The Medical Department Of The United States Army in The World War
SECTION III
HOSPITALS
CHAPTER XXI
HOSPITAL CENTERS
How the hospital center came to be adopted by the Medical Department,A. E. F., is set forth in Chapter XV, Section I. This need not be goneinto further here. Following soon upon the conception, the chief surgeon,A. E. F., recommended in September, 1917, after the layout and buildings for individual typeA (base) hospitals had been approved, that five such units be erected, to form a hospital center atBazoilles-sur-Meuse.1This project was promptly approved by the general staff, A. E. F. As the situation developed, larger and larger centers wereprovided, the erection of new units and the utilization of existing buildingsfor this purpose progressing rapidly.1 On December 12, 1917,authority was given for the construction of 10 type A hospitals at Allerey,Beaune, Mars, and Mesves.2 The next day a project for 3,000beds at Nantes was approved. By the end of December other centers had beenauthorized in the following places:2 Beau Desert (Bordeaux),5,000 beds, to be expanded to 20,000; Langres, 2,000 beds; Rimaucourt,2,000 beds, to be expanded to 9,000; Limoges, number of beds to be determined;Perigueux, number of beds to be determined.
Other centers were gradually added at Vittel-Contrexeville, Savenay,Vichy, Toul, Kerhuon, and on the Riviera, so that eventually 20 hospital centers were operating before the armisticebegan, of which 5 were located in the advance section, 8 in the intermediatesection, and 7 in the base sections.1 A number of others werebeing constructed and additional ones were projected when the armistice was signed.1
SELECTION OF SITES AND CONSTRUCTION
Sites were selected by one or another member of the hospitalizationdivision of the chief surgeon's office, A. E. F. In some cases the sites had been suggested by French authorities.1Proposed sites were finally accepted or rejected by a joint board, of Americanand French officers, on which were American representatives of the generalstaff (G-4), the chief surgeon's office, the Engineer Department, and arailway transportation expert.1 The sites were leased by anofficer of the Quartermaster Department assigned to duty with the chiefsurgeon for that purpose, but construction was in charge of the EngineerDepartment.1
Approval of a site was determined largely by conformity with the proportionof beds authorized in the advance, intermediate, or base sections; and by availability of railway facilities.3This latter requirement took cognizance of all matters affecting railwayservice, that is, distance from the front, proximity to main railway lines,grade and condition of trackage, strength of bridges
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(whether sufficient to support American hospital trains), availablerolling stock, existence or practicability of sidings, and similar considerations.3Since the French controlled the railways, their advice and cooperationwere essential in locating these centers.3
Buildings utilized by centers were of two general types-preexistingFrench buildings and newly constructed barracks.3 The former consisted of groups of hotels or military barracks wherefrom two to seven hospitals were operated, and whose capacity varied from 1,000 to 16,000 beds.3 Prominent centersof this type were those at Toul, Vittel-Contrexeville, Vichy, and on theRiveria, the first mentioned utilizing barracks and the last three, hotels.3Often these buildings, especially the hotels, were poorly adapted to hospitalpurposes for they required extensive alterations, additions-especiallyof plumbing-and repairs. Also many of the hotels had no heating arrangementshaving been constructed for occupancy during summer only.3 Rentsof such structures also were excessive.5 On the other hand,the military barracks utilized were obtained from the French practicallywithout cost.1 These, generally speaking, were more desirablefor hospital purposes than hotels for they were large, built of stone orcement, and arranged in convenient groups.1 Each barrack accommodatedabout 1,500 patients in rooms larger than those in hotels, thus assuringeasier service to a given number of patients.1 Their disadvantageswere lack of water-carriage sewer systems, inadequate water supply, andabsence of suitable artificial light.1 When the armistice wassigned six centers were operating in French buildings with a normal capacityof 38,340 patients and an emergency capacity of 51,523.3
Centers occupying barracks constructed for the purpose, consisted ofa number of type A hospital units (whose layout is given in Chapter XV),together with some accessory, communal buildings.3
It was planned eventually that the constructed centers would consistof from 2 to 20 complete type A base hospitals of 1,000 beds each, withfacilities for expansion to from 50 to 100 per cent additional.3Each center was also to include a convalescent camp whose capacity wouldbe 20 per cent of the "normal" beds in the center.3
The geometrical layout of the individual units was admirably suitablefor this arrangement, as exemplified by the ground plan of the center atMars.3 When a site was selected capable of accommodating a numberof type A units the Engineer Department made an initial survey which hadparticular reference to contour lines, and units were disposed in a mannermost adaptable to them, thus saving considerable piering and excavation.
