SECTION II
MEDICAL ACTIVITIES OF TERRITORIAL SECTIONS
The territorial sections, A. E. F., may be divided roughly into two classes:
Those built around the ports (or base sections), and the interior sections. There were 11 territorial sections; however, for present purposes, 3 sections only are considered the advance section(an interior section), and two base sections (Nos. 1 and 5).
THE ADVANCE SECTIONa
The advance section, located in the north and northeastern part of France, embraced in a general way the territory north of Paris, and Dijon. Its geographical limits, as prescribed by General Orders, No. 75, Headquarters, A. E. F., December 14, 1917, included the Departments of Nord, Pas du Calais, Somme, Oise, Aisne, Ardennes, Marne, Merthe et Moselle, Meuse, Haute Marne, Cote d`Or, Vosges, Haute Saone, and Doubs. These limits were somewhat changed from time to time.
At Chaumont, in this section, which was that immediately behind the front, general headquarters of the American Expeditionary Forces were located after September 1, 1918. The section also contained 22 training areas where tactical divisions were billeted, either on their way to the front or for rest, replacement, or refitting. In addition to these were the training area where Medical Department troops were trained, the staff and line schools of all branches of the service, the supply depots, and other installations of the technical services, including 63 hospitals and 10 veterinary hospitals. Despite the fact that practically all of these areas and formations were under direct control of either general headquarters of the American Expeditionary Forces, or headquarters, Services of Supply, the number of troops under the jurisdiction of the section commander sometimes amounted to more than 200,000. The section had been organized to extend the jurisdiction of the commanding officer, Services of Supply, up to the points where supplies would be delivered to the field transportation of combat forces, but in practice distribution was made from regulating stations which were under the direct control of the general staff, general headquarters.
Headquarters of the advance section were located at Neufchateau, where the office of the section surgeon was opened on November 1, 1917.
The office of the section surgeon had three principal divisions: Administration, sanitation, and dental service.
In respect to administration, the duties of the section surgeon were analogous to those of a department surgeon, but were much greater, as they included the sanitary service of many camps and the control of a number of Medical Department units-ambulance companies, field, mobile, and evacua-
aThe statements of fact appearing herein are based on: "Report of the surgeon, advance section, A. E. F." (undated), by Col. F. P. Reynolds, M. C. On file, Historical Division, S. G. O.
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tion hospitals, medical supply depots, sanitary squads, and laboratories. The frequent changes in these commands necessitated a corresponding increase in the activity of the section surgeon`s office. Another difficulty with which he had to contend was the fact that, as a number of formations within the area were exempted from control of the section commander, there was a certain lack of coordination in the medical service of all the commands located within its geographical limits. These exempted areas were schools, regulating stations, supply depots, base hospitals, roads, and other projects. On January 31, 1919, the number of Medical Department personnel carried on the records of this office was as follows: Officers, 1,456; nurses, 500; enlisted men, 14, 413. Medical supplies were at first issued from the supply depot without the approval of the office of the section surgeon. Shortly after the armistice began this arrangement was modified so that requisitions for medical supplies required his approval before issue from the depot was made.
For sanitary service the section was divided into areas, in each of which a local sanitary officer was designated, all under the supervision of the section sanitary inspector. To each divisional training area a sanitary squad was assigned and its commanding officer was charged with the duties of sanitary officer for the area. Each divisional training area included a sufficient number of towns, usually a score or more, to accommodate a full tactical division, the troops occupying houses, barns, or other outbuildings and newly constructed barracks. For administrative purposes a zone major and three or four assistants were assigned to each training area where they were under the direction of the chief billeting officer of the advance section. The zone major assigned brigades to groups of towns; in each occupied town a town major was appointed by the commanding officer of the unit. The general instructions to the zone major directed him to organize and administer his zone to accommodate the unit assigned to it, his primary duty being to provide for the comfort of troops occupying the towns of the zone.
The average towns with which this section was concerned had grown from hamlets and villages without corresponding increase of wealth, for which reason few streets were paved, lighting was most primitive, and sewerage systems generally were lacking; public bathhouses took the place of private baths. Street filth was common in the village of eastern France because of lack of labor and the fact that most of the villagers were farmers, who saved all manure to spread on their lands. When the Americans first entered these villages, with their long main streets lined with manure piles, they at once set to work cleaning up. The result was often a misunderstanding. The rooms used by our troops were paid for at an agreed rate, 2 square meters of floor space being allowed for each man. The sanitary arrangements of the towns were primitive and unsatisfactory to Americans, but were gradually improved. In the end, they were fairly good; at least the billets proved healthful to the troops occupying them.
The general plan for sanitary work in a training area was: (1) To keep the zone major constantly informed of sanitary conditions; (2) to estimate the billeting capacity of each town in order that the troops might have proper air space and comfort; (3) to work in conjunction with the central Medical De-
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partment laboratory in placarding water sources; (4) to assist incoming units in preventing epidemics; (5) to assist in organizing and operating bathing and disinfesting stations; and (6) to exercise a general supervision over the sanitary conditions among the civilian population. When the training areas were not occupied by divisions it proved desirable to assign trained men from sanitary squads on duty in those areas to temporary duty elsewhere with organizations recently arrived from the United States and whose medical personnel were unfamiliar with special sanitary conditions and problems in France.
Following the signing of the armistice and the return of combat divisions from the front to training areas, the work of the sanitary squads was mainly that of assisting the divisional sanitary inspectors in promoting bathing and disinfestation of troops and in improving the sanitary conditions in the towns.
Weekly reports of activities of the sanitary squads were rendered to the zone majors and to the surgeon of the advance section.
The medical and sanitary services of troops in each training area were handled by the surgeon and sanitary inspector of the division occupying it. These officers were assisted by a sanitary squad of 26 men. A medical officer was located in each town of any size but the sick requiring hospital treatment were sent to the camp hospital of the area; the more seriously sick were evacuated to base hospitals from the area railhead.
It was difficult and often impossible to maintain safe or satisfactory standards of sanitation in camps and training areas. Overcrowding in barracks and billets was the most serious defect, due chiefly to lack of buildings and of building material, and transportation. This condition may be said to have been the chief determining factor in the spread of respiratory infections, notably influenza, pneumonia, diphtheria, meningitis and tonsillitis, which prevailed at times, in many places.
Difficulties were experienced in providing adequate facilities for bathing and for drying clothing, with ensuing hardship to the troops. Water supplies, in many instances, were inadequate in quantity, while in quality they generally were unsafe for drinking purposes. Gross pollution was by no means uncommon, and many outbreaks of diarrhea were traced to this cause. The food of the men was ample in quantity and excellent in quality, so that complaints on this subject were few and of minor importance. The same may be said of clothing. A scarcity of blankets was reported in some organizations in October and November, 1918, but this was soon corrected.
Investigations of outbreaks of communicable diseases were made by special inspectors from the office of the advance section surgeon. Often these investigations were carried on in connection with the central Medical Department laboratory and Army laboratory No. 1, both of which were located in the advance section. The facilities of these laboratories were also utilized for the analysis of water supplies and for other chemical and bacteriological work. They were supplemented especially for clinical purposes by the laboratories in camp and base hospitals.
Much difficulty was experienced in making effective measures for the supervision and control of the venereal diseases. The constant movement of troops on their way to and from the front, the lack of control by headquarters
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of the advance section over many of the organizations, and the wide distribution of the troops under its command conspired to make difficult the prosecution of a comprehensive plan. The number of separate camps or stations of troops was over 400. Many small detachments were located in isolated localities, with which it was difficult, if not impossible, to communicate by mail, telegraph, or telephone. Changes in stations of troops occurred so frequently that headquarters of the section was never able to maintain an accurate record in its weekly station list.
The great shortage of medical personnel and of transportation which existed until some time after the signing of the armistice further interfered to a serious degree in this as well as in other sanitary activities.
As a rule, the health of troops in billets was exceptionally good; better than when they occupied crowded barracks, and on the whole was satisfactory. The epidemic of influenza which prevailed during August, September, and October, 1918, constituted the most serious outbreak of communicable disease, for some organizations suffered very severely, and in certain camps, notably at Valdahon, the epidemic assumed a grave aspect. Influenza continued to constitute the principal cause of admission to hospitals to the end of 1918 and isolated outbreaks occurred until March of 1919. After the autumn months the cases of influenza were less severe and their complications, especially pneumonia, were less frequent. Typhoid fever appeared in many places, and in a number of combat organizations there were well-marked outbreaks. Among troops properly pertaining to the advance section, the cases were scattered, with a single exception, when 15 cases occurred in one camp. The development of these cases occasioned a new administration of typhoid prophylactic. Cases of cerebrospinal meningitis occurred in many organizations. By January, 1919, 32 central reporting officers were collecting morbidity reports from troops in their areas, which they sent in weekly by telephone or telegraph.
