Contents

CHAPTER XXII

A TYPICAL HOSPITAL CENTER

HOSPITAL CENTER, ALLEREY^a

PHYSICAL CHARACTERISTICS

The hospital center at Allerey was on the outskirts of the town whenceit took its name. Allerey, at the time, was a town of some 800 inhabitantson the Paris, Lyon, & Mediterranean Railroad, in the Department ofSaone-et-Loire, approximately 11 miles north of Chalons-sur-Saone, thelargest town (population, 30,000) of the department. The center was aboutthree-quarters of a mile from the Saone River, which was at once, in effect,the source of its water supply, and a line of communication over whichfuel and other supplies were brought to the center when access by railwas obstructed.

The site of the reservation covered an area of 172.3 acres, which consistedchiefly of farmland, but included some swampland at the eastern end andsome woodland at the western. The site was low, and generally very level,most of it (e. g., section 4) being lower than the edge, so that properdrainage was difficult.

The soil consisted of a layer of loam, from 6 inches to 2 feet in thickness,superimposed on clay; and though rainfall readily percolated to the claystratum protracted rains soon saturated the upper layer.

Climatic conditions during the existence of the center offered nothingunusual for this region. The summer of 1918 was hot, dry, and at timeswindy; spring, autumn, and winter were rainy, with almost constant cloudinessduring the last-mentioned season, and marked by cold of a penetrating character,but without very low temperature. Rainfall averaged 840 mm. per annum;the mean temperature was 10.52° C.

HOSPITAL CONSTRUCTION

The outlay of the hospital center comprised 13 sections and a cemetery;10 of the sections were to accommodate 1 base hospital each, 1 a convalescentcamp, 1 the quartermaster and motor transport departments, and 1, secludedfrom the rest, a psychiatric unit. Each base hospital was to accommodate1,000 patients with attendant personnel and to supplement its capacityby tentage for 1,000 beds-more if need be. These tents were to be pitchedin the "crisis expansion" areas provided in the rear of the wards. Eachhospital was to be a unit complete in itself, except for transportationand certain other communal elements. Such a unit consisted of 55 buildingsapportioned as follows: Administration; reception and evacuation; diningrooms; kitchens; bathhouses and latrines for patients, nurses, and officers;wards; recreation hall; laboratory and morgue; X ray and clinic; operating;quartermaster and

^aThe statements of fact appearing herein are based on "History of the Allerey hospital center, A. E. F.," by Col. J. H. Ford, M. C., commanding officer. On file, Historical Division, S. G. O.

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medical supplies; garage, shop, and disinfection; fuel house and incinerator.The convalescent camp consisted of a similar layout, except that ward buildingswere replaced by tents for 2,000 patients, and the following were eliminated:Nurses' quarters and appurtenances, receiving ward, laboratory and morgue,operating pavilion, garage and shop.

The areas of the base hospital units extended in juxtaposition alongboth sides of a broad central highway, down whose center ran a double-trackspur of the railway line. From this highway, the backbone of the camp,two branch roads ran the depth of each unit area and were connected byseveral crossroads passing in front of the receiving ward, kitchen, storerooms,and garage. The convalescent camp, located north of the blocks of basehospitals, was reached by the roads which traversed one of them. Roadswere also in service along the back line of each block of five base hospitalareas.

FIG. 87.-Mapof Allerey hospital center and vicinity

The psychiatric unit, consisting of quarters, dining rooms, kitchens,bathhouses, and latrines for 200 patients and attendant personnel, facedthe broad central highway beyond the end of the railway spur. It was nevercompleted, but was occupied by the military police during the period ofgreatest overcrowding.

The quartermaster and motor transport section nearest the proximal endof the railway spur at the east of the reservation included the storehouse,bakery, ice plant, barrack for civilian laborers, garage, motor park, workshops, gasoline station, etc. The cemetery immediately north of this wason the reservation, so that it was readily accessible and could be caredfor the best advantage.

Housing facilities were of two kinds, portable buildings and tents.The types of buildings selected for the center were known as the "Cavanairand Majoram" types, more commonly as type I. These were of knockdown construction,built by securing together uniform sections made up of double thicknessesof ¾-inch tongue-and-groove lumber, inclosing an intervening airspace 4 inches in thickness. These sections, which were assembled at distantfac-

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tories, formed the exterior walls. Roofs and floors were formed of 1-inchboards, the former covered with tar paper. Partitions to form rooms weremade of 2 by 4 studding and beaver board. Practically all buildings were6 meters wide, but varied in length from 10 to 50 meters. This type ofbuilding was constructed very rapidly, but in many instances settling occurredbecause of the softness of saturated ground, and cracks in exterior wallsdeveloped. The tents employed were of the marqueé type and of Frenchmanufacture. Their floor dimensions were 17 by 35 feet, so that three tents,connected end to end, accommodated 50 beds. Such sets of tents to accommodate500 patients were erected back of alternate wards in most but not all ofthe hospitals, there being an insufficiency of tents thus to equip theentire center. Though location back of alternate wards caused some lackof uniformity and balance in ward service, this method was adopted to lessenfire risk.

On February 16, 1918, the Engineer Corps began to lay out the site ofthe center and to supervise the activities of the civilians who had contractedfor its construction. In the latter part of that month the wall sectionsof the portable buildings arrived in such quantities that the freight houseat Allerey station was soon filled and 109 cars were unloaded at St. Loup,a neighboring village. Bad weather hampered the work to such an extentthat by March 23 only 10 buildings had been erected, and the roads werein such condition that only slow-moving ox teams could force their waythrough.

From the outset the labor problem was difficult. Old men, boys, andthose unfit for military service were the only French laborers available,so that it was necessary to recruit workmen for the project in other countries,especially in Spain. For this purpose agencies were maintained by the Frenchand American Governments and in some instances by the contractors themselves.Labor procured in this manner, however, was of a very inferior quality,requiring constant supervision. Also the practice of contractors of paddingtheir pay rolls required a constant check by the constructing engineer.Company C of the Twenty-sixth Regiment of Engineers arrived on May 19,and from that date construction proceeded much more rapidly. Eventuallya labor company was assigned to the center, and its number augmented by40 German prisoners and 20 Russians. These last had been sent to Franceas part of a military force in the early months of the war. Highly importantwork in construction was performed by enlisted men of the Medical Departmentand by convalescent patients. As fast as base hospital units arrived, theirpersonnel was engaged in completing the construction in the areas to whichthey had been assigned, and continued on this duty even after they receivedpatients. Throughout the life of the center, selected men were detailedfor special work such as electric installations, motor repair, operationof stationary engines, etc. Similarly convalescent patients were employedin large numbers for work of every kind according to their strength andability, and this practice expedited greatly the construction of the center.However, as orders required that patients be returned to duty as promptlyas possible, a very rapid overturn of such personnel was necessary, andcompletion of technical work, especially, was delayed to a considerabledegree by the constant necessity for finding replacements for skilled workmentransferred.

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Temporary roads were early laid out by the engineers and graded, buton account of lack of road material many became quite unsatisfactory afterrains commenced. At first cinders were used as surfacing material, butbecause of wet weather and constant passage of heavily laden vehicles theroads were soon cut to pieces and some became impassable. Later crushedrock was received in quantities and distributed where most needed. A steamroller was operated in some sections of the camp. After the armistice wassigned, 10,000 feet of duck board were procured and laid in those partsof camp which needed it most; and after January 1, 1919, some corduroyroads of railway ties were laid.

FIG. 88.-Reservoir,Allerey hospital center

The water supply was drawn by pumps, driven by gasoline motors, fromthree wells averaging 55 feet in depth sunk 200 yards from the bank ofthe Saone at the east end of the camp. A booster pump then forced the waterthrough an 8-inch main into the supply system of the several units, andthe surplus into a reservoir containing 100,000 gallons at the west endof camp. The capacity of the pumping plant varied from 20,000 gallons dailyin August to 50,000 gallons in December, depending on the rate of inflowinto the wells. A 4-inch pipe which could be cut off at its point of junctionwith the main line supplied each unit, and eventual distribution in themwas effected through pipes from ¾ to 2 inches in diameter. As thecentral chlorinating apparatus was never satisfactorily installed, waterwas sterilized by the Lyster bag method in all units.

A sewerage system for liquid waste was installed. It consisted of amain 12 inches in diameter, with ramifications 4 to 6 inches in diameter,reaching

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the receiving wards, operating rooms, kitchens, and laboratory of eachunit. The system was not originally intended for the reception of urine,but eventually it was used for that purpose. The sewage was dischargedinto a concrete sedimentation tank one-quarter of a mile north of the center.Here it was chlorinated in accordance with the requirements of the Frenchregulations on this subject and the clarified effluent discharged throughan open ditch into the Saone.

Before this system was installed, liquid waste was removed by barrelscarried in a motor truck, and later by a steel tank wagon. Because of inabilityto procure pipe installation the sewer system was long delayed and removalof liquid waste continued to be a grave problem for some elements of thecamp even after the tank wagon service was effected.

Original plans had called for a high-tension line from Chalons to furnishelectric light and power, but this project was abandoned. Instead, fivesmall 25-kilowatt electric light and power sets, each to serve two sections,were gradually installed, but as their output was small and each requiredconstant, skilled attention, this arrangement was never satisfactory. Itwas particularly inadequate when later required to serve 12 sections insteadof 10. Illumination was never brilliant, and when patients arrived at night,as they often did, current was not sufficient to illuminate properly thereceiving stations, wards, and operating rooms, and to actuate the X-rayplant. Despite fire risk, it was necessary to supplement the electric lightby lanterns in various parts of the center and at all times to exercisethe most meticulous care in the proper usage of current. Exterior lightshad not been provided in plans for the center, but these were authorizedwhen their need became manifest.

Throughout the operation of the center, until toward its close, therewere frequent interruptions in construction and in the operation of certainutilities. At times, for various reasons, the output of the pumps was limitedor discontinued. Reception of building materials or other supplies wasinterrupted by embargoes, railway delays, or nonavailablity at depots.The electric-light output was at times reduced or perhaps suspended. Inthe original plans no provisions had been made for offices or quartersfor the headquarters group, post office, and certain other elements, butthese were promptly authorized and constructed.

As the center developed, and as the pressure of essential work decreased,certain public-spirited individuals in every unit charged themselves withthe beautification of grounds and improvement of buildings. As a rule,the commanding officers of these units, while encouraging this, left plansand work of this character to those who were interested, believing thatthereby they would secure greater enthusiasm. Rivalry in the beautificationof wards, recreation halls, dining rooms, etc., was evidenced even at theperiod of greatest pressure. In the convalescent camp decoration of groundswas carried to a high point and a number of artistic effects secured, indifferently colored stones, evergreen plants, etc. Especial care was giventhe cemetery. Many floral offerings from French citizens and inmates ofthe center, as well as the painstaking attention to paths, turf, shrubbery,and the markings of graves and boundaries attested the reverent remembranceof the dead.

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ORGANIZATION

Organization of the hospital center at Allerey was commenced June 23,1918. On June 20, Base Hospital No. 26 had joined, being the first organizationof this character to arrive. Its commanding officer, relieved from furtherduty with the hospital and assigned to command of the center, organizedthe headquarters staff from the personnel of Base Hospital No. 26, butfor several weeks the staff continued to function to a diminishing degreein the positions which they had occupied in the hospital until understudiescould be trained. This initial staff comprised the following departments:Adjutant, quartermaster, medical supply, receiving and evacuating, sanitary,and railway transportation. A few days later representatives of the AmericanRed Cross and of the statistical branch, Adjutant General's Department,arrived and joined this staff.