Representatives of the chief surgeon's office, A. E. F., and of theEngineer Department, in charge of construction projects, worked out together the layout for each center. Some of the more importantitems which they considered in this matter were the location and adequacyof railway sidings, frontage of units thereon, provision of such commonbuildings as offices, storehouse, garage, bakery, and ice plant, post office,telegraph and telephone exchange, fire engine house, chapel, laboratory,and morgue, for the service of the entire center, the construction of roadsand installation of drainage, water, sewerage and lighting systems.1Thelarger centers, some of which had a projected
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capacity of 20,000 beds, approximated veritable cities with all theiraccessory public-utility requirements.1
When the armistice was signed, 14 centers were operating in newly constructedbarracks, with a normal capacity of 69,059 and an emergency capacity of 127,270 beds.3 Very few ofthese barracks hospitals, however, were fully completed and it was necessaryto occupy them while yet under construction.1 The personnelof the Medical Department locally on duty and convalescent patients assisted materially in the completion of theseprojects. In many respects service in them was easier than in centers whichoccupied buildings several stories in height.1
Special hospitals were features of all centers. In each, certain unitswere specially equipped for the treatment of surgical, orthopedic, eye, ear, nose, and throat, maxillofacial, psychiatric,neuropsychiatric and, in some centers, contagious cases.3 Thecenter at Savenay had a special hospital for the treatment of tuberculosispatients and that at Vichy had special facilities for maxillofacial cases.3
The following table shows not only the hospital capacity (normal andcrisis) but also the number of beds occupied, grouped by section, on November28, 1918:4
Name | Normal capacity | Crisis | Occupied |
Advance section: |
|
|
|
| Toul center | 15,250 | 15,250 | 10,963 |
| Bazoilles | 7,000 | 13,136 | 2,094 |
| Vittel-Contrexeville | 5,951 | 9,875 | 3,545 |
| Rimaucourt | 5,000 | 10,388 | 2,519 |
| Langres | 2,000 | 3,000 | 571 |
| 35,201 | 51,649 | 19,692 |
Intermediate section: |
|
|
|
| Beaune | 4,000 | 10,200 | 4,934 |
| Allerey | 10,000 | 14,468 | 10,728 |
| Mars | 11,468 | 20,000 | 8,098 |
| Mesves | 10,490 | 21,500 | 16,346 |
| Vichy | 8,327 | 13,000 | 10,250 |
| Clermont-Ferrand | 6,712 | 6,712 | 3,017 |
| Orleans | 2,800 | 2,800 | 1,135 |
| Tours | 2,300 | 2,850 | 1,870 |
| 56,097 | 91,530 | 56,378 |
Base section No. 1: |
|
|
|
| Angers | 3,500 | 4,400 | 2,913 |
| Nantes | 4,300 | 6,278 | 4,383 |
| Savenay (St Nazaire) | 8,000 | 8,316 | 8,500 |
| 15,800 | 18,994 | 15,796 |
Base section No. 2: |
|
|
|
| Beau Desert | 6,924 | 11,000 | 5,439 |
| Limoges | 4,528 | 6,000 | 5,485 |
| Perigueux | 1,000 | 1,500 | 983 |
| 12,452 | 18,500 | 11,907 |
Base section No. 5: Kerhoun (Brest) | 2,800 | 2,800 | 2,438 |
At this time these centers contained about two-thirds of all the hospitalbeds (other than those in field units) in the American Expeditionary Forces.1 It had been planned that should thewar continue until April, 1919, the centers would contain no less than half a million beds.1 Hospital construction with thisend in view was well advanced, but inadequate personnel and equipment were delaying progress. No centers were constructed in Englandor Italy.1
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The center which attained the largest size was that at Mesves, which,from November 11 to December 5, 1918, reported daily a capacity of 25,000beds.3 On November 16 this center had a total of 20,186 patientsand the total strength of the command, including those on duty, was 28,828.3
On November 14, 1918, patients in hospital centers numbered 109,238,with 22,191 men in their convalescent camps-a total of l31,429.5 The total number of patientsin all base and camp hospitals and of men in convalescent camps numbered on that date 190,356. In other words, 69 per cent ofmen then under treatment in fixed formations were occupants of these centers. The total number of normal and emergencybeds (including 29,284 in convalescent camps) then provided numbered 292,049. Of this number 182,045, slightly less than70 per cent, were in hospital centers.5
The following hospital centers were in existence December 1, 1918:6
Name of center | Hospitals comprising | Type of building | Normal bed capacity |
Allerey | 25, 26, 49, 56, 70, 97, and E. H. 19 | Barrack construction | 10,000 |
Bazoilles | 18, 42, 46, 60, 79, 81, 116 | .do. | 7,000 |
Beau Desert | 22, 104, 106, 111, 114, 121, Prov. B. H. No. 7. | .do. | 6,924 |
Beaune | 47, 61, 77, 80, 96 | .do. | 5,500 |
Clermont Ferrand | 20, 30, 103; includes Chatel Guyon and Royat. | French buildings | 5,137 |
Commercy-Lerouville | 90, 91 | .do. | (a) |
Kerhuon | 63, 92, 105, 112, 120 | Barrack construction | 2,700 |
Langres | 53, 88 | .do. | 2,000 |
Limoges | 13, 24, 28 | .do. | 4,528 |
Mars | 14, 35, 48, 62, 68, 107, 110, 123, 131 | .do. | 11,468 |
Mesves | 50, 54, 67, 72, 86, 89, 108, 122, and E. H. No. 24 | .do. | 10,490 |
Nantes | 11, 34, 38, 216 | .do. | 4,300 |
Pau | 71; includes Dax, Lourdes, Argeles Gazost, Bagneres de Bigorre. | French buildings | (b) |
Perigueux | 84, 95 | Barrack construction | 1,000 |
Rimaucourt | 52, 58, 59, 64 | .do. | 5,000 |
Riviera | 99; includes St. Raphael, Cannes, Nice, Menton. | French buildings | --- |
Savenay | 8, 69, 100, 113, 119, 214, 118, and E. H. No. 29. | Barrack construction | 8,000 |
Toul | 45, 51, 55, 78, 82, 87, 210 | French buildings | 15,250 |
Tours | 7 and Prov. B. H. No. 1 | Barrack construction | (c) |
Vannes | 136-236, Quiberon | French buildings | 1,400 |
Vichy | 1, 19, 76, 109, 115 | .do. | 8,327 |
Vittel | 23, 31, 32, 36 | .do. | 5,951 |
aEvacuation Hospital No. 13 was operatinghere until November 30, when it was relieved by Base Hospital No. 91. BaseHospital No. 90 never received patients.
bStaffed, but never received patients.
cDid not receive patients until afterthe armistice began.