A total of 26 camp, mobile, and evacuation hospitals were in operation in this section, with approximately 9,000 beds. The personnel of camp hospitals were assigned by the surgeon of the section approximately in the proportion of 10 medical officers, 10 nurses and 25 enlisted men to each of these units. Each camp hospital served a division of from 25,000 to 30,000 men.
The following camp hospitals operated in this section: No. 1, Gondrecourt; No. 3, Bourmont; No. 4, La Fauche; No. 6, Barisey-la-Cote; No. 7, Humes; No. 8, Montigny-le-Roi; No. 9, Chateau-Villain; No. 10, Prauthoy; No. 12,Valdahon; No. 13, Mailly; No. 18, Liffol-le-Grand; No. 21, Bourbonne-les-Bains; No. 22, Langres; No. 23, Langres; No. 24, Langres; No. 38, Chatillon-sur-Seine; No. 41, Is-sur-Tille; No. 42, Bar-sur-Aube; No. 48, Recey-sur-Ource; No.49, Laigness; No. 50, Tonnerre; No. 64, Semur; No. 65, Semur; No. 67, Moneteau; No. 97, St. Dizier; No. 100, Belfort. Evacuation hospitals in the are awere the following: No. 1, Toul; No. 2, Baccarat; No. 10, Froidos; No. 114, Fleury-sur-Oise. Mobile hospitals were two in number; No. 10, Vitry; No. 11, Donjeux.
On the breaking up of the First and Second Armies the following medical units of these armies and unattached to divisions came under control of the
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advance section-4 evacuation hospitals, 3 field hospitals, 1 sanitary train, and 15 ambulance companies.
In the spring of 1919 disbandment of medical organizations in the advance section went on rapidly. By April 1, Camp Hospitals Nos. 1, 3, 7, 8, 9, 10, 21, 38, 42, 49, 60, 67, and 97 had ceased to function. The evacuation hospitals, field hospitals, and ambulance companies mentioned above were also ready to move to the ports. Twenty-three sanitary squads had finished their labors.
BASE SECTION NO. 1b
Base section No. 1 was located on the west coast of France, bordering the Bay of Biscay and surrounding St. Nazaire. This was the first port used for debarkation purposes. This section, after several changes, embraced the departments of Morbihan, Loire Inferieure, Vendee, Maine et Loire, and Deux Sevres. As St. Nazaire lay at the mouth of the Loire, the main route to the American Army at the front led up the valley of this river. The port had excellent wharves, with water deep enough for the majority of transports, but its harbor was small and in consequence only a limited number of ships could be accommodated at one time.
The office of the surgeon of this section was established at St. Nazaire on July 2, 1917, immediately after the arrival of the first convoy of troops. Among the first of the duties of the base surgeon, whose office was an integral part of that of the section commander, were the provision of infirmaries in and about the city, the establishment of a base hospital (French Hospital No. 59), the assignment of medical personnel, including those detailed to inspect incoming transports, and the establishment of a warehouse for medical supplies. This warehouse was to be a supply depot whence stores would be forwarded to the medical supply depot at Cosne or to the various base hospitals then arriving. Little could be accomplished in the development of the services of base section No. 1 until after the receipt of additional personnel and supplies, but on August 4 several organizations arrived, including Base Hospital No. 8, which was located at Savenay, about 20 miles from St. Nazaire. During the latter part of August, Base Hospital No. 27 was established at Angers, somewhat farther inland. By the end of Augus there were on duty with headquarters of the section 2 medical officers and 9 enlisted men, 7 of whom were handling supplies.
The prevention of venereal diseases was one of the earliest medical problems attacked, but its solution was made difficult by the lack of cooperation between American and French officials, the methods of their respective services being widely dissimilar. Numerous prophylaxis stations were established in the city, instructions concerning their usage were sent to all troops in the section, a base urologist was assigned, and the many venereal cases arriving on transports were isolated and treated. Detailed instructions concerning venereal control were later issued as provided in General Orders, No. 77, headquarters, A. E. F., 1917.
Early in September, 1917, the surgeon was instructed to establish a motor ambulance assembly park, where all motor transport for the Medical Department would be assembled and thence delivered to the proper organizations. An officer of the Sanitary Corps and 35 enlisted men were assigned to duty with this formation.
bThe statements of fact appearing herein are based on "Report of Medical Department activities, base section No. 1" (undated), made by Col. Charles L. Foster, M. C. On file, Historical Division, S. G. O.
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By the 1st of October resources and responsibilities had so increased that the section surgeon`s office was divided into three departments, viz, central office charged with administration, correspondence, records, and similar duties; motor transport branch, concerned with the receipt, assembly, and delivery of motor vehicles; medical property branch, concerned with receipt, storage, and shipment of general medical supplies.
The office of the surgeon of base section No. 1 remained an integral part of the headquarters of that section until January 28, 1918, when in anticipation of the reorganization of the entire American Expeditionary Forces it became a separate office of record in which the following departments were established: (1) General correspondence, including selection of hospital sites, establishment of hospitals and infirmaries, and issuance of instructions;(2) personnel branch, including reports on personnel; (3) sick and wounded branch; (4) property branch. Subsequently other departments were added, so that, as finally organized, the surgeon`s office comprised the following departments: (1) personnel and motor transportation; (2) files, records, and general office branch; (3) evacuation of sick and wounded; (4) property and accounts; (5) hospitalization; (6) sanitation; (7) epidemiology; (8) base laboratory; (9) food and nutrition; (10) urology, including venereal diseases; (11) dental service; (12) professional consultants; (13) medical boarding service (of transports); (14) attending surgeon`s office; (15)attending dental surgeon`s office; (16) embarkation branch (concerned with troops returning to America).
The personnel and motor transportation branch acted on all reports concerning commissioned and enlisted personnel, made assignments to duty, kept personnel records and rendered reports concerning them to the chief surgeon, A. E. F. It also kept a record of the number and location in the section of all motor vehicles assigned to the Medical Department, requisitioned and assigned such vehicles and rendered such reports on motor vehicles as were called for. This branch was established on January 28, 1918, and did its maximum work during the latter half of that year, when the medical personnel numbered 500 officers and 4,500 men.
The files, records, and general office branch dated from the reorganization of the American Expeditionary Forces into sections on January 28, 1918. It handled all mail, conducted correspondence, issued circulars and similar documents, maintained a decimal filing system, mailing lists, and the custody of the office property. Pertaining to this branch were the commanding officer of the medical detachment on duty in St. Nazaire and a separate mess conducted for the men on duty in the office at the base laboratory, and at the supply depot.
The evacuation branch was charged with the movement of patients from hospitals to ships and with duties incident thereto. Before August, 1918, the number of patients evacuated to the United States through the port of St. Nazaire was not large, and included chiefly personnel recommended for discharge because of physical disability. During August and September, 1918, wounded began to arrive in this section, and during September 3,190 of them were evacuated to the United States.
An evacuation motor ambulance battalion was unofficially organized in November, 1918. A little later Motor Ambulance Company No. 44 and Evac-
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uation Ambulance Company No. 9 were organized as a battalion to transport sick and wounded in the course of evacuation; later, Evacuation Ambulance Company No. 22 was added to this organization.
The first evacuation of any importance was made on September 20, 1918. From this time on the number of evacuations increased steadily, and by the latter part of March, 1919, this organization had transported 33,500 sick and wounded. The number of ambulances was increased to 38 Fords and 24 G. M. C.`s. Later10 White reconnaissance cars were added for long hauls, the total vehicles now numbering 72.
These cars evacuated sick from all the base hospitals in the vicinity of the port as far as Quiberon, Carnac, Muecon, Vannes, Coetquidan, Plouharnel, Savenay, Nantes, La Croissic, and La Baule. The largest number transported to one boat in one day was 1,476 on December27, 1918. The record for rapid evacuation was made on December 18, when520 walking patients were unloaded from trains and transported to the wharves in 28 minutes. The longest evacuation, 78 miles, was made from Plouharnel. Patients evacuated through St. Nazaire came from the hospital centers at Nantes, Savenay, and from the hospitals at St. Nazaire. They were collected at Savenay for final examination, assembly of records, and provision of equipment, clothing, and kits, including toilet articles.