As in other hospital centers, each staff officer at first had severalpositions. Thus at Allerey the commanding officer performed the dutiesof executive officer and, at first, inspector; the adjutant was also judgeadvocate, personnel and statistical officer; the quartermaster was chargedwith motor transport duties and immediate responsibility for those activitieswhich were later assumed by subordinates under his general direction. Thesanitary inspector was also laundry officer, fire marshal, supervisor ofbuildings and grounds, etc. No detailed instructions covering the administrativeorganization of the center were received, and development progressed asdetermined by force of circumstances and existing resources. Throughoutthis formative period staff duties were clearly delimited so that as occasionarose they could readily be distributed among individuals who could givethem their undivided attention. Until the close of the center, however,a number of officers continued to exercise the duties of several positions.Assignments to the headquarters staff were a continuing problem, for onlya few staff officers arrived from extraneous sources, and officers alreadyon duty in the center who possessed administrative ability were neededin their several units to meet the great expansion which these underwentthrough the establishment of provisional hospitals, overcrowding, etc.Pressure was such that the loss by any unit of one or two good administratorswas felt at once locally, and the local deficiencies in service arisingtherefrom had to be met by increased activities at headquarters. The situationwas ameliorated to a degree by the assignment to the center from otherpoints of officers for service with the convalescent camp, motor transport,engineer, military police, statistical bureau, medical supply, and thequartermaster department. Also a number of officers undergoing treatmentin the convalescent camp assumed some very important duties-e. g., commandingofficer of the interior guard and assistants to the receiving and evacuatingofficer-so that during their stay in the center they promoted greatly itsstaff activities.

The specialization of headquarters, developed to its final organization,was as follows:

  Commandingofficer.
  Adjutant.
Personnel officer.
Statistical officer.
  Civilian employment officer.
Commanding officer, headquarters detachment.
  Post-office service.
  Banking service.

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  Quartermaster.
Subsistence.
  Center purchasing agent.
  Sales commissary.
  Bakery.
  Butchery.
  Ice-plant farm.
Clothing, equipage, etc.
Finance.
Laundry.
Animal-drawn transportation.
Utilities.
Salvage.
Commanding officer labor battalion, etc.
Cemetery.
Interment.
  Motor transportofficer.
  Ambulancecompany.
Truck company.
Repair shop.
  Medical supplyofficer.
  Receivingand evacuating officer.
  Inspector.
  Sanitary inspector.
Inspection of buildings and grounds.
  Fire marshal.
  Signal officer.
  Engineer officer.^b
  Assistantjudge advocate.
  Assistantprovost marshal.
  Commandingofficer of the interior guard.
  Intelligenceofficer.
  Ecclesiasticalofficer.
  Railway transportationofficer.
  Center laboratoryofficer.
  Consultantsin professional services:
General medicine.
Psychiatry and neuropsychiatry, cardiovascular.
General surgery.
Orthopedics.
Ophthalmology.
Otology, rhinology, and laryngology.
Roentgenology.
Neurology.
Urology.
Laboratory officer.
Consultant in dentistry.
Chief nurse.
Chief dietitian.
Red Cross officer.

^bThis officer was one who had been selected from the patients in the convalescent camp. As noted below the engineer who constructed this center was never a member of the staff of its commanding officer.

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After September 20 a center officer of the day, chosen by roster fromamong the available captains, was detailed to inspect patients' messes,assist the receiving and evacuating officer, if required, inspect the guard,and meet emergencies.

An executive officer was never detailed as in the hospital centers atMars and Mesves. The duties of his office were divided between the commandingofficer and adjutant, the former charging himself with all executive administration,the coordination of the activities of the staff departments, direct supervisionof units, important correspondence, and leaves of officers.

ACTIVITIES

COMMANDING OFFICER

The commanding officer held conferences at 1 p. m. daily, except Sunday,which were attended by heads of staff departments and commanding officersof units. The constructing engineer, who was not under the jurisdictionof the commanding officer of the center, was invited to attend either inperson or by representative and habitually did so. At these staff meetingsthe fullest discussion was invited and suggestions and recommendationssought on all subjects relevant either to the interior service of the centeror to its external relationships. Most written orders were emitted onlyafter their purport had been fully considered at these conferences by allparties concerned, their scope and limitations determined and, if necessary,their provisions clarified. By this means several ends were attained, themost important being the engendering of a spirit of cooperation, the formulationof orders in such a manner that they seldom had to be revised, despitethe mutations incident to the growth of the center, and the avoidance ofmisinterpretations. Each officer concerned was encouraged to feel thathe had an important influence in the formulation of orders concerning activitiesof his department; and this was believed to have promoted the solidarityof the center and smoothness of cooperation much more than could have beeneffected by autocratic methods. In some instances, however, as need aroseorders were issued without consulting subordinates. Most orders, instructions,etc., that were of temporary or individual interest were given verballyby the commanding officer at these meetings to those concerned, who maderecord of them in their notebooks at this time; but orders affecting communalservice or of more permanent interest, whether from higher authority orof local origin, were issued in the form of special orders or memoranda.

Similarly, staff meetings were held by the several chiefs of professionalservices. At these sessions professional activities were coordinated, and,so far as was feasible and reasonable, standardized throughout the center.In this field, however, individualism in methods of treatment was encouragedrather than restricted, provided results achieved were satisfactory, exceptthat in some fields of endeavor (e. g., control of infectious diseases,débridement of wounds, etc.) orders issued were mandatory.

A stenographer attended all staff meetings and made of record discussions,verbal orders, etc. These notes were read at the next staff meeting likethe

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minutes of a board of directors, and were open to inspection of anyperson concerned who later wished to refresh his memory on any point.

The commanding officers of units also held conferences with their subordinatesdaily except Sunday, when in a manner comparable to that at headquartersall items of interest, whether administrative or professional, were discussedand appropriate orders given.

The commanding officer of the center and those of the several unitswere accessible to any member of their commands daily during hours setaside for that purpose. The object of all these measures was to have thecenter and the several units respectively as highly centralized as wasreasonable without infringing unduly, in the first instance, upon the prerogativesof unit commanders, and in the second upon that of individual officerson duty in the units, and that in determining the manner and degree ofcentralization officers concerned should have a constructive share. Apparentlycentralization was carried further at Allerey than at other centers forthe reason that in proportion to its resources it cared for more patientsduring a certain period than did any other. In order to secure the fullestcoordination a corresponding degree of centralization was imperative.

Each unit was allowed the fullest possible freedom in interior organizationand administration, subject to existing general regulations. In order thateach unit might have the benefit of acquaintance with methods evolved inothers, the commanding officer of the center and his staff, accompaniedby the commanding officers and staffs of the several units, visited eachhospital in turn, in order that all concerned might acquaint themselveswith respective methods of service. There was thus promoted mutual acquaintanceshipand a free exchange of ideas throughout the center. The result was an amiablerivalry extending to every element of each unit and prompt applicationof new ideas wherever found. It was interesting to note, however, thatmany of the ideas thus exchanged were modified in greater or less degreewhen applied in hospitals other than that in which they had their inception.Sometimes this was due to differences in local requirements or resources;more frequently to differences in the personal coefficient of the administratoror other personnel concerned, who found that they secured better resultswith methods to a degree individualized. The results showed the advisabilityof leaving to unit commanders and to the members of their staffs the largestlatitude possible in the discharge of their respective duties.

ADJUTANT

The adjutant promulgated orders, acted on furloughs of enlisted men,and on charges preferred, reviewed court-martial proceedings and actedfor the commanding officer on questions which did not demand the latter'sattention. In addition, he was charged with routine administration andcorrespondence, preparation and issue of all court-martial orders and thoseaffecting audits of public vouchers, examination of requisitions and rationreturns, command of the headquarters detachment and supervision of thesergeant major's office. Under his supervision units longest in the centerinstructed newly arrived units in orders, customs of the service, use ofblank forms with

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which they were unfamiliar, etc. Instruction in some subjects, however,was given by selected officers, usually those more immediately chargedwith their execution; e. g., receiving and evacuating officer, fire marshal,sanitary inspector, the chiefs of professional services, and others. Thethree base hospitals which first arrived were employed as schools for theinstruction of later arrivals. As soon as a new hospital reported, itsadjutant, registrar, mess officer, sanitary officer, sergeants (first-class),and clerks, were distributed for instruction to one or the other of thesehospitals, and remained there until they became fairly familiar with therecords and their own hospitals were ready to receive patients. Usuallythis was a period of about two weeks. Similarly, at the direction of thecommanding officer of the center, the adjutant directed the professionalpersonnel, in conformity with the recommendations of chiefs of servicesto visit these hospitals and familiarize themselves with both professionaland official standards required. The adjutant apportioned numerous dutiesamong his assistants. One of these was an officer from the statisticaldepartment of the adjutant general's office who joined in July, 1918.

The sergeant major's office, under the adjutant's jurisdiction, wasdivided into the several sections noted below. The reports prepared andforwarded by it are mentioned in the preceding chapter, which discussedhospital centers generally. The personnel section of the sergeant major'soffice consolidated all data pertaining to personnel on duty in the center,other than those serving with the engineers, forwarded appropriate reportsconcerning them, except that the daily and weekly numerical reports wereformulated by the statistical section, and kept up rosters of officers,nurses and enlisted personnel. Those for officers and nurses were enteredon file cards, which carried notations concerning military status, professionaland administrative aptitudes, etc., while the roster for enlisted men waskept up by appropriate entries on a copy of the muster roll of the organizationsto which men belonged. The preparation of a card index for enlisted personnel,though its desirability was recognized, was not feasible with the clericalresources available. These rosters, especially that of the officers, provedof great value in making details to meet the ever-shifting needs of thecenter.

The statistical section checked the accuracy of all reports receivedfrom units concerning patients, consolidated these for transmission tohigher authority (except those noted below under the receiving and evacuatingsection), formulated the daily bed reports and collective numerical reportsof patients and personnel, consolidated daily reports of all cases of infectiousdiseases, whether among duty personnel or patients, and placed these last-mentioneddata at the disposal of the sanitary officer. The head of this sectionwas charged with the engagement, supervision and discharge of all Frenchcivilians employed in the center by the Medical Department. Such femaleemployees to the number of 50 for each hospital were authorized by thechief surgeon, A. E. F., subject to rates of pay and terms of service requiredby him and the civil requirements of the French Government. These womenwere assigned to duty under the supervision of the chief nurses of thehospitals and by them distributed to best advantage. In order to promoteprompt reply to the many queries received from outside points concerningindividual patients, the statistical

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bureau maintained a card-index file for all patients, showing name,serial number, official designation, location in center (with notes ofall transfers, even from ward to ward), date of evacuation, classification(A, B, C, or D) and destination, or date and cause of death and numberof grave. This index was in constant use. In order to expedite the deliveryof mail until the post office prepared its own card index, that officeconsulted it during the night.

The receiving and evacuating section was closely associated with thestatistical section. It prepared all the reports concerning the reception,distribution, classification, and evacuation of patients other than thedaily and weekly statistical (numerical) reports. It was responsible forthe service records of outgoing patients and for the completion of theirrecords.

The order and record section received the orders from higher authority,as well as those of local origin, recorded and promulgated them. It checked,consolidated, and forwarded the records of the various activities of thecenter not covered by other sections of the adjutant's office. Thus, ithandled requisitions for medical supplies and blank forms, reports of progressof construction, of transportation facilities, pay rolls of marines andof civilian employees, statements of hospital fund, reports of purchasesfrom funds allotted the commanding officer of the center and the commandingofficers of units, ration returns, reports of fire marshal, etc. This sectioneventually had custody of all documents as they found their way into thefiles.

The filing, distributing and mailing section was charged with the upkeepof the index of all orders, reports and correspondence, the proper filingof papers, delivery of all documents throughout the center and obtainmentof receipts for same, verification of addresses on envelopes of outgoingofficial mail and on telegrams, recording date when such were sent. Theofficer in charge of this bureau supervised the post-office activitiesin the center.

As commanding officer of the headquarters detachment, the adjutant supervisedthe assignment of its personnel and kept in the detachment office all recordsconcerning them. His duties also included supervision of the property officerfor the headquarters office, of the courier service of the post-officeservice and of the activities and protection of a branch bank which wasestablished in the center.

COURIER SERVICE

Important papers, destined for headquarters, intermediate section, Nevers,and for the office of the chief surgeon, A. E. F., at Tours, usually weresent by courier, and were received from these offices in the same manner.

POST OFFICE

Post-office activities in the center began July 6, 1918, but not untilAugust 25 was the center given its post-office number, viz, A. P. O. 785.At this time the office was moved into a building provided for it nearheadquarters. In September, 1918, money order and registered mail departmentswere organized, service in both increasing rapidly. By December, 1918,the value of the money orders handled monthly was $20,000. By November,1918, the service handled daily approximately 40 pouches of incoming mailand 10,000 outgoing letters. At this time the service was reorganized anda card-index file was formulated

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similar to that at headquarters, carrying the names of all personnelin the center so that prompt delivery of mail was feasible. The eventualsuccess of this service had a very important influence on morale.