The increase in bed capacity of all the centers is shown by the followingtable:1
| Normal | Emergency |
1918 |
|
|
July 1 | 30,890 | 33,498 |
Aug. 1 | 70,124 | 86,252 |
Sept. 1 | 78,371 | 102,144 |
Oct. 1 | 109,897 | 160,286 |
Nov. 1 | 143,869 | 221,421 |
Dec. 1 | 163,368 | 282,182 |
As an index of the extent of activities of the different centers, thefollowing table is given. It shows the total number of patients passingthrough the principal hospital centers to March 31, 1919:3
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| Patients |
Toul (nearest front) | 67,866 |
Bazoilles | 66,284 |
Savenay | 61,973 |
Beau Desert | 47,238 |
Vichy | 46,297 |
Vittel-Contrexeville | 44,855 |
Mesves | 38,765 |
Allerey | 33,658 |
Mars | 33,256 |
Nantes | 29,538 |
Kerhuon | 24,533 |
Limoges | 23,818 |
Rimaucourt | 21,067 |
Joue-les-Tours | 13,701 |
Riviera | 13,446 |
Beaune | 13,500 |
Perigueux | 4,540 |
CONTROL
Hospital centers were under the direct control of the commanding general of the Services of Supply, except in matters of discipline, guard, fire control, supplies, and inspection.1 For all these excepted matters each center was under control of the commanding general of that section of the Services of Supply in which it was located.1
In so far as subordination to the commanding general, Services of Supply,was concerned, centers were more immediately under the jurisdiction of the chief surgeon, A. E. F., who (after thepromulgation of General Orders, No. 31, in March, 1918) was also the chiefsurgeon of the Services of Supply; with yet greater particularity theywere under the hospitalization division of his office.1Afterthe armistice was signed and the Third Army advanced into Germany, itshospitals functioned in the Coblenz area virtually as a center, which alsowas under control of the hospitalization division. Eventually commandingofficers of centers were given full authority in many matters. Thus, theywere authorized to transfer and assign commissioned and enlisted personnelfrom one unit to another within their command without reference to higherauthority, to promote or demote enlisted men up to and including the gradeof sergeants, first class, Medical Department, to direct the disposal ofall supplies received, to approve requisitions on the American Red Cross,employ civilian labor (under certain limitations imposed) authorize expendituresof Medical Department funds, convene special (but not general) courts-martialand issue necessary travel orders for patients transferred.1Bulletin 29, 1918, Services of Supply, A. E. F., conferred on center commandersall the authority of a post commander.1 They did not have authorityto approve for issue requisitions upon depots nor did they have jurisdictionover the engineers constructing the center.1 On November 13,1918, the judge advocate general, Services of Supply, ruled in referenceto this matter that "the senior officer present of the department to whichthe formation belongs is the commanding officer, regardless of what otherofficers, line or staff, are present.7 All sick and woundedrecords were forwarded direct to the chief surgeon's office by each hospital,but other documents from those units were required to pass through theoffice of the center commander.1
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STAFFS
As no orders from higher authority prescribed the staff organizationof hospital centers, each developed that organization which was most compatiblewith its needs and resources. Inevitably this led to some minor differencesin such organization, but these were relatively few and unimportant. Thusat Mars,8 and Mesves,9 thecommanding officer designated an executive officer, while at Allerey10and Beaune11 because of the shortage of officers and nurses,the commanding officers assumed the duties of that officer. At Allereya chief dietitian for the entire center was appointed-an assignment whichappears to have been unique.10
At Mesves the staff organization, consisting of 40 members, was as follows:91 colonel, commanding officer; 1 major, executive officer; 1 captain, adjutant; 1 lieutenant, statistical officer;1 major, quartermaster; 8 first lieutenants, assistants to the quartermaster;1 captain, central purchasing agent; 1 captain, salvage and burial officer;1 captain, supervisor of buildings; 1 lieutenant, medical supply officer;1 lieutenant, motor transport officer; 1 lieutenant, assistant to motortransport officer; 1 lieutenant, railway transport officer; 1 captain,provost marshal; 4 first lieutenants, assistants to provost marshal; 1intelligence officer; 1 captain, commanding headquarters detachment andband and fire marshal; 1 major, evacuation officer; 1 captain, assistantto evacuation officer; 1 captain, sanitary inspector; 1 major, medicalinspector; 1 lieutenant colonel, medical consultant; 4 majors, medicalconsultants; 1 major, laboratory officer; 2 captains, assistants to laboratoryofficer; 1 chief nurse.