The property and accounts branch performed the duties indicated by its name. When the first stores arrived in June, 1917, a part of warehouse F was assigned to the Medical Department. Here stores were sorted and repairs made, but the bulk of the stores were loaded on cars at once and shipped to the supply depots in the interior. Later, warehouses E and G were assigned to the Medical Department and used in the same manner.
It was apparent almost from the first that a medical supply depot was necessary at the port for local issues. As an expedient, a small supply of extra stores was kept at Base Hospital No. 101, St. Nazaire, for emergency issues. On March 26, 1918, the section surgeon requested permission to keep on hand the most necessary stores for issue to nearby units. This request was granted and by July 1, 1918, a depot, though imperfect, was in operation. By September 1, warehouse E had been obtained, rebuilt, and stocked as a supply depot, and was issuing general stores to base section No. 1 and to base section No. 5 (Brest).
The hospitalization branch of the section surgeon`s office was established in October, 1918, to have direct charge of hospital sites, buildings, administration, inspections, records, supplies, and similar duties incident to the service of such formations as were not under the direct control of the chief surgeon`s office, A.E. F.
The sanitary branch of the section surgeon`s office was organized on January 28, 1918. At first, this branch was concerned with reports and classifications of infectious diseases; isolation and treatment of cases of infectious disease arriving on transports; correction of sick and wounded reports; weekly sanitary reports; reports on evacuations; and reports on venereal diseases. Upon the organization of separate departments for venereal diseases, epidemiology, hospitalization, and evacuation, this branch controlled only purely sanitary affairs.
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In August, 1918, base section No. 1 was divided into 12 sanitary districts to each of which a sanitary inspector and a health officer were assigned. These officers kept themselves informed concerning epidemic diseases in their respective districts, and reported them as occasion required.
An isolation camp with a capacity of 3,000 was established near Camp Hospital No. 11, but when preparations were made for the return of troops to the United States its capacity was increased to 4,000 and it was made a part of the embarkation camp, except that barracks for 1,500 men and for a proportional number of officers were reserved for isolation purposes. This group of barracks was located in one corner of the camp, inclosed by barbed wire, and so arranged as to permit its operation as a separate unit.
The epidemiological branch of the section surgeon`s office was not made a separate element until November, 1918. Its duties were: (1) To receive and tabulate reports of epidemic diseases; (2) to direct measures for stamping out epidemics; (3) to maintain charts and graphs of prevailing communicable diseases; (4) to prepare the required reports for the chief surgeon.
From November 17, 1918, the epidemiological division issued a weekly report of infectious diseases, showing the number of different diseases developing in each camp, the weekly rate per 100,000f or each disease, and the strength of each camp or locality.
The base laboratory was opened at St. Nazaire on December 22, 1917, in two rooms. The purposes of the laboratory were those of a base laboratory for the section, viz, to distribute media and other laboratory articles to the various hospitals, to do routine analyses for permanent troops of the port, and to make Wassermann reactions for the whole base section. By July, 1918, the laboratory had enlarged its quarters, to a sufficient size and was prepared to do all required work, several additions having also been made to the personnel. During the summer of 1918, the unit received an 8-chest United States Army transportable laboratory, which was used in emergencies at Camp Hospitals Nos. 11 and 15.
One of the important duties of the base laboratory was to make water analyses, for water supplies throughout the section generally proved unfit for drinking purposes until purified. At first, St. Nazaire had a very small and poor water supply, of about 660,000 gallons per day. This supply was increased to 2,000,000 gallons per day by taking water from the Trignac Canal. Intensive sedimentation and chlorination of the canal were necessary, but even with these measures this water could not be made satisfactory, and a new system was later installed by the Engineer Corps, taking water from the River Brivet. This latter plant furnished 3,000,000 gallons per day, the water being coagulated, filtered, and chlorinated. Another plant for the Montoir camps provided 1,000,000 gallons per day. These plants were not completed until February 1, 1919. A separate plant for Savenay which furnished 720,000 gallons daily was in use by August,1918. Other camps and billeting areas were supplied in various ways. The laboratory checked and supervised all these water plants and their output and published its findings.
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The food and nutrition branch of the section surgeon`s office was concerned with improving troop messes and conserving food. It was organized on April 16, 1918.
The branch of the section surgeon`s office, concerned with urology and venereal diseases was organized on August 20, 1917. The general measures instituted by it were: (1) Formulation of instructions to be given the men by their officers; (2) the establishment of adequate prophylaxis stations; (3) recommendations concerning passes; (4) inspection of restricted districts; (5) supervision of the enforcement of general orders, A. E. F., relating to venereal diseases.
It was the policy to maintain a station in each permanent organization, and others at central points in the city, all being open day and night. For service of stations in the various parts of the section, the sanitary inspectors were responsible. The success of these stations may be inferred from the fact that during the last six months of 1918, only 1 case of venereal disease developed to each 312 prophylactic treatments given.
The office of the supervising dental surgeon was established at St. Nazaire on April 1, 1918. The supervising dental surgeon`s duties at that time included the supervision of the dental work in base sections Nos. 1, 2, 5, and 7. Since organizations going through the section remained but a short time, the scope of the work was limited, for each organization had its own dental surgeon and but few were assigned to the base section.
On November 2, 1918, dental infirmaries were established at camp No.1 and at Montoir. On December 17, the scope of the service was enlarged to meet the increased demands incident to the return of the troops to the United States; infirmaries were opened at camps Nos. 4 and 5 and additional ones at both Montoir and camp No. 1; more dental officers were assigned to the dental supervisor and one was placed in charge of each district.
The attending dental surgeon`s office was established April 17, 1918, at section headquarters building in St. Nazaire, where 1,900 patients were treated and 3,000 operations performed.
A system of reports was established so that the work done each day by each dental office was tabulated and made of record. At the reception camp, dental officers were on duty making inspections of all men arriving for embarkation. Patients were listed according to the urgency of their needs for dental treatment and were ordered to the infirmary accordingly.
Consultants for the base section were appointed in general surgery, orthopedic surgery, and general medicine. These officers visited the various hospitals from time to time, made special reports on personnel and equipment and endeavored to remedy deficiencies. They were directed when necessary, to remain at a hospital long enough to give special instruction and training to the personnel, so as to insure the latest methods of treatment and uniform procedure throughout the section. When better facilities for special cases were known to exist at a particular hospital, recommendations were made for the transfer thereto of selected cases, especially the wounded. The orthopedic consultant also visited trains and transports to insure that the wounded were comfortable and that the apparatus in each case was properly adjusted.
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The American and French health authorities agreed that our Medical Department should execute the French quarantine regulations of the port, in so far as these regulations applied to American transports. Consequently, a quarantine office was established about December 1, 1917, and the officer in charge was designated the medical boarding officer. His duties were defined as follows: (1) Transmission of the instructions to transport surgeons; (2) report of patients to be put ashore; (3) report of infectious diseases; (4) furnishing correct list of Medical Department personnel; (5) report of venereal inspection of troops and crews; (6) venereal inspection on ships which were without a transport surgeon. Later, the following duties were added: (7) Report of typhoid and paratyphoid fever vaccinations; (8) report to French authorities; (9) report on requirement that sera and vaccines be available on all vessels clearing the port with the Government passengers;(10) distribution of orders, letters, memoranda, etc., to transport surgeons. A bill of health was issued to each vessel sailing.
The medical boarding officer also supervised the sanitary condition of the wharves and transports at St. Nazaire and was a member of the board of inspectors which reported on the accommodations for troops all returning ships. Approximately 198,000 troops entered France through this port.
Following the signing of the armistice the section surgeon recommended that all incoming troops destined for the United States be placed in a receiving camp, where a thorough physical examination could be made, and where all officers and men having infectious disease, including skin or venereal diseases, could be separated and placed under treatment; that the remainder should be then disinfested, equipped with a complete change of clothing, and placed in the clean or embarkation camp proper.
The inspection and clearance of troops was placed under a special officer ;the embarkation surgeon and all disinfesting operations were under the Quartermaster Department. Embarkation Memorandum No. 1, laying down regulations for the inspection of troops and the loading of transports, particularly stressed the subject of infectious diseases.
