History

CHAPTER XXIII

OTHER HOSPITAL CENTERS

HOSPITAL CENTER, BAZOILLES^a

The hospital center at Bazoilles-sur-Meuse was located about 4 miles southwest of Neufchateau (Vosges) and was built around the small village of Bazoilles-sur-Meuse. The center was located on both sides of the River Meuse.

The site was well suited for a hospital. The moderate slope of the groundafforded excellent natural drainage and the Est Railroad ran through the village.

A group of six hospital sections, each accommodating 1,000 patients,was authorized, each section to have sufficient ground space for a tent expansion accommodating 1,000 beds. The capacityof the entire group was to be about 13,000 beds. This included one hospital unit (Base Hospital No. 18), whichoccupied buildings that had been erected around a château in Bazoilles and operated individually before the centerwas organized. Another unit, Base Hospital No. 66, at Neufchateau, about 4 miles from Bazoilles, was added later to the center.The Engineer Corps began construction toward the last of October, 1917, but progress was very slow. Macadamizedroads were built, and the French railway authorities put in siding to accommodate hospital and freight trains. An unloadingquay was provided for patients.

The commanding officer of the center arrived June 30, at which timethe construction was far from complete. Sections 1, 5, and 6 were most advanced, but in them windows and plumbing fixtureswere wanting. A warehouse was nearing completion and work on a steam laundry was just beginning, but thisplant did not begin operating until October 10, 1918.

The project was reported completed, with the exception of minor changes,on November 1, 1918. Its cost was approximately $2,027,266.

ADMINISTRATION

On July 2, 1918, when the center was officially organized, three base hospitals were present. The chief surgeon, A. E. F., furnished the following outline of the organization of the center, for which personnel would be furnished.

^aThe statements of fact appearing herein are based on the "History of the Bazoilles hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical
Division, S. G. O.-Ed.

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F IG. 101.-View of Bazoilles hospital center

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AMERICAN EXPEDITIONARYFORCES,
OFFICE OF THE CHIEFSURGEON.

Memorandum to commanding officer, Bazoilles:

Table of organizations-central administration

	Officers	Enlisted men
Number of base hospital units, 7.
Commanding officer and assistants (colonel or lieutenant colonel)	1	3
Adjutant and assistants (major or captain)	1	5
Medical supply officer (captain)	1	2
Laboratory officer (major or captain)	1	---
Evacuation officer (major or captain)	1	1
Sanitary squads (captain or lieutenant)	2	52
Evacuation ambulance company (captain or lieutenant)	2	90
Subsistence, procurement, and issue; cold storage; clothing, equipment, procurement and issue; fuel, procurement and issue; salvage (captain or lieutenant, Quartermaster Corps)	2	^a26
Detachment and records; finance, paying, accounting, railway transportation (captain or lieutenant, Quartermaster Corps)	2	^a28
Technical labor troops to care for buildings, electric light plants, water system, drains (captain or lieutenant, Quartermaster Corps)	2	^a23
Labor troops performing purely common labor (30 to each base hospital unit)	---	^a210
Motor truck company	2	84
Assistant provost marshal (lieutenant)	1	10
Railway transportation officer (lieutenant)	2	6
Fire marshal (lieutenant)	1	2
Total	21	542

^aQuartermaster.

* * * * * * *

QUARTERS ALLOWANCE ?
Administration, barracks	1¹/3
Officers' mess, barracks	1
Officers' quarters, barracks	1¹/3
Men's mess	2
Men's quarters	1½
Total	7¹/6

Some of this staff personnel was sent from other stations, and somewas taken from base hospital units of the center. The ambulance and truck companies did not arrive until after the armistice.No attempt was made at first to interrupt the customary administration routine of the hospitals, but as the centerheadquarters organization improved it was required that practically all reports, with the exception of the monthly sick andwounded report, be sent through the center commander.

The function of the headquarters was in general the same as in any otherlarge military command. The center commander was able to keep in close touch with the activities within his commandthrough various reports and returns, and by inspections, either personal or by members of his staff. Conferenceswith the unit commanders and among personnel employed on special work were of much value.

Various orders, bulletins, and circulars received from higher headquarterswere distributed and the most important of these abstracted, or had attention called to them in special memoranda. Theusual difficulties in getting officers among the personnel to read and study instructions were met with in a degreecorresponding to the experience of the personnel, and an effort was made to overcome this by means of informatory memorandaand by requiring attendance upon formal instruction, devoting to it a certain number of hours each week for both officersand enlisted men.

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The following data summarize the activities of the organizations formingthe center:

Designation	Arrived	Began operation	Ceased operation	Departed
Base Hospital No. 18	July 26, 1917	July 31, 1917	Jan. 9, 1919	Jan. 18, 1919
Base Hospital No. 42	July 15, 1918	Aug. 6, 1918	Jan. 7, 1919	Jan. 29, 1919
Base Hospital No. 46	July 2, 1918	July 23, 1918	Jan. 1, 1919	Mar. 19, 1919
Base Hospital No. 60	Sept. 15, 1918	Oct. 4, 1918	Mar. 31, 1919
Base Hospital No. 66^a	Jan. 13, 1918	Jan. 15, 1919	(^b)
Base Hospital No. 79	Oct. 16, 1918	Nov. 5, 1918	(^c)
Base Hospital No. 81	Sept. 25, 1918	Oct. 4, 1918	Mar. 31, 1919
Base Hospital No. 116	Apr. 9, 1918	June 2, 1918	Jan. 31, 1919	Mar. 19, 1919
Evacuation Hospital No. 21	Jan. 4, 1919	Jan. 7, 1919	Apr. 22, 1919
Provisional Base Hospital No. 1	.do. (org.)	Jan. 9, 1919	Apr. 27, 1919
Convalescent Camp No. 2	June 10, 1918	July 13, 1918	Jan. 25, 1919	Mar. 7, 1919
Sanitary squad No. 29	July 13, 1918	---	---	Mar. 12, 1919
Sanitary squad No. 30	.do.	---	---	Do.
School of Roentgenology	Sept. 1, 1918	---	---	Dec. 4, 1918
Evacuation Ambulance Company No. 10	Dec. 29, 1918	---	---
Hospital unit A	Feb. 1, 1918	(^d)	---	Jan. 18, 1919

^aThis unit, located at Neufchateau, was assigned to this center and first included in its bed report on Aug. 15, 1918.
^bCeased to be part of center Nov. 10, 1918.
^cStill operating Apr. 30, 1919.
^dAttached to Base Hospital No. 18 (enlisted personnel only) on Feb. 4, 1918.

ENGINEER OPERATIONS

	Date of arrival
Companies B and C, 101^st Engineers	Oct. 23, 1917
Companies C and F, 6^th Engineers	Feb. 5, 1918
Company C, 502d Engineers Service Battalion	Feb. 8, 1918
Companies A and D, 508^th Engineers Service Battalion	Feb. 11, 1918

At various intervals during construction, detachmentsof 23d, 26th, 28th, 33d, and 37th Engineers, 162d Labor Company (Portuguese),and Chinese Labor Company No. 26 were attached to 508th Engineers ServiceBattalion.

All engineer organizations withdrew from the center November1, 1918.

MILITARY POLICE

Company L, 2d Pioneer Infantry, arrived July 27, 1918.On December 13, 1918, the detachment of 210th Company Military Police Corps was organized by transfers fromCompany L, 2d Pioneer Infantry.

LAUNDRY COMPANIES

Designation	Arrived	Departed
313^th Mobile Laundry Company	Oct. 8, 1918	Feb. 27, 1919
505^th Laundry Company	May 12, 1918
517^th Laundry Company	Sept. 13, 1918
519^th Laundry Company	Mar. 1, 1919
Provisional Laundry Company 1, Company B	.do.
162d Administrative Labor Battalion	Mar., 1918	Oct. 7, 1918
185^th Administrative Labor Battalion (organized Sept. 13, 1918)

CASUAL ORGANIZATIONS

Designation	Arrived	Departed
Evacuation Hospital No. 2	(^a)	(^a)
Evacuation Hospital No. 6	(^a)	July 18, 1918
Evacuation Hospital No. 16	Sept. 23, 1918	Oct. 12, 1918
Evacuation Hospital No. 20	.do.	Oct. 2, 1918
Convalescent Camp No. 1	(^a)	Aug. 25, 1918
Mobile Operating Unit No. 1	July 18, 1918	Sept. 4, 1918
Evacuation Ambulance Company No. 64	Dec. 5, 1918	Dec. 15, 1918
115^th Sanitary Train	Dec. 14, 1918	Dec. 29, 1918
Motor Supply Train No. 46	Oct. 23, 1918	Nov. 4, 1918
156^th Infantry Band	Nov. 19, 1918	Dec. 5, 1918

^aBefore organization of cente

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In July and August, 1918, the quantity of water was insufficient. Atone time it seemed as though the operation of the center would be seriously hampered on this account. Several wells were drilledand dug near the river and pumped to a collecting reservoir at the main pumping plant, where the water was chlorinatedand pumped into the system through 3-inch turbine pumps. Water was drawn also from an old French system in Bazoilles,a booster pump being located at the spring about 3½ miles south of the center.

The sewer system carried only the drainage from sinks and bathhouses,as the pail and soakage pit system was used for all latrines. Two Horsfall destructors were installed in each hospitalunit. One sink was installed in each ward and in other buildings as required.A part of the kitchen waste was burned; some was disposed of to civilians.When sold, usually little or nothing could be received for it, and sometimesit was necessary to pay for its removal.

F IG. 102.-Coveredwalk connecting the wards at Base Hospital No. 18, Bazoilles hospital center

Electrical power for lighting and X-ray machines was supplied by 19generating units; eighteen 17-kilowatt and one 14-kilowatt machines being used. Each of the seven hospital units hada separate power plant and could be supplied independently with electric power from its own machines. Some troublewas experienced by the hospitals in adapting the large 7½-kilowatt X-ray machines to the 110-volt direct currentfurnished, as their rotary converter had been built for 220-volt direct current.

Disinfection of clothing and bedding was accomplished by means of largeThresh or American steam sterilizers. The Thresh apparatus was

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stationary and required a good deal of labor and material. Six of thesewere received, one for each hospital section. Four were installed and work on others was stopped when hostilities ceased.The American sterilizers were portable and four hospitals used this type during the period of their activity. Thismodel was considered the better of the two.

The supply service of this department was uniformly satisfactory, forrarely was there any shortage or inability to furnish articles. No bakery was operated, and bread was obtained from the QuartermasterCorps at Neufchateau. A small cold-storage plant was built, but was not operated, as weather wasnever sufficiently warm to require the use of a cold room. A small amount of ice was made, but the hospitals showed no inclinationto make use of it.

From six to nine men were constantly employed as clerks, checkers, andpackers. In addition, 10 men on an average were used in handling property; unloading it from cars and delivering itto hospital units. The amount of property received during the 10 months beginning July 1, 1918, aggregated 310 carloads. Supplieswere received from supply depots at Is-sur-Tille, Gievres, Cosne, and the base ports. The American Red Cross also supplied10 carloads of prepared dressings and mess and kitchen equipment. All supplies were formally transferred to supplyofficers of separate units on invoices. It was believed, however, that the issue of supplies on memorandum receiptwould have been better, thus leaving the center supply officer accountable for all property in the center. This arrangementwould have put one experienced man in charge rather than several who usually were very inexperienced.

On July 1, 1918, the available transportation was such as had been furnishedto hospital units then operating, namely, 9 ambulances and 9 trucks, and other motor cars. The greater part wasold and in poor condition, but no material additions were made until after signing of the armistice. Trucks were used fortransportation of patients throughout the whole period prior to November 11, 1918.

In the latter months additional transportation was received, and onApril 1, 1919, there were on hand: 11 motor cycles, 8 touring cars, 5 Ford ambulances, 15 G. M. C. ambulances, 6 Ford lighttrucks, 12 one and one-half and two ton trucks, and 30 three-ton trucks.

The pooling of all transportation was highly successful, for by so doing,the work of seven or eight hospital units was done with the normal allowance of two or three.

As all of the buildings of the center were of light wood constructionand the intervals between hospitals were taken up with tentage, the fire hazard was very great. A center fire marshal wasappointed, and working under his supervision each hospital unit had its local fire marshal in charge of a fire platoon.The loss from fire was insignificant. During the winter some hundreds of stoves were installed, usually in a very crude way. Manytimes fires started, but were extinguished almost at once.

A school was established and began operating January 4, 1919. Qualifiedenlisted men were detailed as instructors. Organization commanders were

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required to have attend such men as were most in need of instruction,including those deficient in primary branches. By April the number of students reached a total of 167, and classes were heldin reading, spelling, and writing, French, French history, United States history, civics, economics, mechanical drawing,and agriculture.

LABORATORY

At first the center laboratory was located in Base Hospital No. 18.Later a building was provided, and on September 2, 1918, the equipment was transferred to the new location. As the severalunits arrived in the hospital center the laboratory personnel of each unit came under the control of the laboratory officerof the center, who was empowered to detail them to the central laboratory as needed. The work of the laboratory was organizedas noted below, but elasticity in the scheme was allowed in order that the personnel could assist in any departmentwhose work might suddenly increase. There were eight general divisions, with one of the laboratory staff in chargeof each, as follows:

1. General bacteriology-blood cultures, throat cultures,spinal fluid examination, and general bacteriologist work.
2. Typhoid-dysentery examination and water analysis.
3. Wound bacteriology.
4. Pneumococcus typing.
5. Serology.
6. Pathology. This department handled the surgical specimenssubmitted for diagnosis and performed all the post-mortem examinationsinto the hospital center.
7. Preparation room. This department made all stainsand solutions used by the sterilization of discarded cultures and glassware.
8. Office and supplies.

No chemical work was done in the central laboratory. All clinical pathologywas done in the subsidiary laboratories and the center laboratories assisted in an advisory capacity. No operativeprocedures were done by the staff of the center laboratory.

OPTICAL AND OPHTHALMOLOGICAL DEPARTMENT

This service for the center was maintained at Base Hospital No. 18 untilNovember, 1918, when it was transferred to Base Hospital No. 46. In May, 1918, an optical unit was added to this department.The personnel usually consisted of 5 officers and 6 enlisted men. This department served not only the center, butalso a large part of the entire advance area, including other base hospitals in the vicinity and the army of occupation inGermany.

SCHOOL OF RÖENTGENOLOGY

A school of Roentgenology was established in August, 1918, its purposebeing the provision, at a convenient point near the
American front-line sector, of a school for the instruction of officersand enlisted men in various matters pertaining to X-ray
work under war conditions and to maintain a depot from which skilledoperators could be taken for service when needed.
From September 1 to November 11, 1918, the school was in constant operation.Both officers and enlisted men were
received and after a period of training sent to the front.

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RECEIVING AND EVACUATION

The receiving and evacuating system was organized in July, 1918. Theevacuating officer maintained control over all admissions, distribution, transfer, classification, and evacuationof all patients. During the earlier months of our military operations, unremitting efforts were made to evacuate to hospitalsfarther toward the rear; later, when the fighting progressed more nearly in the immediate front of this hospital center,all the hospitals were in reality functioning as evacuation hospitals. Frequently patients were received, operated upon,and transferred to the rear within 48 hours. During the Meuse-Argonne operation approximately 7,000 sick and wounded werereceived and about 12,000 evacuated. At this time, many of the wounded were received in bad shape. Conditions inthe advanced area were such that many battle casualties did not reach the center for four or five days after receivingtheir wounds. A fair proportion had not been operated upon, and severe infections were present. The following chartsshow the admissions and dispositions in the center.

Admissions and dispositions, by hospitals, August 1,1917, to April 30, 1919; hospital center, Bazoilles-sur-Meuse, France,including hospitals operating independently prior to July 1, 1918

Hospitals	Base Hospital No. 18	Base Hospital No. 116	Base Hospital No. 46	Base Hospital No. 42	Base Hospital No. 66	Base Hospital No. 60	Base Hospital No. 81	Provisional Base Hospital No. 1	Evacuation Hospital No. 21	Base Hospital No. 79	Total
Period, Aug. 1, 1917, to June 30, 1918:
Admissions	7,066	855	---	---	---	---	---	---	---	---	7,921
Disposed of	6,411	262	---	---	---	---	---	---		---	6,673
Remaining June 30, 1918	655	593	---	---	---	---	---	---	---	---	1,248
Period, July 1, 1918 to Apr. 30, 1919:
Remaining July 1, 1918	665	593	---	---	(^a)	---	---	---	---	---	1,248
Remaining at Base Hospital No. 66, Aug. 11, 1918	---	---	---	---	^b562	---	---	---	---	---	562
Admitted	7,106	11,526	8,323	7,111	6,913	5,988	5,991	2,413	3,391	4,993	63,755
Total	7,761	12,119	8,323	7,111	7,475	5,988	5,991	2,413	3,391	4,993	65,565
Disposed of	7,424	11,328	7,915	6,443	6,624	5,723	5,781	2,261	3,240	4,781	61,520
Transferred	^c337	^d791	^e408	^f668	^g851	^h265	ⁱ210	^j152	^k151	---	3,833
Remaining Apr. 30, 1919	0	0	0	0	0	0	0	0	0	^l212	212

^aBase Hospital No. 66 was operating independently of the center until Aug. 11, 1918.
^bNumber of patients in Base Hospital No. 66 when the organization came under the command of the center.
^cTransferred to Provisional Base Hospital No. 1 when Base Hospital No. 18 discontinued operations on Jan. 5, 1919.
^dTransferred to Base Hospital No. 79 when Base Hospital No. 116 discontinued operations on Jan. 31, 1919.
^eTransferred to various hospitals of center when Base Hospital No. 46 discontinued operations on Jan. 19, 1919.
^fTransferred to Evacuation Hospital No. 21 when Base Hospital No. 42 discontinued operations on Jan. 7, 1919.
^gNumber of patients in Base Hospital No. 66 when the organization was taken from the command of the center.
^hTransferred to Evacuation Hospital No. 21 (165), Provisional Base Hospital No. 1 (100), when Base Hospital No. 60 discontinued operations on Mar. 31, 1919.
ⁱTransferred to Base Hospital No. 79 (145), Provisional Base Hospital No. 1 (65), when Base Hospital No. 81 discontinued operations on Mar. 31, 1919.
^jTransferred to Base Hospital No. 79 when Provisional Base Hospital No. 1 discontinued operations on Apr. 27, 1919.
^kTransferred to Base Hospital No. 79 when Evacuation Hospital No. 21 discontinued operations on Apr. 22, 1919.
^lRemaining in Base Hospital No. 79, the only unit operating Apr. 30, 1919.

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Summary of sick and injured admitted to hospital center, Bazoilles-sur-Meuse, France, July 1, 1918, to April 30, 1919

Cases of sickness	Total					Pneumonia	Dysentery	Malaria	Venereal	Paratyphoid	Typhoid	Measles	Cerebrospinal meningitis	Scarlet fever	All other diseases
Cases of sickness	Hospital	Quarters	Total	Disease	Injury	Pneumonia	Dysentery	Malaria	Venereal	Paratyphoid	Typhoid	Measles	Cerebrospinal meningitis	Scarlet fever	All other diseases
Remaining^a	^a1,248	0	1,248	447	801	5	0	0	24	20	0	0	0	2	416
Admitted	62,521	0	62,521	36,718	25,803	1,450	85	18	1,481	45	280	111	80	72	33,096
Total treated	63,769	0	63,769	37,165	26,604	1,455	85	18	1,505	45	280	111	80	74	33,512
Died	850	0	850	564	286	414	2	0	1	2	28	1	28	2	86
Transferred to organization	15,908	0	15,908	11,254	4,654	324	42	5	576	10	43	33	6	24	10,191
Otherwise disposed of^b	46,799	0	46,799	25,135	21,664	705	41	12	828	33	209	67	43	48	23,149
Remaining sick^c	212	0	212	212	0	12	0	1	100	0	0	10	3	0	86

^aThe remaining 1,248 cases comprises total number of patients in Base Hospitals Nos. 18 and 116 on July 1, 1918, the date the hospital center was established
^bSent to other hospitals, replacement depots, regulating stations, etc.
^cIn Base Hospital No. 79, the only hospital operating April 30, 1919

Cases completed by hospitals operating independently priorto July 1, 1918: Base Hospital No. 18, 6,411; Base Hospital No. 116, 262;total, 6,673.
Cases evacuated by hospitals ceasing to operate to otherhospitals in the center are included in admissions and discharges. BaseHospital Nos. 46, 60, 79, and 81 were so evacuated.
Cases taken over from outgoing units by arriving unitsare not included in admissions and discharges. Base Hospitals Nos. 18,42, and 116 were relieved by incoming organizations.
Thirty-two deaths occurring in prisoners of war and alliedpatients at Base Hospital No. 66, shown in total of 850 above, not includedin table for admission and disposition.

AMERICAN RED CROSS

This was the only welfare organization authorized to operate in hospitalsafter August 31, 1918. Prior to January 1, 1919, the Y. M. C. A. conducted a canteen, religious services, and entertainments.

The buildings erected by the American Red Cross consisted of two verylarge and two smaller huts, operated by them for officers and nurses.

The representatives of the American Red Cross worked constantly in cooperationwith the center and unit commanders, their chief functions consisting in searching for missing men and distributingsupplies (Red Cross), writing letters for the patients, sending or procuring information from their homes, or anysimilar service which would relieve mental or physical trouble. Also they furnished athletic equipment, musical instruments,etc. In the huts were presented opportunity for refreshments, recreation, education, and entertainment. They containedbilliard rooms, auditoriums, writing rooms, and rest rooms. There were on the average 8 entertainments and 32 moving-pictureshows each week.

CONVALESCENT CAMP

The chief surgeon in a letter of June 21, 1918, ordered that a convalescentcamp be operated in connection with the center. The proportion of beds was fixed at one convalescent bed tofive of the base hospital capacity of the center, all crisis expansion accommodations being excluded. For this purpose, thenumber of active beds in buildings was assumed to be 7,000, thus fixing the bed capacity of the camp at 1,400. The sitefor the camp was selected at Liffol-le-Grand, a village 4 miles west of Bazoilles. This site had been used at one time as acamp hospital and contained a number of small structures and a 14-room château. The personnel of Convalescent Camp No.2, consisting of 10 officers and 90 enlisted men, arrived on June 10, 1918.

The preparation of buildings and grounds with provision of new barrackbuildings, water supply, and roads was begun at once. A satisfactory water supply was not obtained until November,1918.

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The medical organization of the camp was quite simple. On admissionafter the bath, the patient was weighed, stripped. He was outfitted with essential clothing and assigned to a bed in thebarracks. At once a physical examination was made, and he joined in the class work the following day. This class work consistedof physical exercise in the morning, followed by a short period of squad drill. After dinner and after an hour's completerelaxation in bed, he was sent on a mile march. On returning, he took part in various games according to his ability.After supper, varying amusements, held in the Y. M. C. A. hut, were available. At the discretion of the medical officer, he waspromoted to Company 2, with its increased physical demands, and then to Company 3, where the work consisted of 40-minutesetting-up exercises, an hour's squad drill, and a 5-mile march in the afternoon. By the time the patient had successfullypassed the physical examination in this company and could successfully perform the strenuous exercises, he was dischargedto duty. Men unable to meet these qualifications were reclassified. In the first 5,000 cases, there were less than 10classified D. But there were probably about 7 per cent who proved unable to meet the tests. It is worthy of comment that thesetests were of much greater value as a basis for classification than those heretofore employed; that is, the stethoscope,physician's opinion of patient's statement. Great emphasis was laid on the necessity for military discipline; and althoughon a patient's status, all convalescents were treated as soldiers training for the front line. Great difficulty was experiencedin the lack of standardization of the type of patients received. Thus, one convoy would comprise a case of pneumonia out ofbed one day, a mumps patient convalescent three weeks, a patient with flat-foot, gas cases of varying degrees of severity,and superficial gunshot wounds. An occasional valve lesion was discovered,a few cases of pulmonary tuberculosis were found, and not infrequentlypatients were sent directly from the admitting office to the camp hospitalsuffering from acute infections, such as bronchopneumonia, influenza, andtonsillitis. Another interesting feature is the fact that promotions weremade daily instead of at weekly intervals. This increased markedly the capacity of the camp, and cut down the stayin camp of those physically fit on admission to the remarkably short period of 72 hours. It was this factor that allowed2,431 admissions and 998 discharges in October, when the camp was in full working order.