PROFESSIONAL SERVICES
Medical officers who were consultants in their respective specialtieswere designated as chief of their several services in each hospital center.1 These officers were drawn habitually fromthe local personnel and, at first, performed their duties as consultantsin addition to personal attendance on patients; however, as the centersdeveloped, these officers found it necessary to delegate more and moreof their personal practice to assistants.1 The consultants ingeneral medicine, general surgery, and orthopedics usually were membersof the staff of the center, together with the center laboratory officerwho, as described below, was in a somewhat different category. In somecenters the consultants for each of the special services prescribed bygeneral orders, A. E. F., were members of the staff. Whether on the centerstaff or not, designated consultants supervised the urological, X-ray,neurological, ophthalmological, maxillofacial, and otolaryngological services,corresponding to the branches of the professional services of the AmericanExpeditionary Forces.1 Occasionally, in some centers, certainofficers were designated who, to a degree at least, acted as consultantsin other specialties; e. g., cardiovascular and cutaneous diseases. Ingeneral, the duties of consultants were as follows:1 To investigateand report to the commanding officer on all professional matters withintheir jurisdiction, control professional emergencies, keep themselves informedof the qualifications and character of the service of their subordinatesand of the equipment, service, and acute needs of the several hospitals,recommend changes in assignments and distribution of equipment, coordinateprofessional efforts, and disseminate
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professional information.1 Their services were purely advisory.In each base hospital the chief of a service performed the duties of aconsultant for his specialty in so far as that unit was concerned, conforminghis activities and policies to those of the consultant for the center,who, in turn, conformed to the policies of the chief consultant, in thatspecialty, of the American Expeditionary Forces.1
CONSULTANT IN GENERAL MEDICINE
The consultant in general medicine was essential at all times but especiallyso in October and November, 1918, when the overcrowding in most centers facilitated the spread of epidemic diseases.His most important duties were the recommendation of assignment of personnelto the best advantage, recommendations concerning the control of infectiousdiseases, and the dissemination of professional information. He cooperatedwith other consultants in organizing the medical society of the center.1
CONSULTANT IN GENERAL SURGERY
In the field of general surgery, the surgical consultant exercised dutiesaltogether comparable to those of his colleague at the head of the medical service.1 An important part of his workwas checking and reporting to the chief consultant in surgery, A. E. F., the results obtained by hospitals further forward which clearedinto the center.1 Other important duties were recommendations for assignment of personnel, supervision and coordinationof service, distribution of equipment to the best advantage, supervision of requisitions for supplies and disseminationof information.1 Because of the limited quantity of instrumentsand some other surgical supplies available, it was especially necessarythat patients requiring surgical or orthopedic treatment be concentratedin certain hospitals, and here he was especially active.1 Healso supervised instruction in minor surgery given to nurses and enlistedmen. The subjects most considered in the classes organized for this purposewere anesthesia, practice in the application of dressings and splints andaftertreatment of battle casualties.1 As the shortage of nursesin the American Expeditionary Forces necessitated the employment of enlistedmen to a very considerable degree to perform nurses' duties the trainingof selected men was an important, continuing service.1
CONSULTANT IN ORTHOPEDICS
The orthopedic consultant cooperated with the consultant in surgeryin matters pertaining to instruction, assignment of personnel, obtainment and distribution of supplies, and similar duties.In a number of centers the consultant in surgery was also the consultantin orthopedics.1
CONSULTANT IN MAXILLOFACIAL SURGERY
The center consultant in maxillofacial surgery was instructed to keepin view both the best possible treatment of the wounded and the early determination of those who would not be fit to returnto duty within a reasonable time. It was not practicable to assign a specialist in this subject to each
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center, but one most qualified among the general surgeons was in suchcases assigned to this duty.12 With him cooperated a specially qualified dental surgeon who performed the splinting andprosthesis required and gave such other care as came properly within his province.12 He also consulted in a numberof cases with the center oculist and center otolaryngologist.12Habitually, maxillofacial cases were concentrated in one hospital in eachcenter, but when their needs required and their condition permitted theywere transferred to the hospital center at Vichy, which was designatedas the organization which would care for cases of this nature.12It was staffed and equipped accordingly. A number of cases were sent toAmerican Red Cross Hospital No. 1 at Paris. Such patients as could notbe transferred to the Vichy center or to the hospital at Paris, or whosetransfer was not indicated, were retained in the center to which they hadbeen admitted. It was not the policy to remove cases from the care of thosewho had shown interest and competence, except as the exigencies of hospitalservice demanded.12
CONSULTANT IN ROENTGENOLOGY
The center consultant in Roentgenology supervised and coordinated allactivities in his specialty throughout the center.1 Habitually he was also a member of the staff of some base hospital.Ordinarily only three hospitals in a center were equipped with the Army base hospital outfit for X-ray work, the other unitsbeing supplied with the Army portable machine and the bedside unit.1Supplies pertaining to this specialty were handled in a different mannerfrom the others under control of the Medical Department, for requisitionsfor them were sent to the chief consultant in this service. He modifiedthem if need be and sent them to the medical supply officer at Cosne forissue.1 Some centers had abundant supplies while others neededthem very badly. Electric current from French plants was utilized in somehospitals but in others 8-kilowatt generators were installed for each X-rayplant in operation.1