Troop trains were met by a medical officer, ambulances, and guides. Inspection was made, acute surgical cases were sent to Base Hospital No. 101, and medical, contagious, and venereal cases to Camp Hospital No. 11. Contacts were placed in the isolation camp, and were detained there as long as necessary.
At the gate of the embarkation camp, men stripped to the waist, dropped their breeches and passed in line before the medical examiners. One officer made examinations above the umbilicus and another below. Venereal cases(or suspects) were sent to a special examiner. Those unfit to travel were removed and diagnosis tags affixed to them. Vermin infested men were marked with argyrol. In this manner 12,000 or more could be examined in one day,20 medical teams working at the same time.
After this examination the men who had passed secured their packs and went on to the clean camp, which could be entered only by way of the bathing and disinfesting plant. All took shower baths; the hair of those marked as vermin infested was clipped and crude oil was applied to the head, to remain
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15 minutes. All then passed to a warm drying room where new underwear and socks were issued, then to the clean side where they received their packs, which had been heated for 20 minutes to 160°. From the clean camp the men went directly to the ships; but another examination was required if 24 hours had elapsed since the previous one. A clearance certificate was prepared for each organization or separate individual passed.
The hospital centers at Savenay and Nantes and Base Hospital No. 101,at St. Nazaire, had authority to evacuate patients directly to the transports, after their clothing, equipment, pay, and records had been inspected by the base inspector and personnel adjutant.
BASE SECTION NO. 5
In August, 1917, when the line of communications, A. E. F., was organized ,base section No. 1, included the authorized facilities in the port of Brest.1 It was not until December14, 1917, that base section No. 5 was organized.2 At that time it contained but one Department of France-Finistere. Eventually, base section No. 5 embraced parts of Brittany and Normandy (viz, the Departments of Finistere, Cotes du Nord, Ille et Vilaine, and Manche).3
Undesirable conditions which militated against the value of Brest for our debarkation purposes were the heavy rainfall, a soil which soon became a deep and tenacious mud, inability of large vessels to reach the piers, and the fact that the French Government hesitated to transfer to the United States debarkation facilities, in large degree, until after the armistice was signed, for Brest was the most important French naval base on the west coast.4 All disadvantages, however, were far outweighed by the situation, good harbor, and railway facilities of Brest. How indispensable this port proved is evidenced by the fact that approximately 791,000 of our officers and men here entered France and that an almost equal number left through it on the return voyage.4Prior to November 11, 1918, Brest, and to a much less degree Cherbourg, were points of disembarkation in this base section and thereafter Brest was the principal port of reembarkation of the American Expeditionary Forces.4
A very limited personnel for the operation of the section arrived in Brest November 11, 1917, two days before the arrival there of the first convoy, consisting of 4 transports carrying 11,000 troops.3Of these troops, 3 companies of the 301st Stevedore Regiment, with a detachment of 21 enlisted men of the Medical Department, were assigned as permanent troops in this section.3 The surgeon of this organization instituted the office of the section base surgeon on November 13.3
During the period when troops were arriving from America no large camps were established in this section, for no good sites existed in the immediate vicinity of the port nor could such as were available be made suitable without much time and labor; also the supply of building material was extremely limited.3 Because of this lack of camp facilities the troops of the first and many subsequent convoys were kept on board ship, where they could be sheltered and fed, until trains were available, and thence were sent toward the front or to other sections as quickly as possible after arrival.3 This procedure prevented isolation of cases of infectious diseases and contacts, and
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permitted spread of such diseases along the line of communications, a circumstance that was attended by especially bad results, from a medical standpoint, during the epidemic of influenza.3Brest at first also lacked many sanitary facilities and appliances for troops permanently assigned to this section. Buildings used as barracks and latrines by the troops first serving in the section were in poor condition and were very limited in number. The water supply was limited, and unsafe until chlorinated, but the limitation in its supply was overcome in part by collecting rain water. An adequate water supply, though early recommended, was not installed until July, 1918. Fuel was scarce, heating apparatus inadequate, and bathing facilities at first werelacking.3
For administrative purposes, base section No. 5 eventually was divided into the following units:3 Casemates Fautras Barracks; Fort Bouguen casual camp; Fort Bouguen prisoners-of-war inclosure; Camp Federes; Penfield prisoners-of-war inclosure; motor reception park; motor ambulance pool, Camp President Lincoln; Camp Gambetta; Camp de la Rampe; Camp Port Foye. The surgeon at each of these was in charge of sanitation and of a sanitary squad which each organized.
In addition to the section surgeon and section sanitary inspector, other officers eventually on duty in the office of the section surgeon were his assistant, an adjutant, a food and nutrition officer, and consultants in medicine, surgery, urology, orthopedics, neurosurgery, and dentistry.3
When American activities began in this section the hospitals operating in Brest were Navy Base Hospital No. 5, serving the personnel on American naval transports based on that port, and the French marine hospital performing the same duty for the French naval forces.3 Arrangements were made with the commanding officers of these hospitals for the care of such patients as might be among the arriving troops. At this time the first mentioned unit had a capacity of 40 beds, but was in process of moving to larger quarters where a capacity of some 400 beds was provided. All of these were not available for the Army, but as many as could be spared were freely allotted it. The number of beds made available at the French marine hospital was between 100 and 150.
During the month of December, 1917, Navy Base Hospital No. 1, with a capacity of 417 beds, expanded in times of stress to nearly 700, and staffed by Navy personnel was established in the Petit Lycee at Brest. This unit was loaned to the Army.3
On January 15, 1918, a formation first known as Pontanezen Barracks Hospital and later (February, 1918) designated as Camp Hospital No. 33, was opened in Pontanezen Barracks, its limited personnel being drawn from organizations passing through the port and from other sources.3 No nurses arrived until April. The bed capacity of this unit, at first 200, was increased in April, 1918, to 1,000 normal and 200 emergency. Later it was at onetime increased to 2,600 beds, but never cared for more than 1,900 patients at one time. It occupied four barracks, 300 feet long, 13 Adrian barracks, and an old building formerly used by the French as an infirmary. In May,1918, a hospital for contagious cases, under the jurisdiction of Camp Hospital No. 33, was built in its vicinity. This unit, Camp Hospital No. 33, was used for troops located permanently at or near Brest, but it also received patients from troops moving
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to the front, and later those belonging to troops being returned to the States. During the period when influenza prevailed, August to December, 1918, the admissions numbered 12,465. This unit experienced many difficulties, of which the most serious were shortages in personnel, supplies, and equipment, and the fact that it was required to supply with medicines transient organizations temporarily in camp in this section. The base surgeon, in order to meet urgent needs, was obliged to divert supplies en route to medical supply depots farther inland. Sanitation of the hospital with the primitive facilities afforded was very difficult, and methods employed in different elements of it were, because of conditions encountered, somewhat diversified. Some latrines were pumped out by tank wagons, while others of the can type were emptied by contractors. Disinfectants were very scarce and it was impossible to render latrines fly proof. Eventually large cement latrines were constructed, which were to have been connected with the sewer system and flushed by waste water from the shower baths, but these were never installed, and the pits therefor were emptied by tank wagons or buckets.
Infectious cases were sent at first to the French marine hospital, but as more beds were provided in American formations the usage of that unit by Americans was gradually discontinued.3Thereafter as far as possible infectious cases were sent to Camp Hospital No. 33 and noninfectious cases to Naval Hospital No. 1. It had been believed during the earlier period of activity in this base area that the units mentioned above would prove adequate, for at that time it was estimated that troop arrivals would average 20,000 per month.3 Later it was proposed to establish a hospital of 12,000 beds at Landerneau, about 30 kilometers east of Brest, and as a nucleus Camp Hospital No. 46, with a capacity of 260 beds, was established in June, 1918, in a convent at that place. This hospital was not increased in size-orders for the construction of a center there being cancelled when the armistice was signed-and it was used chiefly as a hospital for convalescent wounded, except that in the fall of 1918 (October and November) it accommodated influenza-pneumonia patients from the transports.3
The most serious difficulties which the Medical Department encountered in this section were those incident to hospitalization and transportation.3
In order to care for patients brought ashore from transports and for others belonging to the troops permanently stationed here, hospital accommodations were rapidly expanded.3 They proved adequate even during the influenza epidemic when bed capacity rose to 6,200, though the Medical Department personnel then available was very limited.3
Hospitalization at Cherbourg for Army troops was provided by the British under an agreement whereby duplication of hospitalization facilities by the Allies was avoided.3 The British personnel charged with care of American patients there was assisted by 5 officers and 21 enlisted men of our Medical Department. A total of 179,911 troops landed at that port, which was closed December 27, 1918.
