SECTION V
THE ARMY OF OCCUPATION IN GERMANY
CHAPTER XXVIII
THE AMERICAN FORCES IN GERMANY
Immediately after the signing of the armistice, the American Third Army,awas organized as an army of occupation in Germany, in accordance with thearmistice terms.1 The territory assigned to the American ThirdArmy was the historic Moselle Valley from the borders of Luxemburg to theRhine.1 The area contained about 1,000,000 people, with onlytwo large towns-Treves, with 45,000 inhabitants, and Coblenz, with 65,000.1
The maximum number of American troops ever in Germany was in February,1919, when the number totaled 10,426 officers and 251,833 men.1On July 1, 1919, the Third Army had been reduced to 5,095 officers and100,695 men, and its designation was changed July 2, 1919, to the Americanforces in Germany.1 On October 1 the forces consisted of some510 officers and 10,556 men.1
MEDICAL SERVICE
Though, as stated above, the change in designation of the Third Armyto that of American forces in Germany, was not effected until the summerof 1919, it will be convenient here to consider our medical activitiesin Germany from the beginning of that year.
The surgeon's office, Third Army, continued to have the same generalcomposition after location of the Third Army in Germany as it had had priorto that event;b however, a department of sanitation,with much broader interests, was established in the first part of 1919,after the army had been stabilized in the area of occupation.2
As army epidemiologist was attached to the office of the sanitary inspector.2His work was the collection and compilation of data on sickness in thearmy, the dissemination of this information in the publication of memorandaand a Weekly Health Bulletin, and the formulation of measures for the controlof communicable disease. Field work by the epidemiologist was not required,because no extensive outbreak of infectious disease, aside from widespreadinfluenza, occurred.
Territorial sanitation by sanitary squads as army units was not considerednecessary after the combat divisions had become stabilized in the areas.2It was decided by headquarters of the army that the divisions with theusual
aFor the compositionof the American Third Army and its march into Germany, consult Sec. VII,Vol. VIII, of this history.-Ed.
bConsult Vol. VIII,Sec. VII, Chap. XXXVIII, for details concerning the composition of theoffice of the surgeon, Third Army.
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divisional medical personnel would be able to carry on continuous sanitarywork in their permanent areas without the assistance of a separate armysanitary force. This plan proved satisfactory and, as records of sanitaryconditions in the various areas were kept in the office of the army sanitaryinspector, no difficulty was experienced in furnishing incoming divisionswith the essential information regarding the sanitary conditions of theareas which they were entering.2
In the area of occupation about 10 per cent of the troops were quarteredin barracks, while about 90 per cent were billeted with civilians in citiesand villages.2 The civil sanitary arrangements varied from crude,primitive methods of water supply and refuse disposal to the fairly wellorganized sanitary systems of the larger cities. The number of soldiersin this area, at first approximately 250,000, practically doubled the population.2So severely did this increased density of population tax the general livingarrangements, water supplies, and conservancy system, that a considerablepart of the sanitary work of the Third Army was concerned with increasingthe capacity of these rural and municipal systems. In this work, watersupplies were increased, barracks built to obviate overcrowding, and messhalls erected to provide shelter for men at meals.2
Infections diseases, with conditions highly favorable to their transmissionto troops, were found to be prevalent among the civilians, the most importantwidespread epidemic diseases being typhoid fever and diphtheria.2Arrangements for dealing with the civil phases of the situation were inthe hands of the chief sanitary officer, civil affairs, advance generalheadquarters, at Treves. By a close coordination between the medical organizationof the Third Army, the chief sanitary officer of the section of civil affairs,and local German health officials' reports, on infectious diseases amongcivilians and reports of typhoid fever carriers were obtained systematically.2Through this system the Army exercised control over disease among the civiliansand enforced various measures for improvement of civil sanitation.
