. 322, paragraph 3, subparagraph A, it was stated that it wasthe unanimous opinion that evacuation ambulance companies be organizedwith the equipment and personnel of the sections of the United States ArmyAmbulance Service. This request was referred to again in a letter fromthe chief surgeon, A. E. F., written December 24.
2. In cable No. 486, paragraph 8, from the commandinggeneral, A. E. F., the recommendation was made that the remaining 73 sectionsUnited States Army Ambulance Service be used in organizing the ambulancecompanies of the army sanitary train, item M201, and evacuation ambulancecompanies, M406, and that the remainder be drawn on for all ambulance personnelfor replacement draft according to paragraph 4, cablegram 318.
3. The sections of the American Ambulance Service referredto are those now mobilized at Allentown, Pa.
4. It is the understanding in this office that when thesesections were organized they were intended for service with the FrenchArmy, and they have heretofore been used for that purpose.
5. A decision is requested as to whether these sectionscould be used for the purpose indicated in General Pershing's cables.
6. It is to be noted that in some cases the officers attachedto these sections are not medical officers. Also that they are equippedand have been trained with Ford ambulances, and that the ambulances providedfor the ambulance companies of the Army are G. M. C.'s. Should the useof these sections be allowed, the personnel will differ from that as authorizedfor evacuation ambulance companies in the second indorsement of The AdjutantGeneral's office, dated December 28, paragraph 3, subparagraph 8.
On March 12 The Adjutant General replied:34
There is no objection to the use of the enlisted personnelof the American Ambulance Service now at Allentown, Pa., organized undersection 2, General Orders, No. 75, War Department, June 23, 1917, as amendedby section 1, General Orders, No. 124, War Department, September 20, 1917,for any purpose for which the enlisted personnel of the Medical Departmentmay be used. The commissioned personnel may be used in a like manner exceptthat those officers who are not doctors of medicine will be assigned tosuch duties as their technical training permits. It is, however, to beunderstood that this authorization in so far as it relates to these officersis not to be construed as in any way modifying the provisions of paragraph3, Manual for the Medical Department, 1916, which prescribes that:
"An applicant for appointment in the Medical Corps ofthe Army * * * must be a graduate of a reputable medical school legallyauthorized to confer the degree of doctor of medicine, etc."
and as fast as these officers are separated from the servicetheir places will be filled by the appointment of medical officers.
In connection with the personnel of evacuation ambulance companies,the Surgeon General on March 22, 1918, wrote The Adjutant General, UnitedStates Army, as follows:35
1. Subparagraph H, paragraph 3, of second indorsement,Adjutant General's Office, December 28, 1917 (322.3 Medical Department,Misc. Div.), gives the personnel of evacuation ambulance companies as:1 lieutenant, Medical Corps; 3 noncommissioned officers; 34 privates.
2. It is requested that this be amended to read as follows:1 captain or lieutenant, Medical Corps; 3 noncommissioned officers; 3 mechanics;2 cooks; 24 wagoners; 5 privates, first class, and privates.
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3. In General Pershing's organization project for evacuationambulance companies, all transportation is motorized and consists of 20motor ambulances, 1 touring car, 1 motor cycle with side car, 2 motor trucks.
4. The unit is liable to expansion by the addition ofother ambulances.
5. The 2 cooks for the organization are necessary, the3 mechanics are required to keep the motor transportation in proper order,and the 24 wagoners are the chauffeurs.
This request was granted in the following terms:
The following personnel for evacuation ambulance companieshas been approved: 1 captain or lieutenant, Medical Corps; 3 noncommissionedofficers; 3 mechanics; 2 cooks; 23 wagoners; 6 privates, first class, andprivates.
This authorization must not be construed to change thenumbers or grades of medical officers provided for the Medical Departmentin War Plans Division 9199-25, approved February 4, 1918.