Though medical supplies for shipment elsewhere began to arrive at Brest in January, 1918, it was not until December 6, 1918, that authority for the establishment of an issue depot was obtained.3 On December21, 1918, the
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base supply depot was stocked and prepared to make issues to hospital trains, transports, dispensaries, troop organizations and, in emergencies, to base hospitals.
The laboratory unit assigned to serve this section was organized in Washington in February, 1918, as stationary laboratory No. 2, but after its arrival at Brest in the following May its designation was changed to base laboratory No. 5.3 It was gradually equipped to do the necessary work for this base section. Its greatest activities were the study and control of infectious diseases throughout the section, but it also exercised supervision over the smaller laboratories in and about Brest. Difficulty was experienced in securing supplies, but by August, 1918, all necessary equipment had been received. Thorough studies were made of all infectious diseases appearing in the section, from both bacteriological and pathological viewpoints.3 Also the laboratory prepared antitoxics era and issued these and other supplies to hospitals in the section and to transports, and maintained close liaison with all units of the Medical Department, especially in respect to infectious diseases, and with the Engineer Corps in matters pertaining to water supply. Thorough examinations were made weekly of all water supplies, and all American troops were instructed to use no water for cleansing teeth, washing mess tins, or for drinking purposes unless drawn from a faucet marked "potable." Faucets were marked under supervision of the military officer commanding the area.
The only ambulances at first available were those furnished by the Navy, and despite its difficulties the ambulance service of Naval Base Hospital No. 1 was especially satisfactory.3Later a few ambulances from the Army were received, but for several months after the port was opened the total number available was very limited. Ambulance Company No. 105 reached Brest on July 13, 1918, and was used to assemble ambulances and trucks at motor reception park No. 716.3In August this company was also required to assist in the transport of sick and wounded. There were then but 9 ambulances available, 4 belonging to Naval Base Hospital No. 1 and 5 to Camp Hospital No. 33, but in September5 more were assigned.3 Meanwhile trucks were used whenever possible. On October 12 Ambulance Company No. 105 was ordered to rejoin the 27th Division; and on the 19th Evacuation Ambulance Company No. 17, consisting of 1 officer and 31 enlisted men (later in the same month augmented by 37 others), was assigned to the pool, though it was not actually authorized in formal orders until November 12.3 On December 5, 1918, Evacuation Ambulance Companies Nos. 28, 37, and 38 were also assigned to this pool, with 3 officers and 110 enlisted men.3 The number of vehicles in and near Brest gradually increased so that eventually there were 70 ambulances at the motor ambulance pool, 16 ambulances at Camp Pontanezen,5 ambulances at Camp Hospital No. 118, and 1 ambulance at Camp PresidentLincoln.3 The personnel consisted of 9 officers and 242 enlisted men.
Beginning with December, 1918, the pool took over the emergency ambulance service of Brest and vicinity, excepting Camp Pontanezen. Ambulances and men were always at call and requests were answered from points as far away as Quimper and Morlaix. In four months these calls numbered 1,243, and the number of patients carried was 2,920. This service, which operated under the
461
direction of the surgeon of the base section, unloaded all hospital trains either at the Kerhuon hospital center or at the Port du Commerce; transferred all patients from other hospitals to those at Kerhuon and from that center to the wharves and transports.
An officer of the food and nutrition section of the base surgeon`s office reported September 14, 1918, and about a month later was joined by two noncommissioned officers especially qualified as instructors.3Other officers and enlisted men joined, until on December 24, 1918, the force consisted of 7 officers and 6 sergeant instructors, which number was gradually reduced by needs elsewhere. This personnel, under general orders of this section, was directed to investigate conditions of messes, the preparation, conservation, and handling of food, instruction of mess sergeants and cooks. Improvements that could be made by local commanders were recommended directly to them, if they were able to effect them; otherwise to higher authority. Also messing conditions on transports and commercial vessels were inspected from time to time and appropriate recommendations made. The food service of transient troops, permanent troops, and hospitals presented many problems because of highly different conditions constantly being encountered, which were aggravated by shortage of material and labor and by unfavorable climatic conditions. Because of the policy to ship to the front, as far as possible, all men and materials and retain the barest necessities in building materials, as well as other assets, the base section for a long time lived under primitive conditions. Camps were so widely scattered throughout the vicinity of Brest and transportation was so limited that the ration period, except for bread, meat, and vegetables, was made to be one month, though storerooms were small and inconvenient.3Water was scarce and its points of supply poorly distributed, necessitating several messes carrying by hand for long distances all water that theyused.3 Mess service in hospitals was rendered difficult by the lack for a considerable period of a number of the usual ingredients of hospital diets and by the pressure of a number of patients greatly in excess of those for whom normal accommodations were available.3 Messes were operated by transients troops at the casual officers` camp, Camp Port Foye, Fort Bouguen, Casual Camp, and Camp Pontanezen.
The company kitchens at Camp Pontanezen were replaced at about the time the armistice was signed by others, each adequate to serve 5,000 men, some feeding as many as 9,800 men in 70 minutes.3 This method afforded certain advantages over that of company messes, but did not permit the preparation of so diversified or elaborate a menu. Because of the difficulty in getting permanent personnel to operate these kitchens, the primitive mess halls, the scarcity of fuel and water, and the inclement weather, mess service was at first difficult, but eventually satisfactory preparation and service of food were made possible.3
The dental service of this section was generally inadequate, the number of dental officers available being insufficient to meet the requirements of the troops stationed in the section and of those passing through.3The situation was met as well as possible by shifting dental officers in accordance with the most emergent needs.3
462
During 16½ months, 2,105 deaths occurred at Brest, of which 59per cent were among the troops who contracted their disease, or were injured, outside the base section.3 Sixty-seven percent of the total occurred during the last week of September and the first three weeks of October, 1918, when influenza was epidemic. Of the latter percentage, 72 percent occurred among patients who had contracted disease outside this section .A total of about 70,000 patients were cared for in the section.3
As the transports of the first convoy were obliged to anchor in the open road, and heavy rains were falling, pneumonia cases at or near the crisis were left on board, but other patients in that convoy were sent to Naval Base Hospital No. 5 or to the French marine hospital in Brest. Most cases of sickness among arriving troops was due to infectious disease, some cases of several different kinds being found on every transport. Thus the sick in the first convoy included men suffering from cerebrospinal meningitis, mumps, measles, and pneumonia. The same infectious diseases were found in all subsequent convoys, with also in some instances scarlet fever, diphtheria, and influenza. At first mumps and, to a less degree, measles were the most common infectious diseases, but on one transport an epidemic of scarlet fever developed.
The influenza epidemic began in a replacement draft from Camp Pike on August 12, 1918. These men were so closely quartered in a wooden barracks as to have but 129 cubic feet of airspace each. By August 24, about 90 cases had developed, with 17 deaths. The draft was removed to a tent camp, where quarantine and other measures were enforced. Soon afterwards, influenza appeared in the civilian population of Brest. On September 8, an order was issued prohibiting troops entering places of public congregation. This local epidemic spread but little and subsided in a short time.