BANK

In November, 1918, at the invitation of the center commanding officer,the Chalons branch of the Société Généraleopened a branch bank in the center. The military police furnished guardsfor the movement of funds back and forth between the center and Chalons,and the motor transport park furnished transportation for funds and personnel.The bank proved to be a great convenience; in addition to cashing checks,it sold bonds of the fourth French loan. Banking hours were from 10 a.m. to 4 p. m. on Mondays, Wednesdays, and Fridays.

QUARTERMASTER

The group quartermaster had general charge of the activities of thatdepartment.

The subsistence branch of his service was charged with those dutieswhich its name implies. For several weeks after the first hospital arrived,bread and fresh meat were hauled from Dijon by truck, but after patientsbegan to arrive in considerable numbers motor transport proved inadequateand a shuttle railway car convoyed by an enlisted man was put in operation.Thisshuttle service was continued for this purpose for about six months, untila bakery was established in the center and fresh meat was shipped in directfrom depots. It was used for the transportation of soiled linen to a civilianplant in Dijon. Subsistence supplies, other than bread, were eventuallyreceived by automatic supply from the base stations and distributed bythe quartermaster of the group to quartermaster units. This method of supplyrequired about 10 cars daily but at one period (November and December,1918), when the center was operating at its maximum and about 23,000 rationswere required daily, as many as 27 cars were received in one day.

In order to meet increasing needs, a group purchasing agent was detailed.His office consolidated the requisitions of the several units for the procurementof fresh vegetables, eggs, milk, etc., not obtainable from depots. Suchan arrangement was necessary in order to prevent the several hospitalsfrom bidding against one another in local markets, to effect savings bypurchasing in large quantities, to prorate available supplies accordingto needs, and to extend the radius of purchases beyond points accessibleto the units themselves. These supplies were often bought in distant markets;e. g., potatoes in Brittany, eggs in Algiers.

To relieve congestion in the group warehouse and to meet needs thatmight arise because of unexpected expansion, unit commanders were requiredto keep on hand nonperishable comestibles to the limit of their facilities,viz, about two months' supply. This measure proved fortunate when the centerexpanded rapidly in October, 1918, for neither condition of roads nor availabletransportation would have permitted satisfactory commissary service ifunit warehouses had not been well stocked.

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When fresh meat began to arrive in quantities, it was at first storedin a cooling room erected in the warehouse after plans furnished by thechief quartermaster, Services of Supply. This room was simply a box 20feet square and 12 feet high, with walls and roof 1 foot thick. These wallswere filled with packed sawdust and provided with very carefully fitteddoors. The frozen meat soon brought the temperature of this room down toa point which permitted one week's supply to be kept on hand without ice.Later an ice plant was built, with an output of 1 ton of ice daily, andin conjunction therewith a cooling room where 50 tons of meat, fresh vegetables,etc., could be stored.

FIG. 89.-Exteriorview of warehouse, Allerey hospital center

A sales commissary was organized promptly after the organization ofthe center, but it was soon found that direct sales by it alone could notmeet requirements. Many patients were physically unable to visit the salesroomand attendants often did not have time to do so. The American Red Crossworkers in units purchased articles in greatest demand (e. g., tobacco,confectionery, etc.) to the limit of their storage facilities, and resoldthese at cost to enlisted men, whether patients or duty personnel; articlesfor similar resale to officers and nurses were handled by the unit messofficers. All such sales were in addition to those made direct to individuals,whether commissioned or enlisted, by the sales commissary itself, and werein effect an extension of its service throughout the center.

A bakery was established by Bakery Company No. 357 in August and thereafterwas gradually expanded to 7 ovens. By October, it was turning

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out 27,000 pounds of bread daily, and continued this output for severalmonths, though less than half the bakery company had joined. This output,made possible by day and night shifts, was not quite equal to demands,however, at the high-water mark of the center, and several shipments fromthe bakery at Dijon were necessary to meet requirements.

Butchery Company No. 331, assigned to duty in the center, was distributedamong the several hospitals, where its personnel gave instruction to cooksin the care and cutting of meats.

The property branch of the Quartermaster Department supplied fuel, forage,gasoline, clothing, equipage, ordnance, etc. Wood and forage were purchasedlocally, coal was shipped in from base ports, and other articles handledby this department were drawn from depots. It was necessary to keep onhand a large supply of clothing and equipment, because of the rapid overturnof patients, whose average stay in hospital was but 17 days, and who, onevacuation, had to be fully clothed and equipped. The quantity on handat one period was sufficient for 40,000 men and approximated in value $1,000,000.As no buildings were available for the storage of such a quantity, thebulkiest articles were stored without injury under paulins, on platformsbuilt for this purpose. No shortage of fuel or clothing occurred at anytime.

The finance section disbursed all funds other than those allotted tothe commanding officers of units by the chief surgeon, A. E. F. Commutationof rations and liquid-coffee money were paid by the group disbursing officer,but unit quartermasters made monthly payments of patients and personnelof their respective organizations. The monthly disbursements usually approximated$500,000, but for several months were 20 per cent greater than that figure.

The laundry service of the center was a grave problem from the openingof the center until toward its close. Some of the laundry was done undercontract at Dijon, 34 miles distant, linen being sent back and forth, firstby truck and later, as mentioned above, by shuttle railway car. All resourcesin that city soon proving inadequate, a hand laundry was organized at Verdun-sur-Doubs,2½ miles from the center. A laundry barge was hired, 30 French washerwomenemployed and 15 marmites erected. Later two portable laundries were receivedand operated by day and night shifts. The output of these establishmentswas about 200,000 pieces per month. During September, 1918, several truckloads of hospital linen were handled by the portable laundries at Beaune,when circumstances permitted that they give this assistance. In October,the steam laundry at Beaune, designed to serve both that center and Allerey,began operations, and as soon as it was able to meet demands of both centersall other service of this utility was discontinued. The laundry at Beaunewas operated on day and night shifts, but its output never reached thatat Mesves, which had been designed to handle 600,000 pounds monthly. Thelargest number of pieces done for Allerey in any month was 300,000 piecesduring December, 1918. During the period of greatest pressure, female civilianemployees in the several hospitals laundered the linen used in the operatingrooms, but despite their efforts and the utilization of all available resources,as many as 100,000 pieces were awaiting laundry at that time. An exchangewas established in the warehouse where issues were

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made against articles turned in and appropriate records kept, includingnumbers of all cars in which laundry was shipped.

The animal-drawn transportation at Allerey never assumed very largeproportions, but several teams were kept in service until near the closureof the center. They were used chiefly to supply units inaccessible by autotrucks.

After the establishment of an auto park, the only other transportationwhich remained under the charge of the quartermaster were the shuttle railwayfreight cars, and the others which operated on the railway spur withinthe center. These latter cars were loaded at the warehouse and then drawnby truck, which moved on the road beside the track. It was soon found thatmore supplies could be delivered in this manner than by this truck aloneand that this expedient released a number of vehicles that would have beennecessary to move many small shipments. The quartermaster had supervisionover this spur and the unloading of the cars bringing freight to the center.

Coincident with the construction work of the engineers, the quartermastertook over maintenance and the service of utilities. He effected repairsand operated cobbler, carpenter, and plumbing shops, the lighting plants,pumps, etc. So far as possible, maintenance was effected by the quartermastersof the several units, but communal service of this character was carriedon by the group quartermaster, as well as that requiring large resourcesor technical skill not available in the units concerned.

Land was rented for a farm, to be cultivated by convalescent patients,and considerable work was done to prepare it for seeding; but it was neverfurther developed by the center, which was closed before seeding was practicable.This farm, however, was employed to good advantage by the agriculture departmentof Beaune University when it took over the hospital center at Allerey.

The salvage service of the center was under the general supervisionof the group quartermaster, but in fact was largely carried on in the severalunits. He consolidated their results. The articles receiving the greatestgeneral attention were fats, burlap, paper, tin cans, bottles, bones, rubber,and wire. Fats collected in the several units were clarified by boilingand straining before shipment; burlap and paper were baled, and a few carloadsof tin cans were shipped to salvage depots. Unsuccessful attempts weremade to sell the remainder of them locally. Bottles were turned in forreissue or shipment if not needed in the center. Nails, wire, rubber, andbones were shipped to the depots designated. Salvage operations extendedfar beyond these simpler items, however, for all articles that could beemployed to some alternative use or could be renovated were turned in forlocal repair or cleaned, and shipped to appropriate depots; e. g., instruments,appliances, clothing, ordnance, utensils, etc. Closely associated withsalvage was prevention of waste, whether of comestibles or other supplies,especially dressings. Per capita wastage of foodstuffs, including liquids,was about 3 ounces per day, but this wastage was made to show some returnthrough its sale to the contractors who removed garbage.

Another duty of the group quartermaster was the command of the laborbattalion assigned to this center, the bakery and butchery companies, thefield laundry detachment, details from the convalescent camp, civilianclerks, labor-

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ers, and other employees in his department. Proper performance of thisduty was difficult because of the wide dispersion of such personnel ondifferent tasks, and could be met only by the detail of convalescent officersto supervise the work of the larger groups. One minor but constant dutyin which the labor battalion was of especial service was that of unloadingall railway cars within 12 hours and their notification, for removal, tothe railway transport officer.

The cemetery for the center (A. E. F. Cemetery No. 84), was under thecare of the quartermaster, in all that pertained to its physical care,such as preparation, filling, and marking of graves, provision of casketsand crosses, maintenance of roads, paths, shrubbery, etc. This office alsokept a register of all burials and serial numbers of graves. In order thatinterments might be made with due reverence and with proper religious andmilitary ceremonies, the first chaplain who arrived in the center was chargedwith making arrangements for all funerals. He also made the reports calledfor to the central records office and to the graves registration service,cared for all correspondence relative to interments, including the notificationof relatives, and kept records of the name, rank, organization, religion,nearest relative, and cause of death and number of grave of each decedent.His records thus confirmed some of those of the quartermaster, but weremore extended. He made appropriate notifications to other chaplains ofthe same faith as that of the deceased in order that they might officiate.Prior to the arrival of a chaplain of the Catholic faith, the parish priestat Verdun was requested to visit the center, to administer extreme unctionand conduct funeral services for Catholic patients. If no chaplain of thesame faith as the decedent (e. g., Jewish) was present, the services heldby the officiating chaplain were as nearly as possible in harmony withthose prescribed by his church. Remains were removed by ambulances. Firingsquads, which attended all funerals, were detailed by the military police,and pallbearers were selected by the commanding officer of the hospitalin which the patient died. Because of lack of lumber, it was at first necessaryto mark graves by pegs instead of crosses. Each peg showed the notationlater made on the cross which marked each grave, viz, name, rank, organization,and date of death of the deceased. To this peg, and later the cross, wasfastened one of the decedent's identification tags, the other being buriedwith the remains.

A monument to the memory of Private Paul H. Burton, Base Hospital No.25, the first soldier buried in the cemetery, was erected by the citizensof Allerey. A resident, whose château was located on the outskirtsof that village, later offered to donate an elaborate monument to the cemetery,but as orders had been received in the interim that no monuments were tobe erected, the offer was declined. A number of floral and other offeringswere made by the French citizens of the neighborhood as well as by theoccupants of the center.