CONSULTANT IN UROLOGY
In most centers one officer was assigned to the staff as consultantin urology, dermatology, and venereal diseases, but in others one officerwas charged with control of dermatology and another with the other specialtiesmentioned.1 The dermatological service was especially developedin the convalescent camp at Mars. The consultant in urology, as the officerusually charged with these collective duties was designated, supervisedthe establishment and operation of prophylactic stations, both in the centerand in nearby towns; he handled all venereal reports and statistics, supervised,directed, and coordinated the activities pertaining to his specialty throughoutthe center, promoted compliance with military orders concerning venerealdisease, requested the personnel necessary for practice of these specialties,and received all reports, returns, and statistics pertaining to them.1
CONSULTANT IN OPHTHALMOLOGY
In one hospital in each center a department was organized to which allcases in the center requiring ophthalmological treatment were sent.1This section was equipped as thoroughly as possible and staffed to thebest advantage
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by personnel drawn from any hospital in the center. The consultant,who was (at least nominally) assigned to this hospital, himself rendered professional service so far as practicable.1This department conducted an out-patient clinic to which patients, in suchother hospitals as did not have proper equipment, were sent for refractionsand minor operations.1 All personnel including nurses and enlistedmen on duty in this department were especially trained. The consultantin ophthalmology supervised and coordinated the ophthalmological work ofother units, for these, as rapidly as equipment was received, organizedtheir own departments where such cases were cared for.1
CONSULTANT IN OTOLARYNGOLOGY
In the otolaryngological service, the consultant's duties were similarto those just mentioned.1 Usually this service was conductedin some hospital other than that in which the center ophthalmological servicewas operated because of the limits of available space in any one unit foroperating room bed capacity and other facilities.1 The hospitaldesignated for each of these clinics was adequately equipped in other respectsas well, that is, X-ray, surgical, and isolation facilities, in order thatthese also could be used if necessary.1
CONSULTANT IN NEUROLOGY
Psychiatric and neuropsychiatric cases were clearly differentiated,and habitually were segregated in different groups in respective hospitals.1 Plans for hospital centers providedfor a separate hospital unit, located at a quiet point on its outskirts, where psychiatric cases would be cared for, but in a number of centersthis was never completed. The two classes of patients above mentioned werehabitually cared for by different groups of specialists, both of whichwere under the general supervision of the neurologist for the center.1As resources improved, reconstruction facilities, such as those affordedby shop and art work for the rehabilitation of the neuropsychiatric cases,were rapidly developed, especially in the centers at Beau Desert and Kerhuon.1
SENIOR DENTAL OFFICER
One or more dental officers were assigned to each hospital where minorand emergency work were performed.1 Much of the more elaboratework of these specialists was performed at a central clinic, which wasmore thoroughly equipped than were the others, and was under the directsupervision of the senior dental officer, who was also in general controlof the dental service throughout the center.1 Like the laboratoryofficer, the senior dental officer was not a local representative of anymember of the staff of consultants for the American Expeditionary Forces.1In professional matters he was directly under the senior dental officerof the American Expeditionary Forces.1 As consultant he performedduties similar to those of other chiefs of service, but in a number ofcenters no consultant in this service was designated.1
SPECIALISTS IN CARDIOVASCULAR AND DERMATOLOGICAL DISEASES
Specialists in cardiovascular and dermatological diseases were not,generally speaking, designated as consultants in all centers.1 Theywere of special value in the convalescent camp, through which, in manycenters, all patients
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were made to pass before they were sent to replacement camps or depots.1Here medical officers examined all patients to determine the presence of the effort syndrome, and in this servicecardiovascular specialists proved of essential value.1 At Mars, all patients, before they were returned to full class A duty,were required to march 12 miles, after which they were examined.1 At the same center a dermatologist examined allpatients when they entered the camp and, when called in consultation, he also examined patients in other formations.1By his systematic methods he discovered that an unexpectedly large number of patients was suffering from cutaneous diseases, someof which were rarely found in civil practice.1
LABORATORY SERVICE
The laboratories of the several centers were under the jurisdictionof the central laboratory of the American Expeditionary Forces at Dijon, which in turn was under the sanitation division ofthe chief surgeon's office.1 The center laboratory officer wastherefore in a somewhat different category, though in the same status asa consultant, as were the chiefs of the other professional services.1 The general plan for the laboratoryservice of the centers was prescribed in Memorandum No. 8, from the directorof laboratories, dated July 23, 1918, but the degree of centralizationdeveloped under that plan, varied among the different centers accordingto circumstances.1 A center laboratory and usually a morguewere provided which supplemented the similar small installations operatedin the several hospitals.1 Autopsies usually were performedat the center morgue. In general, all work requiring use of animals, serology,water analysis, inoculations, and special pathological or chemical studywas carried out at the center laboratory, and all other laboratory workwas performed in the plants of the several hospitals.1 The laboratoryofficer coordinated this service throughout the center and made appropriaterecommendations concerning distribution of personnel, supplies, and duties.1At Mesves he was a member of a permanent board which, as stated above,was organized for the control of infectious diseases.1