Cases of influenza began to arrive again early in September, but were few in number until September 12, when the Kroonl and brought 117cases of influenza and 6 of pneumonia.3 From this time on the number of cases rapidly increased until the middle of October, after which they rapidly declined. During September and October, 4, 187 cases of influenza and 913 of pneumonia were disembarked.3 The transport surgeons on arrival often reported fewer cases of influenza and pneumonia than were detected after the troops landed, the number of influenza cases reported being about 50 per cent of those detected and the number of pneumonia cases about 95 per cent.3 Conditions on board naturally changed rapidly and records were made at the moment of anchorage, though sometimes the transports were not unloaded for from 24 to 48 hours, during which time cases developed in addition to those reported. Within five days after the different bodies of troops arrived at Brest on transports there developed among them 4,354 cases of influenza and 2,539 of pneumonia; i. e., 90 percent of the pneumonia and 88.7 per cent of the influenza admissions for base section No. 5 developed among troops from transports. The number of deaths from pneumonia among these troops after landing was 1,217; 497 patients had died of that disease en route, making a total of 1,696 deaths among 218,000 troops transported.3
Sick were brought ashore by small launches, and as the larger transports anchored in the open road, where they were exposed to the rough sea, andas
463
there were frequent rains during the winter months, the transfer of patients to shore was slow and attended by much discomfort to them. Recumbent cases were transported in the Stokes litter, and after the armistice began on a special boat, for additional water transportation was then secured.3Pneumonia patients, except when on foreign ships, were not removed unless they were in the first two or three days of their illness or had passed the crisis at least three days, and were in transportable condition. Eventually it was ordered that no pneumonia patients be transferred from ship to shore unless safely past the crisis.2 Patients debarked at several piers, each of which offered some disadvantages, until finally Pier 5 was used, though here there was no shelter and patients had to be loaded direct from the tugs into ambulances, which at first were few in number.3
This port, in addition to St. Nazaire and Bordeaux, was used for evacuating sick and wounded to the United States from June, 1918.3 At first-that is, in May and June, 1918-patients arrived on hospital trains from the hospital center at Savenay, usually at night. Since they were evacuated usually the following day, all were fed and had their dressings changed. These requirements necessitated an increase in the bed capacity of the local hospitals, especially of Navy Base Hospital No. 1, the unit then principally used for this purpose because it was nearest the docks.3
Patients first began to arrive in appreciable numbers from hospitals farther forward early in July, 1918, in small but numerous detachments, which had been forwarded from Savenay.3 Soon a hospital car was added to the trains from that point, and others were added until they were replaced by a hospital train. As the sailing time and capacities of transports were uncertain a plan was developed and applied to hold patients in considerable numbers until they could be received on board the ships.3
With the exception of a few patients transferred direct from trains, patients were evacuated to the United States principally through the hospital center at Kerhuon, where shortages in equipment were made up, wounds dressed, payments made, records completed, and classifications effected according to navalrequirements.3
As all transports coming to this port were under the direct supervision of the Navy, liaison relative to patients was established through a representative of the Medical Corps of the Navy and one of the Army, the latter being the evacuation officer.
Though evacuations were affected by an officer on duty in the office of the base surgeon, the medical boarding officer superintended the embarkation, and also received the sick from transports for transfer to hospital.
Patients were held at Kerhuon hospital center as short a time as possible, depending on the quality and quantity of bed space available for them on transports.3 Patients were classified as follows:
1. Bedridden: (a) Medical, (b) surgical.
2. Walking dressing: (a) Legless, (b)armless, (c) not needing assistance.
3. Tuberculous: (a) Bedridden, (b)requiring special attention, (c) requiring no special attention.
4. Mental: (a) Requiring restraint,(b) not requiring restraint.
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Immediately before departure patients were inspected by an officer from headquarters, base section No. 5, who assured himself that all existing regulations had been complied with.3Other hospitals in this base section evacuated through Kerhuon hospital center.3
Five hundred of the beds in the Kerhuon hospital center were set aside for the accommodation of nurses about to sail to the United States. This arrangement was made about February 14, 1919; prior to that time there had been no systematic arrangement for their lodging when awaiting return to the United States.3
The first hospital train from forward areas arrived in the base section October 26, 1918, and the great difference in the character of the cases received from this time forward required radical reorganization of the professional services.3 From this time the Kerhuon hospital center acted as one of the evacuation hospitals of the American Expeditionary Forces.3 The vast majority of patients arrived with very meager data. Several forward base hospitals evacuated all their patients at one time, including some who needed daily dressings, which were impracticable during the three or four days en route.3 This policy was sooncorrected.3 Patients at Kerhuon constituted a group whose members were given final preparation for their voyage to the United States and could be held to meet, on short notice, calls from the Naval Transport Service to fill such space as might be available for the several classes of patients to be placed aboard.
After October 1, 1918, the carrying capacity of transports was increased and the disposal of patients simplified. Thereafter hospital trains were loaded in sections, each section being meant for a transport and having its passenger list, which was made up in triplicate. One copy was used to check patients on board, the other two filed in the base surgeons` office.3
Until November 15, 1918, 98 per cent of the casualties evacuated through Brest came from Savenay, where passenger lists were made up, a copy of which was given the transport service.3From this the regular passenger list required for each transport was made up and patients according to the quota of each class on each transport were placed on board. A letter from the commanding officer of the transport service to the base surgeon, prescribed the quota for each transport and gave the following data concerning classification both of accommodations and of those who would utilize them.3 Number of beds, including those in the sick bay, for the bedridden; number of beds for those who could walk and could occupy troop standees, though requiring surgical dressings; number of nervous and mental cases, that could be carried; number of tuberculosis cases that could be carried in isolation or on open decks; beds available for those able to walk, requiring no attention, in rooms for officers; beds for convalescents requiring no attention.
A Red Cross rest station was erected on Pier 5 in the autumn of 1918,and later in the same year a larger and more modern building on Pier 6 was used by that association for the same purpose. From their station the society issued refreshments to patients awaiting transfer to the tugs that would take them to theirvessels.3
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A replenishment depot for hospital trains, with a personnel of 1 officer and 4 enlisted men, was established about December, 1918, in order to replenish with medical and quartermaster supplies such of those units as entered the base section.
The following tabulation shows the number of patients evacuated from Brest to the United States from May, 1918, to July, 1919:3
Evacuation of sick and injured to the United States, base section No. 5, from May, 1918, to July 31, 1919, inclusive?
|
Medical |
Surgical |
All others |
Total | |
|
1918 | ||||
|
May |
--- |
--- |
--- |
20 |
|
June |
--- |
--- |
--- |
152 |
|
July |
--- |
--- |
--- |
425 |
|
August |
--- |
--- |
--- |
324 |
|
September |
--- |
--- |
--- |
2,784 |
|
October |
--- |
--- |
--- |
3,220 |
|
November |
--- |
--- |
--- |
5,807 |
|
December |
2,646 |
4,922 |
831 |
8,399 |
|
1919 | ||||
|
January |
1,824 |
1,656 |
350 |
3,830 |
|
February |
5,190 |
2,215 |
250 |
7,655 |
|
March |
4,546 |
2,804 |
--- |
7,350 |
|
April |
5,468 |
3,510 |
--- |
8,978 |
|
May |
5,338 |
2,925 |
--- |
8,263 |
|
June |
5,120 |
2,644 |
--- |
7,764 |
|
July |
3,318 |
301 |
--- |
3,619 |
| Total |
32,450 |
21,977 |
1,431 |
68,390 |
CAMP PONTANEZEN
From January to December, 1918, Camp Pontanezen functioned as a debarkation and rest camp, with a small permanent garrison.5 From (and including) December, 1918, it operated as an embarkation camp.5 The permanent strength of this camp rose to about 15,000.5
In the spring of 1918 a board of officers examined Camp Pontanezen and found it fairly satisfactory for about 10,000 men, provided certain improvements were made.5 Some of the improvements recommended by the board were effected, but during the summer and fall of 1918 the small permanent garrison was straining every nerve to keep the tide of men and supplies moving toward the front, and had but little time or resources wherewith to accomplish much in the way of improvement.5
The camp consisted of an interior and an exterior area. The interior area, covering approximately 15 acres, was inclosed by a wall and contained six old and very large stone barracks and several other smaller buildings. This area, known as Pontanezen Barracks, had long been used by the French as a military garrison.5 The exterior area, comprising farmland surrounding the inclosure, was gradually extended by requisitioning land from the French as it was needed. It expanded from about 90 to approximately 1,000 acres when the camp reached its maximum capacity in the spring of 1919.5
The final dimensions of the camp were approximately 1 mile wide by 1½ miles long.5 It lay on a hillside, sloping toward the south, about a mile and a half from the harbor. Though the slope afforded drainage, there was neither good roads, walks, sewers, nor drainage ditches, and the clayey loam surface
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was cut up into small rectangles by dykes and hedges. Consequently, conditions at first were very unsatisfactory, for not only was it necessary to utilize the camp before it was ready, but also the weather was cold and inclement and the soil such that it formed a deep and tenacious mud. The last mentioned fact greatly interfered with both construction and service. Other defects were insufficient kitchens, lack of mess halls, inadequate means of sterilizing mess kits, poor latrines, limited bathing and disinfecting facilities, limited means for washing hands, shortage of fuel, and an inadequate water supply, which was polluted. These unsatisfactory conditions were intensified by the relative lack of trained camp personnel and the great numbers of troops which arrived.5
At first there were only two roads, which ran north and south; however, two east and west roads soon were built, and a number of good thoroughfares had been completed by April, 1919.5Also by that time footways, largely "duckboard," were provided.