Provision of facilities for disinfestation and bathing were urgent sanitaryproblems during January, 1919.2 At that time approximately 90per cent of the men were infested with lice, consequent upon the lack ofbathing and delousing facilities in the zone of combat and on the march.Upon the stabilization of troops in this area energetic efforts were madeto free the command of these vermin. Only one Foden-Thresh machine wasavailable, and the facilities for bathing were inadequate. Much improvisedapparatus was constructed by division medical establishments and by theengineers; Serbian barrels, Canadian hot-air disinfestors, cave disinfectors,and steam barrels, supplied with steam from tractor engines or factories,were set up throughout the area. By these means, augmented later by standardsteam disinfestors and portable shower baths, louse infestation was rapidlyreduced, until by May 31, 1919, the degree of infestation as determinedby inspection, was not above 1 per cent.2
During the first three months of 1919 the general camp sanitation oforganizations of the Army was greatly improved.2 The problemsdepending for solution upon the supply of lumber and other materials wereefficiently
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handled by divisions and the Corps of Engineers.2 Improvedconstruction of kitchens, screening of food receptacles, fly-proofing oflatrines, and removal of manure piles and other breeding places of flieshad progressed well toward completion before the commencement of the seasonwhen flies might prove prevalent. Supplies of clothing were ample; foodsupplies were sufficient, of good quality, and generally handled with cleanlinessduring transportation. Efforts to provide men with amusements which givethem facilities for sports and other recreation were extensive and verybeneficial.
The water-supply service was found to be the only sanitary work requiringa definite Army organization as distinct from that of the divisions.2The organization of the water-supply service was begun in the surgeon'soffice in January, 1919, when it was found that purification of water suppliesat their sources would be necessary. Many of the towns in the area of occupationwere supplied by water systems carrying tap lines to the houses. A numberof these supplies were found on examination to be polluted, particularlyin the towns in valleys of the Rhine, Moselle, and Ahr Rivers.2Since chlorination of water in water sterilizing bags was an inadequatecontrol of drinking water for men who had free access to water from tapsin houses, a water-supply service was organized under officers of the SanitaryCorps, with one section in the surgeon's office and another section inthe office of the army chief engineer.2The section in the surgeon's office was engaged chiefly in conducting surveysand examinations of water supplies and recommending the installation ofapparatus for systematic chlorination of water at suitable points. In thiswork the division field laboratories were being utilized as extensivelyas possible and proved of great value. The section in the chief engineer'soffice was concerned primarily with the assembling, construction, and installationof apparatus and the training and provision of personnel to operate theplants.
The first evacuation hospitals which operated in Germany were EvacuationHospital No. 3, which reached Treves on December 3, 1918, and EvacuationHospital No. 12, which arrived at the same city on December 4.2The former relieved a Fourth Corps field hospital which had taken overa German hospital on December 1.
During the week ending December 15, when the divisions reached theirfinal areas, additional evacuation hospitals arrived. It was planned tohave these evacuation hospitals function as base hospitals in order thatas many patients as possible might be retained in the Army and returnedto duty. To this end these hospitals were staffed and equipped as completelyas possible with well-trained personnel and with adequate supplies.2Without exception, they were unusually well housed in suitable buildings,a few of which had been constructed for hospital purposes; others werein large schools and military barracks previously used by the Germans tocare for the sick.2
It was the policy, as far as possible, to group the hospitals in centersso that special services could be more highly developed.2 Thelarge area over which the Third Army spread made it necessary, however,to place a few isolated hospitals at outlying points. The largest centerwas situated in Coblenz.2 Here Evacuation Hospital No. 6 wasestablished in a splendidly
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equipped German military hospital. This was used for surgical and orthopediccases and for sick officers and nurses. Evacuation Hospital No. 2 had aurological and contagious service. Evacuation Hospital No. 4, located ina schoolhouse on Oberwerth Island, had the eye, ear, nose, and throat cases,as well as medical service. Evacuation Hospital No. 14 took over the Bruderhaushospital and, later, a military hospital in Ehrenbreitstein. This includedneuropsychiatric and medical services and in addition was used as the triageto which all patients received in Coblenz were sent and thence distributedto other hospitals.
The second center, at Treves, consisted of Evacuation Hospitals No.3 and No. 12.2 In the former, surgical, orthopedic, eye, ear,nose, and throat, and medical services were developed; in the latter, urological,neuropsychiatric, contagious, and medical services.