A follow-up system was instituted, and the final proof of the successof the camp as measured by the ability of members of the outgoing drafts to perform front-line duty was supplied by themedical officers of units to which the patients were returned.

The constant support and assistance afforded by the American Red Crosscarried the camp far beyond the standards obtainable under purely military control. Games and other equipmentfor the amusement of the patients were all supplied through this organization. A regular representative of that societydid not arrive for some weeks after the camp was opened because of the lack of such officers, but thereafter it engaged innumerous activities for the promotion of morale.

The convalescent camp ceased to function on January 25, 1919.

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DISCONTINUANCE

The Bazoilles center ceased operation May 1, 1919, evacuating on thatdate all patients remaining in Base Hospital No. 79 to Angers and Nantes. The shipment of all medical property remainingin the center began at once. A large quantity of beds and bedding already had been shipped to Treves. Other property wasnow shipped to the hospital center at Mars-sur-Allier for storage.

This center was the first to start as an organized center, and after10 months of very active service was one of the last to close.

COMMANDING OFFICER

Col. Elmer A. Dean, M. C.

HOSPITAL CENTER, BEAU DESERT^b

In the late fall of 1917, Beau Desert, in the vicinity of Bordeaux,was selected as the site for a hospital center, and construction was begun in December of that year. The site, about 5miles west from Bordeaux and near the small village of Pichey, was a nearly level tract of land of approximately 550 acres.

Originally it was planned that there would be 10 base hospital unitsat this center, each of 1,000 beds, with an emergency expansion to 1,500, but during the summer of 1918 the constructionof 7 additional units was authorized.

A railroad track built by the American engineers, which connected withthe P. & O. Railway, ran through the center. The hospitals were located on either side of the track, thus affordingrapid detraining and entraining of patients. The storehouses and laundry were also situated on this line, so that freight couldeasily be removed from cars to the loading platform.

Construction was effected by the United States Army Engineers. A largeforce of men was employed for this work, and during the summer of 1918 more than 4,000 American soldiers, prisonersof war, Chinese, and other laborers were at work. On June 22, 1918, when the first base hospital group arrived,only one unit had been completed. Nine hospital units were eventually completed, in addition to the convalescent camp, steamlaundry, and warehouses, making a total of nearly 600 buildings. Twelve miles of gravel walk and 8 miles of board walkwere constructed and 4 miles of roads and over 11 miles of railroad track were built.

When the Medical Department took over the center there were availablea few old wells, mostly in a dirty condition. Only one of these was in use, furnishing about 50,000 gallons of water daily.This output was barely enough for drinking and a reasonable amount of washing, so that on many occasions the entirecenter was practically without water for 24 hours at a time and with none whatever for fire purposes. An artesian well, 1,500feet deep, was sunk, but could not be used for some time through lack of a powerful enough pump. Later this well, connectedwith a 100,000-gallon cement storage tank, afforded ample supply.

^bThe statements of fact appearing herein are based on the "History of The Beau Desert hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

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F IG. 103.-Airplaneview, Beau Desert hospital center

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Due to the very slight fall in the ground, laying sewers which wouldpromptly carry off the waste water and take care of the drainage proved difficult; however, all the hospital units had a sewersystem which emptied into a clarification tank, which in turn emptied into a small stream running through Pichey. The sewersystem received only wash and waste water.

Human excreta were disposed of by the pail system. These vessels wereemptied by contract with French laborers and buried 18 inches below the surface of the ground. At first an attemptwas made to burn feces in Horsfall incinerators, but there were so few of these and the method was so unsatisfactory andexpensive that the burial system was resorted to.

F IG. 104.-BeauDesert hospital center, showing railway facilities

Electric power was furnished by the French from Bordeaux. At first thesystem was very unsatisfactory, as the lights were frequently off and short circuits due to imperfect wiring were therule rather than the exception. Eventually the powerhouse at Bordeaux was taken over by the Government, and after January 1,1919, no trouble was experienced.

Early in August, 1918, a motor-transport officer was assigned to thecenter to organize the service. A motor-transport pool was established and the 312th Motor Truck Company was assigned to BeauDesert for duty. This service had grown from 1 ambulance and 4 trucks to 131 motor vehicles. All motor vehicleswere pooled, subject to call from any organization at any time under certain restrictions imposed by orders from center headquarters.
ORGANIZATION AND ADMINISTRATION

The center was officially organized on July 6, 1918, the staff thenconsisted of the commanding officer and adjutant, assisted by two clerks. Later, when a large force was available, the centeradministration was organized as follows:

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Diagram of central organization at Beau Desert

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Though only two base hospital units arrived prior to the armistice,the following hospital units eventually were located at this center: Base Hospitals Nos. 22, 114, 104, 106, 111, 121, EvacuationHospital No. 20, and the convalescent camp.

The sanitary inspector had general supervision of the sanitation ofthe entire center and was authorized to order the correction of suchdeficiencies as were in his judgment necessary.

A center chaplain was assigned in July, 1918. It was his duty to supervisethe work of all chaplains in the center; also, he was directly responsible for the record of all deaths in the center,for the care of the cemetery, and all funerals.

The office of center chief nurse was not created until March, 1919,when changes in the nursing personnel became very numerous. The incumbent met all the chief nurses of base hospitalsperiodically, observed the work of nurses in all the hospitals, and recommended transfers in the interests of the service.

Shortly after the establishment of the center an officer of the QuartermasterCorps was appointed center fire marshal. Fire companies were organized in the different units and frequent drillswere held. Great difficulty was experienced in obtaining fire-fighting apparatus and the extreme shortage of water in the summerof 1918 made fire hazard very serious. In its whole history the center had but one serious fire. This occurred on the nightof February 6, 1919, a ward in one of the units being destroyed.

The center laboratory officer was in charge of all the laboratory activities.The staff consisted of 5 officers and 8 enlisted men. The laboratory made all important examinations, including Wassermanntests and routine examinations of water.

The medical supply depot occupied a building, 150 by 60 feet, with anadequate unloading platform, situated on a spur track. Supplies were received from the supply depots at Cosne, Brest,and Bordeaux. Large quantities of supplies were also purchased in open market.

The center quartermaster office was organized July 22, 1918, when itwas divided into the following departments, each under charge of an officer or noncommissioned officer. Subsistence,finance, clothing and miscellaneous supplies, fuel procurement and issue, laundry, salvage and disposal of wastes, corraland stable, Quartermaster Corps detachment and labor troops. The bakery operated in the center for a short time butwas then transferred to Camp de Souge, about 7 miles distant. Hospital laundry was at first done by the quartermaster atBordeaux and by a French laundry, but in September, 1918, a large laundry was completed in the center. This center plantlaundered all hospital garments of base section No. 2, and in addition did the bulk of the salvage work for the section. Itoperated 19 hours a day, with a personnel of 20 officers, 26 enlisted men, and 165 female civilian employees. During March, 1919,the plant laundered approximately 1,300,000 pieces.

The duties of the receiving and evacuating officer were specificallylaid down in orders issued by the center. He was charged with meeting all hospital trains, the distribution of patientsto the various hospitals of the center, according to their classification or instructions from the commanding officer, as wellas the evacuation of all class A patients to the convalescent camps or to their organizations. The evacuation officerkept in touch with the railway

552

transport officer in Bordeaux as to the time of arrival of hospitaltrains, and boarded all the trains at Bordeaux. During the trip from Bordeaux to Beau Desert, which occupied from two to threehours, the receiving officer classified all patients. When each patient was classified, he was tagged with a large slip,showing the number of the hospital to which he was assigned. The majority of patients received in the center came on hospitaltrains; at times two or three trains arrived almost simultaneously. Ambulatory patients were always detrained first. Detrainingfor a full train occupied, on the average, one hour. These hospital trains were always furnished, when required, allthe supplies they needed.

The evacuating officer was also responsible for the efficiency of receivingofficers in the various hospitals and of the litter squads effecting reception and evacuation. He was the only officerauthorized to give any orders to the train crew relative to switching points, stop, splitting of train, etc. He also kept a chartshowing the rapidity of evacuation of each hospital. If it was found that a hospital was slowing up on its evacuation the reasonwas sought for by him and usually found to be due to failure of the ward surgeons promptly to report cases suitable forevacuation. Experience proved that the evacuation of class A patients from the hospitals averaged about 2 per cent of strengthdaily. Before the establishment of a convalescent camp, class A patients were evacuated direct from the hospitals toreplacement depots. Each hospital was furnished each month with a chart showing the standing of the hospitals with regardto evacuation, thus creating a spirit of competition among them.

Shortly after the armistice began, the Beau Desert center was changedinto an evacuation center. Base Hospitals Nos. 114 and 22, because of their experience, were designated as evacuatinghospitals and the remaining four as receiving hospitals. Later only Base Hospital No. 22 performed this evacuation duty. Inthis way all the responsibility of evacuation was placed on one unit, thereby eliminating all differences in method and standardswhich would have existed if all the hospitals had been charged with evacuation. All patients for evacuation were divided,according to the classification required, into companies of 150 or less, all papers were completed, and five copiesof passenger lists made for each company. All patients were examined physically, issued new uniforms, and paid infull. They were inspected when leaving the center and
again while boarding the transport at Bordeaux. The following tablesshow the number of patients received and their disposition.

Total number of admissions and disposition of patientsto April 1, 1919

Admitted by convoy	45,398
Admitted from command	1,840
Total	47,238
Transferred to United States	22,880
Returned to duty	12,699
Died	304
Total	35,883

Total number of hospital trains received, 84.

From April 1, to the date of closing of the hospital center, on June25, 1919, 3,681 patients were received, making the total
of cases handled over 51,000.

553

CONVALESCENT CAMP

This camp was organized late in July, 1918, and consisted of 25 woodenbuildings and about 200 double hospital-ward tents, giving a capacity of about 4,500 beds, with a possible expansionto 8,000. The largest number ever accommodated was 3,800. No personnel was at first provided, and the hospital furnishedthe personnel required. Later, personnel was secured from officers and men that were unfitted for combatant service.The patients were divided into companies and battalions and given regular graded drills, exercise, and sports.

WELFARE WORK, SCHOOLS, ENTERTAINMENT, AND ATHLETICS

The welfare societies comprised the American Red Cross, Young Men'sChristian Association, Knights of Columbus, and the Jewish Welfare Society. The American Red Cross, in addition toproviding entertainment, furnished large quantities of hospital supplies. The Young Men's Christian Association confined itsactivities to the convalescent camp, providing there athletic entertainments and educational and musical programs. The aidextended by the Knights of Columbus was occasional and was rendered from Bordeaux. The Jewish Welfare Societyconducted a clubhouse.

Post School was established on February 1, 1919, where at first onlyelementary courses for illiterates were given. Later, courses were given in higher mathematics, mechanical engineering, fineand applied arts, government, law, French, Spanish, shorthand, and typewriting.

COMMANDING OFFICER

Col. Harold W. Jones, M. C.

HOSPITAL CENTER, BEAUNE^c

This center was located close to the city of Beaune, Department Coted'Or. Its construction was authorized on December 12, 1917, but did not commence until March, 1918.

A double-track spur from the Paris, Lyon & Mediterranean Railwayran east and west the full length of the center, and the hospital units were placed on both sides of this track. Ten units wereplanned, but only seven were constructed when hostilities ceased. Hospital construction, varying with the materialavailable, was of brick, tile, concrete blocks, and poured concrete, with fabric cord roofs. One complete unit was of wooden Adrianbarracks, but it was occupied throughout by construction personnel and never used as a hospital. Warehouses, laundry,and bakery were of galvanized iron. All units were built on the type A plan, each successive one being somewhat modifiedin detail, chiefly in the direction of economy of labor and material, with a view of speeding up the work. Special constructionincluded the center laboratory building,
located in unit 2, and a special neuropsychiatric building, which wasused as an isolation ward for diphtheria and meningitis was located in unit 7.

^cThe statements of fact appearing herein are based on the "History of the Beaune hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

554

Water at first was hauled from Beaune in large wine barrels; and later,about the time when first patients arrived, water from Beaune was piped into the center. Meanwhile the engineers were makingefforts to develop an independent supply through driven wells, and were finally successful in locating an abundant artesianflow, from which about 500,000 gallons a day could be secured. Receiving tanks and pumps were installed and aboutthe time the armistice began the water supply was fully provided for. The Beaune and artesian supplies were rather hard,but repeated laboratory tests showed them to be entirely potable at their source. However, the delivery pipes werebadly contaminated, as tests showed the water to be dangerous for use as delivered through them, so that chlorination inLyster bags was always practiced.

The bucket latrine system was used; solid matter was disposed of inHorsfall incinerators, and liquids were emptied through sewers into a septic tank.

One large steam sterilizer was used to disinfect all bedding and clothing.Electric power was brought into the center from Beaune. A permanent transformer was never installed, but only a temporaryone of insufficient capacity was available, necessitating the use of a number of oil lamps and candles. An improvisedPrest-O-Lite apparatus for emergency use was installed in each operating room. During November, 1918, an accidentoccurred by which the high-power transmission line became fouled with the lighting wires, resulting in the death by electrocutionof 3 patients, 2 Hospital Corps men, and 1 civilian employee.

Laundry was handled at first by Mobile Laundry Unit No. 303, which arrivedSeptember 11, 1918; on September 19, the permanent laundry was put into operation by Mobile Laundry Unit No.321.

The transportation consisted of 3 General Motors Co. ambulances, 3 trucks,1 touring car, and 1 motor cycle. These were far insufficient, and trucks had to be used late into the night inorder to handle the large amount of incoming supplies. Motor Transport Co. No. 477 arrived for duty on November 10, 1918, and tookcharge of all transportation.

The first base hospital unit arrived on July 31, 1918, and shortly afterwardsthe center was organized. The following units operated in this group: Base Hospitals Nos. 47, 61, 77, 80, 96; EvacuationHospital No. 22, Sanitary Squad No. 22, and Hospital Train Unit No. 40;Evacuation Hospital No. 23 (September 19 to October 9, 1918), and HospitalTrain Unit No. 45 (August 27 to October 31, 1918). None of the units broughttheir hospital equipment. The equipment was received from supply depotsin various shipments and immediately installed, and as soon as a hospitalwas prepared to feed and house patients its beds were reported. Each hospitalfirst received medical and minor surgical cases, the more severe ones goingto the more completely equipped units. The matter of equipment and nurseschiefly governed the distribution of patients throughout. Special wardsfor officers, women, contagious and mental diseases were established, butthe more detailed classification which was contemplated in the fully developedcenter was not put into effect.

555

Valuable assistance in the matter of medical supplies was given by theAmerican Red Cross, especially in the way of blankets and prepared surgical dressings. A hut was furnished by thisorganization in each unit where concerts, dances, moving-picture shows, etc., were given.

CONVALESCENT CAMP

Convalescent camp was opened on October 7, 1918, and operated as suchuntil January 31, 1919, handling approximately 5,000 patients. A disability board was appointed and evacuation beganwithin a few days. The average length of stay of each patient in the camp was 11 days.

F IG. 105.-An operating room, Beaune hospital center

DISCONTINUANCE

The Beaune center was discontinued on March 29, 1919, and the site utilizedfor the American Expeditionary Forces University.

COMMANDING OFFICER

Col. Clarence J. Manley, M. C.

HOSPITAL CENTER, CLERMONT-FERRAND^d

The hospital center, with headquarters at Clermont-Ferrand, was establishedon September 23, 1918, for the purpose of not only extending hospitalization of that district but also of unifyingthe hospitalization already established

^dThe statements of fact appearing herein are based on the "History of the Clermont-Ferrand hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

556

there. This group included hospitals in the towns of Chatel-Guyon, Royat,Mont-Dore, la Bourboule, and Riom. These towns were composed almost entirely of summer hotels, the capacityof which varied from small villas of 15 to 20 rooms to large hotels of 250 to 300 rooms. Certain public and private buildingsin the above places were taken over by the American Army, and plans were formulated for the establishment of six base hospitalswith a capacity of 13,600 beds. Two base hospitals (Nos. 20 and 30) were functioning in Chatel-Guyon andRoyat, respectively, when the center was organized.

Headquarters were established first at Royat, and on October 1 at Clermont-Ferrand.On October 17, a provisional base hospital was extemporized at Mont-Dore by drawing some personnel, and100 convalescent patients from the two hospitals already operating. On November 6, 1918, Base Hospital No.93 arrived and two days later Base Hospital No. 103. Base Hospital No. 103 never functioned as a hospital.

After the signing of the armistice further extension of the hospitalizationin section was abandoned and buildings were gradually returned to the French. Discontinuance of the hospitalizationin this region was completed about February 20, 1919.

The total number of patients cared for in this center was 17,042. Thisincludes patients admitted prior to the organization of the group.

COMMANDING OFFICER

Col. John S. Lambie, M. C., September 23, 1918, toFebruary 8, 1919.
Lieut. Col. John A. Murphy, M. C., February 9, 1919,to March 10, 1919.

HOSPITAL CENTER, COMMERCY^e

This center was organized on November 4, 1918, at Commercy, where itoccupied the Caserne Oudinot. Barracks were taken over also at Lerouville, a few kilometers northwest of Commercy.The buildings were of stone and in fairly good condition, but a great deal of renovating was necessary to make themsuitable for hospital purposes. The windows were torn out, electric wiring was missing, sewers were blocked, and thewater was unsafe for drinking. Evacuation Hospital No. 13 had been operating in the Caserne Oudinot since October 30,and was the only hospital in the center during the active period. Base Hospitals Nos. 91 and 90 arrived on November 30and December 1, respectively. The former relieved Evacuation Hospital No. 13 and the latter took over the caserneat Lerouville, but never functioned as a hospital. During January, 1919, all patients were evacuated to Vichy and Bazoilles-sur-Meuse,and the center was discontinued on January 30, 1919.

COMMANDING OFFICER

Col. William A. Powell, M. C.

HOSPITAL CENTER, JOUE-LES-TOURS^f

This center was established in the grounds of a château about5 kilometers (3 miles) west of the city of Tours. The property was leased by the United

^eThe statements of fact appearing herein are based on the "History of the Commercy base hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed. ^fThe statements of fact appearing herein are based on the "History of the Joue-les-Tours hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

557

States Government from the owners in April, 1918, and two type A unitsand a convalescent camp were constructed by the United States Engineers. The entire center, including its water supplyand sewerage system, was completed in October, 1918. The bed capacity of this group was 4,600 beds, but this capacitywas never reached.

The method of handling the sick and wounded followed the usual procedurein base hospitals. The center was operated by Base Hospital No. 7 from July 30, 1918, tothe latter part of October, 1918, when Provisional Base Hospital No. 2 was organized. On January 18, 1919, Base HospitalNo. 120 took over the activities of Base Hospital No. 7, thereafter, with Provisional Base Hospital No. 2, operatingthe center until its closure early in June following.

F IG. 106.-A view of part of Kerhuon hospital center

COMMANDING OFFICER

Col. Allen M. Smith, M. C., July 30, 1918, to January17, 1919.
Col. Edward W. Pinkham, M. C., January 18, 1919,to closure of center.

HOSPITAL CENTER, KERHUON^g

The hospital center at Kerhuon was situated 4 miles southeast of Brestand about 1½ miles from the railroad station of Kerhuon. The center was planned to consist of 8 base hospitals, witha total capacity of 8,000 beds, for embarkation purposes; however, only 4,000 beds had been provided when the armisticewas signed and further construction was abandoned.

^gThe statements of fact appearing herein are based on the "History of the Kerhuon hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

558

The construction of the center, according to the estimate of the EngineerDepartment, was to be completed by September 15, 1918. However, at that time only about 50 per cent of the buildingswere under roof, few of them were entirely finished, the water and sewerage systems still were under construction, and therewere no roads or walks of any kind.

The first unit (Base Hospital No. 65) reported on September 16, 1918,and on the 20th the center was organized. Subsequently, the following additional arrived: Base Hospitals Nos.105, 92, 120. Unlike the other hospital centers of a like capacity, this center always operated as one hospital, this inview of the fact that at least 90 per cent of the activities were devoted to receiving, preparing, and evacuating patients to theUnited States, and one administration instead of four was desirable.

Approximately 75 per cent of the patients who passed through the centerrequired little or no professional care. Bedridden medical and surgical cases and those requiring professional care wereplaced in two blocks of wards. The ambulatory cases requiring no professional care were placed in other wards regardlessof their physical disability. Medical officers assigned to these wards acted more in the capacity of detachment commanders thanward surgeons; their principal duties were to see that all patients were properly clothed, equipped, and paid preparatoryto their embarkation.

The evacuating activities were entirely dependent on space alloted patientson naval transports, on the one hand, and the availability of patients at other hospitals in France, on the other.It might be said that the center coordinated the patients with the vessels so that there was always on hand a sufficient number ofpatients under the classification demanded by the Navy to fill all space on vessels allotted to them. The Navy was representedby a naval medical officer who furnished the information relative to the dates of sailing and the space allottedfor patients. The port of embarkation was represented by a medical officer of the army who, after consultation with the commandingofficer of the center, made requisitions on the chief surgeon's office for patients to fill the Navy requirements. The chiefsurgeon, in turn, ordered patients from hospital centers at Savenay, Nantes, and Beau-Desert to the center at Kerhuon.

When information was received from the naval authorities that a vesselwould sail on a certain date and the number and classification of patients required was forwarded, passenger listsof patients were prepared from those available for evacuation and patients tagged with colored tags, each color representinga certain physical classification. These tags were very much cherished by the patients and regarded by them as a tickethome. One-half hour before the evacuations were to begin a bugler sounded "assembly," followed by "overcoats." At thissignal all patients who had been tagged repaired to their wards and thencemarched to the receiving ward. Here a final inspection of their personnelappearance was made, their records were verified as to completeness, andthey were then loaded on ambulances and taken to Pier No. 5, Port du Commerce, Brest. From here they were taken by steam lighters to thetransports. This activity was so organized that
frequently 1,100 patients were evacuated in less than three hours.

The following is a detailed outline of the evacuation system as operatedin the center.

559

Evacuation Office, Hospital Center, Kerhuon, France

ADMINISTRATION OF RECEIVING,RECORDING, EQUIPPING,AND EVACUATING OF PATIENTS

Evacuation:

Receivingward.
Ward surgeon.
Equipment.
Statisticaldepartment.
Registrardepartment.
Tagging department.
Liaison.

Function of receiving ward.-To receive patientssent to this hospital center and investigate source of admission as to authority and correctness; to receive papers anddata; to assign patients to ward on information from evacuation office; to receive and check baggage and furnish runnersto conduct patients to wards, and litter bearers for bedridden patients.

Reception of patients.-When notice is receivedof train arrivals a noncommissioned officer from this office is dispatchedto the station. He represents this center and obtains information relativeto convoys, etc., and accordingly makes out report, which is placed onfile at this office.

REPORT OF HOSPITAL TRAINS, PATIENTS, BAGGAGE AND EQUIPMENT(ARRIVAL)

Hospital train No. ------ Date of arrival ------------------------------------------------

Number of patients in convoy: Officers,------; enlisted men,------; total, ------
Embarked at -----------------------------------;time, ---------------; date, ---------------
Arrived at --------------------------------------;time, ---------------; date, ---------------
Detrained at------------------------------------;time, ---------------
Name of train commander ------------------------------------------------------
Seriously ill on train -------------------------------------------------------------
Remarks: -------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------
Condition of men on detraining ------Time of loading ambulances -----------------------------------------
First ambulance arriving HCK ------Last ambulance arriving HCK -----------------------------------------
Last patient sent to ward -------------------------------
Number of patients not paid for precedingmonth --------------------------------------------------------------
Record shortage ---------------------------------------------------------------------------------------------------------
Baggage ----------------------- Numberof pieces ------------------- Sent via ------------------------------------
Condition --------------------------------- Shortage --------------------------------------
-------------- Officers in chargetrain. Number of attendants ----------------------
------------------------------------------------------------
------------------------------------------------------------ -----------------------------------------------------
------------------------------------------------------------Detraining Sergeant.
------------------------------------------------------------
------------------------------------------------------------- ----------------------------------------------------

Evacuation Officer.