In addition to Pontanezen Barracks, the only other shelter at first available consisted of several temporary barracks, which had been erected in November, 1918, and pyramidal tents for 5,000 men.5 Prior to this time, a number of the troops had to occupy shelter tents. In the latter part of December, 1918, only 44 percent of the pyramidal tents were floored; however, by April, 1919, barracks and floored tents were adequate. At that time 450 barracks each accommodating 110 men, and 5,000 floored tents, each accommodating 6 men, were available.5
The activities of the camp surgeon`s office were varied. Sections of it were charged, respectively, with administration, records, statistics, sanitation, and medical clearances.5 The camp hospital and segregation camp were ultimately placed under control of the camp surgeon, thus promoting their coordination.5 Weekly conferences of medical officers were held and health and venereal bulletins were issued to acquaint line and medical officers with prevailing local sanitary and health conditions. Although most organizations passing through the camp were accompanied by their medical detachments, some were not, and for these it was necessary to maintain six infirmaries, besides the seven maintained for permanentorganizations.5
For purposes of sanitary control Camp Pontanezen was divided into 17sections, each supervised by a sanitary inspector.5 Senior surgeons of organizations were held responsible for sanitation in their own areas, to each of which two men and a sufficient number of labor troops were assigned.5 Under the control of the camp sanitary inspector were 3 chief assistants, 2 sanitary squads, and 265 men from a labor battalion. Three men from the labor battalion were assigned to each kitchen, and six to every five latrines. Those on duty at the kitchens were required to keep the garbage cans and surroundings clean; those at the latrines washed the seats daily and sprayed the interiors twice daily with cresol and crude oil.5The sanitary squads (which supervised the work of the labor troops) were in addition to two others which operated the disinfecting plants.5
Certain sanitary activities required special inspectors; for example, one officer was engaged solely in the inspection of troop kitchens, one had entire charge of drainage problems, another supervised construction of latrines.5 The
467
officers concerned with drainage and latrines worked with the Engineer Department.5
Every day the camp sanitary inspector held a meeting of his assistants, and each week the camp surgeon held a conference attended by all senior surgeons and sanitary inspectors.5
For a long time there was but one kitchen in Camp Pontanezen. This was operated in an old stone building within the walls of the caserne.5 It had 7 double field ranges and 41 French caldrons, but no mess hall. In December, 1918, a mess hall was built, but since it accommodated only 400 men, the great majority ate in the open, although there was almost incessant rain at this time.5 This kitchen fed about 7,000 men daily and operated day and night until April, 1919.5
In December, 1918, seven kitchen buildings were constructed and temporarily equipped with field equipment.5 These buildings were long and low, each being divided into five separate kitchens, equipped with two double field ranges and a number of caldrons for coffee, stews, etc. At the end of December, 1918, but three kitchens had mess halls.5These had high, wooden tables, and dirt floors, which emitted a putrid odor from the trampling in and decomposition of food particles. Since these kitchens had to prepare food for from four to seven thousand men each, necessarily the menus were simple, consisting chiefly of bread, beans, coffee, and stew.5 Subsequently, these kitchens were properly equipped and were made permanent.5
Meanwhile, model kitchens were being constructed, one for each area into which the camp was divided.5 These were called "troop kitchens." Each was approximately 375 feet long and comprised six completely equipped unit kitchens, with all necessary modern appliances, and had a concrete floor, water supply, and sewer connections. Vegetable bins, made of wire netting and set above the floor, were installed, and a room for meat was built in each kitchen. The mess halls were about 300 feet long. Each could feed 5,000 men in 40 minutes. By a system of inspections and markings, a friendly competition was brought about among the personnel of all kitchens; personal cleanliness on the part of the kitchen force was a requirement especially stressed.5
The disposal of garbage was a constant problem.5 Early in1918, part of the garbage was taken by French civilians, but for sanitary reasons this had to be discontinued. The garbage was then buried in great pits. After the troop kitchens, referred to above, had been constructed and a less simple ration became possible, the amount of garbage increased to such an extent as to fill from 60 to 8 large cans per day at each of the 16 kitchens. This was too large an amount to be constantly burying, so during March, April, and May, 1919, incinerators were constructed at the kitchens, each capable of disposing of all the garbage, then averaging more than 45 cans per kitchen daily. These cans were kept in a special concrete stand.
Feces were disposed of as follows:5 In the caserne a number of old French latrines of the hopper type, with cesspools, were utilized. In the outside area latrines were constructed, use being made of galvanized cans. In October, November, and December, 1918, about 25 cement-lined pit latrines, with urinals, were constructed and their contents removed by odorless excava-
468
tors. In January, February, and March, 1919, these were supplemented by a large number of pit latrines of the box type. The contents of the latrines of the can type and of the cement vault type were hauled away and buried in two deep pits, or trenches, at the edge of the camp. These pits were frequently burned out with crude oil and the contents covered with dirt. By April this system was abandoned.
From November, 1918, to July 1, 1919, there were practically no flies at Camp Pontanezen.5 One reason for this was that there were very few animals in camp, as motor trucks were used instead of horse-drawn vehicles, and the small amount of manure which required disposal was hauled away by French farmers, or buried in the pit latrines with feces.5
The sick at Camp Pontanezen were cared for usually at Camp Hospital No. 33.5 Navy Base Hospital No. 1, Camp Hospital No. 46 at Landernau and the Kerhuon hospital center were also available.5 During the influenza-pneumonia epidemic of October, 1918, and at times soon after the armistice was signed, the hospital facilities were taxed to their utmost capacity, but the sick and wounded were always provided for.5
A quarantine camp, including a venereal segregation camp, was established December 6, 1918, at the northern extremity of Camp Pontanezen in a triangular area, bounded by three public roads.5The entire plant was termed "the quarantine camp" until February 13, 1919,when the designation "Segregation camp" was adopted. The men were quartered in floored tents, not more than six men to a tent.
The segregation camp was divided into plots, to each of which was assigned a certain class of cases.5 The quarantine section proper had a capacity of 300 beds and received the contacts of communicable diseases from among permanent troops at Brest and Camp Pontanezen and from transient troops en route to the United States. The venereal section, divided into subsections for white and colored, and with a total capacity of 700beds, was used for all uncomplicated cases of venereal disease in a communicable stage. Complicated cases were sent to hospital. The staff of this section consisted of 10 officers and 244 enlisted men, the officers including 3 genitourinary specialists, 1 skin specialist, 1 dentist, and 1 laboratory officer. Negro venereal patients were separated from the white men in this class; venereal suspects were also separated from those with a definite diagnosis of such diseases. Patients with definitely established venereal diseases were classified as A, B, and C. The men in class A were those unable to do any duty. Those in class B performed light duty, and those in class C full duty (or labor).
A hospital with 200 beds and a laboratory was maintained for this camp. Patients with scabies were treated in an especially equipped building.
The capacity of the segregation camp was about 1,500 until June, 1919,when all venereal cases in the vicinity of Brest were transferred to it.5 Early in July, 1919, all the venereal cases from the Third Army were received, as well as others from various parts of France, necessitating extensive additions.5All patients were organized into battalions, of which there were six in July, forming a provisional regiment. Extensive buildings for treatment were provided, with facilities for treating 4,000 cases of gonorrhea and 2,000 cases of chancroid
469
in one-half hour. At this time the camp was largely a venereal camp; the number of contacts being relatively small. The number of cases of venereal disease segregated in it numbered about 1,200; and all contacts about 200.
This camp had a canteen and a Y. M. C. A. hut (with capacity of 2,000).Educational classes were maintained, instruction was given in hygiene, citizenship, and other subjects, and a generally friendly attitude wasmaintained.5
PREPARATION FOR EMBARKATION
The principal function of Camp Pontanezen was to prepare troops forembarkation.5 The basic idea was a division of the entire camp into areas, each receiving an entire organization. Within its own area each unit had its kitchen, infirmary, prophylactic station, and welfare hut. From all these units a communal segregation camp received venereal cases and infectious disease contacts. Men, seriously sick, suspected of having an infectious disease, or with fever, were sent to Camp Hospital No. 33.5 Sterilizing and disinfesting plants were provided to eliminate vermin. The plan was not to pass men from area to area but to hold them in one, retaining from each command the contacts and patients with venereal disease.5
Organizations arrived from the interior at all hours of the day and night. Data concerning the strength of each arriving organization were telephoned to the billeting officer, and tents were assigned before troops reached their designated area. Preparations for embarkation of the organization were then begun conformably to the following method.5 On arriving at the camp the organization, as stated above, was assigned to a definite area, containing a kitchen, infirmary, water supply, latrines, sewer connections, etc. Commanding officers and medical officers reported at the main billeting office for instructions. Instructions for medical officers dealt with:(1) Reports required; (2) disposition of sick and contacts; (3) physical examinations required; (4) infirmaries, ambulances, and prophylactic stations;(5) medical supplies and dental treatment; (6) general orders and memoranda of medical interest.