To serve the more remote areas, Evacuation Hospital No. 8 was locatedin Mayen and Evacuation Hospital No. 7 in Prum.2 In order tocare properly for the 42d Division, at the extreme left of the area, evacuationon Hospital No. 26 was established at Neuenahr in a large hotel providing1,000 beds.2
The Sixth Corps was attached to the Third Army during the first twoweeks in April, 1919, and with it Evacuation Hospital No. 13, at Wolferdange,near the city of Luxemburg.2 This hospital remained attachedto the Third Army after the disbanding of the Sixth Corps. It was establishedin a château affording 150 beds. Additional beds to the total of500 were provided in tents. Because of its limited capacity the hospitalcontinued to function more as an evacuation hospital, sending many of itscases to the center at Treves.2
Some of the divisional and corps field hospital were put in operation,but retained only those cases which could be returned to duty in a fewdays. An exception was made in the case of the 90th Division, which occupieda large area.2 Here it was considered advisable, because ofthe long distance to Treves, to equip a field hospital at Cues with femalenurses and a good medical staff in order that pneumonia cases might behospitalized.
During March, 1919, certain of the evacuation hospitals which had beenlongest in the American Expeditionary Forces were relieved by others witha shorter term of service overseas, as follows: No. 2 by No. 49, No. 6by No. 27, No. 4 by No. 22, No. 8 by No. 30, No. 7 by No. 29, and No. 3by No. 19.2 Evacuation Hospital No. 16relieved Evacuation Hospital No. 14 on April 3.2 The retention,with one exception, of the commanding officers and of some of the medicaldirectors of the relieved hospitals resulted in a continuity of policy.The decrease in the size of the Third Army led to the closing of the followingevacuation hospitals in May:2 Evacuation Hospital No. 9, Coblenz;Evacuation Hospital No. 12, Treves; Evacuation Hospital No. 29, Prum. Noneof the special services in these hospitals was discontinued, however, eachbeing carried on in one of the hospitals remaining. It was assured thatwith the contraction of the medical activities coincident with that inthe size of the army, the character and adequacy of the service did notsuffer.
The epidemic of respiratory infections during January and February necessitatedfrequent evacuations to the services of supplies.2 Occasionallythe congestion of the hospitals in the Coblenz center was lessened by sendingcon-
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valescent patients to Treves. Following the stabilization of the armyin the occupied area, however, patients to be evacuated to the servicesof supplies were collected at the hospital centers.
Subsequent to the early part of March, 1919, the steady decline in thehospital admission rate made it possible to retain a much larger numberof patients in the army until they could be sent to duty or it could bedemonstrated that they should be returned to the United States. This policycreated the necessity for convalescent sections in the hospital centers.2One of these was organized at Evacuation Hospital No. 19, Treves; one atEvacuation Hospital No. 9, Coblenz; and one at Evacuation Hospital No.26, Neuenahr.
The Third Army laboratory service consisted of 2 Army laboratories,10 evacuation hospital laboratories, 7 divisional laboratories, and limitedlaboratory facilities in isolated field hospitals, with 47 commissionedofficers.2 The laboratories were so distributed and their workso divided and coordinated that the entire army had immediate access toexcellent pathological, bacteriological, chemical, and serological facilities.In addition to the routine work of the service, extensive bacteriologicalsurveys of the water supplies in the Third Army area and surveys for chroniccarriers of typhoid, paratyphoid, and dysentery bacilli among the troopswere made. Several research problems were taken up, one on the earliestevidence of tuberculosis infection; another on the pneumonias; and stillothers, prompted by the interest of interested officers.
The major part of the professional work in the hospitals and divisionsof the army fell upon the internists, due to the fact that by far the greaternumber of cases admitted to hospital were for medical, rather than surgical,conditions.2 Since the evacuation hospitals had been organizedprincipally for surgical work, it was appreciated that their personneland equipment would not be adequate for the type of cases now to be treated,consequently in January, 1919, the staffs were supplemented with a numberof internists.2 A medical service under a competent chief wasmaintained in each hospital, and much shifting of personnel was done toput each service on the most efficient footing possible.
As the Third Army was reduced in size, more particularly during therelease of the final divisions, the various evacuation hospitals were closedand returned to the United States, until Evacuation Hospital No. 27 aloneremained. This occupied the buildings of the former German military hospitalat Coblenz, which, as will be referred to below, became the base hospitalfor the American forces in Germany.
When the office of the surgeon, Third Army, became that of the chiefsurgeon, American forces in Germany, this difference obtained:2Whereas, the Third Army was a part of the American Expeditionary Forces,the American forces in Germany were subordinate only to the War Department,consequently there was now no intermediate officer between the chief surgeonand the Surgeon General, in so far as matters purely medical were concerned.