NURSING SERVICE
Each of the several centers had about 40 nurses to each 1,000 patients,distributed as most needed throughout the several hospitals.1 The plan designating a chief nurse for a center,which developed in November, 1918, was soon applied in most of these formations.She was elected from among the nurses on duty in the center and exercisedover their service a general supervision comparable in some respects tothat of the consultants.1 One of her most important duties wasthe distribution of the nursing personnel to the best advantage to meetthe shifting needs among the different units.1 Other dutieswere the following:1 To meet incoming nurses and provide fortheir reception, systematize the rules and regulations governing the nurses,carry out the policies of the chief nurse, A. E. F., keep informed concerningthe nurses' quarters, subsistence, social activities, and the care theyreceived when sick, recommend assignments and transfers, keep a file ofnurses' qualifications, act on all papers pertaining strictly to the NurseCorps, and keep the commanding officer of the
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center fully informed concerning the nursing personnel.1Nurses' hours were long and the strain on them severe, for their numberwas insufficient and for a long time their recreational facilities werealmost nil, but after the armistice, when tension lessened somewhat, itwas possible for them to enjoy recreation to a much greater degree thanformerly. Small social affairs such as dances were very frequent and ofgreat value in promoting morale.1 Until March, 1919, socialrelations between nurses and enlisted men were forbidden, but in that montha circular from the chief surgeon's office directed that in social mattersthere would be no distinction between officers and enlisted men when offduty.1 This circular was in conformity with a law recently enactedby Congress.1
Centers located near cities sometimes furnished for nurses' use a limitedamount of automobile transportation between the two communities.1
SANITARY SQUADS
A number of sanitary squads, each consisting of 1 officer and 25 enlistedmen, had been withdrawn from divisions which had been assigned to replacement duty and which for this reason no longerneeded them, and were distributed among the hospital centers.1Some centers such as Mars, Mesves, Beau-Desert, Allerey, and Savenay hadtwo of them.13 Usually, but not invariably, the commanding officerof a squad was assigned as the sanitary inspector of a center.1In certain centers, because of shortage in personnel, these squads wereabsorbed by other organizations and assigned to miscellaneous duties, butin others they retained their autonomy and were used for purely sanitaryservices-e. g., construction, repair, and direction of operation of sanitaryappliances, such as incinerators, latrines, grease traps, etc.; inspectionof water supply and sewer systems and of alterations in the same; operationof disinfesting plants; inspection and direction of proper sanitary operationof laundries and bathhouses; inspection of bakeries, butchers, kitchens,barracks, and provision of men as superintendents over details of specialsanitary or police work; and preparation of all necessary reports in connectionwith the above services.1
CIVILIAN LABOR
Without civilian labor the operation of hospital centers would havebeen very difficult1 to a large degree, the only labor of this character available for the Medical Department consisted of Frenchwomen, about 50 of whom were employed by each hospital.1 It was found they could be hired, controlled,and distributed most efficiently by a central employment bureau which generally was operated by the quartermaster, but in some centers wasconducted by other offices.1 These employees served in variouscapacities, such as interpreters, cooks, waitresses, laundry workers, andscrub women, and were paid upon civilian rolls by the Quartermaster Department.1Their pay averaged about 5 francs a day when they were not furnished subsistence,or 3½ francs when furnished it. Some male labor also was employedby the Quartermaster Department in some centers to perform such labor asremoval of garbage.1
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MEDICAL SUPPLY DEPOT
The personnel of a hospital center depot usually consisted of an officerof the Sanitary Corps, assisted by a chief clerk, returns clerk, and stenographer,and a warehouse force consisting of a noncommissioned officer and some20 other enlisted men, among whom were the receiving clerk, who received,checked, and arranged supplies and checked cars, and the issue clerk, whomade issues on approved requisitions.1 The chief clerk keptthe office records, which included a correspondence book, a requisitionbook, and a car book. The first contained records of letters received andsent. The second contained captions giving the number of each requisition,the date and place from which it was received, class of supplies calledfor, date requisition was filled, date shipped, voucher number, and nameof checker.1 In the car or receiving book were recorded theinitials and number of each car received, by whom and when shipped, whenreceived, contents as actually inventoried on receipt, date emptied, dategoods were placed in warehouse, and the name of the checker.1
From the medical supply depot of the hospital center articles were distributedlocally among the several units, each of which had its own depot.1 Because of the important and technicalnature of this service, the medical depot at each center required exceptionally competent personnel. Eventually a number of men fromeach center were sent to the medical supply depot at Cosne or Gievres for a brief period of training.1
Other records maintained in this office were a file of warehouse receipts,a special order book for emergency issues only, a file of retained copiesof orders for supplies purchased, depot property returns, warehouse records(which included a copy of warehouse receipts), a special issue book andseparate stock lists. Surgical instruments, poisons, alcoholic liquorswere kept in a locked closet.1
Medical supplies usually were classified and sorted in the followingcategories: Medicines, antiseptics, and disinfectants, surgical (including splints and dressings), dental, laboratory, X-ray,identification, furniture, and miscellaneous.1