Unfortunately, as may be seen from the following references to correspondencebetween War Department and the American Expeditionary Forces, these sectionswere not made available until the end of hostilities. On August 26, 1918,the chief surgeon, A. E. F., initiated a cablegram to the Surgeon General,in which he requested that the personnel of 48 ambulance sections, underprocess of organization for service with the French Army, be sent to Franceas casuals and without officers, since it was his desire to appoint officersin the American Expeditionary Forces selected from experienced men, graduatesof the French motor service school.36 To these recommendationsWar Department replied that only 31 sections of the American AmbulanceCompany were available and that these would be shipped in September.37On September 14 the Surgeon General notified the chief surgeon, A. E. F.,that the 31 sections would be formed and sent to the American ExpeditionaryForces, and that the personnel of these sections would be available forshipment in October instead of September, as formerly stated.38On October 17 the Surgeon General notified the commander in chief, A. E.F., that Ford ambulances were being sent for the equipment of these sections.39
As some difference of opinion had arisen between the Surgeon Generaland the chief surgeon, A. E. F., concerning the number of ambulance companysections which had been organized and the number of sections yet remainingavailable under the Executive order authorizing them, the chief surgeon,A. E. F., on September 21, 1918, reported to the Surgeon General as follows:40
Commander in chief requested 48 ambulance sections aspart of exceptional Medical Department replacements. The Adjutant Generalreplied that only 31 sections were available. From the 169 sections hadbeen already subtracted the number already organized, giving credit inthe latter for 49 organized in France, whereas only 30 were organized there,and also they failed to consider 7 sections which had been disbanded andthe enlisted personnel sent to France to fill up numerical shortages inthe sections organized from the American Ambulance Service. It is a factthat there are 48 sections available and 9 others which; however, it isnot deemed desirable to organize at the present time because the officersof these will be needed as supernumeraries for purposes of administration.It is requested therefore that the 48 sections asked for by paragraph 12,cable P 1591 be sent without officers in the manner requested by that cable.It is also requested that the shipment of Motor Transport Corps tonnageand allotment be made as called for, for October. Request every effortbe made to ship material and personnel in October, and material remainingunshipped will be covered in November Motor Transport Corps priority.
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On October 30 the Surgeon General cabled that 31 ambulance sectionswere formed and available and that the remaining sections, to completethe 48 asked for, would be ready to sail in a few days.41
Meanwhile, on September 26, 1918, the chief surgeon, A. E. F., recommendedto the chief of staff, A. E. F., the issuance of a general order, whoseterms he proposed, concerning the operation of ambulances in the Servicesof Supply.42 In brief this was to provide that all ambulancesin that territory be assigned to 18 definite evacuation ambulance companies,with the enlisted personnel then assigned to duty with these vehicles.The personnel of each unit, as recommended, should be 2 officers (captainsor first lieutenants, M. D.), 2 sergeants, first class, 4 sergeants, 23wagoners, 1 cook, 1 mechanic, 20 privates, first class, and 5 privates.42The units were to be equipped with 20 ambulances or more, 1 motor cyclewith side car, and such temporary additional machines and personnel asmight be necessary, and vehicles so far as possible were to be garagedat hospital centers, base hospitals, camp hospitals, and other camps wherethey were thus used, but would at all times be under the orders of thecommanding officer of the respective companies.42 A list showedthat from 9 to 22 ambulances were garaged at the more important localitiesin the Services of Supply. In support of this proposed arrangement thechief surgeon urged that this organization would promote service by thepooling of ambulances and would provide units which in emergency couldbe sent to the zone of the advance.42 To these recommendationsthe chief of staff replied that as the assignment of ambulances was underthe jurisdiction of the chief surgeon it was believed that they could bedistributed by him as required for the purpose mentioned.43The formation of provisional evacuation ambulance companies of varyingstrength, as outlined by the chief surgeon, was not favorably considered.43
On November 2 the chief surgeon, A. E. F., requested orders concerningpooling of ambulances at base ports, hospital centers, and other localitiesin the intermediate and base sections of the Services of Supply,44but the general staff, general headquarters A. E. F., ruled that such orderswere unnecessary, ambulances being under the jurisdiction of the chiefsurgeon and he enjoying authority to pool them if he so desired;45accordingly, the chief surgeon, on November 6, 1918, issued orders thatthis be done.46
A total of 82 evacuation ambulance companies (including ProvisionalAmbulance Company No. 1) saw service in the American Expeditionary Forces.32Of these, 12 which arrived after the armistice was signed were disbandedand their personnel reassigned in base section No. 2.32
Those which served overseas before the armistice, November 11, 1918,are discussed individually in Volume VIII.