Within 24 hours after arrival, the transient organizations received orders to report for physical examination at a specified time.5 These orders were so issued as to call for 240 men every 10 minutes. The unit reported at a large central building arranged for examination and bathing. This structure had numbered seats (benches) for 480 men. The men stripped to their undershirts and stood on benches, two rows facing each other. The medical inspector then passed between each two rows examining for venereal disease and vermin, thus making it unnecessary for the inspector to stoop. The men then stepped down from the benches and pulled their undershirts over their heads and the inspector passed along a second time examining for skin diseases, scabies, and body lice. Men found to be diseased or infested with vermin were at once segregated in a special room. The others placed their underwear and socks in bins for sterilization, leaving their outer clothing on the numbered seats. At a given signal, 120 men went to the shower-bath room, where they received a four-minute hot bath. Each man was then given a clean towel, clean socks, and underwear, where upon all men returned to the numbered seats. Here they dressed quickly in their old clothing and then passed out of the building. But one minute was
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allowed for a change of groups in the bathrooms, so that a continuous stream of bathers was kept going at the rate of 120 men every 5 minutes, orderlies being in charge to prevent talking and to maintain order. Lists of men cleared were sent daily to the medical clearance officer.5
Men found with lice or nits were sent with an officer of their organization to their quarters to procure their blankets and other clothing and then to a disinfesting plant.5 There they undressed completely and placed all their clothing in receptacles to be sterilized, themselves passing to a room where the axillary and pubic regions were closely clipped and treated with vinegar. They then went to a bathroom, where they rubbed the entire body with kerosene soap (1 pint of kerosene to 5 pounds of soap dissolved in hot water), following this with a hot shower. While this process was going on, all the men`s clothing, except leather and rubber articles, was sterilized by steam for a period of 20 minutes. On leaving the bath, men were given clean underwear and clean socks and their own outer clothing was returned to them. The medical officer in charge then checked the list of men and receipted it by writing "deloused" with date and signature. This list was then forwarded to the medical clearance officer.
Though men with lice were sent to the disinfesting plant and treated as detailed above, those found with scabies or venereal disease were sent to the segregation camp for treatment.5
Before organizations could embark, they were required to have clearance certificates covering all officers and men.5 Whereas each officer was required to have a separate certificate, the clearance for an organization covered all its enlisted men. A medical clearance officer received all lists of clearance from the examining and bathing building, from the disinfesting plant, or from the segregation camp, as the case might be. The certificates of examination of an organization, certificates of examination of its officers, and lists of men found with vermin, scabies, or venereal disease were clipped together and marked "Uncleared." When the report of the disinfesting plant was received this was added, as was also the report of admission of cases of scabies and venereal disease to the segregation camp. When all lists were checked and balanced, all men found to have been examined, all those with lice had been disinfested, and all scabies and venereal cases sent to the segregation camp, the papers were signed by the chief epidemiologist, and the organization concerned was "cleared." Clearance certificates were then sent to the troops movement office and to the base surgeon, one was filed, and one was furnished to the organization when it received sailing orders. If the organization did not sail within six days, it had to be reexamined.5
One other, last certificate was required showing that each man`s throat had been examined daily and his temperature taken within 24 hours of sailing.5 Any man having a temperature1° above normal was sent to hospital; any with a suspiciously appearing throat was sent to the segregation camp.
If men in hospital became of duty status in time to sail with their organization, they were returned to it; if not until after the organization had sailed, they were transferred to a casual company, which embarked as a unit.5 Personnel to be embarked as "sick" or "injured" were transferred to the embar-
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kation hospital at Kerhuon. Contacts in the segregation camp were treated as ordinary sick.5
The camp surgeon received the following three troops lists daily:5(1) Billeting office, giving organization, strength, and location and date of arrival (changes of location were also reported); (2) personnel office, strength for statistical purposes; (3) camp headquarters, list of transient troops, preparing for inspection, ready for inspection, and ready for embarkation.
SURGEONS OF TERRITORIAL SECTIONS
BASE SECTION NO. 1, FRANCE
Col. George P. Peed, M. C., July 2, 1917, to July 17, 1917
Col. Clyde S. Ford, M. C., July 18, 1917, to December 29, 1917
Col. Charles L. Foster, M. C., December 30, 1917, to June 28, 1919
Lieut. Col. Felix Hill, M. C., June 29, 1919, to July 15, 1919
BASE SECTION NO. 2, FRANCE
Col. Larry B. McAfee, M. C., August 30, 1917, to February 22, 1918
Col. Henry A. Shaw, M. C., February 23, 1918, to October 13, 1918
Col. H. C. Coburn, jr., M. C., October 14, 1918, to October 28, 1918
Maj. Gen. Robert E. Noble, M. C., October 29, 1918, to April 20, 1919
Col. C. R. Reynolds, M. C., April 21, 1919, to July 13, 1919
BASE SECTION NO. 3, ENGLAND
Col. W. J. L. Lyster, M. C., July 7, 1917, to January 13, 1918
Lieut. Col. Robert M. Skelton, M. C., January 14, 1918, to January 24, 1918
Col. Charles F. Mason, M. C., January 25, 1918, to April 15, 1918
Col. Thomas U. Raymond, M. C., April 16, 1918, to May 16, 1918
Brig. Gen. F. A. Winter, M. C., May 17, 1918, to October 17, 1918
Col. F. A. Washburn, M. C., October 18, 1918, to March 10, 1919
Col. A. M. Whaley, M. C., March 11, 1919, to June 15, 1919
BASE SECTION NO. 4, FRANCE
Lieut. Col. Edward L. Napier, M. C., January 1, 1918, to July 12, 1918
Lieut. Col. Ralph H. Goldthwaite, M. C., July 13, 1918, to May 10, 1919
BASE SECTION NO. 5, FRANCE
Lieut. Col. William Denton, M. C., November 12, 1917, to May 11, 1918
Col. Guy L. Edie, M. C., May 12, 1918, to May 10, 1919
Maj. Gen. R. E. Noble, M. C., May 11, 1919, to July 15, 1919
BASE SECTION NO. 6, FRANCE
Maj. Holland M. Tigert, M. C., June 2, 1918, to July 14, 1918
Col. W. E. Vose, M. C., July 15, 1918, to January 15, 1919
Col. C. E. Morrow, M. C., January 16, 1919, to April 9, 1919
Col. Paul S. Halloran, M. C., April 10, 1919, to June 18, 1919
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BASE SECTION NO. 7, FRANCE
Lieut. Col. C. C. Demmer, M. C., July 1, 1918, to July 15, 1918
Col. Herbert G. Shaw, M. C., July 16, 1918, to April 25, 1919
BASE SECTION NO. 8, ITALY
Col. Elbert E. Persons, M. C., October 17, 1918, to April 7, 1919
BASE SECTION NO. 9, BELGIUM
Col. Jacob M. Coffin, M. C., May 13, 1919, to July 15, 1919
DISTRICT OF PARIS
Col. E. G. Bingham, M. C., May 5, 1918, to September 21, 1918
Col. Larry B. McAfee, M. C., September 22, 1918, to July 15, 1919
REFERENCES
(1) G. O. No. 20, H. A. E. F., August 13, 1917.
(2) G. O. No. 75, H. A. E. F., December 14, 1917.
(3) Report of Medical Department activities, base section No. 5, undated, compiled under the direction of the base surgeon from official records in his office. On file, Historical Division S. G. O.
(4) Ayres, Leonard P., Colonel, General Staff: The war with Germany. Washington, Government Printing Office, 1919.
(5) Report of Medical Department activities, Camp Pontanezen, Brest, compiled under the direction of the camp surgeon. On file, Historical Division S. G. O.