MOTOR TRANSPORT

The motor transport service was charged with the procurement, maintenance,and operation of all motor vehicles assigned to the center, procurementof spare parts, provision of adequate transportation for all units, controlof personnel assigned to this service, and preparation of appropriate reports,returns, etc. This service at Allerey was at first under the supervisionof the

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quartermaster, but in July, 1918, a separate department was organizedby which all transportation belonging to the medical service of the centerwas pooled and repair shops operated. In the early period of occupancyno trucks were available for the service of hospitals, but needs were metto a degree by borrowing from the constructing engineer after 6 p. m.,and at other times to meet emergencies. The motor park grew gradually andwas placed on a much better footing after the arrival of Truck CompanyNo. 554, with 72 men and adequate transportation. Truck and ambulance companieswere formed, but service frequently was impaired by nonreceipt of spareparts or lack of gasoline. The automatic supply of 4,000 gallons per monthauthorized for the center proved quite inadequate and was increased fromtime to time until double the amount was being furnished. Much of thiswas used to operate pumps and the stationery engines, for lighting plants,etc. On several occasions, when grave difficulties arose because of nonreceiptof spare parts and of gasoline, it proved necessary to send trucks thatcould hardly be spared to Nevers and Dijon for enough of these to tideover an emergency. By November, however, shops were well equipped; thegasoline station had been established and these shortages had ceased; expertauto mechanics had been found among the personnel on duty in the centerand in the convalescent camp and had been attached to the truck company.Usually not more than 1 vehicle of the 50 then in the center was in theshop at one time; rarely more that 2, though work was normally carriedlate into the night. Orders required that the drivers should not leavefor the day until they had cleaned and oiled their vehicles, filled thegasoline tanks, performed necessary minor repairs, or reported these tothe shop if unable to effect them themselves. One of the greatest handicapsto the motor service was the poor condition of the roads, which not onlyobstructed operation of vehicles but was responsible for many damages tothem.

The three hospitals in the center which had been organized as AmericanRed Cross units had each collected certain motor transportation in theUnited States, but these never reached their units in France, because ofpooling and redistribution of motor equipment at base ports. The AmericanRed Cross provided four Ford cars, which were put at the disposal of theseveral units by roster.

MEDICAL SUPPLY SERVICE

A depot for medical supplies was established at Allerey, as at othercenters, for the following purposes: (1) To have on hand supplies to meetimmediate needs, (2) to lessen fire risk at central depots, and (3) tofacilitate shipments by enabling these to be made in bulk and when carswere available. To further reduce fire risk, storehouses were also establishedin all units in the centers.

The medical supply personnel at Allerey consisted at first of but 1officer and 3 enlisted men, but this force was later augmented as needarose to 2 officers, 8 noncommissioned officers, and clerks and laborersas required. Valuable additions were officers and enlisted men who hadseen service in larger depots. Duties were divided as follows:

Record section.-The sergeant in charge of the record sectionsupervised all other personnel and had immediate custody of records, correspondenceand reports, requisitions and returns of the depot.

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Receiving and storage section.-This section checked in all supplies,received and arranged in the storehouse those not issued to units directfrom cars, and was in charge of the storehouse. Its personnel checked theunloading of all cars, whether unloaded into the storeroom or direct tounits, and made record of contents of each car, with number of same.

Issuing section.-This section modified requisitions as needsrequired and made issues from the depot to units. It also received notationsfrom the receiving section of such issues as it had made direct from cars.Such issues comprised chiefly beds, cots, bedding, and the supplies belongingto certain units which they had had shipped from the United States.

The first duty of the medical supply officer at Allerey was to inventorythe considerable quantity of property already there when the center wasorganized and for which no packers' lists or invoices had been received.Supplies accumulated in the United States by the unit which first joinedthe center were not received until some two months after it arrived, sothat meanwhile articles were drawn to meet its needs. An acute emergencywhich arose at the outset of the service at Allerey before all needed supplieshad been received was met by securing supplies by truck from the depotat Is-sur-Tille instead of awaiting their arrival by train from the moredistant depot at Cosnes, which normally supplied the center; also, by shipmentsfrom the American Red Cross depot at Dijon and by purchase in open marketof some articles not obtainable from either of these sources. After thisinitial deficiency, supplies secured were, generally speaking, adequate,though sometimes very limited and in a few items, insufficient. Often,supplies sent from the depot at Cosne were from two to four weeks in transit,for one reason or another, such as an embargo. Hence, constant provisionwas required of all concerned and responsibility clearly fixed for anydeficiency through lack of timely requisition. Whenever less than 10 days'supply of needed articles were on hand in a unit depot the fact was reportedto the officer in charge of the center depot, who took appropriate measuresto prevent shortages becoming deficiencies. Similarly this depot soughtto keep a month's supply in stock. It had been planned to keep on handsupplies for 20,000 men for three months, but quantities for such reserveswere not available at the depots.

As no separate storeroom had been provided for medical supplies, thequartermaster allotted half of his warehouse to that purpose. This wassupplemented by the medical storehouses in all units which were kept filledto capacity, with the result that storage facilities proved adequate. Wheneverpossible, cars were unloaded at the unit needing their contents, so thatmuch bulky property did not pass through the warehouse, being checked directfrom the cars to the units. In October, on account of the sudden demandfor beds because of the influenza epidemic and the Meuse-Argonne operation,each of the best-equipped hospitals in the center established a provisionalhospital of 1,000 beds, for whose supplies the parent unit assumed accountability.In order to reduce paper work, these slenderly staffed provisional hospitalscarried all property on memo, receipt, and issues made to them were takenup and accounted for by the parent unit.

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The quantity of medical supplies reaching the center is indicated bythe following figures:

RECEIVING AND EVACUATING OFFICER

The receiving and evacuating officer was responsible for the properreception and distribution of patients and their evacuation as soon astheir condition permitted, with proper records and equipment, to stationsdesignated by higher authority. He received from the statistical officerdaily abstracts showing the number of patients and empty beds in each hospitaland in the convalescent camp, the number of officers and enlisted men readyfor transfer to the camp and from the camp to depots. His office maintainedgraphic charts showing these data. Usually, but not always, the arrivalof trains would be previously reported by telegram to the center by theregulating station at Is-sur-Tille, giving the number of the train, timeof arrival, and number of medical and surgical cases. The receiving andevacuating officer then determined where these patients should be distributed,taking into consideration not only the number of empty beds in each hospitalbut also the respective facilities of each hospital. The most serious surgicalcases including all litter surgical cases were sent to the hospitals whichhad first reached the center, as these were best equipped to handle them.Incoming patients with influenza were sent to one hospital; other infectiousdiseases, including venereal, to another, etc. Having decided upon numericaldistribution so far as possible, the receiving officer made appropriatenotification to the hospitals concerned and to the motor transport andsanitary officers. The receiving officer furnished details to remove patientsand prepared for their reception, the motor transport officer furnishedambulances at the time and place specified, and the sanitary officer arrangedfor the cleaning and disinfection of trains and the police of the railroadspur. Triage was effected in the train by the receiving and evacuatingofficer, his assistant, the center officer of the day, and officers detailedfrom each hospital. This method delayed somewhat the cleaning of the train,but 600 cases could thus be classified and removed in three hours. Duringa certain period more than 2,000 patients a day were distributed in thismanner, with a minimum of inconvenience both present and subsequent toall concerned. When necessary to release trains more promptly triage wasexpedited and effected in from one-half to three-quarters of an hour, butit was always found that this required some subsequent transfer of patientsbetween hospitals. During the removal of contagious respiratory cases thehospital personnel discharging this duty wore masks.

The receiving and evacuating officer also supervised the activity ofthe disability boards in the several hospitals meeting with them frequentlyto assist in the classification of patients. When it appeared from dailymorning reports that any hospital was not evacuating its patients as rapidlyas it should-i. e.,

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was allowing patients to remain an undue time on sick report-he visitedits wards and, by personal examination of patients and service with itsboard, expedited their transfer to the convalescent camp.

These boards classified patients into four categories: A, fit for combatservice; B, temporarily unfit for combat service but retained for earlyreclassification; C, permanently unfit for combat but fit for service inthe rear; D, unfit for further service in France.

At first all patients of whatever class were evacuated direct from theseveral hospitals to the depots designated by higher authority, but laterall except those in class D, and a few special cases, were evacuated onlythrough the convalescent camp. Class D patients, including those seriouslywounded who could be moved, psychiatric cases, etc., were evacuated directlyfrom the several hospitals by special trains, which, on request of thecenter commander, were sent by the chief surgeon, A. E. F., from time totime for this purpose. Lists of these patients submitted by the severalhospitals were consolidated and appropriate orders made when notice wasreceived of the prospective arrival of a train. Each hospital evacuatingclass D patients was furnished a list with date, time, and place of entraining.It checked its patients into the train under the direction of the receivingand evacuating officer, and transmitted their completed records. Specialcases requiring hospital treatment elsewhere-e. g., those requiring fittingwith artificial eyes-were sent direct from the hospital in which they werebeing treated. They, like class B and D cases, were transported on ordinarypassenger trains.

FIG. 90.-Interiorof receiving ward, Allerey hospital center

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Patients were tentatively classified by their ward surgeons, then examinedby the chief of service, and finally by the disability board of the hospitalwhere they were undergoing treatment. Patients suitable for transfer tothe convalescent camp were moved at a specified hour daily under a noncommissionedofficer on order of the receiving and evacuating officer, who also notifiedthe camp of the number to be expected from each hospital. With these menwas sent a nominal roll, giving names, serial numbers, military status,age, race, religion, civil occupation, diagnosis in full, and classification,together with a certificate signed by the chief of service of the hospitalwhence they came, to the effect that they were free from vermin and infectiousdisease, were fully equipped and accompanied by complete records. All inmatesof the convalescent camp were reexamined at frequent intervals, and whenfit for transfer were paraded, their equipment was inspected, and thosewho did not feel fit for duty were ordered to fall out for reexamination.All these last-mentioned measures, including the preparation of properorders, lists, etc., were in effect part of the evacuation service, butwere performed under the commanding officer of the convalescent camp.

Several advantages were secured by evacuating all patients except classD and special patients through the camp. The most important of these wereverification of patients' physical condition, frequent examination by trainedphysicians who specialized in this duty to determine progress, coordination,and verification of records, provision of a depot whence men could be drawnfor needed service in the center while awaiting transfer, collective supervisionby specialists of graded calesthenic exercises, and reestablishment ofmilitary discipline which may have been lost to a degree by patients whileundergoing treatment in hospital.

Outgoing men had to be grouped according to destinations, for the severalarms of the service had individual replacement depot or regulating stationsto which class A patients were sent and, similarly, B and C patients wereevacuated to designated points. It was found to be much simpler to evacuateone consolidated convoy than to notify all hospitals concerned and movea number of small detachments, the method that would have been necessaryhad evacuations taken place direct from hospitals and which had been practicedduring the early days of the center.

Patients were transferred from unit to unit in the center as occasionrequired-e. g., transfer of infectious cases-by mutual arrangement betweenthe respective commanding officers, and such transfers were then reportedto headquarters of the center.

Arrangements for transportation of troops were made by the local railwaytransportation officer (on notification from the evacuating officer) who,in turn, made arrangements with the troop movement bureau headquarters,Services of Supply. It was sometimes difficult to get the reservationsdesired. Space allotted on local trains was often usurped by other organizationsbefore they arrived at Allerey, and very frequently trains were many hourslate. To diminish discomfort of men scheduled to leave during the night,they were transferred after the evening meal to quarters nearest the railroadstation and not moved until the railway transport officer telephoned thenear arrival of

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the train. This measure, not available until overcrowding diminished,was important, for it saved many hundred patients the necessity of marchingto the station, three-quarters of a mile distant, and then waiting throughthe night in cold and rain for transport, which occasionally did not arrive.Special trains, which were sometimes necessary, were available as a ruleafter three or four days' notice. Class B and C cases were evacuated onordinary trains. Outgoing convoys, if their size warranted, were undercharge of an officer. Sometimes several officers were detailed for thisduty, as when, in one convoy, more than 1,200 men were transferred.

INSPECTOR

The duties of an inspector for the center never received undivided attentionof an officer, for there was none available for this duty exclusively.To meet as well as possible a very evident need, the commanding officerdirected the only other officer of the Regular Army who was present forany considerable period to assume these duties in addition to those ofthe commanding officer of Base Hospital No. 49. This hospital functionedso well that this officer was able to devote most of his time to inspectionswhich took cognizance of both conditions within the center and its externalrelationships with French communities and individuals. He followed no routine,but inspected all elements of the command as need arose, recommending appropriatechanges of method, transfers of personnel and equipment, investigated complaints,reported defects in service of units and individuals, etc. An importantduty was the investigation and rectification, if just, of any complaintarising from misconduct of occupants of the center while on pass, and hisactivities in this field promoted amicable relations between the Americansand the French.