Patients arriving at this center are brought to the receivingward, lined up and are given a slip of paper with the number of the ward to which assigned written thereon. Passing downthe line they are questioned by medical officers who write on the ward assignment slip, data relative to pay, Navy classificationand diagnosis taken from field medical and transfer cards; the latter in conformity with the Manual, Sick and Wounded,A. E. F. Patients then have an opportunity, if they desire, of handing over money or valuables to a representative ofthe registrar's office, for safe-keeping, to be given back when ready to be evacuated to the United States. They then passon to the clerical room, where a force of about 12 typists fill out the Form 55a complete in quadruple, getting the data fromthe patient and from the records in his possession. The patients are then sent to the ward to which assigned. This work canbe accomplished at a rate of about 175 men per hour.

Ward surgeon.-We depend upon the ward surgeon forthe accurate and easy running of the mechanism-first, when patients arrivein the ward, verification of data on the Form 55a, any change in Navy classification,diagnosis or delayed evacuation to be made on form provided.

560

CONTAGIOUS DISEASE-CHANGE OF DIAGNOSIS-CHANGE OF CLASSIFICATION-DELAYED EVACUATION-RELEASES FOR EVACUATION

Note: ---------------------------------------------------------------------------------------------------------
Chiefs of service.
--------------------------------------------------------------------------------------------------------------------
Ward ---------------------------------------------Date ------------------------------------------------------
Name -----------------------------------------------------------------------------------------------------------
Serial No. ----------------------------- Rank --------------------------- Organization ------------------
Navy class -------------------------- Navy class new -------------
Admission diagnosis --------------------------------------------------------------------------------------
Present diagnosis -------------------------------------------------------------------------------------------
Noted by registrar -------------------------------------------------------------------------------------------
Reason for delayed evacuation --------------------------------------------------------------------------
Ward surgeon ------------------------------------------------------------------------------------------------
Approved by chief of service ----------------------------------------------------------------------------
Received by evacuation officer --------------------------------------------------------------------------

This form is sent to evacuation and registrar's officewithin 24 hours, if possible.

Second, transfer of patients from one ward to another.This should be carefully recorded by use of the following transfer form.
HOSPITAL CENTER, KERHUON-TRANSFER OF PATIENTS

Request transfer of this patient fromward ---------------to ward ---------------
Name ----------------------------------------------------------------------------No. ------------------------
Rank --------------------------------- Organization -------------------------------------------------------
Diagnosis -----------------------------------------------------------------------------------------------------
Navy class ------------------- Navyclass, new ------------------
Reason for transfer --------------------------------------------------------------------------------------------
-----------------------------------------------------,
Ward No. ----------- Ward Surgeon.

Approved:

Chief of:
  Medical.
  Service transportation.
  Surgical.

------------------------------------,
Base Hospital No. --------

Approved:

Chief of:
Medical.
Service records.
Surgical.

--------------------------------------,
Base Hospital No. -------

The above patient will be transferredto ward -------------------------------------------------------
Registrar.
Notice to detachment commander totransfer above patient.
-------------------------------------------------------,
Detachment Commander.

Received the above patient.
-------------------------------------------------------,
Ward Surgeon, ward -----

EVACUATING OFFICE.
Notice received of transfer. Date ----------------------------------------------- Time -----------

---------------------------------------------,
Evacuating Officer.
Change in file made by --------------------------------------------------------

To receiving officer, to note and returnto evacuating officer.
---------------------------------------------------,
Receiving Officer.

The question of diagnosis is carefully considered andany change is immediately reported, through proper channels, to the
registrar and evacuation office.

561

EQUIPMENT

Equipment officer.-The function of this officeris to see that the enlisted patients coming into this hospital are madeready to be evacuated as soon as possible, and that all existing ordersrelating thereto are complied with. When patients are sent to the ward,a careful inspection of the personal equipment is made by the ward surgeon,and any shortage noted.

The articles to complete the personal equipment are immediatelydrawn from the quartermaster and supplied to the patients.

After careful inspection of their physical condition,the ward surgeon submits a list of those ready for inspection to the localinspector who notifies the inspector general at base headquarters, andthe section inspector comes out and certifies to the equipment, physicalcondition, and pay of each man.

This certificate is made in duplicate on blanks providedfor that purpose, one of which is retained by the patient until he reachesthe receiving ward on evacuation, where a final inspection is made. Thiscertificate is retained with the hospital records. The original copy accompaniesthe patient.

This form is shown below:

General Orders, No. 3, Hospital Center Kerhuon, January10, 1919.

1. The physical examination of patients and the completionof their equipment must be certified by the ward surgeon within the periodof 24 hours after a patient is admitted to the hospital. The certificatewill be made in duplicate on the evacuation-inspection slips which havebeen provided for the purpose.

2. In each case one of the certificates will be retainedby the patient until he reaches the evacuation office, where it will berequired by the evacuation officer before the patient is allowed to leavethe hospital.

3. The other certificate will be transmitted by the wardsurgeon through military channels to the section director.

4. The section director each day, at 2 p. m., will supplythe representative of the inspector general's office with the certificatesof patients who are prepared for inspection.

5. The certificates furnished by the section chiefs willbe used by inspection department to compile a list of the patients whoare prepared for inspection.

6. These certificates, after having been initialed bythe inspector general, will be delivered to the evacuation officer andwill be filed in the patient's envelopes with their other records.

7. Upon notification that the inspector general is preparedto inspect the patients in any ward, the ward surgeon will direct thatthe equipment of the patients concerned be displayed on their beds in anorderly manner so that every article may be easily seen. When physicallyable to do so, the patient will stand by his bed dressed as when he willembark upon the ship. His identification tags must be worn about the neckand displayed outside his clothing.

HOSPITAL CENTER, KERHUON, BREST-EVACUATION INSPECTIONSLIPS

Ward ----- Classification ----- Date -------------------------
Name ---------------------------No. --------------
Rank -------------------- Organization ------------------------------

Complete equipment:
Cap	1	Blankets, olive drab	3
Coat, olive drab	1	Barrack bag	1
Breeches, olive drab	1	Canteen and cover	1
Belt, waist	1	Gloves, pairs	1
Leggins	1	Laces, shoe, pairs	1
Shoes	1	Tags, identification	1
Overcoat	1	Ornaments, collar, cap	3
Shirts, olive drab	2	Toilet kit, complete	1
Undershirts	2	Cup	1
Drawers	2	Knife	1
Socks, pairs	4	Fork (1 spoon)	1
Slicker	1	Meat can	1

562

I have received the articles checked on this list, requiredto complete equipment as shown on list.

I was paid in full to include month of -----------------------------------1919, $ -----------------

I certify that I did not enter the service in Europe.
-----------------------------------------------,
Patient.

I certify this patient's equipment to be complete as shownby above list, except for initialed erasure of articles not available for
issue.

Date ------------------------------------------------1919.
(Name) --------------------------------------------------,
(Rank)Ward Surgeon.

I certify that I have examined this patient and foundhim free from communicable venereal diseases, from skin and contagiousdiseases, and vermin infestation.
(Name) --------------------------------------------------,
(Rank)Ward Surgeon.

Inspection, general:

I inspected this patient immediately before evacuationfrom the ward and found no evidence of acute infection in eyes, nose, throat,skin, or general condition to contradict evacuation, and has no explosivesor combustibles.
(Name) ---------------------------------------------------,
(Rank) Ward Surgeon.

Evacuated ----------------------------------------------------- Date -------------------------------------------
S. S. ---------------------------------------------------

The detail of this process is outlined as follows:

Before the sick and wounded are ready to return to theUnited States a number of conditions must be satisfied, including:

1. The physical condition of the patient must be suchas to insure his safe transportation.

2. He must not be suffering from a communicable diseaseor vermin infestation, thereby endangering the health of his
traveling companions.

3. He must be provided with clothing which will affordhim protection and, in the case of ambulatory patients, they must presenta neat and military appearance.

4. He must have been paid in full to include the monthpreceding his embarkation for the United States.

5. His service record must accompany him, if available;and, if not, a supplementary service record must be provided.

6. All foreign money must be exchanged for American money.

EQUIPPING THE PATIENT

Immediately after the reception of the patient in theward the ward surgeon proceeds with the preparation of the patient forevacuation, and takes the following steps:

(a) The equipment which the patient possesses isorderly displayed upon his bed and checked against the specified list givenon page 8 of Embarkation Instructions No. 13, January 4, 1919, headquarters,Services of Supply, A. E. F.

(b) The articles mentioned in the aforesaid listwhich are not in the possession of the patient are immediately requisitionedfrom the quartermaster. If the quartermaster is unable to supply any ofthe articles requisitioned he certifies to that fact.

(c) Inquiry is made of the patient regarding thepay he has received and he is required to state over his own signaturethe amount and the period of time covered.

(d) Inquiry is made as to whether or not he enlistedin Europe, if so, whether he desires demobilization in the United States,under provision of General Orders No. 40, G. H. Q., paragraphs 1-6. Ifhe so desire, the attached declaration is used and information sent tobase commander through military channels.

563

HOSPITAL CENTER,KERHUON,
BASE SECTIONNO.5, A. P. O. 716,

(Date) --------------------------------, 1919.

Under the provision of General Orders No. 40, paragraphs1-6, G. H. Q., March 3, 1919, I, ----------------------------------------------------, hereby
declare that I entered the service of the United Statesin Europe, at --------------------------------------------------, on (date)--------------------------;
I desire to be retained in the service for the purposeof returning to the United States for discharge. I understand that I amprivileged to be discharged in Europe if I so desire. I do not requestto be retained in the service for the purpose of returning to the UnitedStates for discharge. In consideration of this privilege of being returnedto the United States, I waive all claim for travel allowance from the placeof discharge to the place of entry into the service, and fully understandthat I will be discharged at the demobilization center nearest my homeand that I must defray my expenses from the demobilization center at whichdischarged to my home.

-----------------------------------------------

Witness:
--------------------------------------------

(e) The physical inspection of the patient determineswhether or not he is suffering from communicable venereal disease, skindiseases, contagious diseases, or vermin infestation.

(f) The requisition upon the quartermaster havingbeen filled and the articles thus acquired having been added to those alreadyin the possession of the patient, the ward surgeon now makes a final checkto determine that the patient's equipment is in full accord with the instructionscontained in Embarkation Instructions No. 13.

NOTIFICATION BY THE WARD SURGEON

The ward surgeon now requests the chief of the serviceto verify the findings which he has recorded with regard to the patient'sphysical condition, equipment, and pay.

The chief of the medical service confirms the findingswhenever a patient is reported suffering from vermin infestation, communicablediseases, etc.

A representative of the inspector general's office visitsthe ward and confirms the fact that the patient is properly equipped forevacuation to the United States, initialing the record in evidence of thefact that this inspection has been made.

The statistical officer verifies the pay status of thepatient and prepares his service record for return to the United States.

CERTIFICATION

The correctness of the findings which have been enumeratedis attested by proper signature. The patient acknowledges over his signature the correctness of the statement regardinghis pay and also that the required equipment for evacuation is in his possession.

The ward surgeon certifies that the patient has been equippedin a proper manner and also signs a certificate indicating that the patient may be transported to America with safetyto himself and without endangering his fellow passengers from vermin or communicable diseases.

As a period of a few days may elapse between the timewhen a patient arrives in the hospital and the time when he is placed upon the passenger list, the ward surgeon makes a finalinspection in each case in order that he may give the proper assurance regarding the suitability of every case forevacuation. This final certificate covers the question of acute infection,vermin infestation, and venereal disease.

WOUND CHEVRONS

General Orders, No. 110, general headquarters, A. E. F.,July 7, 1918, prescribes the conditions under which wound chevrons maybe worn. Many wounded men have been unable to secure authority to wearthese chevrons, due to the loss of necessary papers. To obviate this difficulty,telegraphic authority was given to the commanding officer of this centerto take the affidavit of any man whose papers were lost or confused. Asa matter of practice it is found that greater speed is obtained and betterrecords made available for our own protection if the affidavits are preparedin each case. As soon as the patients are assigned

564

to the ward, the ward surgeon asks for all men to notifyhim who have never had an order authorizing the wearing of his wound chevron.The ward surgeon prepares an affidavit showing, name, rank, company, organization,number, place of action where wound was obtained, nature of missile orgas, part of body injured, and date of injury. This blank is sent to theadjutant's office. The adjutant sends a commissioned officer, having powerto administer an oath, to see the soldier and attest his signature on theaffidavit. This affidavit is returned to the adjutant's office, and a specialorder issued authorizing the individual to wear a wound chevron for thewound specified. Two chevrons are then issued to the men with the orderauthorizing their use, one for the coat and one for the overcoat. If thepatient already has an order but no chevron, a chevron is issued and anotation made on the order. If one chevron only is needed for the overcoat,one is issued for that purpose. In the month of March, about 800 woundchevrons were issued.

HOSPITAL CENTER, KERHUON, FRANCE

A. P. O. 716

(Date) -------------------------------------------------,1919.

Personally appeared before me, the undersigned authority,one --------------------------------------------------------, -----------------------------------------
(Number)
who, after being duly sworn, deposes and sayeth, I was(1) wounded while in action with the enemy; (2) wounded as a result ofan act of the enemy; (3) was gassed, which necessitated treatment by amedical officer at ------------------------------------------------------------------------,
(Place)
-----------------------------------. That the wound wasdue to ---------------------------------------------------- and I was woundedin
(Date)(Nature of weapon)
-----------------------------------------------; thatI am not now wearing a wound chevron for this wound.
(Part of body injured)

Further deponent sayeth not.
Ward --------------
-----------------------------------------
(Name, rank, and organization)

Sworn to and subscribed before me this------------------ day of --------------------, 1919.
-------------------------------------------,
----------------------------------------

HEADQUARTERS, HOSPITAL CENTER, KERHUON, FRANCE

A. P. O. 716

(Date) -------------------------------------------------------, 1919.

Special Order No. -----------------

EXTRACT

* * * * * * *

PAR-- Pursuantto telegraphic authority, headquarters, Services of Supply, 8th February,1919, the following-named men, having been wounded in action with the enemy,or as the result of an act of the enemy, on the date and at the place specifiedopposite their names, are hereby authorized to wear the wound chevron prescribedin G. O. 110, G. H. Q., July 7, 1918:

Name Number Rank Organization Date and place of injury

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

By order of Colonel Koerper:

FREDERICK THOMAS,
Major, Sanitary Corps, Adjutant.
Ward----------
Original copy.

565

SERVICE STRIPES

This matter is taken up with every man coming into thiscenter, and handled in a similar manner to wound chevrons. Many men arefound who are not wearing service stripes, although entitled to them. Inthe month of March about 3,000 service chevrons were issued and authorizedas per order attached.

HEADQUARTERS, HOSPITAL CENTER, KERHUON, FRANCE

A. P. O. 716

(Date) -------------------------------------, 1919.

Special Order No. ------

EXTRACT

* * * * * * *

PAR -- Pursuantto the provisions of G. O. 110, sec. 1, Hqrs., A. E. F., July 7, 1918,as amended by G. O. 147, sec. 3, par. 4, Hqrs., A. E. F., Sept. 2, 1918,permission is hereby granted the following-named members of the AmericanExpeditionary Forces, now at this hospital center, to wear ----- war servicechevrons.

Name Number Rank CompanyOrganization Date of arrival

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

By order of Colonel Koerper:
FREDERICK THOMAS,
Major, Sanitary Corps, Adjutant.

Ward --------
Original copy.

EVACUATION

The evacuability of a patient is indicated when the wardsurgeon forwards, through military channels, the evacuation-inspectionslips, which contain the certificates referred to above. This slip is madein duplicate, one of which is taken up by the inspector; when all are collecteda list is made and handed to evacuation department, which thereupon releasesthe equipment check of patient, kept on file at evacuation office. Theduplicate slip is kept by patient, who brings it to the receiving wardand when he is checked on the passenger list he hands the slip to the inspector,who examines it once more to insure correctness and then places it in thepatient's envelope. This envelope is then given directly to the detachmentcommander. At this point the patient is given the final inspection as toneatness and military appearance.

FORMATION INTO DETACHMENTS

Prior to evacuation, patients are grouped into detachmentsof 75 to 150 and placed in the charge of a medical officer, who receivesthe records relating to the patients and conveys them to the United States.

STATISTICAL

The function of this department is to see that the servicerecords are complete; or if not and not obtainable, to provide supplementalservice records, and to see about pay for every man. A roster of detachmentsof men to be evacuated, which is the passenger list of the evacuation office,is submitted to this department, and 12 copies of passenger list made fromthe data contained thereon. Two copies of the twelve contain red-ink notationsconcerning the absence of service records. These copies are disposed ofas follows:

5 copies for personnel adjutant, UnitedStates port of debarkation.
2 copies to central records office.
1 copy to headquarters, Services ofSupply.
1 copy to be retained at port of embarkation,A. E. F.
1 copy for executive officers on boardship.
1 copy to The Adjutant General ofthe Army.
1 copy to detachment commander.

566

REGISTRAR

The registrar accepts one of the Forms 55a, places itin live file; when passenger list is called for and patient ready to goout the Form 55a is taken out, stamped with proper date,and placed in dead file.

TAGGING

This department receives a copy of passenger list, andfills out the tag, form shown below:

P. L. No --------- Detachment ---------- Class -------------------------
Name --------------------------------------------------------------------------
Rank -------------------Serial No ------------------------------------------
Company --------------Organization ------------------------------------
Diagnosis--------------------------------------------------------------------
Home State--------------- Ward No -------------------------------------

The patients are tagged in the wards, and made readilydistinguishable and ready to go to the receiving ward for final inspectionand loading when called for.

Tags are colored, denoting classifications:

White-Walking, no dressing ------------------------------------------------------------------------------------------- (WND a, b)
Green-Walking, dressing ------------------------------------------------------------------------------------------------ (WD a, b, c)
Yellow-Tubercular -------------------------------------------------------------------------------------------------------- (TB a, b, c)
Red-Mental ----------------------------------------------------------------------------------------------------------------- (Ment a, b)
Blue-Bedridden ------------------------------------------------------------------------------------------------------------ (BR a, b)

Barrack tags.-Tags are made in duplicate, onepart is tied on the barrack bag and the other the patient keeps in hispossession.

Det. 278. No. 50	Det. 278. No. 50.
John Doe	John Doe
Pvt. 1/cl.	Pvt. 1/cl.

OFFICE SURGEON,BASE SECTIONNO.5, A. P. O. 716,
(Date) March 24, 1919.

To: C. O., Hospital Center, Kerhuon, France.
Requisition for classified patientsfor evacuation to transport:
Transport: S. S. Mount Vernon.
Date of sailing: March 28, 1919.
Hour for ambulance loading: 8:00a. m.

	Bed ridden		Walking, dressing			Walking, no dressing		T. B.			Mental		Total
	A	B	A	B	C	A	B	A	B	C	A	B	Total
Officers	---	---	---	---	---	---	---	---	---	---	---	---	---
Enlisted men	---	10	---	---	---	50	750	---	---	---	---	---	810
Nurses	---	---	---	---	---	---	---	---	---	---	---	---	---
Total	---	10	---	---	---	50	750	---	---	---	---	---	810

(Signed) --------------------------------------------,
Captain, M. C., Assistant Adjutant.

567

LIAISON

The duty of this department is to keep in touch with thebase evacuation officer and other points that send patients to this centerfor evacuation to the United States; to arrange for their reception andrequisition through office when needed; to keep live statistics on thegeneral information board as to movement of patients and nurses, and expectedarrivals of ships. In other words, to coordinate all outside informationthat has to do with the reception and evacuation of patients, and to maintaina sufficient number of patients at all times to fill the requisitions madeby the Navy.
* * * * * * *

The physical function of evacuatingpatients is as follows:
When the passenger list is completedthe following form is made out:

EVACUATION OFFICE,
HOSPITAL CENTER,KERHUON, A. P. O. 716,

Memorandum: ---------------------------------------------, 1919.

1. Loading from the S. S. -------------------------------------------------------------------------------------------will start at -------------------------------- M.
------------------------------------------------------------------,1919.
The following detachments will load:

Detachment No. -------------------------------------In command of --------------------------------------------------
Detachment No. -------------------------------------In command of --------------------------------------------------
Detachment No. -------------------------------------In command of --------------------------------------------------
Detachment No. -------------------------------------In command of --------------------------------------------------
Detachment No. -------------------------------------In command of --------------------------------------------------
Detachment No. -------------------------------------In command of --------------------------------------------------
Detachment No. -------------------------------------In command of --------------------------------------------------
Detachment No. -------------------------------------In command of --------------------------------------------------

2. Evacuation will take place from the following wards:
----------------------------------------------------,
Evacuation Officer.

Copies to-

Commanding officer, Base Hospital No.65.
Chief of professional services.
Chief of medical service.
Chief of surgical service.
Chief nurse.
Detachment commander.
Receiving officer.
Mess officer.
Baggage sergeant.
File.

These are sent to officers that are in any way connectedwith the process that they may be informed and have patients designatedto go at appointed hour. To the receiving officer is sent, first, a "wardcheck," that he may know the wards from which the patients are to be called,their number, and classification:

Detachment No. 136:

Enlisted men-

BRb ---------------- J2 J4 J5 J6
3 10 34 1

WNDb ------------Y7 Y4
45 5

Detachment No. 137:

Enlisted men-

WNDb -------------Y7 Z1 X2 D7
30 22 2 1

TBc ---------------- A3 E5 X2 A4
31 19 2 17

568

Detachment No. 138:

Enlisted men-

TBa ---------------- A3 A4 A6 J1 ES E6
8316 12 74

TBc ---------------- A6 J1 E6
1631

WNDb -------------Z1Z2 Y7 C6 H10 H9 F3 D5
1 191313 2

ClE4E3 E2
2 411

Detachment No. 139:

Enlisted men-

WNDb -----------D3 D4
3436

WDa ------------ C5C4H2Al C2
2 11126 10

Detachment No. 140:

Enlisted men-

WNDb --------- D4D5D6
43828

WDb ------------Z1C6Y3 C2 Z2 Y2
4 2332 1

Detachment No. 141:

Enlisted men-

WNDb -------- J7ClA8 Al X2 A2 Z2 Z3
2913 2148 120 53

Detachment No. 142:

Enlisted men-

Mentb -------- A9 Al0P2P6
2438 4 6

Detachment No. 143:

Enlisted men-

WNDb ----- Z1 Z3 H9 D3 D2
62 44 19 1 24

Detachment No. 144:

Enlisted men-

WNDb ------ H9 H10 C5 C6
21 37 29 38

Detachment No. 145:

Officers-

WNDb ------- B2 Al B3 B4 B5 B6
16 1 11 8 4 1

WNDa ------- B4 B5
1 1

TBc ----------- B2
1

WDc ----------- B5
2

WDb --------- B4 B5
1 2

WDa --------- B4 B5
1 1

Detachment No. 146:

Nurses-

WNDb ------- K4
22

Detachment No. 147:

Mental officers-

Mentb --------- B7
32 or 33

569

Second, an office detachment sheet showing how each detachmentis to be made up. An office detachment sheet is given below, showing themake-up of the passenger list of the Steamship Leviathan. This list,as will be noted, calls for most of the sick and wounded classification.It will be noted that the detachments are made up in "splits"; that is,not all are of the same class, the reasons for which are: First, evacuatingfacility; second, part of the detachment in the class are able to helpthe others, which tends to shorten the transportation time; third, it doesnot load up a detachment commander with a lot of one class of patientswho might be sick and require a lot of attention and care.
OFFICE DETACHMENT SHEET STEAMSHIP "LEVIATHAN"?