One of the most difficult problems connected with the administrationof centers was obtaining medical supplies. Particularly was this true ofthose units which began to operate between July and October, 1918. Usuallya base hospital unit had asked for initial equipment before leaving theUnited States and of its own efforts often had procured considerable material.1After the unit reached France its equipment did not arrive until one ormore months later, and equipment received from depots was inadequate for the complete outfitting of all hospitals so that eachcould serve all classes of patients. Largely because of the restrictions on shipping space, to which all departments were subjected,and the lack of many articles in European markets, the chief surgeon, A.E. F., urged that the organization of these centers be made in such a mannerthat deficiencies could be compensated for by providing special equipment for only a fractionof the hospitals present.1 Supplies that could not be
procured from A. E. F. depots were obtained to a limited degree bypurchased in the open market or from the American Red Cross.1
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MOTOR TRANSPORTATION
In each of the large centers an officer of the Motor Transport Corpswas assigned to duty with personnel which usually was insufficient.1 At no time before the armistice was motortransportation adequate.1
All motor transportation at centers was pooled and vehicles were furnishedonly on signed requests of the commanding officers of units.1Supplies were delivered from the depot by trucks assigned to that dutyand much hauling was done at night. Experience led to the conclusion thata center of 15,000 beds with the most favorable arrangement of buildings,railway spurs, depots, and roads would require 15 trucks of from 3 to 5tons, 15 light trucks of three-fourth ton, 12 G. M. C. ambulances, 2 touringcars (7-passenger) 5 touring cars (light type), and 12 motor cycles withside cars.1
It became fully apparent that for several reasons all motor equipmentshould be standardized.1
After the armistice was signed, evacuation ambulance companies becameavailable for the purpose and were stationed at a number of centers.1 Each of these companies consisted of1 officer, 39 enlisted men, and 12 G. M. C. ambulances, in some centers operating under the evacuation officer.1 They answeredlocal calls as well as calls from outlying organizations which had no transportation,served in the evacuation and loading of hospital trains, and, in emergencies,carried supplies. Their vehicles were also used to convey the remains ofthe dead.1
A central garage and repair shop was provided in each center.1
DISINFESTING PLANT
Central disinfesting plants were established in most centers for therewere not available in France enough mobile disinfestors to serve all unitsindividually.1 In some centers this communal plant was assignedfor one day each week to each unit. One plant at Mesves, for example, byoperating day and night did all the work of the center for almost a month.In some other centers portable disinfestors were furnished the units caringfor the most serious cases, other units employing a central disinfestorof the Canadian hot-air type in the convalescent camp.1
FIRE DEPARTMENT
Fire control at hospital centers was under the general jurisdictionof the bureau of fire prevention, Services of Supply.1 Fire fighting apparatus, including chemical engines, ladders, hose, buckets,barrels, and extinguishers were obtained through it. Fire regulations werepromulgated in each center. Each hospital and other unit organized itsfire-fighting force and conducted drills under the general supervisionof the fire marshal of the center.1 Fire risks in barrack hospitalswere very great; fortunately, however, no serious conflagration occurredin any center.1
SALVAGE OF PROPERTY
The salvaging of property of whatever character was an important andextensive undertaking.1 Each center provided a salvage dumpwhere material coming for the separate hospital units was sorted, cleaned,renovated if pos-
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sible, and either redistributed locally or shipped to a central salvagedepot.1 The principal classes of supplies salvaged were: Clothing, ordinance, boxes, bags, crates, paper, metal scraps, tincans, grease, garbage, and writing paper.1 Clothing was disinfected, laundered, repaired, renovated, and, if possible, reissued;otherwise it was sent to a central salvage depot. Mess kits were assembled and placed in stock for reissue.1 Gasmasks, helmets, and rifles were cleaned and transferred to any neighboring replacement camp or were shipped to a large salvage depot.1Boxes, crates, etc., except such as were needed for use at the center,were shipped in returning cars to large salvage depots. Tin cans were cleanedin boiling water at each hospital, flattened at the center salvage dump, and then shipped toa local salvage depot. Grease was saved by the units and generally used for making soap; several centers had efficient soapfactories.1 Garbage was reduced to a minimum by food
saving; one hospital with 540 ambulant patients had less than halfa can of garbage daily. That remaining was disposed of either by a centralincinerator, by sale to French civilians (an arrangement which gave verydifferent degrees of satisfaction), or at the center's pig farms.1
FARMS
At several of the centers, especially that at Savenay, farms and gardenswere operated successively and arrangements were under way for their provision at almost all centers when the armisticewas signed.1 Land for this purpose was procured through theAmerican Expeditionary Forces garden service, and whenever possible animalsand manure were provided from neighboring veterinary hospitals. Implements were procured throughthe garden service, the American Red Cross, or from hospital funds. Seeds and plants were supplied by garden service; laborwas performed by volunteers from the convalescent camp. Farms that were most highly developed were equipped with a smallbarracks and appurtenances for 100 men and a dispensary, the convalescent camp exercising medical and disciplinarysupervision over the personnel.1
Pig farms proved especially lucrative, the animals being subsisted ongarbage from the center.1
CEMETERIES
On request of the Medical Department, land for cemeteries was acquiredin the vicinity of all large centers, or permission obtained to make interments in French cemeteries.1 Lawsin France were such that new locations for cemeteries could be obtained only after compliance with a number of requirements, but throughthe graves registration service these were complied with, sites obtained,and arrangements made for their control and maintenance, and for the propermarking and preservation of graves.1 Graves were dug by personnelassigned to the quartermaster. The chaplain of the unit in which a deathoccurred conducted funeral services, except when the deceased belongedto another denomination, in which case, if at all available, a chaplainof the same faith officiated.1