ASSEMBLY, SALVAGE, AND REPAIR
Assembly, salvage, and repair of ambulances were important activitiespertaining to their provision and adequacy within the American ExpeditionaryForces.
On May 4, 1918, the chief surgeon informed the Surgeon General47that motorized Medical Department organizations under orders for Franceshould
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leave the vehicles they used while training at their respective trainingareas, receiving new and standard motor equipment in France.
This procedure was to obviate transporting used machines, which in mostcases could not reach France until after the organization had been suppliedthere with other standard vehicles, another unit later receiving the usedcars, which were apt to be minus part of their equipment and tools.
In the early days of the war the General Motors Corporation type ofambulance was adopted, because of its capacity.16 The ambulanceswere shipped to France, unassembled, the constituent parts of the bodiesbeing placed in crates, and a series of envelopes were made up containingthe number of screws, bolts, and nuts necessary for assembling the ambulances.16Each operation was numbered and the corresponding number was placed onthe envelope containing the hardware used.16 This ambulancebody was not what is regularly known as a knocked-down body, and it wasappreciated that considerable difficulty would be encountered in its assembly,unless trained men fully familiar with body construction were availablein France.16 The Surgeon General's Office accordingly organizeda unit known as the motor ambulance assembly detachment, consisting of3 officers in the Sanitary Corps and 60 body builders and motor experts.16After arrival in France this ambulance assembly unit began operations onJanuary 2, 1918, at St. Nazaire.16 Within two weeks the necessaryshelters had been constructed, power lines had been run, and the ambulanceassembly commenced.16 A number of chassis and bodies had accumulatedon the beach at St. Nazaire, and there was an urgent call from variousorganizations and divisions then in France for ambulances. The shop soontook on the appearance of a modern American factory and ambulances wereturned out at the rate of 4 a day. This number was gradually increaseduntil a daily output of 15 was reached.16
It was expected that all motor transportation would be delivered atthe port of St. Nazaire.16 This, however, proved to be impracticable,and before long ambulances were being received at Le Havre, Brest, Bordeaux,Marseille, and La Pallice.16 Certain numbers of the originalmotor ambulance assembly detachment were sent to the parks at these portsand soon built up assembly organizations composed of Medical Departmentpersonnel and Motor Transport Corps personnel and the same efficiency wasobtained as at St. Nazaire.16
In general orders, general headquarters, A. E. F., and headquarters,Services of Supply, ambulances were classed as "special vehicles."16While orders covering assignments had been prepared by the Motor TransportCorps, all requisitions had been submitted to the chief surgeon's office,A. E. F., and that office had submitted requests to the Motor TransportCorps to assign ambulances to the points where they were most needed.16Many organizations to which ambulances were assigned in the United Statesdelivered them to the ports of embarkation there and they were shippedto France whenever practicable. However, no notice of prior assignmentwas taken in France and all motor transportation received was pooled.16
About one month before the armistice was signed a new type of knocked-downbody was shipped to France. Inasmuch as it was assembled and painted inthe factory and was then taken down in sections and shipped in crates,con-
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siderable time was saved in the final assembly at base ports in Franceand very much less personnel was required to operate the body shops. Fourmen could assemble two bodies in a day.16
The total number of ambulances shipped to France and Italy was 6,875;3,805 were of the Ford type and 3,070 General Motors Corporation type.16The former were used especially for primary evacuations in rear of thefighting line and the latter in other services farther to the rear andthroughout the Services of Supply. There was never sufficient transportfor the sick and wounded.48 Shortage of ambulances was placedat 40 per cent in April, 1918, at 50 per cent in September, and at 20 percent in October of that year. Only by borrowing front the French and ItalianGovernments 30 of the ambulance sections loaned by the United States tothose countries could our needs be met in the St. Mihiel and Meuse-Argonneoffensives.48
REFERENCES
1. Manual for the Medical Department, U. S. Army, 1916,par. 613.
2. Circular letter from the commander in chief, A. E.F., to the assistant chief of staff, G-4, First Army and Paris Group andto regulating officers, August 29, 1918. Subject: Evacuation of sick andwounded.
3. Report of evacuation of the wounded into fixed formations,by Col. R. M. Culler, M. C. On file, Historical Division, S. G. O.
4. Memorandum from the chief surgeon, A. E. F., to thechief of staff, A. E. F., July 14, 1917. Subject: Weekly War Diary. Copyon file, Historical Division, S. G. O.