In command of convalescent detachment No. 138, Capt. ----:
(1) TBa (patients), 49 enlisted men, 1 civilian	50
TBc (patients)	20
WNDb (patients)	29
Total	99
In command of convalescent detachment No. 136, Maj. ----:
(2) BRb (patients)	49
WNDb (patients)	50
Total	99
(Supplemental 101 to 110.)
In command of convalescent detachment No. 137, First Lieut. ----:
(3) TBc (patients)	69
WNDb (patients)	55
Total	124
In command of convalescent detachment No. 142, Maj. ----:
(4) Mentb (patients)	58
Attendants	6
Total	64
In command of convalescent detachment No. 139, Capt. ----:
(5) WNDb (patients)	69
WDa (patients)	49
Total	118
In command of convalescent detachment No. 140, Capt. ---:
(6) WNDb (patients)	70
WDb (patients)	49
Supplemental list, WNDb (patients)	12
Total	131
In command of convalescent detachment No. 141, Capt. ---:
WNDb (patients)	148
In command of convalescent detachment No. 143, Maj. ---:
WNDb (patients)	150
In command of convalescent detachment No. 144, Capt. ---:
WNDb (patients)	125
In command of convalescent detachment No. 145, Lieut. Col. ---:
Officers-
TBc (patients)	1
WDa (patients)	2
WDb (patients)	3
WDc (patients)	2
WNDa (patients)	2
WNDb (patients)	40
Total	47
In command of convalescent detachment No. 146, Capt. ---:
Nurses-
WNDb (patients)	22
Attendants	3
Total	25
In command of convalescent detachment No. 147, Lieut. Col. ---:
Officers-Mentb (patients)	32

570

When there are many bedridden patients to be evacuated,the ambulances are run right down to the wards where they are located,where a temporary evacuating shelter is set up and the patients checkedthere instead of in the receiving ward. The burden of transporting is practicallynil, the patient being taken out of his ward and almost into the waitingambulance, and thence directly to the ship. The ambulatory patients gothrough the receiving ward. Thus the evacuation can be carried on in twoplaces at the same time. It might be interesting to note that the passengerlist of the Leviathan, calling for 1,162 patients, a somewhat complicatedone, calling as it does for bedridden, ambulatory, mentals, and attendants,was loaded from this center in 3 hours and 15 minutes.

OFFICE ADMINISTRATION

A file, made up of Forms 55a, a copy of which was obtainedfrom clerical room on the reception of the patients, is arranged accordingto the classification of sick and wounded as required by the Navy, andunder which the Navy calls for patients to be transported. Form 55a containsall information necessary to make out a passenger list, and since theyare filed in order of arrival, they thus establish a priority list.

This file is also kept in subdivision by wards, so thatthe number in each class and also the number in each ward of each class can be readily determined. For a daily report thefollowing form is used:
Morning situation report of patients, hospital center,Kerhuon-Navy classification?

OFFICERS

Bedridden

Walking, dressing

Walking, no dressing

Tubercular cases

Mental cases

Total

Remaining

---

Admitted

---

Total

---

Disposed of:

Lost by reclassification

---

Gained by reclassification

---

Died

---

Remaining

---

Available

---

ENLISTED MEN

Remaining

---

Admitted

---

Total

---

Disposed of:

Lost by reclassification

---

Gained by reclassification

---

Died

---

Remaining

---

571

P./L --------------------------------------------------------------------------------------------------------------------------------------------------------------

Temporarily held ---------------------------------------------------------------------------------------------------------------------------------------------

Available -------------------------------------------------------------------------------------------------------------------------------------------------------

Total ----------------------------------------------------------------------------------------------------------------------------------------------------------

Local patients --------------------------------------------------------------------------------------------------------------------------------------------------

Grand totals -------------------------------------------------------------------------------------------------------------------------------------------------

The distribution of the Form 55a is made either immediatelyfollowing the completion of its typing in the receiving ward, or as soonas the patients have passed through it, and sufficient time has been hadto make a careful check as to diagnosis, etc., and to make comparison withthe transfer card from the forwarding hospital and other papers which willcome in on the convoy, but not in the possession of the patient. The originalof the Form 55a which is retained in the receiving ward is filed accordingto wards, and the patient remains unavailable for evacuation until suchtime as he has been released from all checks. The Form 55a is transferredfrom the "hold-over" file to the "available" file, and there arranged accordingto the Navy classification and by wards.

A patient to be made evacuable must be equipped, paidin full to include the month preceding his evacuation to the United States,have his service record completed, not be awaiting trial by court-martial,be free from orthopedic complications and temporary illness. In other wordsthese are six points which have to be considered and checked.

When this office is called on for a certain number ofpatients in the various classifications required by the Navy, the Forms55a are "pulled" from the "available file" and blocked out and given theserial numbers to be used in making the passenger list. Typists preparethe passenger list. Approximately 10 per cent more names, if available,in each classification as called for by the Navy are placed on the passengerlist and service records for this number called for. As the system worksout we find that in practically every list there are a number of "hold-ups"at the last moment, so that as a name is scratched one of the other namesis used to fill in. Those that are not needed are scratched. After thepassenger list is complete, the Forms 55a are kept in their respectiveorder, to be accessible, in case anything arises requiring their use forreference, until the patient is actually evacuated. For instance, if atthe last minute a patient for evacuation is found too ill to travel, changewill be made. When the evacuation is accomplished and the patients havegone to the ship, final disposition is made of the Form 55a by markingeach copy with the number of the special order and paragraph which authorizesthe patient's evacuation, giving date and ship on which he travels. They are thenfiled alphabetically as a permanent record of this office.

Seventeen copies of a passenger list are made by the evacuationoffice; disposition a follows:

    4 to transport surgeon for use at portof debarkation.
    1 to chief surgeon, A. E. F. (throughbase surgeon).
    1 to base surgeon.
    1 to statistical and registrar departments.
    8 to Army and Navy medical authorities.
    1 retained for tagging and permanentfile.
RED CROSS HUT ACTIVITIES

Previous to arrival of a convoy the American Red Crossis notified by the receiving department. When the patients arrive and areawaiting registration, hot chocolate is served, and cigarettes are passed.

When patients go out, representatives of the Red Crossare present and supply each patient as he passes by the desk with a cigarette,giving him a light and a parting word before he gets into the ambulance.This detail, while small in itself, is important, as it serves to leavea good impression in the minds of the patients.

572

COMMANDING OFFICER

Col. Clyde S. Ford, M. C., September 20, 1918, toFebruary 11, 1919.
Col. Conrad E. Koerper, M. C., February 12, 1919,to discontinuance of center.

HOSPITAL CENTER, LANGRES^h

This hospital center was situated about three-fourths of a mile to theeast of the city of Langres. Construction of the center began during the early part of the summer, 1918, but delay in receiptof building material and the shortage of labor prevented its completion until after the armistice began. The originalplans for this center contemplated four base hospitals and a convalescent camp; however, buildings for only two base hospitals,a convalescent camp, and for the center administration were constructed.

To the wooden buildings were added later, 36 marquee tents, crisis expansion,to each base hospital, and 72 to the convalescent camp. This addition gave each hospital a capacity of 1,500and 1,000 to the convalescent camp, a total of 4,000 available beds for the entire center.

The center was organized on August 15, 1918. At this time the permanentbuildings were partially completed, most of the roads and a few walks laid, the electric plants in operation, and waterand sewer pipes laid.

The administrative staff of the center was organized into the followingdivisions: Adjutant, evacuating officer, sanitary officer, medical supply officer, laboratory officer, and quartermaster.

The following units comprised the center: Base Hospital No. 53; EvacuationHospital No. 18 (temporarily, September 15 to October 26); Base Hospital No. 88; Hospital Unit I, which arrivedon January 10, 1919, and was incorporated with Base Hospital No. 53.

One of the greatest handicaps under which the center operated was itsdistance from the detraining point, necessitating the transportation of all patients a distance of more than 2 miles by ambulanceand truck over rough narrow roads. There never was sufficient ambulance transportation available, and the majorityof patients were transported by trucks. At the time the armistice began, plans were under way providing for a railway trackto be built directly into the hospital area.

Water was obtained from the Marne River. It was treated with alum forcoagulation, and then with free chlorine. Because of the heavy pollution, it was necessary to chlorinate again in Lysterbags all water used for drinking purposes.

The sewerage system handled only liquids, which passed through a septictank, and after purification were discharged into a branch of the Marne River. The bucket system latrines were in operationand proved fairly satisfactory. One Horsefall destructor was installed. This proved effective, but proved ratherexpensive in the matter of fuel. One steam sterilizer was adequate for all the work for the center.

^hThe statements of fact appearing herein are based on the "History of the Langres hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

573

CONVALESCENT CAMP

The camp consisted of 72 marquee tents and 17 portable wooden barracks. The patients were classified and divided into several grades, according to physical strength, and were given graduated exercises, drills, and walks.

The American Red Cross constructed a large hut where amusements in theform of motion pictures, athletic exhibitions, and games were held. During its three months' existence the camp receivedabout 3,500 patients.

DISCONTINUANCE

On January 13, 1919, Base Hospital No. 88 was ordered to Savenay, leavingonly one base hospital in the center. As the central administrative staff was no longer necessary, it was discontinuedon January 22, 1919.

COMMANDING OFFICER

Col. William R. Davis, M. C., August 27, 1918, toNovember 21, 1918.
Col. Conrad E. Koeper, M. C., November 22, 1918,to January 22, 1918.

HOSPITAL CENTER, LIMOGESⁱ

The hospital center at Limoges was organized July 22, 1918. Severalhotels, schools, and other buildings were leased from the French; in addition, type A barracks were constructed by the UnitedStates Engineers. The hospitals were widely separated in different parts of the city. The entire group was plannedto accommodate 5,500 patients, but this number was increased so that on November 13, 1918, 9,093 beds (including the convalescentcamp) were reported as available.

Three base hospital units, Nos. 13, 24, and 28, arrived and were functioningsome time before the center was established. Ambulance Company No. 347 arrived September 25, 1918, and was usedin the evacuation of patients. Sanitary squad No. 79 reported September 29, 1918, and performed the sanitary workin the center. During January, 1919, Evacuation Hospital No. 32 and Base Hospital No 98 arrived, relieving Base HospitalsNo. 13 and No. 28, respectively.

Laundry was handled by local contract, but facilities were inadequateand a center laundry was authorized, but due to the signing of the armistice it was never completed.

Laboratory work of the center was distributed among the three hospitals,one performing the Wassermann tests, another the survey work, and a third the paraffin section work. Each laboratoryoperated independently, making its own routine examinations, with the exception of meningococcus typing, which wasassigned to one hospital.

Beginning December, 1918, the bed capacity of the center was graduallyreduced, until on February 28, 1919, all buildings but one were returned to the French. During its activity, this groupadmitted 23,592 patients.

ⁱThe statements of fact appearing herein are based on the "History of the Limoges hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

574

CONVALESCENT CAMP

The camp was opened September 21, 1918, and occupied a tract of landof about 10 acres, on which 50 tents and 12 frame buildings were erected. The initial capacity of the camp wasto be 1,000 beds, but during November this was found insufficient and barracks were rented from the French Government, increasingthe bed capacity to 2,200. The largest number of patients in camp at any one time was 2,165; total numbercared for was 3,077.

F IG. 107.-Aview of part of Limoges hospital center

The camp was operated by a section of Convalescent Company No. 5, consistingof 7 officers and 45 enlisted men. Patients were also used, especially in the offices and in the kitchen.Incorporated in the daily schedule of the camp operation were regular hours for physical exercises, drills, and outdoor games,patients being formed into graded companies which were allotted schedules based on the physical possibilities of itsmembers. The camp was evacuated on January 2, 1919, and turned over to the Engineers on January 13.

COMMANDING OFFICER

Col. William B. Bannister, M. C.

575

HOSPITAL CENTER, MARS-SUR-ALLIER^j

The construction of this center was authorized in the fall of 1917. It waslocated about 2 miles from Mars-sur-Allier and was to have a capacity of 43,000beds, including crisis expansion and convalescent camp. This capacity was neverreached. At the time of the armistice the center had 30,000 available beds.

Actual construction began in February, 1918, but at first it wascomparatively slow through lack of material. The work was under the direction ofUnited States Army Engineers. Railroad sidings ran into the center and thehospital units were grouped on either side, thus making it possible to stop thetrain in front of any hospital designated to receive patients. When thecommanding officer of the center arrived, on July 19, 1918, two units werefairly well toward completion. After August 2, 1918, the development of thecenter was very rapid. Material came in by trainloads almost every day. ByNovember 11, 14 units had been completed and were functioning; 3 were almostcompleted, and material was on hand for 3 other units.

The following organizations formed the center and arrived in the order named:Base Hospitals Nos. 68, 48, 35, 14, 62, 131, 123, 107, 110; Evacuation HospitalsNos. 31 and 37. Some of these did not arrive until after the armistice began.

At first, water for the center was derived from a spring, being pumped into alarge concrete tank, located at the highest point in the center. This supply wasample in the early stages of development, but when the population increased toabout 10,000 it proved to be insufficient, so additional water was drawn fromthe Allier River, some 4 miles distant. The water from both of these sources wasfairly good, but too uncertain in quality for use without chlorination.

The sewerage system disposed of only the liquid waste. The pail system wasused in connection with the latrines, the pails being collected once or twice aday and their contents burned. A few of the earlier units to arrive wereequipped with Horsfall incinerators, but the later units used improvisedcrematories which seemed to work equally as well. These crematories were fairlysatisfactory, but required a great deal of fuel and were not entirely free fromodor.

All laundry work was done at Nevers, the nearest city of any size. A laundrywas under construction in the center when the armistice was signed.

Bread at first was obtained at Nevers. Later a bakery company established abakery, which proved very efficient and adequately met all demands.

The headquarters of the center were organized into the following departments:Commanding officer, chief of staff, adjutant, professional staff, sanitarystaff, medical supply department, quartermaster department, receivingdepartment, evacuating department, motor transport, railway transport, personneladjutant, central purchasing agent, signal corps, central records office, engi-

^jThe statements of fact appearing herein are based on the "History of The Mars-sur-Allier hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

576

F IG.108.-General view of Mars hospital center, looking northeast from tower at westend of center

577

neers, headquarters detachment and band, post office, fire department,provost marshal, welfare organization, judge advocate department, chief nurse.These departments were developed to fit the needs of various organizations, andwith slight modification proved very efficient in hospital administration. As anexample, the professional staff at headquarters, consisting of the surgical,medical, genitourinary, neuropsychiatric, orthopedic, X-ray, eye, ear, nose andthroat, laboratory and dental consultants, were responsible for the coordinationof the professional work of the center. Another important department was thecentral purchasing agency, a development made necessary by the large amount ofsupplies purchased and the tendency of independent organizations to bid againsteach other, thus raising the price of supplies. This was overcome by having allpurchasing for the entire center made through one department and distributed tothe various organizations as required.

F IG.109.-One of the operating rooms, Mars hospital center

The central records office was established at the beginning of the center. Inthis office an effort was made to keep a duplicate record of every person thatcame into the center. Thus it was possible within a very few moments to locateany individual in the hospital. This department was a great timesaver and provedits value as the center grew.

As frequent calls came in for operating and special teams for duty at thefront, many of the hospitals were reduced to an actual minimum of workingpersonnel. It became necessary to centralize the various departments of thehospital. The central laboratory was first to be organized, and here the bulk oflaboratory work was performed, but each hospital maintained sufficient equipmentto do routine urinalysis and simple blood work. Similarly the

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X-ray and eye, ear, nose, and throat departments were centralized. As thecenter grew, it proved advisable to classify all cases and assign them tospecial hospitals. Some of the special hospitals were concerned largely withbone work, some with chest, and others with general medicine and surgery. Acomplete contagious hospital was in the process of organization when thedevelopment stopped. A central dental clinic was in active operation at the timethe armistice was signed.

Prior to the influenza epidemic, in the fall of 1918, the medical service wasnot very active. With this epidemic, however, came a great number of pneumoniacases, with resultant complications of empyema. This made specialization ofchest work necessary, and most of this surgery was handled by one unit. Eachhospital maintained a contagious department of its own for each particular classof disease. One hospital cared for mumps, another for measles, another forscarlet fever, and so on. Medical cases were almost entirely confined to twohospitals. In addition to those mentioned, there was the orthopedic hospital andone for neuropsychiatric cases.

Owing to the unfamiliarity of the new personnel of the hospitals with MedicalDepartment records, it was necessary to install some system of instructing thenew organizations on these particular subjects as soon as they arrived. Two ofthe units were utilized as school of instruction. When a new hospital unitarrived its adjutant, registrar, mess officer, sanitary officer, seniornoncommissioned officers, and clerks were distributed for instruction to one ofthese hospitals and remained there until they were fairly familiar with therecords and their own hospitals were ready to receive patients.

All notices regarding the arrival of hospital trains were sent by telegramfrom regulating stations. Upon arrival of the trains the ambulant cases wereremoved first, all patients as a rule being taken directly to the receivingsheds of the hospital to which they had been assigned. At first, class Apatients were evacuated direct to duty; later all evacuations were made from theconvalescent camp.

A Red Cross hut was established at each hospital, where refreshments wereserved every afternoon, and practically every night some form of entertainmentwas given. In addition to these huts, a central theater was operated by the RedCross.

The center organized a complete symphony orchestra of about 60 musicians, anda band of 36. It had an excellent vaudeville troupe, glee club, and several malequartets.

The convalescent camp occupied an area of about one-half mile square andcomprised 100 tent units, with 301 tents (299 marquee and 2 Denry), 38 woodenbuildings, 4 wooden latrine groups, 3 sheds, and 4 feces destructors. All tentunits, buildings, and roads had double ditches.

Patients were admitted to this camp not only from the Mars center, but alsofrom the Vichy center, Chatel Guyon, and Chaumont. On August 18, 1918, therewere 130 patients in the camp, and on October 1 there were 1,796. This numbersteadily increased until the maximum of 4,565 was reached on December 5, 1918.The greatest number ever received in one day was 435. The largest evacuation was1,336, made on December 18, 1918. Up to January 1, 1919, 11,497 men had beenreceived and 9,638 evacuated.

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The policing of camp was a large problem, necessitating a guard ofapproximately 210 men. The guard was partially armed during the day andcompletely so at night. An officer of the permanent personnel always acted aspolice officer, while the officers of the day were drawn from the convalescentline officers. The institution of formal guard mount very much improved thediscipline and behavior of the guard. The center sanitary officer did notexercise jurisdiction over the sanitation of the camp, therefore a sanitarysquad of from 50 to 100, headed by one of the permanent officers and assisted bya number of noncommissioned officers, was organized.

The military discipline was splendid, largely due to a greater percentage ofmilitary ceremonies and drills than usually occurs in establishments of thatnature. The camp maintained from 4 to 10 companies of convalescents, numberingfrom 150 to 520 each. The medical officer in charge of each company was not onlyresponsible for the records and the health of the men, but also for theirmilitary instruction. All phases of military work were taken up, including theschool of the soldier, company, battalion, and regiment, and special ceremonialformations as well.

F IG.110.-View of convalescent camp (east end), looking north from water tower, Marshospital center

Next to military discipline and drill there was nothing that contributed somuch to the physical and mental welfare of convalescents as agreeable work. Tenshops were established, 2 tailor shops, 2 barber shops, 1 electrical-repairshop, 1 cobbler shop, 1 cot-repair shop, 1 carpenter shop, 1 disenfecting shop,and 1 sign-painting shop. When a patient was discovered who had any particulartraining or inclination, industrially or artistically, he was given everyopportunity to work.

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Athletics were encouraged in all forms, and intercompany competition inbaseball and football was very keen. The convalescent camp closed on February 1,1919. The hospital center at Mars-sur-Allier was discontinued on May 20, 1919.

COMMANDING OFFICER

Col. George A. Skinner, M. C.

HOSPITAL CENTER, MESVES^k

CONSTRUCTION FEATURES

Construction of the Mesves hospital center, located between the villages of Mesves and Bulcy, in the Department of Nievre, was approved by the general staff, A. E. F., in December, 1917. This site was selected because of its location on the Paris, Lyon & Mediterranean Railroad, its rolling and slightly elevated contour and its accessibility to the Loire River for water supply.

F IG. 111.-Aview of part of Mesves hospital center during the construction period

The original plan for the center embodied 10 base hospital units, each of1,000 beds, with space for crisis tent expansion of an additional 1,000. Eachunit was to consist of 55 buildings apportioned to administration, receiving andevacuating, bathhouses, quarters for personnel, recreation hall, morgue, X-rayand operating, supply storehouses, garage, and disinfection.

In July, 1918, additional plans were approved to increase the construction ofthis center to 20 base hospital units. These additional units were somewhatmodified; the number of ward buildings was reduced by half, and each wardbuilding made twice the size of the earlier ones.

^kThe statements of fact appearing herein are based on the "History of the Mesves hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

581

The construction of the center was left to a firm of contractors in Paris, onJanuary 31, 1918, and under the terms of the contract they were to furnish allmaterial which could be obtained in France and all labor possible. The actualconstruction was to be done under the direction of an engineer officer, AmericanExpeditionary Forces. The construction work was begun on February 7, 1918, butprogressed very slowly during the first three months. In fact, so slowly, thaton June 15, 1918, when the commanding officer of the center arrived, the onlybuildings completed were 6 wooden barracks in unit No. 10, and 5 barracks inunit No. 1, partially completed. At this time about 20 hotels and otherbuildings in Pouges-les-Eaus, about 11 miles from the Mesves center, were takenover by the center and converted into a base hospital.

F IG.112.-A row of wards, Mesves hospital center, during construction period

This delay in construction was largely due to difficulties in receivingbuilding material and transportation. A standard-gauge railroad siding was builtand numerous roads were constructed throughout the center before anyconstruction of barracks was begun. The first units to be partially completedwere Nos. 1 and 5, closely followed by 6, 10, 2, 3, 4, 7, and 8. Patients beganto arrive before the hospital buildings were completed, and many of these wereoccupied with only a floor, walls, and a roof; there were no windows, doors,plumbing, lighting, and heating facilities. However, they served the purpose ofshelter, which was a point of paramount importance. During the last six monthsof 1918 the construction work progressed fairly satisfactorily, and by December1 the first half of the center was practically 100 per cent completed, and inthe second half, units 15, 16, 12, 13, and 11 were partially completed, wereoccupied, and cared for a full quota of patients. The construction of the fiveremaining units was stopped with the signing of the armistice.

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The water supply at first was obtained from a well, which soon dried,necessitating the use of water from the highly contaminated Mazon Creek, whichrequired the utmost care and supervision as to proper chlorination before using.This continued until the latter part of October, 1918, when the supply wasaugmented from the Loire River. In the latter part of November all water wassupplied by the pumping station on the Loire, with chlorination at the source.

The sewerage system emptied into a clarification tank, constructed ofreinforced concrete, on the banks of the Loire about 2 miles from the center.The construction of the sewerage system was very slow, and it was late inNovember before any of the units in the first half of the center had sewerageconnections.

F IG. 113.-Rockquarry, used in construction of Mesves hospital center

The latrines of the center were operated on the pail system. Five Horsfalldestructors and a central destructor were in operation until January, 1919, wheneach hospital unit was supplied with a brick feces destructor. Some garbage andwastes were disposed of by contract to civilians; the remainder being destroyedin the central destructor. Later a type A hospital incinerator was constructedin each unit.

At first only one disinfector, American Sterilizer Co. type, was available;however, in August, 1918, two Thresh disinfectors were received, and these byconstant use took care of all disinfections. In December there were 4 portableand 4 Thresh disinfectors in use.

The lighting system consisted of two 25-kilowatt General Electric sets andone 50-kilovolt-ampere steam-driven plant. A
permanent lighting system

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was installed December 10, 1918, furnishing current of 110 volts to allbuildings throughout the center and 220 volts to X-ray and operating buildings.

UNITS

On June 15, 1918, the commanding officer of the center arrived. On June 23the crew of Hospital Train Unit No. 26, consisting of 2 officers and 31 enlistedmen, arrived, and were immediately assigned to work on unit 1, making it readyfor the reception of patients. On June 26, 6 officers and 60 enlisted men,comprising Convalescent Hospital Unit No. 2, arrived at Pougues-les-Eaux andwere assigned to the newly leased hotels at that place. On this dateConvalescent Depot Unit No. 1 (the only one ever organized), consisting of 2officers and 5 enlisted men, also arrived. This constituted the MedicalDepartment personnel until July 18, when the Sanitary Squad No. 2, consisting of1 officer and 26 men, reported for duty. On the 23d the crew of Hospital TrainUnit No. 35 arrived.