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CHAPLAINS
A chaplain was to be assigned to each base hospital unit, primarilyto minister to both patients and personnel. There was never a full quotaof these officers in the American Expeditionary Forces, in so far as hospitalunits are concerned, for which reason each chaplain habitually performedduties in several hospital units, including that to which he was specificallyassigned.1 All chaplains in a center were under the supervisionof the senior chaplain present, who distributed the services of his colleaguesto the best advantage.1 The senior chaplain supervised recreationaland entertainment activities, conducted services for the group weekly,was responsible for the proper conduct of funerals, and in some centerswas liaison officer between the hospital center and the graves registrationservice, reporting to that organization all interments and supervisingthe proper marking of graves. The last-mentioned duties were sometimesdelegated to a junior chaplain.1
AMERICAN RED CROSS ACTIVITIES
American Red Cross activities in the center were supervised and coordinatedby the representative of that service on the staff of the commanding officer.They were concerned chiefly with home and hospital service, recreation,and procurement of hospital supplies. The home and hospital service had one or more workersin every hospital who assisted in tracing the missing, distributed chocolates,cigarettes, and other articles of this kind, to incoming patients and throughoutthe wards. An important part of their service was the writing of lettersfor disabled patients.1 As mentioned above, Red Cross activitiesin promoting recreation were coordinated with those of the chaplains andwere under their general control but more immediately under the directionof the Red Cross worker in charge of the Red Cross hut.1 Herea library, reading and writing rooms were provided, a piano or phonographinstalled, and space was available for presentation of vaudeville or moving-pictureshows, and such social diversions as dancing and receptions. In the provisionof medical supplies the American Red Cross supplemented the Medical Department,sometimes furnishing articles in very large quantities.1 Requisitionsfrom units habitually passed through the center commander before beingreferred to the American Red Cross. This organization maintained in manycenters a small depot where there was a rapid turnover of the delicacies,stationery, toilet articles, and similar supplies which it distributedto personnel and patients.1
RECREATIONAL ACTIVITIES
Even before the armistice, entertainment of patients and personnel wasan important element of center service, which was under the general supervisionand control of the senior chaplain.1 In the several units thechaplains organized recreational activities, promoted sports, providedmoving picture and other shows and organized similar diversions, but itwas not until after the armistice was signed, when pressure of other dutiesrelaxed, that this service attained its
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highest development.1 There was a general exchange betweenunits throughout each center of entertainers drawn from the personnel or patients. A number of others, including many professionalentertainers sent overseas to serve the troops in this capacity and volunteer companies organized by other units, greatlypromoted this service during the armistice.1 If a band was not assigned to a center by higher authority, one usually was organizedin its convalescent camp, and orchestras were developed in a number of units. The orchestra developed by the centerat Mars, comprising over 70 pieces, was a remarkably fine organization.Instruments for bands and orchestras usually were furnished by the AmericanRed Cross, which cooperated with the chaplains in furnishing diversionand were in immediate charge of a number of details connected therewith.The recreation huts provided, so far as possible, for each base hospitalwere erected at the expense of the American Red Cross, and a Red Crossworker was immediately in charge of the social and recreational activitiesin each.1
REFERENCES
1. Report on organization of hospital centers, A. E. F.(undated), prepared under the direction of the chief surgeon, A. E. F.,by Col. H. C. Maddux, M. C. On file, Historical Division, S. G. O.
2. Report from the chief of the medical group, fourthsection, general staff, G. H. Q., A. E. F., to the chief of G-4, generalstaff, G. H. Q., A. E. F., December 31, 1918, on activities of G-4 B, forthe period embracing the beginning and end of American participation inhostilities: Appendix E. On file, Historical Division, S. G. O.
3. Report from the chief surgeon, A. E. F., to the SurgeonGeneral, U. S. Army, May 1, 1919, on the activities of the chief surgeon'soffice, A. E. F., to May 1, 1919. On file, Historical Division,S. G. O.
4. Consolidated weekly bed reports, A. E. F., office ofthe chief surgeon, A. E. F., November 28, 1918. On file, Historical Division,S. G. O.
5. Consolidated weekly bed report, office of the chiefsurgeon, A. E. F., November 14, 1918.
6. Report from the chief surgeon, A. E. F., to the commandinggeneral, A. E. F., April 17, 1919, on the activities of the Medical Department,A. E. F., to November 11, 1918. On file, Historical Division,S. G. O.
7. Report of activities of the hospital center at Bazoilles,undated, prepared under the direction of the commanding officer. On file,Historical Division, S. G. O.
8. Report of the activities of the hospital center atMars, undated, prepared under the direction of the commanding officer.On file, Historical Division, S. G. O.
9. Report of the activities of the hospital center atMesves, undated, prepared under the direction of the commanding officer.On file, Historical Division, S. G. O.
10. Report of the activities of the hospital center atAllerey, undated, prepared under the direction of the commanding officer.On file, Historical Division, S. G. O.
11. Report of the activities of the hospital center atBeaune, undated, prepared under the direction of the commanding officer.On file, Historical Division, S. G. O.
12. Letter from the senior consultant in maxillofacialsurgery, A. E. F., to local consultant in maxillofacial surgery, September24, 1918. Subject: Information. On file, A. G. O., World War Division,chief surgeon's file, 321.624.
13. Based on reports of activities of hospital centers,A. E. F. On file, Historical Division, S. G. O.