SANITARY INSPECTOR

The sanitary inspector supervised the sanitation of the center and wasauthorized to give orders on this subject. More specifically he was chargedwith making suitable arrangements for the disposal of excreta, waste, andrefuse, disinfection of clothing, bedding, buildings, and hospital trains,supervision of measures ordered effected for the control of infectiousdiseases, inspection and report on the sanitation of units, coordinationof the efforts of the sanitary officers of units, and report on progressof construction of buildings and grounds. Sanitary problems were numerous,and were intensified by overcrowding, shortage of equipment, and poor conditionof roads.

The sanitary officer of the camp was assisted by the officers holdingsimilar positions in the respective units. Also, in each unit there wasa small, permanent detail of enlisted men engaged in sanitary work. Atfirst, these enlisted men were selected from the units concerned; however,when sanitary squads No. 23 and No. 77 joined, personnel from these squadswere distributed among the several units, thus permitting the release ofthe unit personnel. Members of the sanitary squads inspected and reportedto the center sanitary officer upon all matters affecting sanitation therein;e. g., quantity and removal of garbage, collection and disposal of otherrefuse, ventilation, and water purification. Defects reported were correctedby the sanitary officers of the

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center and of the unit concerned. Another section of the sanitary squadssupervised general police duty, such as that of the railway spur, the cleansingand disinfection of hospital trains, operation of the center incinerator,and cleansing of the settling tanks of the sewer system.

The condition of buildings and grounds and of water, food, and clothingsupplies of the center have been discussed above under the constructionand the quartermaster service, respectively. No further reference needbe made to these subjects here, except that milk was purchased from neighboringdairies, but it was so heavily contaminated that local orders requiredits Pasteurization before use.

Garbage was removed under contract twice a day by a nearby farmer who,under supervision, performed this service very satisfactorily.

The pail latrine system was employed. As to the final disposal of excreta,this was buried in a pit north of the center, until an extemporized incineratorwas built of salvaged material. The pails were emptied into covered barrelswhich were hauled by truck to this point. Unsatisfactory as was this method,it had to be employed from time to time until toward the close of the center.No excavator wagon was obtainable. Five Horsfall incinerators were receivedfrom time to time, but these proved quite inadequate for the needs of themaximum population in the center, so that recourse was had, with satisfactoryresults, to the use of the center incinerator. Pits were dug to collecturine and waste water, but because of the impermeable soil these soon filledand their contents were removed in barrels to a disposal tank on the outskirtsof center. Eventually these fluids were removed largely through the sewer,though by the end of October, 1918, not more than half of the seweragesystem had been completed. Urine pits were never connected with the sewer,but their contents were pumped into it by hand pumps.

Disinfection was effected at first in Serbian barrels, but later fourportable disinfectors, American type, were installed from time to time.These, together with a Canadian hot-air disinfector built in the convalescentcamp, met most needs, but during periods of stress were supplemented bythe Serbian barrels until toward the end of the center's existence. Theportable appliances were distributed, and their use by neighboring unitsregulated, according to roster. Mess utensils were disinfected after eachmeal by immersion in boiling soapy water and boiling clean water successively.

The sanitary officer inspected all parts of the camp at least twicemonthly and daily any part of it which required especial attention (e.g., wards for infectious diseases). He kept a blue print of the camp, markedeach day with colored pins, which indicated the location and characterof sanitary defects reported by the sanitary squads or the sanitary officersof units, or discovered on his inspections. He graded on a percentage basisthe sanitary condition of wards, kitchens, latrines, food wastage, andgeneral police of the several units. These gradings of all units, publishedtwice a month to the command, proved a stimulus to amiable rivalry

An important duty of the sanitary officer was the enforcement of ordersfor the control of infectious diseases. Such orders, in so far as professionalmeasures

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were concerned, were initiated by the chiefs of the medical and laboratoryservices; methods of their application were determined by the sanitaryofficer in conjunction with them.

The sanitary officer kept up graphic charts showing the number of casesof each infectious disease in the center. The occurrence of each case ofdiphtheria, meningitis, mumps, and measles in each building in the centerwas shown on a diagram of the center, by the appropriate insertion of pinswith differently colored heads-one color for each disease.

FIG. 91.-Delousingapparatus, Allerey hospital center

In November, 1918, the center at Allerey was housing over 22,000 inaddition to about 600 troops and employees of the engineers and was severelyovercrowded. A number of cases of influenza and pneumonia had been receivedduring October, together with many gassed cases who were very susceptibleto respiratory infections. The greatest number of influenza cases was 1,002on November 4, when the total number of patients in the center was 16,063;and the greatest number of pneumonia cases, 291, was reached four dayslater. By January 1, 1919, the number of cases of each of these infectionshad fallen to 100 and 51, respectively. Influenza and pneumonia cases developingin the center were transferred so far as practicable to appropriate wardsin the same hospital in which they arose, but all other infectious caseswere transferred to appropriate wards in Base Hospital No. 56. Though otherinfectious diseases-diphtheria, cerebrospinal meningitis, mumps, measles,German measles, erysipelas, typhoid, paratyphoid, and scarlet fevers-wereintroduced into the center,

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only diphtheria occurred in any alarming number. It had been introducedby chronic carriers, especially those who had been gassed, these latterbeing highly susceptible to the disease. The number of cases rose graduallyto 95, on December 2, the most important factors in its spread being overcrowding,contaminating hands, and fomites (indirect droplet infection), and, atfirst, delayed diagnosis in laryngeal cases. Clinically these cases oftenwere very similar to membranous laryngitis caused by "mustard" gas. Measuresfor control adopted were:

(1) Inspection of all throats daily and prompt segregation of positivecases, carriers, and suspects. These were transferred to cubicled wardsand wore masks when out of their cubicles.

(2) Quarantine of wards in which a case developed until the throatsof all therein were cultured, inmates meanwhile wearing masks.

(3) Contacts, including those occupying, or working in, the same buildingwere given the Shick test, and if this proved positive they were givenantitoxin.

(4) Carriers and contacts were quarantined until two negative cultureswere obtained, at 48-hour intervals, from the nose and throat.

FIG. 92.-Clothingpreparatory to delousing process, Allerey hospital center

When five or less positive atypical cases were found in a ward whena case of diphtheria had appeared, they were sent to the quarantine wardsin Base Hospital No. 56; when more than that number were found in a ward,the ward was quarantined. The throats of all its inmates were treated for3 days and, after 24 hours' respite, were recultured. Quarantine, thoughrigorous, was made as brief as possible, in order to insure cooperationof those affected by it.

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Similarly, meningococcus carriers were quarantined until after two negativecultures were obtained at one-week intervals. Eighteen cases of this diseasedeveloped, between no two of which could close contact be established.Ten cases appeared at the time of greatest crowding, but epidemic developed.

Observation wards were provided in each unit for the segregation ofsuspected cases of infectious disease. All these beds, as well as in thecontagious wards, were cubicled and attendants were masked. The sanitaryofficer in each hospital made frequent day and night inspections of thewards for contagious cases, and exemplary punishments were inflicted forviolation of quarantine. Proper ventilation and head-to-foot sleeping arrangementswere enforced. Public gatherings were forbidden for a few weeks duringthe height of the influenza epidemic.

FIG. 93.-Interiorof one of the quarters for enlisted men, Allerey hospital center
Buildings were heated by coal and wood stoves, but a sufficiency ofthese to make all structures comfortable never was received. Proper heatingof tents was especially difficult.

French shower baths, provided in adequate number, proved very satisfactory.Personnel and ambulant patients were required to bathe twice weekly atleast, and permitted to do so more frequently if they did not interferewith the use of these baths by roster.

Very few venereal cases developed. Preventive measures were those usuallyemployed.

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FIRE MARSHAL

The fact that the housing facilities in the center were constructedentirely of pine or were canvas caused the fire hazards to be exceptionallygreat, though these were minimized as far as possible by the spacing ofunits and tents and by the installation of spark arrestors on all smokestacksor chimneys.

FIG. 94.-Heatingapparatus for patients' baths, Allerey hospital center

The fire marshal of the center was charged with the formulation of fireregulations, procurement and distribution of fire-fighting material, instructionof the fire marshals and squads of the several units, supervision of theirdrills, inspection of apparatus at least twice monthly, etc. The fire marshalbeing also sanitary officer, he added the duties of firemen to those ofthe sanitary squads and required that, when making sanitary inspections,the members of these squads were to note the condition of buildings andgrounds and of fire-fighting apparatus. Such apparatus was rather delayedon delivery. When received, much of it was placed in those units treatingthe greatest number of bed patients and the remainder as equitably as mightbe throughout the center. At first the only facilities were fire buckets(which were used for no other purpose), 45 fire barrels, and 2 hand pumpsto each unit. Eventually all units were equipped with Pyrene and Hardinextinguishers, 10 pumps of 5-gallon capacity, and 640 feet of 2-inch hose.A central fire department, consisting of 12 men on day and night duty whowere in charge of a 90-gallon chemical fire engine, was soon expanded tooperate three other such engines, which were distributed through the center.Detailed regulations covering fire service were posted in all wards, barracks,etc., and fire drills in accordance therewith were held weekly in each

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unit and by the fire department of the center. Notwithstanding all precautionsa number of small fires occurred, of which about 90 per cent were attributedto cigarette stubs; the only one that was at all serious was caused byan explosion of a small gasoline tank. Because of the danger of fire tothe bed patients and the grave effects of the loss of even one structurein so crowded a community, smoking in wards and barracks was forbiddenuntil the number of bed patients and the population of the center wereconsiderably diminished and fire apparatus fully installed. The gravityand imminence of the fire menace is attested by the fact that within twohours after the premises were turned over to the French, four buildingswere burned and the conflagration arrested only with considerable difficulty.

SIGNAL SERVICE

During the early history of Allerey, the French telegraph line was theonly one available. An interpreter in the engineer's office was the connectinglink, receiving and delivering by telephone, through the French officeat the railroad station, messages pertaining to the center; but this servicewas very unsatisfactory as messages were often garbled in transmission.Exterior telephone service was soon extended to Dijon, but connectionswere difficult to get, and these usually were cut before a conversationwas completed. It was not until after the center was linked up with theAmerican lines that exterior service was reliable. At first no telephoneswere provided for interior communication, a circumstance which both slowedup service and necessitated the use of runners who could illy be sparedfrom other duties, but these instruments were gradually installed, untilby October, 1918, 46 were in operation. At that time a detachment of theSignal Corps joined and began operating a central office, which soon handledthe following average business daily: Telephone calls, internal, to thecenter, 425; outgoing, long distance, 25; incoming long distance, 36. Telegramsreceived (2,950 words), 60; telegrams sent (3,400 words), 75. In additionto the foregoing were the internal calls (of whose number no record waskept) to the several units which had separate systems of local calls.

ENGINEER OFFICER

Throughout the occupancy of the center, the constructing engineers continuedto be engaged in the completion of the project, but were also concernedto a degree with the solution of engineering problems which arose in sectionsalready occupied; e. g., settling of water mains, upkeep of roads, etc.As this constructing force was to be withdrawn, however, as soon as thecenter was completed, and as no provision was definitely made for the assignmentto the center of an engineer to solve problems that might later arise inthis field of work, an officer of engineers in the convalescent camp wasassigned to duty at headquarters to acquaint himself in detail with theproblems which the constructing force had encountered and how they hadbeen overcome. It was proposed to have him detailed as the engineer officerof the center when the constructing force was withdrawn, but this neverproved necessary as the constructing force remained until the center closed.

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ASSISTANT JUDGE ADVOCATE

The duties of an assistant judge advocate were discharged by the adjutantin addition to his other services. These comprised examination and, ifneed be, the correction of charges and findings, details of special courts,etc. General courts-martial for the center were detailed by the commandinggeneral, Services of Supply.

ASSISTANT PROVOST MARSHAL AND COMMANDANT OF GUARD?