The following organizations constituted the Mesves Hospital Center:

MEDICAL

Sanitary Squad No. 44.
Sanitary Squad No. 50.
Sanitary Squad No. 78.
Sanitary Squad No. 80.
Hospital Train Unit No. 35.
Provisional Base Hospital Unit No. 3.
Provisional Base Hospital Unit No. 8.
Base Hospital Unit No. 44.
Base Hospital Unit No. 50.
Base Hospital Unit No. 54.
Base Hospital Unit No. 67.
Base Hospital Unit No. 72.
Base Hospital Unit No. 86.
Base Hospital Unit No. 89.
Base Hospital Unit No. 108.
Evacuation Hospital Unit No. 24.
Evacuation Hospital Unit No. 27.
Evacuation Hospital Unit No. 29.

ENGINEERS

Detachment 109th Engineers.
Engineer Train Unit No. 109.
Detachment 521st Engineers.
Detachment 529th Engineers.
Casual Engineers Detachment.

QUARTERMASTER CORPS

Quartermaster Detachment.
Detachment Bakery Company No. 2.
Detachment Bakery Company No. 314.
Detachment Butchery Company No. 328.
Detachment Laundry Company No. 323.
Detachment Laundry Company No. 324.
Pack Train Company No. 329.

ARMY SERVICE CORPS

Administrative Labor Company No. 2.
Administrative Labor Company No. 26.
Administrative Labor Company No. 28.
Administrative Labor Company No. 90.
Administrative Labor Company No. 91.
Administrative Labor Company No. 134.
Administrative Labor Company No. 182.

MOTOR TRUCK COMPANY

Motor Truck Company No. 543.

MILITARY POLICE

Military Police Company No. 223.

ADMINISTRATION

HEADQUARTERS

The commanding officer established his headquarters in a set of buildingsknown as the central administration group, and from here the entireadministration of the center was accomplished. The work was, as rapidly aspossible, divided into departments, and an officer assigned in charge of each.

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The officers composing the staff of the commanding officer and many of theirassistants, were taken from the various organizations within the center. Thispersonnel lived in buildings provided for this purpose in the administrationgroup. The enlisted men composing the headquarters detachments were secured fromvarious sanitary squads, hospital train units, and casuals, ordered to thecenter. These organizations, upon arrival, immediately lost their identity assuch and were amalgamated into the headquarters detachment.

Each organization in the center was allowed absolute freedom in administeringits own internal affairs, subject to existing regulations. Policies affectingthe entire command were controlled by the commanding officer of the center.

SANITARY OFFICER

In addition to the center sanitary officer, each unit had a sanitary officer,who was directly accountable to his unit commander but cooperated with thecenter sanitary inspector. The center sanitary officer maintained a shop wheresanitary appliances were made and repaired

QUARTERMASTER

The office of the center quartermaster was established July 13, 1918, with 1officer and 5 enlisted men. The personnel was augmented gradually until early inJanuary, 1919, when it reached maximum strength of 500 officers and enlisted menand 600 laborers. The office eventually comprised the following divisions:Personnel, finance, property, subsistence, bakery, laundry, and salvagesections, and center purchasing agency.

MEDICAL SUPPLY DEPOT

This depot was organized in August, 1918. The major portion of the medicalsupplies was received in carload lots from base storage stations and the largercentral depots, ranging from 10 to 15 cars per day. A spur track permittedplacing cars of supplies alongside the warehouse.

RAILROAD TRANSPORTATION SERVICE

This office was inaugurated on August 1, 1918. In addition to numerous clerksand messengers, an engineer, fireman, conductor, and two brakemen were added tooperate the center switch engine. During its existence this office handled 3,500cars. In addition, 86 hospital trains were handled between August 1, 1918, andJanuary 1, 1919, and 1,600 transportation orders were issued.

MOTOR TRANSPORTATION DEPARTMENT

This department was organized in the latter part of September, 1918, when alltransportation of the center was placed in a pool under direct control of themotor transport officer. The transportation consisted of 127 trucks, ambulances,and other vehicles.

RECEIVING AND EVACUATION SERVICE

On arrival of a train at the Mesves station, the center receiving andevacuating office was so notified by the railroad transportation office.Messages, stating the number and kind of cases, were sent immediately tohospitals

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of the center that were to receive patients. The motor transport officer wasalso notified as to the number of the train and the prospective disposition ofthe patients in hospitals. The assignment of patients to hospitals was gauged bythe kind of cases being received.

Up to January 1, 1919, 86 hospital trains arrived at the center, with a totalof 31,912 patients. Seventy-two of these trains came directly from theevacuation hospitals at the front, arriving in an average time of 28 hours. Inaddition to these patients brought by the hospital trains, a great manyconvalescents and slightly sick and wounded were received from near-byhospitals. Upon arrival, patients were classified into class A, B, C, or D.

Prior to October 1, 1918, all evacuations, except class D, were made from theconvalescent camp, transfers to the camp taking place informally by returningmen to duty status from the hospital in which they had been treated. AfterOctober 1, all class A and permanent class C men were evacuated directly fromhospitals, and class B and doubtful class C cases were sent to the convalescentcamp. Class D patients were transferred to the base ports. Up to January 1,1919, the center evacuated a total of 28,456.

MEDICAL INSPECTOR

This department was opened December 20, 1918. Its object was constructivecriticism and the rendering of assistance in the various departments ofhospitals. Particular attention was directed toward the administration work ofthe organizations.

MILITARY POLICE

As regular military police were not available, a company was formed fromclass A patients, and an officer for them was detailed from the Engineerregiment. In addition to this company a traffic police detachment was organized,consisting of 70 men under the direction of the fire marshal. The latter wereemployed in policing, fire prevention, and as watchmen over quartermaster andmedical supply depots.

PROFESSIONAL SERVICES

MEDICAL SERVICE

The original conception of the center called for 20 hospitals, with a crisisexpansion capacity for a total of 40,000 beds. Such an immense plant necessarilypresented broad opportunities for classification of cases, and although butlittle over half the number of patients originally intended were sent there, thescheme of differentiation of the medical cases was maintained throughout. Thepatients with pneumonia and severe infectious diseases were sent to specifiedunits; patients with influenza, gastrointestinal diseases, and gas poisoning toanother group, while in a third group the slightly ill were collected.

The distinctively influenza hospitals were cubicled. When shortage of sheetswas imminent, newspapers were employed most usefully to replace them. Isolationwas carried out, and incipient cases of pneumonia were transferred promptly tothe near-by pneumonia units.

The usual group of contagious diseases was divided between two hospitals.Diphtheria, scarlet fever, measles, and mumps were treated in one, and epidemic

586

meningitis and typhoid fever in another. The grouping of other diseasesgradually took place.

An organization for control of diseases at the hospital center at Mesves wasa board consisting of the chiefs of medical and laboratory services and thesanitary inspector, who met informally from time to time and devised preventivemeasures, as required.

OPHTHALMOLOGY AND OTOLARYNGOLOGY

A consultant in otolaryngology was appointed in October, 1918. Each hospitalin the center had on its staff a qualified specialist in these branches, whocared for the cases within his own unit.

MAXILLOFACIAL SURGERY

In October, 1918, a consultant for the center was appointed. He had directsupervision over all maxillofacial cases and determined whether or not thepersonnel of the hospital where these cases were under treatment was capable inevery way to care for them, and ordered the transfer of any cases that neededspecial care to the unit particularly designed for that purpose. A centraldental laboratory was established and operated under the direction of theconsultant. All available material and apparatus for the construction of splintsand appliances was grouped in this laboratory.

ORTHOPEDIC SERVICE

A consultant in orthopedic surgery for the center was appointed the latterpart of August, 1918. At this time two hospitals were selected for the receptionof orthopedic cases, but later it proved necessary to take over certain wards inall other hospitals. The admission of fracture and joint cases was so great inOctober that it became necessary to establish 16 fracture wards in varioushospitals. Owing to the fact that it was necessary to change dressings on allthese cases on admission, it was impossible for the ward surgeon to adjustsplints, erect Balkan frames, and apply extensions, so a splint team wasorganized, consisting of 1 medical officer, 1 sergeant, and 1 private. As soonas a ward began receiving
orthopedic patients this team was set to work erecting frames and suspending thecases. Usually this work would be done for all the urgent cases in a day.

In a latter part of October a curative workshop combined with a splint shopwas opened. During its existence 658 special splints were manufactured. At thistime six reconstruction aids in physiotherapy arrived and were assigned to dutyin the fracture wards.

LABORATORY SERVICE

The center laboratory was opened August 3, 1918, its work being outlined asfollows: (1) Special pathology (gross and microscopic); (2) special bacteriology(pneumococcus typing, typhoid and dysentery); (3) serology (agglutination andcomplement fixation reactions); (4) general board of health for center (wateranalysis, carrier work); (5) preparation of media, purchase and requisition ofsupplies.

All laboratory supplies arriving in the center (except those of Base HospitalNo. 44, at Pougues-les-Eaux) were invoiced to the central laboratory officer andissued by him on memorandum receipts to the several unit laboratories.

587

CONVALESCENT CAMP

On July 17, 1918, a temporary convalescent camp was established in the crisisexpansion tents of one of the base hospital units. The first convalescentpatients were received on July 19. The construction of the permanentconvalescent camp began on July 28, near Bulcy, northeast of the center. Thecamp was occupied on August 7, before any of the permanent buildings werecompleted.

The personnel at this time consisted of commanding officer, adjutant, messand supply officers, 2 medical officers, commanding companies, 1 convalescentline officer, and 35 men from Hospital Train Unit No. 35. By August 30, therewere 1,030 convalescents in camp, and 131 tents had been erected, eachaccommodating 16 men on cots. The administration building, officers' quarters,and mess and kitchens were partially completed and occupied. On September 19,Convalescent Camp Unit No. 4, consisting of 9 officers and 90 men, arrived, andthe patients, now numbering 1,800, were organized into 6 companies. One medicalofficer was assigned to each company.

Admission and evacuation to the camp occurred almost daily, the admissionsalways being larger, leaving an increasing balance in camp, until November 10,1918, when the greatest number (2,859) was reached.

THE AMERICAN RED CROSS

In the early days the work of this organization consisted of distribution ofextra comforts in the wards, letter writing for patients, and searching work.Later, 10 recreation halls were opened, equipped with stages, furniture, andcanteens. In addition to these, an especially large hall was equipped at theconvalescent camp. Also, halls were opened for the Red Cross personnel, nurses,and others. Daily entertainments were furnished by six moving-picture machinesand various theatrical productions.

YOUNG MEN'S CHRISTIAN ASSOCIATION

The Young Men's Christian Association provided a number of lectures,musicians, and vaudeville artists. Baseball outfits, footballs, and basket ballswere also furnished.

CLOSURE

The center ceased operating in April, 1919, and was closed in May, 1919.
COMMANDING OFFICER

    Col. Henry C. Maddox, M. C., June 15, 1918, to August 16,1918.
    Col. William H. Moncrief, M. C., August 17, 1918, to January30, 1919.
    Col. Guy V. Rukke, M. C., January 31, 1919, to closure ofcenter.

HOSPITAL CENTER, NANTES^l

The hospital center at Nantes was organized July 29, 1918, at Doulon, asuburb of Nantes. One base hospital unit (No. 34) was located at Nantes, about 3miles from the center proper. The group originally consisted of three

^lThe statements of fact appearing herein are based on the "History of the Nantes hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

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base hospitals, Nos. 34, 38, and 11, and to these, on November 2, 1918, wasadded Base Hospital No. 216, which had been organized from personnel in thecenter. During January, 1919, Evacuation Hospitals Nos. 36, 31, and 28 relievedthe three original base hospitals. In addition to the above units, the followingorganizations served in the center: Sanitary Squads Nos. 39 and 59 and AmbulanceCompany No. 346.

Water was obtained through the city of Nantes from the River Loire, andproved to be of good quality. Sewage was emptied into the River Loire, afterhaving first passed through a septic tank. Waste material was disposed of in twotype A incinerators constructed by the engineers.

The laundry at first was handled by contract, but as this provedunsatisfactory, small hand laundries were installed in each unit and operated bycivilian laundresses.

ADMINISTRATION

The headquarters staff comprised the following divisions: Adjutant,quartermaster, sanitary inspector, evacuating officer, laboratory officer, firemarshal, medical supply officer, and guard officer. The commanding officer in noway interfered with the internal administration of the units; his relationswith the hospitals concerned chiefly matters which were outside the jurisdictionof the hospital commanders. The office of the group quartermaster wasestablished on August 15, 1918, and a subsistence and sales commissary onOctober 15. Supplies were easily procured as the quartermaster depot of basesection No. 1 was within 4 miles of the center, and all requisitions werepromptly filled. The medical supply depot was not fully established untilOctober 15, 1918. Supplies were usually received from intermediate medical depotNo. 2, Gievres, and base medical storage depot, St. Nazaire. The centerlaboratory occupied a type A barracks and a subsidiary laboratory building, 20by 40 feet. The addition, connected with the main laboratory building, containedan ice chest and autopsy and tissue rooms.

The duties of the evacuating officer comprised: (1) Receiving all patientsarriving at the hospital center, and by the use of bed reports from the varioushospitals directing them to the proper hospitals for admission; (2) file andrendition of reports showing the number and nature of cases of patients in thevarious classes in the center; (3) receiving and executing through the unitevacuating officers, the regulations and orders relative to the evacuation orfinal disposition of all cases.

Prior to the arrival of a hospital train the evacuating officer wasinvariably notified by telegram or telephone. Sixteen ambulances were keptavailable at the center for the evacuation of patients from hospital trains.These trains were sidetracked at the Doulon station, less than five minutes'drive from the center. The patients on arrival at receiving wards were servedhot chocolate and other nourishments by the American Red Cross.

Evacuations to the United States were made through one hospital unit (BaseHospital No. 216) which was designated as the embarkation or evacuation hospitalfor the center. Certain wards of that unit were set aside as embarkation wards,and an embarkation office was opened, in charge of an officer, assisted by anexperienced clerical force. Each day this office notified

589

the various hospitals of the center the exact number of patients expectedfrom them on the following day. Before transfer to the embarkation departmentthese cases were paid, their records completed, they were equipped as fortransfer to any other hospital, furnished with wound and service chevrons andcertified as free from venereal or contagious diseases and vermin. Uponadmission to the embarkation department, they were organized immediately intoconvalescent detachments of 50 or more, all their records checked and corrected,their money exchanged for United States currency, and the passenger listsprepared.

Upon receipt of requisition for convoy of certain numbers of patients thecenter evacuating officer made arrangements with the local railway transportofficer as to the hour of loading, necessary baggage cars, etc., and alsonotified the local representative of the inspector general's office of thenumber of patients to be evacuated and the time that patients' records andequipment would be ready for final inspection, which was held not more than 24hours prior to entraining. After the final inspection, detachment commandersreceipted to the evacuation officer for the patient's records and equipment, andpatients were again checked on board the hospital train by passenger lists.

CONVALESCENT CAMP

The camp was opened on November 7, 1918, and was operated by ConvalescentCompany No. 5. Seventy-two marquee tents, with a bed capacity of 1,000, wereprovided for the housing of patients. The camp functioned from November 7, 1918,to January 9, 1919, during which time it admitted approximately 1,500 patients.About 30 per cent of these were restored to class A and returned to theirorganization.

CLOSURE

The hospital center was abandoned and ceased to function on June 8, 1919.

COMMANDING OFFICER

Col. Thomas J. Kirkpatrick, M. C., July 29, 1918, to March16, 1919.
Col. Ralph C. DeVoe, M. C., March 17, 1918, to June 8, 1919.

HOSPITAL CENTER, PAU^m

A hospital center at Pau was authorized on September 3, 1918. It was plannedthat this would be located in hotel buildings in several widely separated townsin the Department of Basses-Pyrenees, near the Spanish border. Nearly a monthwas required for inspection of the properties offered by the French, and notuntil October 16, 1918, were headquarters of the center opened at Pau. Personneland supplies had begun to arrive at the time the armistice was signed.

Four hospitals reported to the center during December, 1918. These werelocated as follows: Base Hospital No. 71, Pau; Base Hospital No. 98, Lourdes;Evacuation Hospital No. 20, Dax; Evacuation Hospital No. 29, Bagneres-de-

^mThe statements of fact appearing herein are based on the "History of the Pau hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

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Bigorre. These hospitals never functioned, as orders were received onDecember 30, 1918, to abandon the center and the various organizations wereordered to other stations.

COMMANDING OFFICER

Col. Adam E. Schlanser, M. C.

HOSPITAL CENTER, PERIGUEUXⁿ

The hospital center at Perigueux was located in the valley of the Isle Riveron both its banks, about 1? miles above the city of Perigueux and about 90miles east of Bordeaux. The center was organized on September 16, 1918, and thefollowing organizations were attached: Base Hospital No. 84, Base Hospital No.95, Administrative Labor Companies Nos. 147 and 148, Motor Truck Company No.523, Sanitary Squad No. 75, Regimental Band, 136th Infantry, Bakery Company No.316, and half of Convalescent Company No. 12.

The roads in the neighborhood of this center were excellent. Buildingsoccupied consisted of new construction distributed according to the type A planfor base hospitals. Construction was of concrete throughout except nurses' andenlisted men's barracks, which were built of wood. Five units were planned forthis group, two on the south side and three on the north side of the river, butonly the two units on the south side of the river were completed and occupiedwhen hostilities ceased.

Water was obtained from the Perigueux city supply, and was chlorinated at thepumping station, two enlisted men being stationed at the pumping station tosupervise chlorinating the apparatus. In general the supply of water wasabundant, though occasionally difficulty was experienced for a few days at atime. Separate lavatories and baths were provided for patients, personnel,officers, and nurses connected with the sewerage system through a septic tank.Garbage was readily disposed of to farmers, but it was found more profitable tobuy pigs and feed them the garbage. Two Horsfall destructors were erected. Theyproved ample and satisfactory and were economical of fuel.

The operating pavilion was heated by steam; all other buildings were heatedby stoves. Coal was shipped from Bordeaux and there never was a shortage. Woodwas also provided in sufficient amount. Until November 20, 1918, all electricitywas furnished by a local generator and after that date, from the city supply.

The various messes of the center were coordinated under the management of acenter mess officer. This permitted various economies and a more intelligent useand division of the supplies which were obtained by the quartermaster fromBordeaux. A central butcher shop was installed from which all organizations drewtheir meat, properly cut. A bakery company was established in tents and madeexcellent bread. After this organization left, the source of bread supply wasBordeaux, but this was not dependable. A laundry was constructed early, butmachinery was not obtained until after the armistice

ⁿThe statements of fact appearing herein are based on the "History of the Perigueux hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

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began. Until then it was necessary to send laundry to the Beau Deserthospital center in trucks and ambulances, a circumstance which did not allowfrequent changes of linen.

The first hospital train arrived October 18, 1918, and up to March 1, 1919,4,558 patients were received from 9 trains. Early in January the center wasdesignated as an orthopedic center, and 10 orthopedic surgeons reported forduty. Evacuations were made by Hospital Train No. 68 to the Beau Desert hospitalcenter. This group was discontinued in May, 1919.

COMMANDING OFFICER

Col. Edward G. Huber, M. C.

HOSPITAL CENTER, RIMAUCOURT^o

The hospital center located at Rimaucourt, Haute-Marne, occupied newstructures consisting of five type A base hospital plants, supplemented bybuildings to house the center staff. A railroad spur of three tracks was builtinto the center, and hospital units were aligned along both sides of this spur.

The normal bed capacity of the wards was 5,000, but by erection of Marqueetents this was more than doubled. On November 11, 1918, the center reported10,338 available beds for patients and 1,675 personnel. A convalescent camp andfive additional sections were under construction when hostilities ceased.

The water supply was excellent and ample. A 50,000-gallon reservoir was builton a cliff about 1,000 yards from the camp, and two electric engines pumped allthe water that could be used. A system of plumbing conducted this supply intonearly every building of the group.

A sewer system emptied all kitchen and bath wastes into a canal about 2,000yards distant. Bucket type latrines were used in connection with Horsfallincinerators.

Electricity for illumination was obtained from a local French plant,supplemented by a small gas-operated electric machine that was provided for eachunit.

One bakery capable of baking for 20,000 men and one laundry able to care fora like number were also provided.

The following organizations composed the center: Base Hospitals Nos. 52, 58,59, 64, 238; detachments, Quartermaster Corps, bakery company, butchery company,laundry company, Motor Transport Corps, and labor battalion.

The headquarters were organized into administrative and professional staffs.The administrative staff consisted of the adjutant, quartermaster, medicalsupply officer, sanitary officer, assistant provost marshal, post-officeofficer, food conservation and kitchen technique officer, and railway transportofficer.

The professional staff consisted of a staff consultant, consultants ingeneral surgery, neurosurgery, orthopedics, oroplasty, urology, ophthalmology,

^oThe statements of fact appearing herein are based on the "History of the Rimaucourt hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

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otolaryngology, X ray, dentistry, neuropsychiatry, dermatology, laboratory,and pathology. The staff consultant had no administrative power. His duties were(1) to coordinate with the visiting consultants and to present hisrecommendations to the center commander; (2) to advise and keep the centercommander informed about every professional question and to act as his medicalinspector; (3) to advise changes in personnel so as to group specialists wheretheir services were needed, and to report any excess of personnel; (4) toarrange through base hospital commanders, by mutual consent, such transfer ofpatients and personnel as might be desirable without the necessity of issuingorders to accomplish this result. Upon receipt of notification of the arrival ofa hospital train, the staff consultant requested all hospital commanders torequire such officers as were desired to report to him for orders. The staffconsultant and evacuation officer then decided where to "spot" thetrain and gave necessary instructions to the rail transportation officer. Assoon as the train arrived the staff consultant assigned to each of three or morecars, suitable teams of medical officers. These officers decided to whichhospital each patient was to be sent and gave him a slip of paper bearing thatnumber. The litter-bearer section followed the officers and evacuated the train.Walking cases were not permitted to walk from the train to the hospitals, butwere transported in trucks.

Each commander of a base hospital kept two wards open for receiving purposes.All beds in these wards were cubicled and all persons on duty therein woremasks. As soon as admissions began, the surgeons in these wards began thesecondary triage, sending to the registrar and the disinfecting station allcases ready for final disposition. At this triage, if it was found, for example,that a man had been admitted to the respiratory infection hospital when heshould have been admitted to the gas hospital, the staff consultant was notifiedand transfer was effected.

The number of patients admitted to the center from date of opening onSeptember 14, 1918, to January 28, 1919, was 18,308. The center was discontinuedin May, 1919.
COMMANDING OFFICER

Col. Henry Page, M. C.

HOSPITAL CENTER, RIVIERA^p

The origin of the Riviera hospital center was an urgent need for a locationfor hospitals that would give the maximum hours of sunshine and clear skies,even temperature, and the most stimulating atmospheric conditions withinpracticable distance of the advanced areas. This was found in that strip ofcoast line extending from Marseille to Menton, called the Cote d 'Azure, orRiviera, about 180 miles in extent, 5 to 10 miles in depth, facing theMediterranean Sea and sheltered by the Maritime Alps. Rainfall was limited andthe climate mild rather than hot. Aerial bacteriology was low and the generalatmospheric condition partook of the mingling of marine and mountain air. It

^pThe statements of fact appearing herein are based on the "History of the Riviera hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

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was too far from the scene of active operations to receive cases of recentinjuries or acute illness, and therefore all cases received were patients whohad so far recovered as to be able to stand a long journey. The center comprisedall the hospitals along the north coast of the Mediterranean from Toulon to theItalian border, and functioned as a group of convalescent hospitals. The numberof these hospitals was 29.

The hospitals established by the American Expeditionary Forces were locatedat Tamaris, Hyeres, St. Raphael, Cannes, Nice, Cap d 'Ail, and Menton. In eachof these places commodious hotels were leased and changed to hospitals fullyequipped as regards both personnel and furnishings for the accomplishment of themost modern work in medicine and surgery. A certain number of acute medical andsurgical cases developed among those who were on leave or stationed in the area,and hospital equipment took cognizance of that fact. All hospitals wereestablished in hotels and no new construction was attempted. Garage andwarehouses were rented for purposes of supply.