5. Report from the activities of the medical group, fourthsection, general staff, G. H. Q., A. E. F., by Col. S. H. Wadhams, M. C.,December 31, 1918. On file, Historical Division, S. G. O.
6. Report of the evacuation system of a field army (undated),by Col. C. R. Reynolds, M. C. On file, Historical Division, S. G. O.
7. Report of American hospital trains in France, by Maj.Howard Clark, M. C. On file, Historical Division,
S. G. O.
8. Report of Medical Activities in the zone of the armies,by Col. A. N. Stark, M. C. On file, Historical Division, S. G. O.
9. Report of the evacuation of the wounded in the Meuse-Argonneoperation, by Col. H. H. M. Lyle, M. C. On file, Historical Division, S.G. O.
10. Instructions from the chief surgeon, A. E. F., tocommanding officers of hospital trains, December 18, 1917. On file, HistoricalDivision, S. G. O.
11. Reports of Medical Department activities of hospitaltrains, prepared under the direction of the respective commanding officers.On file, Historical Division, S. G. O.
12. Report of the hospital evacuating section, regulatingstation B, St. Dizier, made by Maj. L. C. Doyle, San. Corps. Copy on file,Historical Division, S. G. O.
13. Report of the Medical Department activities of HospitalTrain No. 55, prepared under the direction of the commanding officer. Onfile, Historical Division, S. G. O.
14. Report of the Medical Department activities of HospitalTrain No. 58, prepared under the direction of the commanding officer. Onfile, Historical Division, S. G. O.
15. Report of the Medical Department activities of HospitalTrain No. 59, prepared under the direction of the commanding officer. Onfile, Historical Division, S. G. O.
16. Report from the chief surgeon, A. E. F., to the SurgeonGeneral, U. S. Army, May 1, 1919. Subject: Activities of the chief surgeon'soffice to May 1, 1919. On file, Historical Division, S. G. O.
17. Tables of Organization and Equipment, U. S. Army,series A, Table 28, W. D., April 17, 1918.
18. G. O. No. 70, G. H. Q., A. E. F., December 8, 1917.
19. G. O. No. 77, G. H. Q., A. E. F., May 11, 1918.
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20. Cable No. 1407, from General Pershing to The AdjutantGeneral, July 3, 1918.
21. G. O. No. 75, W. D., August 15, 1918.
22. Memorandum from the chief surgeon, A. E. F., to thechief of staff, A. E. F., September 22, 1917. Subject: Motor vehicles neededby the Medical Department by July 1, 1918. On file, A. G. O., World WarDivision, chief surgeon's files (451 Miscellaneous).
23. Letter from the Surgeon General to the surgeon, medicalbase group, A. E. F., October 27, 1917. Subject: Automatic replacementof supplies. On file, Historical Division, S. G. O.
24. Letter from the Surgeon General, U. S. Army, to thechief surgeon, A. E. F., November 12, 1917. Subject: Evacuation hospitalsand evacuation ambulance companies. On file, S. G. O., Record Room (322.3).
25. Letter from the chief surgeon, A. E. F., to the SurgeonGeneral, U. S. Army, December 24, 1917. Subject: Evacuation hospitals andevacuation ambulance companies. On file, S. G. O., Record Room (322.3).
26. Letter from the chief surgeon, line of communications,to the chief surgeon, A. E. F., November 27, 1917. Subject: Evacuationambulance companies. On file, A. G. O., World War Division, chief surgeon'sfiles (322.321).
27. Cable No. 322S. from General Pershing to The AdjutantGeneral, November 27, 1917. On file, A. G. O., World War Division, chiefsurgeon's files (322.3212).
28. Memorandum from Maj. A. P. Clark, M. C., to chiefsurgeon, A. E. F., December 8, 1917. Subject: Transportation for evacuationof sick and wounded. On file, A. G. O., World War Division, chief surgeon'sfiles (322.3211).
29. Memorandum from Maj. A. P. Clark, M. C., to the chiefsurgeon, A. E. F., December 13, 1917. Subject: Need of evacuation ambulancecompanies. On file, A. G. O., World War Division, chief surgeon's files(322.3211).