When the first unit arrived at Allerey, the only guard provided wasa detachment of 10 men of Company F, 162d Infantry, engaged in protectingproperty of the engineers. This nucleus was gradually augmented, partlyfrom outside sources, partly by details from the convalescent camp. Butfew firearms were available for several months, a circumstance which madeit necessary to arm with clubs the interior guards and some of the personnelat posts outside the center. French gendarmes were too few to effectivelyrestrict the American soldiers or to enforce the laws controlling saleof alcoholic stimulants. The police and guard services grew with the center'sdevelopment, and by September there were 10 military police posts whichcovered 6 adjoining towns and adjacent territory. These were under thecommand of the assistant provost marshal detailed by headquarters of theServices of Supply. This officer was responsible for the discipline, records,etc., of the military police quartered in the center, reports of theiractivities, establishment of an adequate number of police posts throughoutadjoining territory, protection of inhabitants against disorders and depredationsby American troops, supervision of travel by military personnel, arrestand detention of all stragglers, absentees without leave, and other violatorsof the laws and orders whether of French or American origin, to which Americanswere subject. At first the assistant provost marshal also commanded theinterior guard, but this organization later was separated entirely andplaced under the command of a line officer detailed from patients in theconvalescent camp. At this time the guard consisted of 3 platoons, eachhaving 3 sergeants, 12 corporals, and 79 privates, each platoon being commandedby a commissioned officer. Almost all this personnel was drawn from theconvalescent camp and, under existing orders, had to be returned to dutyas soon as fit, a circumstance which required the return of its membersabout as soon as they were trained, and enhanced greatly the difficultyof this service. In August, Provisional Company No. 6 and Provisional CompanyNo. 20, each comprising 100 class B men, were assigned to the center forguard duty. An efficient military police who, as distinguished from theguard, functioned outside the camp was necessitated by infractions of lawon the part of some of the local French population. The most serious ofthese offenses were illegal sale of alcoholic stimulants and the purchaseof Government property, such as military clothing and blankets. These offenseswere controlled only by numerous arrests, search warrants, and prosecutionsin the French courts. Clandestine sales of liquors in camp by employeesand by laborers were suppressed by similar means. Absences without leavewere controlled by demanding passes of all men encountered by the policeoutside

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of camp, and by sentencing men found guilty to unpleasant duty, as withthe labor battalions. One motor cycle was employed by the military policefor the apprehension of such delinquents. By means of this vehicle thepolice reached points where it was impractical to post guards, and theradius and intensity of their control were notably increased.

INTELLIGENCE OFFICER

The intelligence officer for the center was assisted by others occupyingcomparable positions in all units, by officers censoring mail, the post-officeforce, the telephone and telegraph operatives, etc., so that very completeinformation reached headquarters of the conduct and loyalty of individualsand of morale throughout the center. This service was important, for itwas an additional means of determining the needs of personnel and how theymight best be met. Derelictions discovered through it were met in otherways than by court-martial, for none were grave enough to warrant this,and could be handled better by administrative than by juridical methods.

CHAPLAIN

As the center expanded, the number of chaplains present, 4 Catholicand 4 non-Catholic, proved inadequate without some organization, to themany needs arising for their service. The senior chaplain present thereforewas placed in general supervision of the chaplains' activities and in chargeof the center chapel. His functions in these capacities were to make suitableprovision for all those seeking the services of ministers of their faithand to prepare a roster for the use of the chapel by all ministers in turn.Thus such needs throughout the center were coordinated. As chaplains madetheir visits through wards and elsewhere, they learned the names of thoseof other faiths who desired the services for chaplain and promptly tookappropriate measures to secure these services. Each chaplain normally servedthose of his faith, not only in his own unit but in others as well.

In addition to the services in the chapel, others were held in the severalunits in the recreation halls and, when these were filled at one time bybeds, in dining rooms. Dining rooms were by no means suitable for the purpose,but the fact that any other arrangement was temporarily impossible wasrecognized by ministers and congregations alike, and services were conductedwith normal decorum and success. As noted above, suitable provision forinterments was made by the interment officer, who was the first chaplainto come to the center.

From time to time the chaplains met informally to discuss questionspertaining to divine services and social needs, for they charged themselveswith the performance of whatever duty they could discharge which came tohand. These duties included the promotion of entertainment within the severalunits, in conjunction with the American Red Cross, the organization oforchestras, glee clubs, etc., preparation for Thanksgiving and Christmascelebrations, writing letters for disabled or uneducated men, and, by sympathetichelpful interest, promotion of the happiness of such as sought their aid,or when they

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proved in need of help or encouragement. Their counsel was constantlybeing sought by patients and duty personnel alike in matters affectingtheir secular welfare.

RAILWAY TRANSPORTATION

The railway transportation officer was responsible for the transportationby rail of personnel and supplies to and from the center, except movementof hospital trains and supervision of the railway spur, the former beingunder the orders of the regulating station at Is-sur-Tille and the latterunder the center quartermaster. Upon notification of the number of patientsfit for transfer, and their destination, he made appropriate request onthe troop movement bureau at Tours and notified the evacuation officerwhen transportation was made available. He traced lost freight, notifiedthe center headquarters of the time of arrival of hospital trains, arrangedfor the movement of the shuttle railway car back and forth to Dijon, andmaintained liaison with the fourth bureau of the French War Department.His office in the railway station was connected by telephone with the hospitalcenter and maintained day and night service, with the result that localbusiness was handled promptly, and, by means of long-distance telephonecalls, hour of arrival of trains for outgoing drafts was notified to thecenter in due time for them to be moved without tedious waiting, yet withoutdelay.

AMERICAN RED CROSS

Shortly after the hospital center at Allerey was organized, an officerof the American Red Cross joined the headquarters staff and remained incharge of Red Cross activities until the center neared its close. His departmentgrew until it consisted of 3 officers, 23 workers, 2 searchers, and a variablenumber of civilian employees. He exercised general supervision over hisdepartment, obtained and distributed needed Red Cross supplies, and coordinatedefforts of his department personnel; one of his assistants arranged forentertainments to be given in the center from extraneous sources, procuredmoving-picture apparatus, films, etc., and another, as a field inspector,determined needs of patients, efficiency of workers, etc. The workers,distributed among the units, met incoming hospital trains to serve hotchocolate and coffee and to distribute cigarettes. They assisted patientsin many ways throughout their stay in hospitals, as by the donation oftobacco, confectionery, stationery, etc., resale at cost of supplies purchasedfrom the commissary, writing of letters, etc. Among the gifts distributedby the Red Cross prior to January 1, 1919, were 35,000 comfort kits, 375cases of bar chocolate, 50,000 pairs of socks, 35,000 sweaters, 5,000 casesof cigarettes and tobacco, 100 cases of chewing gum; at Christmas, 1918,15,000 pairs of socks were filled and distributed. Part of the contentsof these were 200 sacks of nuts and confectionery made from 15 tons ofsugar. The Red Cross also met the graver needs of patients, its depot supplyingmany articles required for their care and comfort, especially in emergencieswhen there was not time to get them from Army depots. Thus, to meet theneeds occasioned by the Meuse-Argonne operation and when shipments fromthe medical supply depot at Cosne were held up by embargo,

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the local chief of the American Red Cross procured from the depot ofthat society in Paris 10,000 blankets, 10,000 sheets, 1,000 operating gowns,1,000 helmets, 1,000 pairs of bed socks, 600 suits of pajamas, 2,000 yardsCarrel tubing, and 2 cars of surgical dressings. The promptitude with whichthese essential articles were received at this time undoubtedly saved aconsiderable number of lives. These articles were shipped by freight carsattached to the Paris-Marseille express to a point near the hospital center,whence they were transported to the center by truck.

On the one hand, the searchers located relatives and friends at home,of patients in hospital, and, on the other, for interested ones at home,men who had been lost in the American Expeditionary Forces. One of theirduties was the detailed report of the American prisoners of war who reachedthe camp from Switzerland and to assist these men in straightening outtheir affairs.

The several hospital units of the center provided to a degree theirown entertainment, such as dances, theatrical performances, and concerts,but to the local American Red Cross fell the duty of promoting entertainmentgenerally, obtaining troups, films, etc., from outside sources, and coordinatingresources among the organizations. Each hospital unit had a recreationhut accommodating 600 persons; the convalescent camp had a hut accommodating1,500. All of these buildings were donated by the American Red Cross. Thatsociety installed 10 pianos in these buildings and furnished instrumentsfor a band, three orchestras, and a fife, drum, and bugle corps. From themiddle of October, 1918, until November 25, the recreation huts in mostunits were filled with beds, but as rapidly as these were cleared performanceswere staged, and when, in December, sufficient electric current becameavailable moving pictures were exhibited. These were shown five nightsa week in each unit, and from one to three of the American ExpeditionaryForces traveling shows played nightly in the center.

About January 15, 1919, a nurses' recreation hut was opened by the AmericanRed Cross, providing reading, writing, and lounge rooms. Tea was servedhere each afternoon and a dance given every evening except Sundays, thechief nurses of the hospitals acting as hostesses by roster. In the samemonth the Red Cross opened in Chalons-sur-Saone, the nearest large town,a centrally located building which provided a recreation and writing roomfor enlisted men, separate sitting rooms for officers and nurses, and acommon drawing room where tea was served by the Red Cross worker in charge.

A library of 500 books was maintained in each unit and large numbersof current American, English, and French periodicals, especially thosecarrying illustrations pertaining to current events, were distributed.

In the headquarters building, the Red Cross operated a bank and an informationbureau. The bank made loans and cashed checks, the amount of its businessamounting to over 785,000 francs. The information bureau assisted some300 men daily.

CONSULTANTS IN THE PROFESSIONAL SERVICES

The consultants of the several professional branches supervised theactivities of their respective specialties throughout the center, in additionto performing the duties of chief of service in the hospitals to whichthey were assigned.

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They were charged with the study of pertinent professional needs andavailable resources, in personnel and material, recommending transfersas required to the best advantage. They acquainted themselves with thequalifications of their own resources as far as possible, but reportedto the commanding officer those matters needing his cooperation, acquaintedthemselves with new methods of treatment, and disseminated professionalinformation. This last important duty was effected in several ways, suchas by conferences attended by all officers in the center belonging to agiven service, by personal discussion with individuals concerning treatmentof a particular case or group of cases, and by presentation of cases orpapers read at meetings of the medical society. In order to afford a clearinghouse for professional knowledge, the "clinico-pathological society" wasorganized, to meet twice weekly. At one of these weekly meetings unusualcases were presented and discussed; at the other, reports of autopsy findingsand demonstrations were made. It had been noted early that certain clinicaldiagnoses had proved difficult, such as certain cases of laryngeal diphtheria,complicating injury caused by inhalation of "mustard" gas, pericarditis,and empyema, and cases selected for presentation were those that had presenteddifficulties in diagnosis and treatment. Similarly, difficult surgicalcases were presented and discussed. By such means there was promptly disseminatedmuch information of a highly technical character, which was of immediatevalue, especially to medical officers who had newly arrived overseas andhad not yet had practical experience in treatment of certain newly encounteredconditions. By the report of autopsy findings, an error in diagnosis ortreatment by any medical officer was immediately made known to the chiefof service so that appropriate action could be taken. Frequently, the respectivestaffs of the several hospitals met to discuss professional matters internalto the units. A number of papers were written, and later published, onprofessional activities in the center. It had been planned that each serviceeventually would organize its professional society, but because of shortageof personnel and pressure of duties, this project could not be effected.

Through the visits of the consultants from ward to ward, and the discussionsin the medical society and out of it, a standardization and coordinationof service was effected. Though certain professional measures were mandatory,for example, those for the control of diphtheria, medical officers wereencouraged to feel that they had an active part in the development of professionalmethods, and they formulated the few orders published concerning professionalactivities.

To meet the fluctuating needs in the nursing service in different partsof the center, the senior chief nurse, in addition to her other duties,made frequent surveys to determine what transfers of nurses should be effectedbetween hospitals and to make recommendations concerning their activitiesand welfare. Similarly, the senior dietitian made surveys concerning dietaries,the preparation and service of foods, recommended transfers of dietitianswith the different hospitals, and gave assistance in her specialty whereverthis appeared advisable.

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COLLECTIVE ACTIVITIES OF HOSPITAL UNITS

It is the purpose of this chapter to consider collective, rather thanindividual, activities of the hospitals of which the center at Allereywas composed, the individual activities were comparable to those of detachedbase hospitals. Certain notations regarding each unit composing the centerare made, however, to show how each fitted into the general plan.