Acquisition of hotel properties began in July, 1918. By September 1,accommodations for 9,000 beds had been secured and by November 1, 1918, 12,000.On November 11, requests for locations for 6,000 other beds which previously hadbeen made were canceled.

The geographical location of hospitals made it advisable to establish fivegroups, with one hospital in each group for acute medical and surgical cases,and the remainder in each group for ambulant cases requiring but littletreatment or professional observation. Each group was organized as one hospitalfor purposes of admission, transfer and discharge, and general administration.Each building had its own personnel with a responsible administrative officerunder the group commanding officer.

Group 1.-Hyeres, Department of Var (including Tamaris), consisted of 9hotels, with a total capacity of 3,600. This group was first designatedConvalescent Hospital No. 1, but on arrival of Base Hospital No. 99, on November26, 1918, the designation was changed to that of the base hospital.

Group 2.-St. Raphael (including Agay Var) consisted of 3 hotels, witha total of 800 bed capacity. It was known as Convalescent Hospital No. 2 and wasstaffed by casual personnel. It opened January 4, 1919, and closed January 31,1919.

Group 3.-Cannes (including Antiles) consisted of 5 hotels, with 1,450beds, and was known as Convalescent Hospital No. 3. On December 22, 1918, thisgroup was taken over by Base Hospital 93.

Group 4.-Nice (including Cap d'Ail) consisted of 3 hotels, with 2,300beds, and was known as Convalescent
Hospital No. 4.

Group 5.-Menton consisted of 9 hotels, with 2,700 beds. This group wasfirst started with casual personnel and was known as Evacuation Hospital No. 5.From December 23, 1918, to February 13, 1919, Evacuation Hospital No. 49operated this group. The headquarters of the entire center were located atCannes, A. M., the organization being as follows: Commanding officer, adjutant,personnel adjutant, urologist, historian, medical supply officer, group supplyofficer, and motor transport officer.

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The records of the Riviera center embodied the daily, weekly, monthly, andquarterly reports received from each unit commander throughout the center.Reports were transmitted daily by the various units by a system of couriers onmotor cycles. This system, in conjunction with the telephone and telegraph, wasthe main factor in the administrative control of the area and made it into acompact unit, reducing the 220 km. which separated the farthest situated groupsfrom each other into a center linking all the groups together. Under itsefficient service the great distances were minimized, and daily contact wasmaintained by headquarters with each group and by all groups with one another.

F IG.114.-Base Hospital No. 99, Hyeres, Riviera hospital center

Patients were received from November 7, 1918, to April 1, 1919, a total of13,975 cases being admitted during this period. Patients were classified by adisability board appointed for each unit by the commanding officer of thecenter. Hospital trains were provided for transporting discharged patients.Those for home ports were shipped direct to embarkation ports, others to duty orspecial hospitals, as the case called for.

The exercise and training of men partially disabled through wounds receivedin battle were under the supervision of the commanding officers of the variousunits. Voluntary movements were insisted upon, which, with the aid of massageand use of electrical instruments, greatly aided in restoring parts, the use ofwhich would have otherwise been lost.

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Railroad transportation officers were assigned to Hyeres, Cannes, and Nice onDecember 15, 1918, and handled all transportation for the personnel, patients,and supplies for the hospitals. Men from the different rail transportationoffices met the incoming and outgoing trains and did all that was possible toassist members of the American Expeditionary Forces while traveling on theRiviera. Practically all patients were handled on regular United States Armyhospital trains. Thirty-four of these trains arrived during the period thecenter was open. These trains parked at La Bocca, just west of Cannes, wherethey were resupplied. When receiving patients, they were "spotted" atCannes, and patients from Menton
and Nice were transferred to that place for evacuation. The trains for BaseHospital No. 99 were switched at Toulon and "spotted" directly toHyeres.

F IG.115.-Base Hospital No. 93, Cannes, Riviera hospital center

Medical supplies for the center were received on requisition from the supplydepot at Cosne, Maramis, and the depot of base section No. 3. At first, becauseof congestion of railroad transportation, supplies were often delayed (theopening of this center had been delayed by inability to procure supplies), butin February, 1919, a medical supply depot was established at Cannes, andthereafter local requisitions of hospitals were filled promptly.

The Quartermaster Department began to function on October 29, 1918, withheadquarters at Cannes. A suitable warehouse was leased at the latter place anda depot established. Later, four subdepots were established for the needs of theentire hospital center. At the beginning of the center the quarter-

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master operated the post office and railway transportation until theseactivities increased to such a great extent that a regular post office and arail transportation office were established. Repairs and improvements to hotelswere made under the engineer officer.

The American Red Cross attached workers to all the groups, where theypromoted the welfare of all persons in the center.

After November 11, 1918, properties were gradually returned to their ownersor made into accommodations for leave areas. No patients were received afterApril 1, 1919, and evacuation began May 1, 1919, the personnel leaving the wholearea June 1, 1919.

F IG.116.-Evacuation Hospital No. 49, Menton, Riviera hospital center

COMMANDING OFFICER

Col. Haywood S. Hansell, M. C., September 12, 1918, toApril 28, 1919.
Lieut. Col. Leopold Mitchell, M. C., April 29, 1919, to June2, 1919.

HOSPITAL CENTER, SAVENAY^q

The hospital center of Savenay was located in the city of that name, about 18miles northeast of St. Nazaire. Its construction was authorized by the commanderin chief in February, 1918, and was to consist of 15 type A base hospital unitsand 1 base hospital in the normal school of Savenay, which had

^qThe statements of fact appearing herein are based on the "History of the Savenay hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

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been in operation since August 21, 1917. A convalescent camp, the so-calledtype C hospital, was also authorized, with a capacity of 5,200 beds. The centerwas organized on August 5, 1918, when the commanding officer of Base HospitalNo. 8 was also appointed commanding officer of the Savenay center. On that datehis staff consisted of an adjutant, quartermaster, evacuating officer, and asanitary officer. Later the organization of the center headquarters was asfollows: Commanding officer, executive officer, adjutant's department (2assistant adjutants), evacuation officer (1 assistant), receiving officer (2assistants), personnel adjutant (1 assistant), service record division,inspector (3 assistants), maintenance officer, sanitary inspector (4assistants), center laboratory officer (3 assistants), medical supply officer (1assistant), motor
transport officer, hospital train replenishment depot, orthopedic consultant (2assistants), dental supervisor, historical officer, athletic director,entertainment director, disability board, quartermaster (8 assistants). Adequateelements of the center staff were kept on duty during the night so that therewas no interruption of its central service.

F IG.117.-Airplane view, Savenay hospital center

The following Medical Department units formed the center: Base Hospitals Nos.8, 29, 88, 100, 113, 118, 119, 214, Hospital Unit F, field hospital company,Ambulance Company No. 345, 87th Division. The eventual capacity of the centerwas to be 25,000 beds. This program was never fully realized because of thetermination of hostilities.

All the unit buildings which were built by the United States Engineersconsisted of demountable sectional barracks and plaster-block structures. Tobuild and maintain the unit shops were established, a garage, stable, and twolarge freight yards were built. Several miles of standard-gauge track were

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constructed and spur tracks laid to connect the various units of the center.About a mile and a half of roads were built in the units. Each unit wasconnected by telephone with a central exchange, installed by the Signal Corps.

Electric power was obtained from a French producer at St. Nazaire. Each unitof 1,000 beds had a 50-kilowatt capacity, the convalescent camp 25-kilowatt, andthe tuberculosis camp 5.

During the early days of the center most of its important work was carried onby Base Hospital No. 8, which was the first unit assigned to this center. Aseach new hospital unit was constructed and made ready for patients, it was givena number as a unit of Base Hospital No. 8, and its activities were carried onthat hospital's records until personnel of a base hospital arrived from theUnited States to continue its functions. Thus, when a new unit reported for dutyit was assigned to take over some provisional hospital already operated by BaseHospital No. 8.

The shortage of water was very serious until a dam was constructed. This dam,of reinforced concrete, was built across a small valley between two hills,forming a reservoir, which had a total capacity of about 140,000,000 gallons. Itwas completed April 10, 1918. An additional reservoir was planned and built, butdue to the signing of the armistice was never used.

Sewerage for the service of three units was taken care of by an Imhoff typetank. In the units not having sewerage connections the contents of latrine pailswere collected each day in cans by prisoners of war, and carried by truck to agravel pit.

Clothing and equipage were difficult to obtain during active operation, butafter the armistice this shortage was relieved. An excellent laundry was inoperation, which averaged 450,000 pieces of laundry per month. A modern bakerywas constructed which supplied all bread for the center. From October, 1918, toMarch, 1919, this bakery produced 5,094,438 pounds of bread.

The medical supply depot was instituted on September 12, 1918. Thisorganization completely equipped and maintained all the hospital units in thecenter, served as a base of supply for all hospital trains entering that area,and furnished medical supplies for prisoner of war companies and engineers doingduty near the center.

The location of Savenay, within one hour by rail of the port of St. Nazaire,and only seven hours from Brest, made it particularly important as an evacuationcenter.

The problem of receiving and admitting patients to the hospitals of thiscenter was at first handled by a receiving officer from each hospital inrotation, each assuming the work for a definite period of one or two days, andthen being succeeded by the receiving officer of the hospital next on the list.Since the functions of certain of the hospitals of this center were of a specialcharacter (e. g., Base Hospital No. 88 cared for all venereal cases, BaseHospital No. 118 all cases of tuberculosis, and Base Hospital No. 69 the veryseriously wounded litter cases), it was always necessary that a classificationof the patients be made upon arrival of each hospital train. A more satisfactorysystem was finally developed when a center receiving officer, with 2 juniorofficers and 8 enlisted men, was appointed. The receiving officer met theincoming trains, with such

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a number of men that one could be assigned to each car. The receiving officerwent through the train, inspected the field medical card of each patient, anddecided to which hospital he should be sent. With the officer a sergeant was inattendance, carrying a box of tags of various colors, each color representing adifferent hospital. When the officer decided to which hospital a patient shouldbe assigned, the sergeant tagged him accordingly.

While this work was going on, the men assigned to the several cars of thetrain made a nominal list of every patient, showing rank, serial number,diagnosis, hospital of origin, and hospital to which assigned at Savenay. Theselists were then turned in to the records office of the hospital center in orderthat admission cards might be made for file and other purposes of record. Thegreater percentage of patients arriving at the Savenay hospital center came onhospital trains, but there was always a certain number coming by way of trenchtrains of the regular passenger service type, and also some who came by motor transportation. Also some were admitted from the personnel of the center.All of these patients, no matter from what route admitted, were required to passthrough the center receiving office in order that they might properly beclassified and
assigned, and in order that record might be made of their admission in thecenter records office.

Each hospital of the center also maintained its own receiving office, but thereceiving officer of any of these hospitals was not allowed to accept a patientuntil he had been through the regular channel of the center receivingoffice.

In the early days of the hospital center, all evacuations made from Savenaywere handled through Base Hospital No. 8 and passed through the records of thathospital.

Prior to November 11, 1918, all American Expeditionary Forces patientsreturned to the United States on surgeon's certificate of disability wereevacuated through Savenay. Until that date efforts of the Medical Departmentwere directed to sending men back to duty where possible, and large numbers ofevacuations were made to the convalescent camp and from that camp back to duty.

After November 11, 1918, instructions were so modified that many patients whounder previous rules would have been sent to duty in class B, were returned tothe United States.

The evacuation service at the hospital center, Savenay, increased after thearmistice began to such an extent that the simple measure theretofore employedproved insufficient, and the work was centralized under the direction of acenter evacuating officer. Each hospital, however, retained its own evacuatingofficer also, and the center, together with the individual units, combined toform one great evacuation hospital. The operation of the system of evacuationnow adopted was as follows:

A representative of the base surgeon at St. Nazaire, or at Brest-forevacuations from Savenay were made through both of these ports-on learning thata vessel was ready for hospital service and able to accommodate a certain numberof patients, would telephone to the center evacuating officer to the effect thataccommodations were in readiness for a specific number of patients of certaintypes which he specified. He might designate, for instance, that there were

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accommodations for 30 litter cases, 60 ambulatory surgical requiringdressings, 210 medical and surgical patients in standees, 590 medical andsurgical cases not requiring attention, and 20 mental cases requiring restraint.The evacuation officer of the center would call upon the evacuating officers ofthe various hospital units telling them how many and what class of patients hewould require from their respective hospitals. In order that he might know justwhat he reasonably could call for, a morning report was supplied by eachhospital, showing the number and classes of patients ready for evacuation. Fromthese reports the center evacuation officer would know the number and characterof patients in each unit ready for evacuation.

As soon as they had received the patients, the evacuation officer of unitssent the patients' records to the central evacuation office of the center, inorder that passenger lists might be prepared. These lists carried the patientsin consecutive numbers for the entire center, giving the quota from eachhospital on a separate sheet, and showing at the head of that sheet theorganization from which each patient came. It was the duty of the evacuatingofficer of each hospital to see that the patients whose names were sent in onthe passenger lists were fully prepared ready for evacuation in every respect.In order to insure uniformity in evacuation, the following method of procedurewas prescribed:

PROCEDURE OF EVACUATION OF PATIENTS FOR EMBARKATIONFROM HOSPITAL CENTER, SAVENAY

1. When the number of patients for Brest or St. Nazaire isknown, the capacity blank is filled out, apportioning cases to the varioushospitals according to the classified morning report of evacuable cases.

2. Determination of number of detachments of ambulatory sickand wounded.

3. Determination of number of officers and attendants neededfor officers, nurses, litter cases, and mentals (not formed in detachments).

4. Requisitions:

(1) Records of patients from various hospitals (Form E-l).

(2) Detachment commanders and attendants to be furnished by personnel adjutant (Form E-4).
(3) Hospital train from regulator of hospital trains and supplies, a copy of the requisition to R. T. O., Savenay, also for baggage car (Form E-5).
(4) Requisition patients (Form E-2).

5. Record envelopes to be brought to evacuation center byevacuation officers of several hospitals, and histories and records checked atthis time. Check passenger list.

6. Send copies of passenger list to various hospitals and tagpatients.

(1) Duty of "taggers" from center to note any colored men tagged and not so marked on passenger list.

(2) To check patients requiring dressings, and see that they are properly tagged. (Exception: Passenger list will be delivered to Base Hospital No. 214, but the patients are not checked or tagged by evacuation center.)

7. Submit data for special orders to orders department.

(1) Patients, officers, nurses, enlisted men.

(2) Data of attendants and detachment commanders to orders department from personnel adjutant at same time it is sent to evacuation center.

8. Notify quartermaster of several hospitals by phone and memoto commanding officers of several hospitals of number of car and place ofloading baggage (Form E-3). No baggage to be loaded unless checker is presentfrom the evacuation center.

9. Block out convoy for the several trains on block (FormE-6).

(1) Confer with commanding officer of train as to any reasons for not loading as blocked.

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10. Loading of train:

(1) (a) Evacuation officers will instruct ambulatory patients before coming to evacuation center to entrain to look for the corresponding number of their little tag, on the block at each stall in the evacuation center; for example, Car A-l, Nos. A-l to A-36. This stall would include all patients numbered A-l up to A-37.

(b) That when they are placed in the stall, to remain there. When going aboard the train remain in the same numerical order to facilitate detraining.
(c) To remain in line and not wander about or lean on rail during inspection, but to cover off in column of twos and stand at attention while being inspected.
(d) To be quiet and orderly and assist in hastening their departure.
(e) That there will positively be no smoking while waiting to entrain.
(2) Load.

11. Record check.

(1) Pull out record envelopes of cross-offs.

(2) Correct Navy copy.
(3) Correct base surgeon's copy.
(4) Correct train commander's copy.
(5) Correct commanding officer of detachment's copy.
(6) Send 16 uncorrected copies of port personnel adjutant with memorandum of serial number of cross-offs on St. Nazaire convoy. (Send only 6 corrected copies to Brest with memorandum to commanding officer, hospital center, Kerhoun, of serial number of cross-offs.)
(7) Send memorandum to Navy officer on second train, giving serial number of cross-offs, if part of a detachment has gone on a previous train.
(8) Place aboard all records of complete detachments loaded. (If a part of a detachment is loaded, all records will go on train on which remainder of this detachment is completed.)
(9) Complete train commander's block of train.
(10) Complete detraining officer's block of train.
(11) Complete senior detachment commander's block of train.
(12) Furnish all information required by inspectors as to detachments and number of patients loaded.

12. Report to orders department exact number of cases leaving ontrain for telegram when convoy goes to Brest. Call Brest bytelephone.

* * * * * * *

The work of the hospital center, instead of decreasing after the armisticebegan, was greatly augumented because of the closure or contraction of basehospitals farther forward and the evacuation of casualties toward base portswith a view to their return to the United States. Hospitals composing thiscenter were therefore filled. This condition continued until the month of March,1919, when there began to be some diminution in the number of patients. Thiscenter was in effect an evacuation hospital for the American ExpeditionaryForces and cleared a much larger number of patients than did any other formationwhich was engaged in this service.

The following table gives the number of patients evacuated from the hospitalcenter at Savenay, to and including July 31, 1919.

	St. Nazaire	Brest	Bordeaux		St. Nazaire	Brest	Bordeaux
1917				1918
November	3	---	---	January	1,172	2,571	---
1918				Do	3,531	4,205	---
January	234	---	---	Do	6,410	989	---
Do	83	---	---	1919
Do	239	---	---	January	5,022	3,885	---
Do	350	---	---	February	5,092	5,332	124
Do	202	---	---	March	4,449	6,048	---
Do	384	---	---	April	4,518	4,807	---
Do	90	692	---	May	5,019	3,578	---
Do	35	1,590	---	June	3,140	4,731	---
Do	510	2,680	---	July	60	251	---

Grand total of 82,026 patients to the United States. To duty and replacement through this center, 8,696.

602

The chief consultant of the medical service, under date of letter of June 6,organized teams for treatment of gassed cases. These were designated gas teamsand consisted of 1 medical officer, 2 nurses, and 2 enlisted men. August 17 itwas decided to use these permanently for treatment of surgical shock and shouldconsist of 1 medical officer, 1 nurse, and 1 enlisted man. On September 5 thisdesignation was changed to emergency medical teams.

Surgical teams were furnished for the front and for hospitals in the center.Infected cases were isolated in tents; also suspects and observation cases. Tentcolony plan was for infected cases. Laboratory and X ray was used and manypatients were returned to duty. Class D cases were evacuated to the UnitedStates. A tuberculosis camp was erected and taken over by Base Hospital No. 118,on January 25, 1919.

ORTHOPEDIC DIVISION

The designation of Savenay as a center through which all orthopedic patientsmust be sent from the American Expeditionary Forces to the United States had aconsiderable effect in determining nearly all of the activities in thatspecialty in this area. An orthopedic department of the surgical division wasestablished in this center in February, 1918. At the beginning Base Hospital No.8 was called upon to perform such hospital duties as ordinarily fell to a basehospital. In making the first response to demands for convoys to the UnitedStates, patients were evacuated in much the same way as from other basehospitals. It was soon discovered, however, that special preparation would benecessary in the case of patients with battle casualties who were to travel tothe United States-that at least certain types of treatment must be givenbeforehand, and that certain provision must be made against discomfort anddanger of complications on the way across.

Because of the character of the wounds and the condition in which patientsarrived at a point as far from the front line as Savenay, it was subsequentlydecided by the chief surgeon that special responsibility for these patientsshould be given to the orthopedic department. The entire policy was notdetermined at once, but after about August 1, 1918, a detailed scheme was workedout in which the Savenay hospital center had a principal part. Thereafterpatients received the treatment necessary and were prepared in such a way thatmany thousands were transferred with comfort and safety from Savenay tohospitals in the United States.

During August a more comprehensive plan than that which had been in operationtheretofore for orthopedic cases was established. A change in policy with regardto classes of patients to be evacuated to the United States was inaugurated.Changes in staff were effected, and it was directed from headquarters, August20, 1918 (Circular No. 46, office of the chief surgeon, A. E. F.), that theorthopedic department should be responsible for the surgical treatment,corrective and otherwise, of all bone and joint injuries, amputations, tendoninjuries or inflammations, flat feet, spine injuries, and general bad posture.The bone and joint injuries included fractures. The orthopedic department wasmade responsible for the necessary treatment, but more particularly for theadjustment and splinting of all such cases, so that the patients could betransferred to the United States.

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During the first two weeks under the new r?gime about 400 orthopedicpatients had to be splinted and consigned to convoys for transfer.

One effect of this was to exhaust at once the supply of splints available inBase Hospital No. 8. Splints were almost impossible to obtain at the moment, andimprovised splints and plaster of Paris had to be used. The situation wasgreatly ameliorated by the voluntary efforts of a number of the patients who,under the direction of two of the enlisted men of the Medical Department, madehundreds of hand cock-up splints, splints for the support of drop-foot and eventhe more complicated finger extension and flexion splints and airplane splints.

These splints were made mostly of wood, but the salvage department was calledupon to furnish shoes and other necessities. The iron bars of mosquito-barsupports which had been condemned were converted into splints, entirelysatisfactory in every way, except that they lacked the finished appearance ofthe usual article.

Base Hospital No. 8 now accommodated about 3,000 patients. Immediatesegregation of orthopedic patients being apparently impossible, one of the firstrequirements of the department was a system by means of which all such patientscould be located and cared for. This was undertaken both for the benefit of thepatient and to avoid delay in making up passenger lists for convoys. The fourfeatures found necessary to establish in this connection were as follows: (1)The cataloguing and inspection of every orthopedic patient as he entered thehospital; (2) the written opinion of every medical officer on the patients thathe saw; (3) the centralized splint and plaster-of-Paris room, to which walkingpatients were brought for treatment; (4) a card index catalogue with a follow-upsystem by which recommendations made by medical officers were checked up andcontrolled until the patient was pronounced fit for transfer.

The first centralized splint room or dispensary, established about September1, 1918, proved one of the most helpful features. In the course of a few days itreached a capacity of from 30 to 50 patients daily. On one Sunday, afterreceiving a large convoy, over 100 patients were splinted and had plaster castsapplied during the day. Walking patients principally, but also a few cot cases,were brought to the splint room from all the wards and cared for by the surgeonsin attendance, as in any dispensary clinic. At this time the number of neworthopedic patients arriving at Savenay was about 70 per day.

From the beginning, patients were rechecked as they were sent to the trainsleaving the hospital. Occasional defects in splinting were in this way caught upand remedied as the patients departed. After the first fortnight practicallyevery patient in each convoy had been carefully and adequately splinted, whetherfor the needs of immediate treatment or for protection during the journey to theUnited States.

Also, by way of suggestion to medical officers and nurses into whose handsthe patients passed on their way home, tags were printed and attached to thesplints on the patients' departure from the hospital. The following are given asillustrations:

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Tag 1, for Thomas humerus traction splints:

The arm is to be kept securely bandaged into splint at alltimes. Only the bandage immediately over the wound is to be removed fordressings. The hand is to be kept in supination and dorsiflexed. The elbow is tobe kept at or slightly beyond a right angle.

Tag 2, for Thomas femur traction splints:

Please do not release the traction or lift the leg out of thesplint for dressings. Remove bandages only immediately over the woundand keep all others and the traction tight and neat.

The exact methods employed in dealing with patients on admission may best beillustrated by quoting from a circular which was published from the headquartersof the orthopedic department October 15, 1918. The circular was publishedfollowing the completion of a plan by which an extensive segregation of patientsaccording to diagnosis had been made and the patients placed in groups inspecial wards. The first special wards to be provided were those for fracturesof the femur and for amputations. These were provided during September. Theobvious advantages of this plan led to the approval by the commanding officerearly in October of a larger plan, by means of which more than 1,400 beds wereset aside in Base Hospital No. 8, with special wards for leg fractures below theknee (64 beds), battle injuries of the knee-joint (32 beds), gunshot wounds andfractures of the upper extremities (256 beds), gunshot fractures of the femur(196 beds), and amputations (250 beds), etc.

The following is the plan outlined in the circular issued October 13, 1918,to be used in receiving patients:

(a) Patients will be admitted from the receiving roomto wards A-1 to A-15 and to ward 5 in the following groups.

(b) No patients are to be admitted to the B wards.These will be reserved for patients who are ready for transfer to the UnitedStates.