Also, certain changes in the Medical Department units were effected.As finally organized the Medical Department of the American forces in Germanywas as follows:2
Chief surgeon's office.
Attending surgeon's and dental surgeon'soffice.
Medical supply depot.
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Base hospital, including-
Convalescentcamp.
Field HospitalNo. 13.
EvacuationAmbulance Company No. 26.
Hospital TrainNo. 70.
Field HospitalNo. 6.
Field HospitalNo. 8.
AmbulanceCompany No. 6.
Provisional Sanitary Train, 2d Brigade.
Port surgeon's office, Antwerp.
Port hospital, Antwerp.
Medical Department personnel on dutywith the various organizations operating infirmaries and prophylactic stations.
Veterinary service (chief veterinaryofficer in office of chief surgeon and veterinary officers on duty withmounted organizations).
Polish typhus relief expedition (attached).
With the replacement of troops of the army of occupation by regulartroops, the plan of hospitalization necessarily changed.2 Insteadof evacuating to the United States each patient not expected to returnto duty within a short period, a practice hitherto obtaining, all exceptsurgeon's certificate of disability cases were to be retained and treatedin Germany. Accordingly, a base hospital was established, and the sickfrom the various organizations were collected daily and treated in thishospital.2
The base hospital, American forces in Germany, was located in the westernsection of the city of Coblenz.2 It occupied a group of buildingswhich at one time comprised the Germany garrison hospital of Coblenz, andwas used by the Germans in part as a hospital and in part as a medicalsupply depot. There were 13 two-story concrete buildings, with whitestonefoundations, stone-lined entrances and windows; they all were of moderntype and in good repair, and had a normal bed capacity of 460.
Collecting daily and treating sick in the base hospital not only assuredthe proper segregation of cases of contagious disease, but also gave thepatients the benefit of the best modern diagnostic methods and treatmentby specialists.2 But as the base hospital soon became overcrowded,it had to be enlarged by building a number of temporary frame wards.2
At first, five temporary buildings were added. These, with 152 beds,were located across the street from the hospital. Subsequently nine additionalwooden frame buildings, of the Adrian type, were constructed. These buildingswere heated by stoves, illuminated by electricity, and had modern sewerageconnections and flush latrines. A series of wooden buildings (Adrian huttype) which were a part of the hospital was used as quarters for the detachment,Medical Department, and for the supply depot of the base hospital.
The increase in the activities of the base hospital also necessitatedthe establishment of a convalescent camp in connection with it.2Such a camp, with a bed capacity of 500, was opened on September 24, 1919.It was established primarily for the treatment of convalescent venerealpatients, and throughout the period under consideration was utilized toits full capacity.2
Antwerp being a supply base for the American forces in Germany, it wasnecessary to provide for the local hospitalization of our troops there.2Early
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arrangements were effected with the Belgian military authorities bywhich any members of the United States Army in Antwerp, when in need ofmedical or surgical attention, might be taken care of at the HôpitalMilitaire d'Anvers. This arrangement worked very well, but had severaldrawbacks, among which may be mentioned the fact that any soldiers so treatedwere not under the control of the United States Army from the time thatthey were admitted to the Belgian hospital until they were discharged.There was also always more or less difficulty about getting men dischargedon time and in some cases fraudulent release occurred through the Belgiansnot being familiar with the United States Army procedure. Ultimately asmall port hospital of 75 beds was opened.2
Hospital Train No. 70 was turned over to the American forces in Germanyand placed in use, evacuating disability cases to Antwerp, Belgium, forreturn to the United States.2
The amount of sickness among the American troops in Germany was neverexcessive.2 Taking into consideration that these forces weremade up mostly of recruits, the sick rate for communicable diseases wasvery low, although some of the contagious diseases, such as diphtheria,measles, and scarlet fever, were at times above the normal pre-war rate.No serious epidemics occurred. The good health of the command was attributedto the mild, equable climate of the Rhine Valley; to the good health andsanitation of the civil population; to the excellent housing conditionsof the troops, most of them being in comfortable barracks; and to the carefulsupervision of sanitation by medical and line officers. With the exceptionof the control of venereal diseases, no difficult health problems presentedthemselves.
REFERENCES
(1) Annual Report of the Chief of Staff, U. S.Army, 1920, 239-41.
(2) Annual Report of the Surgeon General, U. S. Army,1920, 368-91.