The following hospitals joined the center in sequence: Base HospitalNo. 26, comprising personnel from the University of Minnesota, the Mayoclinic, and the medical profession of Minnesota at large, had been joinedin the United States by 12 officers and 50 enlisted men from Baylor University,Texas. This hospital joined June 20, 1918, with 36 officers, 65 nurses,1 dietitian, 2 technicians, 3 stenographers, and 207 enlisted men. BaseHospital No. 25, comprising personnel from the Cincinnati Medical College,and the medical profession of Ohio at large, joined July 15, with 41 officers,100 nurses, 1 dietitian, 2 technicians, 3 stenographers, and 208 enlistedmen. Base Hospital No. 49, with 38 officers, 100 nurses, 1 dietitian, 2technicians, 2 stenographers, and 208 enlisted men, from the Universityof Nebraska and the medical profession of that State at large, joined August5, 1918. Evacuation Hospital No. 19, with 33 officers, 100 nurses, and237 enlisted men, organized at Fort Riley, Kans., joined September 19.Base Hospital No. 70, with 40 officers, 100 nurses, and 200 enlisted men,organized at Fort Riley, Kans., joined September 28. Base Hospital No.56, with 30 officers, 99 nurses, and 188 enlisted men, organized at FortOglethorpe, Ga., joined September 30. Base Hospital No. 97, with 31 officers,2 dietitians, 192 enlisted men, organized at El Paso, Tex., joined November30. It was joined on December 14 by 97 nurses. Base Hospital No. 82 joinedSeptember 19, but on September 21 it was transferred to Toul.

In conformity with the urgent demand for increased hospitalization inthe American Expeditionary Forces, the first five hospitals which reachedthe center each organized a provisional hospital consisting of from 7 to12 officers and about 40 enlisted men. Each of these provisional unitstook over an unoccupied, uncompleted section of the center and undertookto care for 1,000 patients whose condition was not severe but who werenot ready for transfer to the convalescent camp. The senior unit relievedits respective provisional hospital of as much as possible of administrativework-e. g., reports of sick and wounded, returns for property (except clothingand ordnance)-but, generally speaking, these junior units were autonomous.

The convalescent camp was organized June 26, 1918, from personnel onduty at Allerey and by limited casual personnel assigned to the centerfor that purpose.

The personnel of the three American Red Cross hospital units which hadbeen the first hospitals to join had been selected from large resourcesso that their commissioned staffs were composed of men well trained intheir several specialties, whether surgery, medicine, laboratory, or dental,and who were mutually acquainted with the professional methods of othersin their units. Nurses, dietitians, technicians, and enlisted men comprisingcollege men, professional cooks, technical draftsmen, also had been selectedfrom

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among many who were eligible. Thus each of these units was well balanced.This balance, however, was considerably disturbed by the need of supplyingpersonnel to form the headquarters organization, organize provisional hospitals,provide surgical teams which were sent to the front, and to meet otherneeds. The other hospitals which composed the center contained many verycapable officers, nurses, and men, but in comparison with the Red Crossunits they were handicapped by the lack of prior mutual acquaintance; also,they were handicapped in their earlier professional efforts by the necessityfor concentrating, as described below, a considerable part of the limitedequipment available in the hospitals which first arrived in order thatthe most serious cases could receive suitable care.

FIG. 95.-Anoperating room, Allerey hospital center

Each of the Red Cross hospital units had accumulated medical propertyto the value of from $30,000 to $100,000 in the United States. But sincethe property was not received until about two months after they reportedat Allerey, it was necessary to completely equip them, even at the expenseof other units, so that they could care for all types of cases, and forthis reason they were at first given preferential consideration in thedistribution of equipment. This procedure made it possible to treat satisfactorilyall classes of cases who could not have been so well cared for had equipmentbeen scattered. Later, as resources developed, other hospitals were equippedto greater or less degree, especially in their laboratories, operating,and X-ray departments.

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This distribution of equipment had a corresponding influence on distributionof patients. Thus, grave surgical cases were concentrated at first in BaseHospitalsNos. 25, 26, and 49; psychiatric in Base Hospital No. 25; neuropsychiatricin Base Hospital No. 49; infectious diseases (other than influenza andpneumonia), complicated venereal and dermatological diseases in Base HospitalNo. 56; ophthalmic in Base Hospital No. 26; otolaryngological in Base HospitalNo. 49; influenza and pneumonia in Base Hospitals Nos. 25, 26, 49, and70; complicated dental cases in Base Hospital No. 26, etc. Since many casesadmitted were suffering from two or more conditions a sorting of them waseffected in such a manner as to give the graver condition preferential consideration. The most serious cases of this class were the severely woundedwho had contracted pneumonia. The provisional hospitals cared for patientsnot ready for transfer to the convalescent camp.

FIG. 96.-Sterilizationroom, Allerey hospital center

All hospital units of the center had their medical and surgical casesin wards devoted as far as might be to the treatment of one class of patientsonly. Thus wards were established for patients with infected wounds, fractures,and dislocations, clean surgical cases, surgery of the head, face, nose,throat, dental cases, gassed cases, cases of pneumonia, influenza, etc.Each hospital established a cubicled observation ward, to which was transferredeach suspected case of contagious disease, until diagnosis was established,when it was properly assigned. A nurses' ward for the service of the entirecenter was established in Base

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Hospital No. 49. The infectious cases grouped in Base Hospital No. 56were segregated, as far as possible, though because of the great overcrowdingof the center and limited personnel and equipment, it was not possibleto provide a separate ward for each type of disease. At the period of greatestovercrowding in the center, wards built for 50 patients were sheltering70; however, the wards for infectious cases were made to house but 48 inmateseach.

Consequent upon this segregation of cases was the local developmentof several departments in certain hospitals; e. g., an occupational workshop for psychoneurotic cases in Base Hospital No. 25, orthopedic shopsin Base Hospitals Nos. 25, 26, and 49, and the especial equipment of hospitalswhich were carrying on special activities. A central orthopedic workshopwas never established. The plan had manifest advantages, but at Allereyshops were operated in several hospitals in order that orthopedic appliancesmight be made under the immediate supervision of the respective surgeons,who could illy afford the time necessary to go to a central workshop forthis purpose.

FIG. 97.-A surgicalward, Allerey hospital center

Except that certain departments were more developed in some hospitalsthan in others and that personnel was depleted for various reasons, theorganization of each hospital conformed to the general plan formulatedby the War Department for these institutions. The detail of from 1 to 6surgical teams from each unit, except Base Hospital No. 97, took from thecenter, from time to time, much of its best operating personnel for froma few days to several months. These teams usually consisted of 2 medicalofficers, 3 nurses, and 2 enlisted men.

The total number of cases admitted was 33,658, distributed as follows:Base Hospital No. 26, 5,512; Base Hospital No. 25, 5,860; Base HospitalNo.

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49, 4,626; Base Hospital No. 56, 7,338; Base Hospital No. 70, 5,371;Evacuation Hospital No. 19, 4,951. Base Hospital No. 97 received convalescentsfrom other units.

The following summary of medical cases treated in Base Hospital No.25 prior to January 1, 1919, indicates the general scope of the medicalactivities of the center:

FIG. 98.-A psychiatricward, Allerey hospital center

Similarly, the range of surgical activities is indicated by the followinglist of operations in Base Hospital No. 49:

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The greatest number of surgical operations was performed in Base HospitalNo. 26, where, 1,021 operations were performed in the operating room.

In the treatment of surgical cases, certain hospitals of the centerrequired, in order, the débridement of wounds if this had not alreadybeen done, the culturing of all deep wounds, preparation of smears fromall wounds, treatment of all wounds by Dakinization, and secondary closureafter three clean smears had been obtained, the last of which had precededoperation 24 hours.

In the center otolaryngological clinic, the following cases were treatedand operations were performed from the date of organization (August 20,1918) to January 8, 1919:

FIG. 99.-Eyeand ear clinic in one of the hospitals, Allerey hospital center

Deaths in the center totaled 429, including several deaths by accident,such as drowning or railway accident, giving a mortality of 1.27 per cent.Seventy-

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four and two-tenths per cent of the deaths were from disease, 24.8 percent from surgical causes, but an exact differentiation is difficult forthe reason that though 40 per cent of the deaths among wounded were returnedas due to intercurrent disease, chiefly pneumonia, in certain of thesecases the impaired vitality caused by the wound was a contributing factor.The highest death rate was during October, when 245 deaths occurred, themajority being due to respiratory diseases. It was during this month thatinfluenza and pneumonia were at their height. Pneumonia was present in61.2 per cent of the 356 cases which came to autopsy, bronchopneumoniaconstituting three-fourths of such cases.

LABORATORY SERVICE

In addition to the unit laboratories, provided for the several hospitals,a more fully equipped laboratory was operated for the entire command underthe center laboratory officer. The distribution of duties between the unitand center laboratories was prescribed by the director of laboratoriesand infectious diseases, A. E. F. In general terms, the duties of the unitlaboratories included routine urine analyses, blood counts, examinationsofsputa and stools, media making, wound bacteriology, preparation of Dakin'ssolution, and grouping of blood for transfusions. For November, 1918, whenthe center was at its maximum, the following figures were reported fromfive of the hospitals in the center:

Total examinations, 9,059

For the period prior to January 1, 1919, the following are the figuresfor the more important laboratory examinations made at Base Hospital No.49:

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The following statistical list shows some of the more important workperformed by the center laboratory up to January 1, 1919:

FIG.100.-Center medical laboratory, Allerey hospital center

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In addition to the foregoing, much miscellaneous work was performedin the center laboratory, such as daily examinations of raw water and treatedwater from each unit, examination of clothing harboring nits to determineefficiency of disinfesting apparatus, supply of cultures of hay bacillusto test sterilizing apparatus, isolation of milk-curdling organisms, bacteriologicalexamination of doubtful canned foods, examination of chemicals from thelocal supply depot and of gonorrheal smears from the convalescent camp,and disinfection of mail and personal effects of inmates of the contagiouswards.

CONVALESCENT CAMP

The convalescent camp at Allerey was organized June 26, 1918, the firstgroup of convalescents, 11 officers and 116 enlisted men, arriving on July31. The camp at first occupied one of the hospital sections, for it wasnot until September 19 that its tents were ready for occupancy. Meanwhile,its patients and duty personnel had been employed in completing constructionof that unit, grading and draining the recreation field (1,060 feet by700 feet), building roads and walks, pitching tents, etc. Electric wiringwas completed by the end of October, and a Red Cross recreation hut, measuring50 by 252 feet, was ready for use December 11. This hut, which had an importantinfluence on the welfare of the camp and of the center at large, includedan auditorium seating 1,500 persons, a stage, quarters for Red Cross personnelon duty in it, canteen space, writing and billiard tables, piano, etc.About half the hut was given over to basket ball, croquet, and a boxingring.

Convalescents were organized into a regiment, subdivided into battalionsof 1,000 men each, and these, in turn, into companies of 250 and platoonsof 50. The staff consisted of the commanding officer (who also acted asinspector), a receiving and evacuating officer, an adjutant, a field adjutant,a supply officer, mess officer, physical director, six medical officerswho sat on disability boards and cared for medical and surgical cases,respectively, and a sanitary inspector.

The adjutant's duties were of a dual character, one pertaining to militarysupervision, the other to medical records. In the former he was assistedby a regimental sergeant major, 1 duty sergeant, and 1 clerk; in the latterby 1 sergeant, first class, Medical Department, and 10 clerks, including4 stenographers. This number was increased to 21 clerks when the camp reachedits maximum strength, of approximately 6,000.

The regimental sergeant major prepared the camp morning report, senta list of absentees to the assistant provost marshal, organized detailsfor special duties, furnished lists of men on detached service, and tookcharge of many minor administrative details that arose, including supervisionof the post office established in the camp and the card index of convalescents.The office of the sergeant, Medical Department, checked the field medicalcards against the nominal roll received with each convoy, placed thesein the dead file when men were to be evacuated, and forwarded them monthlyto the chief surgeon, A. E. F., prepared diagnosis cards for all men admitted,listed B and C class cases for the camp disability board, prepared theroll of casualties and changes, and

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listed outgoing men. At the time each platoon was examined, the platoonsergeant made one list of men placed in class A for his own use and onefor the office so that the sergeant, Medical Department, knew, when anevacuation was ordered, which men were to be transferred. As travel orderswere prepared in advance, this measure made it possible for an evacuationof 1,500 men to be effected within two hours after notice was receivedthat transportation was available.