A-1 (64 beds): Miscellaneous (for cases in regard to thediagnosis of which the receiving office is in doubt).

A-2 and 3 (98 beds): Amputation cases.

A-4 (32 beds): Knee-joint injuries.

A-5 (64 beds): All injuries of the upper extremities,including shoulder injuries.

A-10, 11, 12 (196 beds): Fractures of the femur. (Femur caseswill be evacuated direct from these wards to the train.)

A-15 (64 beds): Foot injuries.

Ward No. 5: Will remain, at present, a ward for miscellaneousorthopedic cases.

On the morning following the patients' admission to Savenay,special buff cards for the orthopedic service will be distributed. They willcontain the patient's name, number, unit, date of admission here, and diagnosis.They are to be completed in the manner indicated by the following:

[Sample card]

"Yes" or "No"

Name, Doe, John. Rank, Pvt.

Date, Oct. 15/18. No. 1,000,000. Unit, Co.I, 10 Inf.

Diagnosis G. S. W. left leg with F. C. C.femur and injury to sciatic nerve. (Diagnosis number) 27-31.

Condition 1, 2, 3, (4). (Notes) No splint.A. B. C, (D). Treatment: Thomas splint.

(Initials of medical officer.)

Hospital: 1 2 3. B.H. 4.

Condition as to readiness for transfer isindicated by writing on the margin of the card, as follows:

"Yes," if no treatment isrequired and case is ready for immediate transfer.

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"No," if splinting is required and case will beready for immediate transfer after the required splinting is completed.

"No," if prolonged treatment is required to preparecase for evacuation.

Diagnosis numbers are entered in accordance with charts ofdiagnosis numbers already prepared (an arbitrary code).

Condition: (1) No splint required and wearing none; (2)wearing satisfactory splint; (3) wearing unsatisfactory splint; (4) wearing nosplint, but needing one.

A, B, C, D: Classification as to nature of disability.

Hospital: Number of hospital through which patients havesuccessively passed should be entered here, space (3) being for hospital fromwhich cases have been transferred to this center. These slips must be finishedand returned to the orthopedic office before noon of the same day. There must beno exceptions to this rule.

Patients admitted during the preceding 24 hours, who arefound to require radical changes of splint or other application of new splints,may be sent at once or during the afternoon from 1.30 to 4.30 to the plaster ofParis and splint room, where special medical officers will be on duty to dealwith them. The splint or plaster cast recommended should be indicated on thespecial splint prepared for this purpose and should accompany the patient. Incase of doubt, regarding the exact operation or procedure to be used in thetreatment of any patient, it is expected that the services of the orthopedicconsultant or some one designated by him will be called for. Certain standardmethods have been evolved for dealing with these conditions; but in this center,particularly with both treatment and evacuation in mind, careful judgment mustbe used in order that the best interests of the patients may be served.

During the period of waiting for evacuation for most of thepatients and during the stay in the hospital, extensive use is to be made of theservices of the reconstruction aides. Walking patients are to have exercise andmassage in groups and must be sent to the orthopedic department with specialnotes as to treatment suggested, at certain hours, as indicated in the followingschedule:

(a) Patients with median, musclospiral, and ulnarnerve injuries, 10.30 to 11.30 every morning.

(b) Patients with knee-joint injuries for knee-joint,thigh, or leg massage, 1.30 to 2.30 p. m.

(d) Patients with elbow injuries for forearm, hand orfinger exercises, 3.30 to 4.30 p. m.

Other reconstruction aides (occupational) will be availablefor directing the employment of bed patients. Any note directed to theconsultant in orthopedic surgery on this subject, as to dealing with theindividual patients or wards as a whole will receive prompt attention.

These points with regard to the records of these patientsmust be strictly complied with:

(a) The admission cards must be completed before noonof the day following the patients' arrival at the hospital, and the cards mustbe sent to the orthopedic office.

(b) The patient's condition, when admitted, and thefirst recommendations must be entered the same day on the field medical card sothat the field medical cards, as the patients proceed from admitting wards tothe evacuating wards, will be complete in so far as Base Hospital No. 8 isconcerned.

(d) The orthopedic office must be supplied at 9o'clock each morning by the medical officer or the nurse in charge of each wardwith names, identification numbers, and organizations of all patients admittedto or discharged from the wards, above mentioned, during the 24 hours up tomidnight of the day preceding. Lists of the wards will be checked every morningin the orthopedic office as to whether or not these reports have been received,and the reports must be sent before 9 o'clock without fail.

The care of patients with battle injuries was always so large a problem,especially at this center, that it was important to lay aside all personal anddepartmental considerations. To a large extent this was so successfullyaccomplished that it was considered one of the principal reasons for much of thework done at Savenay.

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One of the earliest, as well as one of the most important features of theorthopedic service at Base Hospital No. 8 was the installation of the amputationservice. Three principal features were to be noted in the inauguration anddevelopment of this service: (1) The treatment of all unhealed stumps by skintraction devices in an effort to preserve the length of the existing stump. Thisplan did away immediately with many reamputations and contributed greatly to thecomfort and welfare of patients with stumps that were not healing properly. (2)The organization of physical training classes. In these men were taughtbalancing to strengthen the remaining portions of the amputated extremities, andto protect themselves against the tendency toward contracture deformities. (3)The application of provisional artificial limbs to accomplish the immediatereplacing of a man on his feet, the exercise and shrinkage of stumps, and thepreparation in all other ways of the men for the permanent prosthetic device tobe applied upon his return to the United States.

In undertaking to provide provisional artificial limbs for all the patientswith leg amputations, the American Expeditionary Forces took an advancedposition. The amputation department of Savenay hospital center undertook toapply to every man with leg amputation a provisional artificial limb before heleft for the United States. Such limbs were prepared in a manner firstpopularized by the Belgians more than two years previously and since extensivelyused by the British. In American hospitals, however, these artificial limbs werefitted earlier and more universally. Ready-made devices were supplied for bothabove and below knee amputations. These were fitted to the stump by theconstruction of a plaster-of-Paris bucket. This was made on the patient himselfand the mechanical devices were built into the bucket as it was applied. In thecase of amputation above the knee, the artificial extremity had a crude kneejoint, which enabled the man to bend the leg when he sat down. This was lockedwithout removing the clothing when he arose from a sitting position. DuringSeptember about 75 of these artificial legs were applied. About October 1,however, the number had grown to average about five a day, and in every convoy avery considerable number of men were being sent with these temporary artificiallimbs, upon which they were walking very well.

During the first four weeks of the operation of the orthopedic service, 1,904patients passed through the department. These were received from about 50 basehospitals, camp hospitals, and other medical organizations throughout France.Thirteen hundred were splint patients, of whom a few more than one thousand hadsplints readjusted or applied for the first time at Base Hospital No. 8. Fivehundred and eighty-one had their splints applied for the first time at thishospital. Twelve hospitals sent more than 100 patients each to Base Hospital No.8 on their way home to the United States.

Of the 1,904 patients, about 500 had wounds of the upper extremity and about350 wounds of the lower extremity. These consisted chiefly of compoundfractures, although a considerable number had wounds of the soft parts includingnerve injuries without bone damage. There were about 100 with injury of themedian, musculospiral, or ulnar nerves and about 50 with injuries of the sciaticand external popliteal nerves.

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The conditions most commonly presenting themselves for operative or splinttreatment were in general as follows: (1) Adduction deformity in upper arm andshoulder injuries; (2) fixation of the elbow, usually with the arm in extension;(3) drop-wrist in musculospiral injuries; (4) fixation of the hand and fingers,usually in extension in gun-shot wounds of the wrist and carpus; (5) femurshortening (in a number of cases as much as seven or eight cm.); (6) malunion ofboth femur and leg fractures; (7) drop-foot due both to nerve injuries and toleg, ankle and tarsal injuries; (8) flexion contractures of all sorts due tosoft part wounds.

Separate wards, about 180 beds, for compound femur fractures and 160 foramputations were set aside. Other orthopedic conditions were treated in otherwards as they came. Staff meetings of the entire surgical staff and the heartycooperation of other departments made improvement in the care and transfer ofthe patients rapid and fairly easy. In the case of some of the larger convoys,surgical officers were detailed to accompany patients to their port ofdebarkation for the United States or even to the other side.

The attitude of the orthopedic service at Savenay hospital center towardconvoys of its patients going to the United States were largely determined bythe visit of the chief consultant in orthopedic surgery to certain convoysleaving Brest about the middle of August, 1918.

During September, at the request of the commanding officer of the center, oneof the transports leaving St. Nazaire was visited and inspected. The followingletter is a report of that visit:

AMERICAN EXPEDITIONARYFORCES,
BASE HOSPITALNO. 8,
September 15, 1918.

From: Chief of the orthopedic service.

To: The commanding officer.

Subject: Condition of patients for transfer to the UnitedStates.

Reporting on the condition of patients on board the ---------, visited on your instructions this afternoon, the following is respectfully
submitted:

1. Patients leaving the hospital at 10 p. m. last eveningwere placed on the boat between the hours of 0 and 10 this morning. Splints andapparatus were in good condition. No surgical dressings had been done since thepatients left the hospital.

2. All splints had tags of instructions attached. The medicalofficer on the boat had deferred the surgical dressings until our arrival. Hewas in doubt as to the method of dealing with surgical dressings for patients insplints (samples of tag instructions are attached hereto for your information).

3. A number of the bed patients should have been dressed thismorning. The ambulatory patients were all in good condition.

4. No medical officer or Hospital Corps men were found whohad previous experience in dealing with this class of patients, a considerablenumber of whom were elaborately splinted and required daily surgical dressing.For these patients to travel in comfort and safety it is necessary that thedressings be done without disturbing the splints and that the staff of surgeonsand orderlies be adequate even under unfavorable conditions.

5. It is suggested that hereafter a medical officer accompanythese patients until they are on board the boats, and at least until they havehad their first surgical attention. Also that arrangements be made so that inthe case of larger convoys a medical officer from the hospital, with specialexperience in dealing with this class of patients, should accompany them totheir destination.

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Thereafter medical officers, one or more, were assigned to almost everyconvoy. During January, 1919, instructions from headquarters provided that every150 patients must be accompanied by a medical officer in charge.

When other hospitals were located in the Savenay hospital center, the lessonsthat had been learned by the experiences of Base Hospital No. 8 were applied tothe new organizations. Admission slips were completed in the same way. Patientswere examined promptly and as far as possible dealt with immediately. Tabreports upon the condition of patients as they arrived at the boats fortransportation and even the reports upon the condition of patients as theylanded in the United States were studied for suggestions as to the best methodsof treatment, splinting, etc., to be employed in dealing with these patientsduring the period which they spent in Savenay preliminary to departure.

In the meantime, also, statistics had been compiled with a view ofdetermining particularly the incidence of the different casualties and thecondition in which they presented themselves at Savenay. It was found thatconsiderable numbers of patients, in some instances as high as 40 or 50 percent, required extensive alterations of position, with new splinting, or evenoperation, by way of preparation for transfer to the United States. This wasdue, of course, to the extraordinarily difficult conditions under which many ofthe base hospitals were compelled to operate, but it also served to emphasizethe importance of just such an organization as had been built up at Savenay fordealing with these patients at the stage and in the condition in which theyarrived.

The service of reconstruction aides had been planned in the United Statesduring 1917, but none reported for duty in France until the end of the summer of1918. As an active part in the Savenay hospital center, however, theyfortunately arrived fairly early. Three principal forms of activity wereemployed by this service, massage and occupational therapy in the wards, amassage clinic in dispensary fashion, and an occupational (curative) workshop.The combination of these three has regularly exercised an influence upon from500 to 1,000 men per week in the Savenay hospital center. The amount contributedby these activities to the more rapid recovery of stiffened, contracted, andslowly recovering extremities can hardly be measured. The results are more rapidin the case of hands and fingers, which often under the influence of suchtreatment make more progress in a few days than had been made in weekspreceding.

NEUROPSYCHIATRIC SERVICE

Until November 6, 1918, the neuropsychiatric service at Savenay was under thedirection of the commanding officer of Base Hospital No. 8. It functionedseparately, with a chief of service, medical staff, and special personnel. Forthe first six months relatively few cases were admitted, from January 1 to June1, 1918, the admission being 369. Two wooden barracks of 90 beds each were usedduring this period, but inmates had their meals with other patients. One wardwas partitioned off, one end being used for disturbed patients.

After June 1, 1918, the admission rate rapidly increased and additional wardsbecame necessary. Three more wooden barracks were used as required

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for this service, providing accommodations for about 500 patients. In themeantime, wards of special construction, designed by the chief surgeon, had beenerected for this service in a locality some distance from the main hospital.These 11 wards, situated on a slight elevation of ground, consisted of theadministration building, a ward for officer patients, a mess hall, a barracksfor enlisted personnel, and a ward for disturbed patients, the remaining wardsbeing of uniform type, with a large day room, shower baths, and running water.This unit was occupied the latter part of August, 1918. There wereaccommodations for something less than 200 patients, but by using officers'barracks and enlisted men's barracks, the capacity was expanded to over 250.During this period, however, the barracks connected with Base Hospital No. 8werestill retained.

In October, 1918, 4 additional buildings of concrete block were added to the11 wards above mentioned. When these were completed, the original barracks ofBase Hospital No. 8 were relinquished. No diminution in the admission rate afterthe cessation of hostilities occurred, and therefore the unit as finallyconstructed proved inadequate. Indeed, in the late fall of 1918, admissions wereso rapid that the commanding officer of the center found it necessarytemporarily to designate wards from two adjacent units-i. e., Base Hospital No.69 and Base Hospital No. 113-for the use of the neuropsychiatric service.

On November 6, 1918, the neuropsychiatric service was organized as anindependent unit, taking over the quarters already occupied. The former chief ofservice was designated as commanding officer.

During the latter part of December, evacuation had been so rapid andadmissions delayed to such an extent that for a short time there were but 65patients in the hospital. Admissions, however, soon increased so that early inJanuary, 1919, the population exceeded 700 patients, including 40 officers. Thiswas quite in excess of the capacity, especially since, except as a temporaryexpedient, the use of the wards of adjacent units was not feasible. Under thesecircumstances the commanding officer of the center gave directions that one ofthe new 1,000 bed units be taken over as a neuropsychiatric hospital.

During the period that this organization was changed from theneuropsychiatric service of Base Hospital No. 8 to an independent unit andduring the transfer subsequently of the hospital to its present site,considerable administrative work was necessary. The responsibility of thisreorganizing, and of the subsequent transfer of the patients and property, aswell as opening and equipping the new unit, rested particularly with the chiefof the service, the quartermaster, and the officer in charge of administrativedetails.

The new unit was occupied January 21, 1919. The construction was notcompleted and special construction was necessary, this being done chiefly bypatients. A sitting room was made in one end of the officers' ward, andfurnished by the American Red Cross. A similar sitting room for nurses wasarranged in another ward. A staff conference room was constructed in theofficers' barracks. A diet kitchen, furnished by the American Red Cross, wasinstalled in the building used for occupational therapy. Four wards wereconstituted closed wards, with screened windows, and in these wards parti-

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tions were constructed in such a way as to make patients' day rooms. One wardbuilding was utilized for a Red Cross recreation hut and appropriatelyfurnished.

The large building adjacent to the mess, used in other units for surgery anddressings, was fitted up for a workshop. This workshop was especially wellequipped. It had the advantage of the use of material formerly used at BaseHospital No. 117, consisting of brass-work tools, lathes, carpentering sets, andan acetylene welding apparatus. Looms for weaving were made by the patients, andwoven bags, belts, and mats were manufactured. A forge was made by one of thepatients. A supply of salvage material for use in the shop was secured from thesalvage department at Tours. Six aides, under a director, were engaged in givinginstruction. The average number of patients engaged daily was 42. A large amountof material of various kinds was manufactured in this shop. Much of thismaterial, such as benches, tables, chairs, cabinets,
and office furnishings, was used to equip the administration buildings and wardsof the unit. In the metal department rings, trays, and other souvenirs were madein great number. Much of the material made was taken home by the patients.

Personnel.-Prior to June 1, 1918, the neuropsychiatric service at BaseHospital No. 8 was under the direction of a chief of service, who had from twoto three assistants. He succeeded in securing the services of nurses andenlisted men with special training in this work. On June 8, 1918, Base HospitalNo. 117 arrived at Savenay from the United States, en route for la Fauche. Apart of the personnel, namely, 3 medical officers, 28 nurses, and 33 enlistedmen remained at Savenay to take charge of the service.

After June 1, 1918, the admission rate increased rapidly. In June, 256 caseswere admitted; in July, 405; in August, 588; in September, 887; in October, 658;in November, 809; in December, 412; in January 1919, 885; and in February, 824.

The organization received the cases, classified them, afforded appropriatecare and treatment and furnished medical officers and personnel to transportthem to the United States. Moreover, the trained personnel was sent to convoypatients to Savenay from other centers and organizations.

For purposes of classification all patients were admitted to one largeadmitting room of 90 beds. A special nursing force was maintained here, andobservations for classifications were made at once. All patients, uponadmission, were seen by the receiving officer and assigned to proper wards. Theacute psychoses, cases of chronic alcoholism, and the delinquents were sent atonce to closed wards. Mild psychoses, epileptics, and mental defectives werekept in open wards under supervision. Cases of psychoneuroses were sent toseparate wards and, as soon as space was available, to the specially constructedwards mentioned above.

By examining and classifying at once every case administrative difficultieswere reduced to a minimum. During this period but two serious accidentsoccurred, although delinquents of every description came through the service. Atthe same time patients were given as much liberty as possible-indeed, libertieswhich in civil life would have been considered impossible.

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There was no separate mess for many months, patients going to the generalmess. The center American Red Cross recreation hut was used by all, and theconvalescent patients from the neuropsychiatric service often contributed veryconsiderably to the entertainments.

As previously stated, supervision of transportation of these cases to Americawas rendered by this organization to the extent of furnishing medical officersand enlisted personnel. The convoys consisted as a rule of from 50 to 200 casesand occasionally more. They went by train to Brest or St. Nazaire forembarkation, patients being loaded in cars especially designated, with acutecases loaded in one special car. The number of attendants sent varied accordingto the type of patients. The train left the hospital under charge of adesignated medical officer, who exercised supervision until patients weredelivered to their destination in the United States. Since such conveys drewheavily upon the personnel, this work could not have been carried on had not thepersonnel been supplemented from the hospital center.

BLIND PATIENTS

All of the blind patients whose blindness resulted from battle casualties inthe American Expeditionary Forces passed through Savenay and were handled in itshospitals, where they received a certain amount of training. The general nursingcare was given by the ward nurses, while the social and educational part of thetreatment was given by trained teachers. Certain of the American Red Crossworkers who were here for the special purpose of looking after blind patientsalso gave special instruction.

A school was established in the rear of ward A-15 of Base Hospital No. 8. Inthe morning the program included work in the schoolroom and the teaching ofBraille and typewriting. In the afternoon on fine days the patients were takenfor walks, or else games and readings and other forms of entertainment wereconducted in the schoolroom or ward. This program was also continued during theevening, varied usually by the reading of the evening paper. On Sundays the menwere conducted to church in the morning.

A pleasant variation of the work as conducted by the women of the AmericanRed Cross was the arrangement of parties for the blind patients, the invitationsto which were written in Braille, and a considerable part of the enjoyment ofthe party consisted of the reading of the invitation and the pleasantanticipation.

Patients who were unable to go to the schoolroom were taught at the bedside,and there were also bedside readings and games.

LABORATORY SERVICE

Each unit in the center had a laboratory which was subsidiary to the centerlaboratory. Supplies for these laboratories were issued by the center laboratoryofficer on memorandum receipt. The center laboratory performed the moretechnical and nonroutine work, such as serology, histology, autopsy,bacteriological type determinations, and surveys in epidemiology.

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The center laboratory was divided into the following departments:

	Officers	Noncommissioned officers or technicians	Private or privates, first class
(a) Administration and supply:	^a1	^b1	^c1
(1) Administration	---	1	---
(2) Supply	---	1	1
(3) Media preparation and sterilization	---	---	3
(4) Glassware preparation and fatigue	1	2	^c1, ^d1
(b) Pathology	1	1	^c1
(c) Bacteriology (general)	1	1	---
(d) Wound bacteriology	1	1	---
(e) Epidemiology	1	1	---
(f) Serology	1	1	---
(g) chemistry (and water analysis)	---	1	---
Total	6	10	8

^aMajor.
^bSergent, first class.
^cClerk.
^dUndertaker.

CONVALESCENT CAMP

A convalescent camp was in operation at Savenay as early as April, 1918, inconnection with base hospital No. 8, where 50 beds were set aside forconvalescent patients.

On August 21, 1918, orders were received from the chief surgeon's office toestablish a convalescent camp as a unit separate from the hospital. Incompliance with this, a site was selected where the parade ground measuredsomething like 1,800 by 1,600 feet. Fifty pyramidal tents were put up and 300French beds placed in the tents for use of the men. This change from hospital toconvalescent camp was made in one day, the patients being transferred fromhospital to camp, and returns made from the camp as a separate organization. Theduty personnel consisted of 1 officer and 1 enlisted man. From the first,patients were selected to act as noncommissioned officers, selection being madewith care in order to get men who were responsible and who took an interest inthe work.

Under Circular 11-A, 1918, chief surgeon's office, A. E. F., all patients inconvalescent camps were placed on a duty status, and consequently returns werethose of line organizations. This was changed after a few weeks and patientswere again put on a hospital basis, necessitating again a change in forms.

In fair weather the following schedule was adhered to: The entire battalionparticipated in the morning exercises. These were ordinary setting up exercisesand lasted for 15 minutes. Then the medical officer of each company made aninspection of his company; patients who were found not fit for further exercisewere required to fall out and return to their quarters. The exercises were thencontinued for 30 minutes and another inspection was made, with the sameprocedure. After this, games were played for 5 to 10 minutes and then thecompanies were dismissed. At 10 o'clock the entire battalion was drilled insquads, platoons, or companies, depending upon the advancement of the soldiers.This drill lasted until 10:45.

At 2 o'clock all men were required to be on the athletic field for games,football, basket ball, indoor baseball, and volley ball, which were played until3.45. Regimental parade was held every afternoon at 4.30. The schedule was

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so arranged that each enlisted man was required to take a routine march onceor twice a week; four companies going on consecutive days until Friday when theentire battalion formed and marched for an hour and a quarter to band music.Each Saturday afternoon competitive games, consisting of tugs of war betweencompanies, baseball, obstacle races, potato races, relay races, boxing contests,and battle royals were held on the athletic field. For each event prizes weregiven varying from 3 pounds of candy to 1 or 2 cartons of cigarettes, thecompany winning most events being given a pennant. These games were alwaysenthusiastically attended and competitors showed great interest in them.

Schools were established in connection with the camp, preliminary for theeducation of illiterates, but after the armistice began classes soon increased.All classes were voluntarily attended, but once a man volunteered for a course,he was required to be present at all classes of his course unless evacuated.Those who volunteered for courses were excused from other duties whichinterfered with their work. Teachers were detailed and the subjects taughtranged from those suitable to an illiterate foreigner to those for a high-schoolgraduate. Instruction was given in arithmetic, reading, spelling, writing,grammar, United States history, civil government, geography, physical geography,European history, and French. The following schools also were established:Tinsmithing, motor mechanics, commercial branches, woodworking, sign painting,
and dramatics.

The hours for each subject extended from 8.30 to 11 a. in., and from 1 p. m.to 4.30 p. m. A man worked the whole day on a course until he completed it. Manymade astonishing progress; some men, unable at first to write their names, wereable within 12 days to write short letters home. The classes were kept small,the largest number taking a course numbering 90. A total of 200 men wereenrolled in the tinsmithing course and averaged six hours daily.

THE CENTER FARM

The center farm consisted of 98 acres of land leased by the American RedCross, through which agency also were obtained implements necessary to startwork. The farm proved not only of value as an adjunct to the mess facilities ofthe center, but also monetarily; during the summer of 1918 the sale of produceeach week exceeded the farm rental for a full month. In addition, the farmproved of great benefit in the reconstruction work.