30. Letter from the chief surgeon, A. E. F., to the commanderin chief, A. E. F., January 14, 1918. Subject: Provision of evacuationambulance companies. On file, A. G. O., World War Division, chief surgeon'sfiles (322.3212).
31. Telegram from the adjutant general, A. E. F., to thecommanding general, line of communications, January 17, 1918. On file,A. G. O., World War Division, chief surgeon's files (322.3212).
32. Report on evacuation ambulance companies (undated)made to the chief surgeon, A. E. F., by the officer in charge of transportation,chief surgeon's office, A. E. F. On file, Historical Division, S. G. O.
33. Letter from the Surgeon General to The Adjutant Generalof the Army, January 30, 1918. Subject: Use of sections U. S. Army AmbulanceService as evacuation ambulance companies. On file, A. G. O., 322.3 (Ambulancecompanies, E. E., Miscellaneous Division).
34. Second indorsement from The Adjutant General to theSurgeon General, March 12, 1918; on letter from the Surgeon General toThe Adjutant General, January 30, 1918. Subject: Use of U. S. Army AmbulanceService as evacuation ambulance companies. On file, A. G. O., 322.3 (Ambulancecompanies, E. E., Miscellaneous Division).
35. Letter from the Surgeon General to The Adjutant Generalof the Army, March 22, 1918. Subject: Personnel evacuation ambulance companies.On file, S. G. O., Record Room, 322.3212 (Evacuation ambulance companies).
36. Proposed cable from the chief surgeon, A. E. F., tothe Surgeon General, U. S. Army, August 26, 1918. On file, A. G. O., WorldWar Division, chief surgeon's files (322.3211).
37. Cable No. 1881-R, par. 6, from The Adjutant Generalto General Pershing, August 28, 1918. Copy on file, A. G. O., World WarDivision, chief surgeon's files (322.3211).
38. Letter from the Surgeon General, U. S. Army to thechief surgeon, A. E. F., September 14, 1918. Subject: Army Ambulance Service.On file, A. G. O., World War Division, chief surgeon's files (322.3211).
39. Cable No. 2035 R., par. 3, from The Adjutant General,to General Pershing, October 17, 1918. Copy on file, A. G. O., World WarDivision, chief surgeon's files (322.3211).
40. Courier cable from the chief surgeon, A. E. F., tothe Surgeon General, U. S. Army, September 21, 1918. On file, A. G. O.,World War Division, chief surgeon's files (322.3211).
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41. Cable No. 45, from The Adjutant General, to the commandinggeneral, A. E. F., October 30, 1918. Copy on file, A. G. O., World WarDivision, chief surgeon's files (322.3211).
42. Letter from the chief surgeon, A. E. F., to the chiefof staff, A. E. F., September 26, 1918. Subject: Proposed general orderfor evacuation ambulance companies. Copy on file, A. G. O., World War Division,chief surgeon's files (322.3211).
43. Memorandum from the assistant chief of staff, G-1,general headquarters, A. E. F., to the chief surgeon, A. E. F., October18, 1918. Subject: Proposed general order for evacuation ambulance companies.On file, A. G. O., World War Division, chief surgeon's files (322.3211).
44. Memorandum from the chief surgeon, A. E. F., to theassistant chief of staff, G-4, general headquarters, A. E. F., November2, 1918. Subject: General order for operation of ambulance service in S.O. S. On file, A. G. O., World War Division, chief surgeon's files (322.3211).
45. Memorandum from the assistant chief of staff, G-4,general headquarters, A. E. F., to the chief surgeon, A. E. F., November5, 1918. Subject: General order for operation of ambulance service in S.O. S. On file, A. G. O., World War Division, chief surgeon's files (322.3211).
46. Circular letter (not numbered) from the chief surgeon,A. E. F., to base surgeons, November 6, 1918. Subject: Pooling of ambulances.On file, A. G. O., World War Division, chief surgeon's files (322.3211).
47. Letter from the chief surgeon, A. E. F., to the SurgeonGeneral, May 4, 1918. Subject: Overseas motor transportation. On file,A. G. O., World War Division, chief surgeon's files (451).
48. Report from Brig. Gen. J. R. Kean, M. C., to the chiefsurgeon, A. E. F., April 24, 1919. Subject: Data to be used by the MilitaryBoard of Allied Supply. On file. Historical Division, S. G. O.