The field adjutant met and inspected incoming drafts, gave them a shorttalk on discipline, and, in the absence of the camp commander, inspectedoutgoing men and their equipment, marched them to the railroad station,superintended entraining and rationing for the journey. He was, furthermore,fire marshal and summary court officer of the camp and acted on passesfor patients and duty personnel.

The supply officer was charged with reception and disposition of bothmedical and quartermaster property. He was assisted by 12 enlisted menwho performed the following duties: General supervision, 1 sergeant; subsistence,including office and field work pertaining thereto, 1 sergeant; transportationof all supplies to kitchens subsisting men under the camp's jurisdictionbut quartered outside of its main element, 1 sergeant; paper work pertainingto subsistence, 1 sergeant and 1 private; subsistence storeroom, 1 private;clothing, blankets, and other durable property, 1 sergeant and 2 privates;transportation of fuel, 1 sergeant; medical supplies, requisitions, andreturns, 1 private.

The mess officer was assisted by 1 mess sergeant, 14 cooks and assistantcooks, 5 butchers, and necessary details of 20 men for kitchen police,6 stokers, etc.

The physical director had charge of all calesthenic drills and exercises.These will be discussed below.

The sanitary inspector performed the duties indicated by his title,including supervision of water-heating appliances, bathrooms, bathing schedules,operation of delousing plants, and preparation and service of food, disposalof waste.

The convalescent officers rendered very valuable assistance in campadministration, and in the service of the center generally. Though patients,they took charge of details, conducted drills and inspections, organizedthe guard, and took command of troops en route to regulating stations.

Other departments in the organization of the camp were as follows: Payoffice, 1 sergeant and 2 clerks; provost, 1 sergeant, 3 enlisted men; sanitation,1 sergeant, 1 corporal and 3 privates for each incinerator, 1 corporaland 3 privates for each set of latrines; medical dispensary 1 noncomissionedofficer; druggist, 1 private; surgical dispensary, 1 noncommissioned officer,1 private; phyiscal training, 1 sergeant for each company; fire department,1 sergeant, 10 privates; prophylaxis, 2 corporals; baths, 1 corporal and2 privates for each bath and ablution barrack, 1 corporal and 2 privatefor each laundry barrack; battalion organization, 1 battalion sergeantmajor, 1 duty sergeant, 1 clerk, 1 corporal of the sick; company organization,1 first sergeant, 1 company duty sergeant, 1 orderly corporal, 1 clerk;platoon organization, 1 sergeant, 1 clerk.

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Incoming drafts were received by the regimental duty sergeant, who arrangedthe men in two lines, one on each side of the infirmary, for inspectionby medical officers. They were examined for vermin, scabies, venereal disease,and were classified as A, B, or C patients. After  examination, thosenot rejected were formed in columns of squads and were marched to headquarters.There their field records, clothing, slips, etc., were checked, the rollcalled by the sergeant major and checked with the field medical cards.They were inspected by the camp commanding officer, who noted if theirclothing and equipment were complete. Men rejected for any reason, suchas physical ailment, vermin, and lack of equipment were returned with theirfield medical cards and appropriate notation to the hospital whence theycame. Men passing medical and military inspection were then given a shorttalk on discipline, standing orders, and daily schedule, divided into detachmentsand assigned to platoons according to vacant bed reports. The platoon sergeantsthen listed names of men assigned to them, and gave the lists to the sergeantmajor, who checked them against the nominal rolls from base hospitals.The admission classification was given the platoon clerk.

The duties of the personnel were such as normally fall to men in comparablepositions with line troops, except that the noncommissioned officers performedalso some duties usually discharged by commissioned officers. The objectof this measure was to reduce the commissioned staff of the camp to a minimum.

The battalion sergeant major received incoming men and distributed themamong the companies. He saw that the men were properly quartered and fed,supervised sanitation and police, formed promptly all details called for,consolidated company morning reports, verified same, enforced orders fromhigher authority, and convoyed evacuation groups from his battalion tothe railroad station. The battalion duty sergeant verified service detailscalled for, checked battalion and company formations and all reports ofcompany first sergeants, turned over delinquents to the labor squad, reportedto the adjutant men returning from absence without leave, reported thebattalion at drill formations and took command of it during the absenceof the battalion sergeant major. The company first sergeants carried outorders from battalion headquarters, checked convalescents into and outof their companies, supervised all efforts to promote health and comfortof their men, furnished details promptly, verified company and platoonreports. The platoon sergeants informed the incoming men of the regulationsof the camp, which were few as possible, checked absentees at formations,taps, and reveille, organized details promptly, made out nominal rolls,and marched platoons to the medical hut for classification.

The repeated classification of patients was one of the most importantand probably the largest portion of the routine medical work in the camp.It was essential that the machinery for doing this be simple, adequate,and accurate. Therefore, men were examined, by platoons, at semiweeklyintervals, and as their condition improved were advanced to a higher category.Those in class A constituted the standing evacuation list. A man remainingfor from two to four weeks in class C was usually examined by the disability

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board and assigned to suitable service for a limited period in the Servicesof Supply, after which he was reexamined.

The average stay in camp was from two to six weeks. If the convalescentperiod was longer than six weeks, the patient was examined by the disabilityboard with a view to reclassification and appropriate transfer.

Accurate physical classification was essential to the success of thecamp; therefore, the physical and recreation trainers kept new arrivalsunder close surveillance to notice lagging during exercises, with a viewto reclassification if indicated. Men properly classified were soon infusedwith a spirit of enthusiasm and competition so that malingering was rarelyfound. Within one week all patients were carefully reexamined and reclassified.Men suffering from cardiac insufficiency, effort syndrome, joint diseases,war neuroses, effects of gassing, or were convalescent from infectiousdisease were assigned to special schedules. The medical staff includedspecialists for cardiac, pulmonary, and orthopedic conditions.

Second only to proper classification and prescription of appropriateexercises, the establishment of a cheerful and competitive spirit was lookedupon as the most important factor in furthering convalescence. The treatmentin general consisted of graded exercises, work that interested, and playthat diverted and cheered. To keep the convalescents as fully occupiedas possible, any measure that might promote among them good fellowshipand light-heartedness was eagerly sought and practiced. Games productiveof enthusiasm and merriment in which all participated were especially successful.As a measure of the success obtained, 95 per cent of the patients advancedregularly, upon the weekly physical examinations.

Because of the fact that many men in hospital tended to lose interestin military precision, personal responsibility and enthusiasm in theiractivities, the physical exercises for convalescents were diversified tomeet these several needs. Commands were given from a drill stand, and asthe troops were under the surveillance of their sergeant instructors, therewas no difficulty in identifying delinquents. Parades and military formationsbefore and after exercises helped appreciably. Garrison schedule was conductedwith evening parade, which was attended by the band.

The routine of the camp was as follows: Reveille, 6.45; breakfast, 7.10;sick call, 7.30. At 8 a. m., the morning reports were received by the regimentalsergeant major from battalion sergeant majors. From these reports the regimentalreport was made, the list of absentees being sent to assistant provostmarshal. Service detachments were organized and distributed as requested.From 8 to 8.45 a. m., calisthenics; 9 to 9.15, running and walking; 9.25to 9.40, athletic games. At 10 a. m., the guard was mounted; from 10 to10.30, jumping exercises were held for other troops; 10.30, recall; 12,dinner; 1 p. m., first sergeant's call; 1.30 p. m. reception, inspection,and disposition of incoming convalescents; 2 p. m. athletics, 2.30 p. m.,parade, inspection, and entraining of outgoing convalescents; 3.30 p. m.,recall from calisthenics; 4.10 p. m., parade; 5, supper; 10.30 p. m., taps.

In order that the military purport of the training might not be slighted,the men were brought into platoon formation before and after each period.Sunday was a holiday.

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It will be noted that calisthenics, games, etc., were conducted simultaneouslywith military formations which affected only certain details. Class C patientshad a routine somewhat different from the foregoing schedule, which wasfor class A and class B men. Their schedule of exercises was as follows:From 8 to 8.45 a. m., exercises with A and B men; 9 to 9.15 a. m., shortrelay races, passing ball to rear of column, etc.; 9.30 to 9.40 a. m.,falling exercises for the arms; 10 to 10.30, jumping contest with A andB men; 10.30 recall; 2 to 2.20, indoor base ball, or relay race; 2.45 to3, passing the ball; 3.30, recall. Gassed cases received a special setof exercises.

Complementary to the schedule of exercise and drills was the systemof employments. There was grave and urgent need that construction of thecenter be pushed as rapidly as possible, and for this purpose convalescentswere detailed to the constructing engineer for service wherever needed.They proved indispensable, for the camp was a reservoir of highly skilledworkmen, mechanics, clerks, chauffeurs, etc., as well as of unskilled labor.A labor bureau was maintained in the sergeant major's office. As occasionrequired, he called on company sergeants for lists of men for designatedduties, listed them and assigned them for temporary duty, rations, andquarters to the unit making the request. After a variable period, determinedby circumstances, these men were recalled and others detailed. In the samemanner, carpentering, plumbing, and ditching details were kept up in thecamp at all times.

The only patients receiving continued medical attention who were treatedin the camp were the uncomplicated cases of venereal disease. Originallyall such cases had been cared for in Base Hospital No. 56, but when thisbecame overcrowded, the uncomplicated cases were transferred to the camp.The clinic there was found to function so satisfactory and disciplinarycontrol was so effective that this clinic was continued until the campclosed.

As the reports were received daily from the medical examiners, listsof patients fit for evacuation were prepared and the men named thereinwere paraded for the inspection of the commanding officer. He inspectedall equipment, assured himself that each man was fit for transfer, andordered all who did not feel fit for duty to fall out. Such men were immediatelyreexamined by the disability board. The remainder, under the officer incharge of the movement, were marched to the railroad station with the bandand field music. At the station, the command was divided into platoonsof 40 men, with a noncommissioned officer in charge of each, and entrained.One noncommissioned and six men from each car loaded its rations. The travelorder was checked by the sergeant major with the officer detailed to accompanythe detachment to its destination.

Until October 14, 1918, the organization of two battalions of 1,000men each was adequate, but thereafter the camp grew constantly until byDecember 9 it contained 6,004 men. This eventuated from the fact that evacuationsfrom the center were stopped by higher authority and orders were receivedfrom the same source that men fit for duty be not carried as patients.To simplify administration and to reduce congestion, certain hospitalstransferred men fit for duty to others and these operated under the jurisdictionof the convalescent camp. The largest incoming groups to the camp wereon Novem-

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ber 19, when 1,763 men were received. The largest outgoing group was1,918 men on November 17.

Theatrical troups, glee clubs, and orchestras were organized in thecamp. Motion pictures of the center were taken and exhibited. A band of35 pieces and a fife and drum corps of 15 pieces organized in the campparticipated in military formations, assisted at theatrical performances,gave band concerts, etc. For a few weeks the band of the 155th Infantrywas attached to the camp.

Provision was made from the outset for diversion of the men when theday's schedule was completed. In addition to the many entertainments procuredfrom outside sources for the camp, a number were provided from local resources.The convalescent camp was closed January 31, 1919.

CLOSURE

As patients in the center diminished after January 1, when the ban ontheir transfer was lifted, hospitals were cleared and closed. EvacuationHospital No. 19 was transferred to the army of occupation on the Rhine,and most of the personnel of Base Hospital No. 97 was retained to formCamp Hospital No. 108. With these exceptions all units were returned tothe United States upon closure. On March 1 the center became the agriculturaldepartment of the American Expeditionary Forces University, whose headquarterswere established at Beaune. On May 28, when the university ceased its activitiesat Allerey, this place was closed and turned over to the French.

COMMANDING OFFICER

Col. Joseph H. Ford, M. C.

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