WELFARE

The American Red Cross assisted in giving surgical dressings, clothing,personal equipment of nurses and secretaries, games, novels, and a portablelaundry, and huts including a nurses' and officers' hut and an auditorium for1,650 people. It leased and equipped an experimental farm, maintained a staff ofsearchers, published a local newspaper, promoted recreation, distributedpersonal gifts such as socks, scarfs, helmets, etc., and conducted a library.

The Young Men's Christian Association conducted religious services andentertainments, including moving pictures, and gave canteen service.

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COMMANDING OFFICER

Col. Wibb E. Cooper, M. C.

JUSTICE HOSPITAL CENTER, TOUL^r

This group of hospitals was organized primarily for the purpose of takingcare of the casualties in the St. Mihiel operation (April 12-16,1918). A numberof base and evacuation hospitals were ordered to Toul, where they took overpermanent military barracks, just west of the city. The group consisted of thefollowing barracks: Caserne Lamarche, Lamarche Annex, Caserne Perrin,Brichambault, Caserne Tavier, Caserne A. R., and Caserne Luxembourg. With theexception of the last, these barracks were situated very close together, on Ruede Justice, about a mile from the center of Toul. The buildings were of stoneand concrete construction and the rooms were fairly well suited for purposes ofhospitalization. There were no bathrooms, no means of disposing of waste in thebuildings, and running water was to be found in but one or two rooms in eachbuilding.

There were two sources of water, one being individual wells and the other theMoselle River. The water was apportioned to the various hospitals at dailyperiods and regulated through a system of valves. It was impossible, however, tofurnish any storage, as any irregularity in apportionment interfered with thesupply of the other areas. The sewerage system consisted of a series of pipelines and drains, which received the liquids from kitchens and baths.

The latrines were of the can type and none were in the buildings themselves.All the excreta of the bed patients had to be carried to these latrines, andthese were often located at some distance from the wards. In the same manner allthe waste liquids, bath water, etc., had to be carried from the buildings andemptied into the sewers.

The center was organized on August 27, 1918. At this time the following unitshad arrived: Base Hospitals Nos. 45 and 51, American Red Cross Military HospitalNo. 114, and Evacuation Hospitals Nos. 3 and 14. Later, Base Hospitals Nos. 82,55, 78, 87, and 210 arrived and Evacuation Hospitals Nos. 3 and 14 were relievedfrom the center. In addition to these, gas, contagious, and neurologicalhospitals were organized. When completely organized the center had a capacity of15,250 beds.

The center staff was organized into the following divisions: Adjutant,consultants in medicine and surgery, quartermaster, evacuation officer,laboratory officer, sanitary officer, transport officer, medical supply officer,and chaplain.

The supply depot was established on September 8, 1918, in one of thepermanent barracks of the center. Prior to this time all supplies had to beobtained from the First Army depot.

The office of the Quartermaster Department began functioning on September 8,1918, when the first carload of supplies was received. During the

^rThe statements of fact appearing herein are based on the "History of the Justice hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

615

month of September, the work of this department was very much handicapped onaccount of the difficulty in obtaining supplies. This was due to the congestionat the railhead during the activities in the St. Mihiel sector. A large ridinghall in one of the barracks was used as a warehouse and afforded ample space. OnNovember 20, 1918, Bakery Company No. 11 was established, and for the first timethe bread supplied to the center was made at that port.

The greater part of the laundry work was done at the large laundries in Touland Nancy. Each unit had one or more French hand laundries, but the amount ofwork these could do was too small to be of material help. A group disinfectingplant, consisting of three steam disinfectors, was operated for all thehospitals.

Evacuation Ambulance Co. No. 7, which arrived on August 28, 1918, handled alltransportation until September 21, 1918, when a center motor transport servicewas established.

The office of the group chaplain was organized on September 21, 1918. Inaddition to the regular duties of a chaplain, this officer also had charge ofall the entertainments furnished through the cooperation of the Y. M. C. A. Apost school was established by the chaplain on March 10, 1919, with a class ofabout 28, but due to the many changes occurring in the personnel it soon becameextinct.

Surgical cases usually were treated in Base Hospitals Nos. 45, 51, 82, 55,and 78; however, in October and November these hospitals received medical casesalso. During the St. Mihiel operation and immediately after, this centerreceived a large percentage of the total casualties for the First Army. Duringthe period September 12-25, 8,340 surgical cases were admitted, and the basehospitals temporarily functioned as field and evacuation hospitals. AfterSeptember 26, the group did not receive any considerable number of battlecasualties direct. The surgical services suffered, especially during the earlyactive period, from lack of surgical instruments and trained personnel. InJanuary, 1919, all surgical cases were transferred to and cared for in BaseHospital No. 45.

The medical service did not receive many patients until the latter part ofSeptember, 1918. After this time, however, the influenza epidemic assumed largeproportions and the service soon became overcrowded. A contagious hospital wasopened, with a bed capacity of 600. All cases were held here until over theirinfectious period.

A neurological hospital was opened on September 7, 1918, with a bed capacityof 1,000. It was well outfitted, in large part by the American Red Cross. Thehospital was designated Neurological Hospital No. 2. It acted very much in themanner of an evacuation hospital, with an equipment and staff of an elaboratebase for nervous cases. Of 259 cases treated there during the first month, 63per cent were returned to duty. Other evacuations were made by ambulance to BaseHospital No. 116, at Bazoilles, and to Base Hospital No. 117, at La Fauche.

A large center laboratory was established in Caserne Lamarche on September23, 1918. It occupied excellent quarters and consisted of six rooms. Thislaboratory made all the special bacteriological examinations, Wasser-

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mann tests, colloidal gold tests, and dark field examinations, made cultures,and prepared media, solutions, and sera. The individual hospitals madepost-mortem examinations, routine clinical, pathological, and bacteriologicalexaminations.

The majority of patients were transported to the center from the front byambulances. Prior to November, 1918, there was no central triage, and thehospitals were designated to receive cases arbitrarily as regards location,personnel, and equipment. This caused considerable difficulty and confusion.About the middle of November a center triage was organized, consisting of 10Bessonneau tents. All incoming ambulances were directed to this central point byroad signs and guides. Two officers, two noncommissioned officers, and twentyprivates, selected from the various hospitals, were on duty at all times. It wasthe duty of the triage officer to have the ambulances unloaded, examine allpatients and field cards (and if necessary make a provisional change indiagnosis), and direct patients to designated hospitals. This systemnecessitated a change in the staffs of the various hospitals so that they morereadily might treat the types of cases sent to them. Evacuation of all patientswas made from the hospitals, as there was no convalescent camp in this center.Evacuation of class A patients was made either through replacement battalions orregulating stations, though some class A patients were evacuated directly totheir organizations. Reclassified patients were sent to the 1st Depot Divisionat St. Aignan, with the exception of class D patients, who were sent directly tothe hospital center at Savenay. All mental and neurological cases were sent inambulance convoys to Base Hospitals Nos. 116 and 117. All patients evacuated tothe rear were transported in American and French hospital trains. A consolidatedlist of patients to be evacuated was telephoned to the regulating officer at St.Dizier twice a day, who, in turn, dispatched trains as necessity called forthem. The evacuating officer usually received from 2 to 12 hours' notice as towhen a train would arrive at the center and made requests for litter bearers onthe hospitals which were to evacuate lying cases.

The American Red Cross furnished the center large quantities of instruments,drugs, and hospital equipment. It also distributed literature and many specialarticles not furnished by the Army to the patients. To each hospital wasassigned a searcher whose duty it was to trace soldiers reported missing, andperform special services for patients, such as writing letters, sendingtelegrams, etc.

Recreation rooms for nurses and enlisted men were established in eachhospital, where theatricals, concerts, and moving-picture shows were produced.

COMMANDING OFFICER

Col. Henry C. Maddox, M. C., August 27, 1918, to November13, 1918.
Col. Robert M. Thornburgh, M. C., November 14, 1918, todiscontinuance of center.

617

HOSPITAL CENTER, VANNES^s

This center came into existence officially on November 3, 1918, when 1officer and 50 men of the Medical Department arrived and took over certainbuildings requisitioned from the French. Geographically the center embracedVannes, Auray, Plouharnel, Carnac, and Quiberon, covering an area of 30 miles.

Headquarters of the center were organized November 11, 1918, at Vannes. Herelarge barrack buildings, known as the Quartier Senarmont, were taken over. Thiscaserne, following the general plan of the French Army barracks, was surroundedby a wall inclosing a compound measuring 760 by 860 feet. Within this area werethree large four-story barracks, kitchens, guardhouse, stables, veterinaryhospital, and other buildings. It was planned that 2,300 patients could be caredfor in this inclosure. The buildings were in very poor repair, and the onlyadvantages provided were ample space, a site free from mud, and an abundantsupply of good water. Considerable construction was effected in this caserne,such as extending water pipes to the upper floors, placing of sinks, etc.

In Carnac the United States Government leased a hotel and five villas. Thehotel, which accommodated about 200 patients, was at the beach of Baie deQuiberon, about 2 miles from Carnac. It was used for convalescent respiratorycases, who rapidly improved in health at this point.

In Quiberon the hospitalization consisted of 12 small hotels and villas, only2 holding more than 100 beds. The hotels were not modern and lacked adequatefacilities for light, heat, and bathing. The distance of this group fromheadquarters of the center made difficult its supply and control; therefore, theproperties were given up on January 18, 1919.

Near Plouharnel, a large three-story monastery, the Abbey St. Michiel, with abed capacity of 500, was taken over, but was used only once for patients, andthen for a short time only.

Hospitalization at Auray consisted of 2 hotels with a capacity of 350 beds.These were unsatisfactory and were never used for patients, leases on them beinggiven up in December, 1918.

Base Hospitals Nos. 136 and 236 operated in this center and up to March 1,1919, admitted a total of 3,224 patients.

In February, 1919, Base Hospitals Nos. 4, 5, 10, 12, and 21 were ordered tothis center for quarters, awaiting transportation to the United States. Thishospital center was discontinued in June, 1919.

COMMANDING OFFICER

Col. Robert M. Blanchard, M. C.

^sThe statements of fact appearing herein are based on the "History of the Vannes hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

618

HOSPITAL CENTER, VICHY^t

The hospital center at Vichy, though planned early in 1918, was not organizedofficially until August 12, 1918. Two base hospital units, Nos. 1 and 19, werethen operating. The French Medical Department had been using many of the largerhotels in Vichy as hospitals since the beginning of the war in 1914.Twenty-eight of these were turned over to the United States Army, and lateradditional hotels were leased from private owners, so that eventually 86 hotels,large and small, were utilized by the center, the total bed capacity of thecenter at its maximum being 19,000. In addition, 13 garages, and laundries weretaken over for use.

The following units operated in the Vichy center before the armistice: BaseHospitals Nos. 1, 19, 115, 76, Hospital Train Unit No. 41, and Hospital Unit D.After the armistice began the following units arrived: Base Hospital No. 109,Evacuation Hospitals Nos. 25, 33, and Convalescent Camp Co. No. 9. The latterorganization never functioned as a convalescent camp.

Vichy had many advantages as a hospital center. The location, althoughapparently somewhat distant from the battle lines, was well chosen owing tofavorable railroad connections. Patients were received in some instances within24 to 36 hours after receipt of injuries, and frequently they arrived with theiroriginal dressings, although a very large proportion of the patients had passedthrough evacuation or base hospitals.

Vichy, being a famous watering resort, established for many years, was awell-developed small city. The streets were well paved and well lighted, thusgreatly facilitating the handling of patients arriving on trains at night. Therealso was an excellent water supply; gas and electric current were obtainable inabundance.

The Grande ?tablissement Thermal et Physioth?rapeutique, which we used, waswell equipped with electrical, X-ray, and orthopedic appliances that were ofvalue in the treatment of orthopedic and nerve injuries during our occupancy.The hotels on the whole were well adapted for hospital use, the larger,first-class ones being well equipped with bathing facilities and modernkitchens. On the other hand, the smaller hotels were not so well suited, butwere used to great advantage for the walking cases and the less seriouslywounded.

The Quartermaster Department was divided into finance, subsistence, property,clothing, and miscellaneous sections. Another officer was assigned to thebuilding department, which was charged with maintenance and repair ofapproximately 90 buildings. A force for this last purpose was organized fromamong the different base hospital units. Requests for repairs averaged 70 a day.As the center grew a railway transport officer, a motor transport officer, andan engineer officer were assigned to the center. A quartermaster officer wasassigned to the bakery and another to the laundry.

Motor transport of various types and makes was provided. Part of thepersonnel to operate this was furnished by the motor transport officer and partwas composed of convalescents and other personnel at the center.

^tThe statements of fact appearing herein are based on the "History of the Vichy hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

619

F IG. 118.-Hoteldes Bains, part of Vichy hospital center

620

The problems connected with the mess arrangement for the center were mostdifficult. By the end of October 15,000 persons were being subsisted. During theperiod of greatest stress there were 36 messes in operation. Though eachhospital unit had its own mess officer, a group mess officer, assisted by 10clerks, managed the messes from the beginning of the center until its closure.In this way a central purchasing department was maintained and the messesthroughout the center were coordinated. The central mess office procured andissued not only food supplies but also mess equipment. The walking patients, whooccupied many of the 86 buildings, were marched under a noncommissioned officerto a close-by mess.

F IG. 119.-HotelLilas, part of Vichy hospital center

For a time, bread was made by local French bakers, who were furnishedAmerican flour; however, on July 10, 1918, three units of Bakery Company No. 12arrived with complete equipment and thereafter baked all bread required by thecenter. During the period November 1 to 10, 1918, this organization produced11,050 pounds of bread daily.

Laundry was done, prior to the organization of the center, by a civilianlaundry. This arrangement soon proved inadequate, and on August 20, 1918, theQuartermaster Department leased a laundry in Bellerive, near Vichy, and LaundryCompany No. 302, consisting of seven men, was placed in charge. This companysupervised a day and night shift of French civilian help. When this laundryproved inadequate another, the Les Bains, was leased and placed in charge ofLaundry Company No. 509. In order to avoid any danger of infection, allunderclothes, uniforms, and linen which had been in contact with incom-

621

ing patients were sent to the Les Bains laundry, all other hospital linenbeing sent to the Bellerive laundry. A salvage department was inaugurated inconjunction with the laundry.

A bathing establishment was secured on October 14, 1918, by contract from theFrench, to provide proper bathing facilities for the patients upon admission.All walking cases were taken there immediately from the train and bathed. Newclothing was issued to them before they were sent to a hospital; their oldclothing was sent to a delousing station. In this way it was possible to keeppractically every one of the 86 buildings in operation free from infection. Thisestablishment was used also for the walking cases and the personnel of thecenter. The heating system was excellent, allowing over 200 baths a day to begiven. The number of baths given at this establishment from October 14, 1918, toJanuary 15, 1919, was 61,854.

F IG. 120.-Award, Base Hospital No. 1, Vichy hospital center

Each of the base hospital units in the center occupied on the average of over20 buildings, each building being in charge of a medical officer who wasresponsible to the commanding officer of his unit for the professional service,both medical and surgical, and the discipline and police of the building ofwhich he was in charge. The commanding officer of the unit was in turnresponsible to the commanding officer of the center.

Maxillofacial and neurosurgical cases were sent to this center, especiallyafter September 6. Base Hospital No. 115, which then arrived, was soon chargedwith the care of such cases as well as general surgical cases.

Evacuation of patients was made as soon as the patients were reported ready.They were classified and reported as in various classes fit for evacua-

622

tion. Each week the commanding officer of each hospital was sent a statementof the percentage of patients evacuated in each of these classes, by the centerand by each base hospital, in order that the commanding officer might knowwhether his ward surgeons were taking advantage of all evacuations possible.

The American Red Cross at Vichy provided a warehouse for materials anddistribution, a canteen, including a hall for dancing, a theater, reading andwriting rooms, and a diet kitchen and a serving room for French. An officers'club, a noncommissioned officers' club, a nurses' club, and a gymnasium wereprovided. It leased a building for a nurses' club over which a representative ofthe Y. W. C. A. presided. The Red Cross furnished hundreds of cases of supplies,provided many entertainments, and conducted, through searchers, ahome-communication service.

F IG.121.-Officers' mess at the Hotel Sevigne,Vichy hospital center

Beginning on February 1, 1919, some of the hotels were returned to theirowners and the center was discontinued in April, 1919.

COMMANDING OFFICER

Col. Walter D. Webb, M. C.

623

HOSPITAL CENTER, VITTEL-CONTREXEVILLE^u

The hospital center at Vittel-Contrexeville was located in the small towns ofVittel and Contrexeville. Vittel is about 60 kms. east of Chaumont and about 90kms. west of the Alsace border. Contrexeville is 4 kms. southwest of Vittel.

Both towns had been well-known watering places, situated in the foothills ofthe Vosges Mountains. Being at a considerable altitude, they had a cold,rigorous climate, with winter coming early and remaining long, accompanied bymuch snowfall. All industries of both places were connected with the service oftheir hotels and springs. The waters in no way influenced the selection of thislocation for hospitals, and they were not used in the hospitals of the center,except by those who desired to do so.

F IG.122.-Casino used as the officers' club, Vichy hospital center

Vittel has an excellent water supply derived from the springs in the hillsabove the town, which, though at times taxed to the utmost, was beyond suspicionas to purity. A total of 100,000 gallons per day was allowed for the hospitals,which, with proper care, was sufficient. Contrexeville was not so fortunatelysituated with respect to its water supply. No large springs were available andeach hotel had its own more or less shallow well. Being intended only for summeruse, all piping was exposed, causing endless trouble from freezing during coldweather. Practically all water in Contrexeville was determined to be nonpotable.

^uThe statements of fact appearing herein are based on the "History of the Vittel-Contrexeville hospital center," prepared under the direction of the commanding officer by members of his staff. The material used by these officers in the compilation of the history comprised official reports from the various divisions of the hospital center. The history is on file in the Historical Division, S. G. O.-Ed.

624

F IG.123.-Building used as the noncommissioned officers' club, Vichy hospital center

625

Both towns had fairly satisfactory electric lighting plants, of sufficientcapacity both for lighting purposes and for the operation of X-ray equipment.

There was also a well-defined park system, especially so in Vittel. This,together with the privilege of the tennis courts and golf links, made a veryvaluable adjunct to the center.

F IG. 124.-Twosmall hotels used for the enlisted men, Vichy hospital center

Prior to the arrival of the Americans and for a short time after theestablishment of our hospitals at Vittel and Contrexeville, in the winter of1917—18, the French occupied some of the hotel buildings for hospitalpurposes. These buildings were turned over to us by the French. All otherbuildings were leased from their owners; in case of refusal on the part of theowner, they were requisitioned. In this way, by November 17, 1917, buildings for5,500 beds had been acquired; and eventually 74 hotels, villas, and otherbuildings were occupied by the hospital units. The bed capacity at its heightwas 11,075, including crisis expansion and beds in the convalescent camp, which,however, were never occupied. In compensation for beds allotted us at otherpoints, 2,700 beds were reserved for French patients. Villas were leased forofficers and nurses, the casino for enlisted men; garages were provided for themilitary police, storeroom, and medical supply. All buildings were of concreteand stone construction and more or less fireproof in some cases; in others,especially in Contrexeville, veritable firetraps. The hotels were from three tofive stories high, with from 40 to 300 rooms, some of which were reserved forstorage. No buildings had heating plants that were adequate. Heating was veryunsatis

626

factory, and it was early realized that proper heating was not to beobtained. Seven thousand French stoves were received shortly after the arrivalof the units and were installed. The labor involved in caring for this number ofstoves, the carrying of the coal and ashes, four to five flights, was enormous.Practically every hotel building had its own kitchen range installed and in fairworking condition.

All buildings were piped for water, and had a sewerage system that was whollyinadequate for the number of patients in each during crisis expansion. Cesspoolswere situated under the kitchen floor, and whenever the capacity of the cesspoolwas exceeded the inevitable result was a flooding of the floor of the kitchen.By continually pumping over the cesspool this was reduced to a minimum.

Four base hospital units were assigned to Vittel and Contrexeville. Thesewere Base Hospitals Nos. 23, 36, 32, and 31 to Contrexeville, the first onearriving December 17, 1917, and the last one January 1, 1918. On March 13, 1918,three hospital units, B, R, and G, arrived and reinforced the hospitals. Priorto the organization of the center, each unit had its own quartermaster andmedical supply officer, submitted its own requisitions, and controlled its owntransportation.

On January 27, 1918, one officer of the group was placed in command of allfour hospital units, thus inaugurating the hospital-center system ofcoordinating the activities of several hospital units grouped together. Theorganization of the center at the height of its activity was as follows:Commanding officer, adjutant, quartermaster, evacuating officer, sanitaryofficer, medical supply officer, assistant provost marshal, air raid officer,motor transport officer, railway transport officer, laboratory officer,professional consultants in surgery, medicine, neuropsychiatry, orthopedics, andophthalmology.

To a great extent the headquarters staff was organized by detailing officersfrom several units. Each headquarters staff in organizing his department chosepersonnel from the organizations which he knew were capable. It was realizedthat these units were well supplied with especially qualified men, therefore norequest was made for an additional force to form a headquarters detachment. Theheadquarters detachment was formed by details from the constituentorganizations, especially the base hospitals.

Certain special and technical units were organized as follows: Sanitarysquads, one in each town. A provisional ambulance company was organized frompersonnel and ambulances belonging to the base hospitals. It was under thecontrol of the evacuation officer, who was responsible for the movement of allpatients. This arrangement was found more satisfactory than to have theambulances under the motor transport officer.

A laboratory was established in each town, under the control of the centerlaboratory office. Each hospital, however, retained enough laboratory equipmentto perform routine clinical examinations.

As all organizations were well equipped with nonexpendable property, amedical supply depot was not established A center storehouse was maintained, andall requisitions were made out by the center supply officer.

627

A laundry plant was leased in a town about 4 km. from Vittel, which, afterbeing remodeled by the Army engineers, was satisfactory. A laundry company of 1officer and 16 men operated the plant.

At first bread was obtained from Is-sur-Tille. Later a section of a fieldbakery was obtained, with two ovens. This, with another oven belonging to one ofthe units, was sufficient to supply fresh bread to all organizations. Duringquiet times the extra oven was used for pastry and other extras.

The quartermaster storehouse occupied two large garages at Vittel, centrallylocated, and a small branch was established at Contrexeville. A well-stockedsales commissary was kept, and organizations in surrounding towns were supplied.There never was a shortage of subsistence articles.

An air raid officer was appointed who drew up such regulations as werenecessary for the protection of patients, personnel, and property. Windows werekept screened at night, which was an extremely difficult matter, with thethousands of windows in a single building, some of them so large and so situatedas to be almost impossible to cover. For some time the French kept a railroadartillery train parked in the city, and considerable time was required to get itremoved. It was not considered in keeping with the provisions of the Genevaconvention to construct a cross for protection while these combat organizationswere within the city, but after they were ordered away the cross wasconstructed. Although surrounding towns were repeatedly bombed this centerfortunately escaped.

During the winter of 1917-18 and spring of 1918 patients were admittedprincipally from the surrounding training areas, and from Baccarat and Luneville,where our troops were in the trenches. Numerous gas cases were admitted to thecenter at this time.

The admission of French patients required a duplication of records andnecessitated a providing of the French ration, but was an excellent experiencefor all the units at a time when there were not sufficient American patients tokeep the personnel busy. During this period of adjustment not many patients werearriving and the keenest rivalry developed in obtaining patients. Later areceiving office was established and all arriving ambulances were required toreport there. All distributions were made by direction of the commanding officerof the center.

During the month of September steps were taken to establish a convalescentcamp of 1,200 capacity. This camp was ready for occupancy when the armistice wassigned, whereupon the project was abandoned.

A Red Cross hut was constructed at both Vittel and Contrexeville for theenlisted men, and a well-stocked canteen was maintained at both places. A hutfor the nurses also was constructed and furnished in Vittel and a theater leasedin the Casino, where moving pictures and other entertainments were provided.This organization also leased a bathing establishment, where hot and cold bathswere available for personnel and patients at all times.

The Vittel-Contrexeville center was discontinued in January, 1919.

COMMANDING OFFICER

Col. Guy V. Rukke, M. C.

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