Field Operations, Table of Contents
CHAPTER XVIII
ARMY HOSPITALS
Casualties were moved by corps and army ambulances from the division hospitals to the army hospitals, as prescribed in the Secret Orders No. 6, July 9, 1918 (quoted in Chapter XI, p. 343). On the southern face of the salient the majority of the wounded went to Evacuation Hospital No. 1 and to Mobile Hospital No. 3, at Sebastopol Barracks,1,2 or to the hospitals grouped in and near Toul. A considerable number, especially from the 1stDivision, were taken to Mobile Hospital No. 39,3 at Aulnois, and to the hospitals at Sorcy, while the hospitals at Pagny, Trondes, and on the right at Chaligny and La Malgrange were but little used.4, 5, 6 Most of the wounded on the western face of the salient were taken to Evacuation Hospitals No. 6 and No. 7 at Souilly.7
Some of these hospitals were new and had not seen active service in combat before this time. Most of the mobile hospitals had been organized and equipped in Paris during July and August, and several of the evacuation hospitals did not reach France until shortly before the St. Mihiel operation. Equipment of certain units, e. g., Base Hospitals No. 45 and No. 51, was relatively limited.8 Though every available hospital unit in France was assembled for this operation, the inexperience of some and the limited equipment of others was the source of considerable apprehension concerning the adequacy of Medical Department provisions should the operation prove protracted. Fortunately, the ordeal was brief and patients comparatively few, thus affording valuable experience to new organizations without breaking them down by overwork and without overtaxing their resources.
Evacuation Hospital No. 1, established February 4 at Sebastopol Barracks, some 11.2 km. (7 miles) from the battle line and 3 km. (1.8 miles) north of Toul, immediately before this operation increased its bed capacity from 900 to 2,800, its personnel now consisting of 97 officers, 92 nurses, and 674 enlisted men. As shown by the evacuation order, this unit, reinforced by Mobile Hospital No. 3, was designed to serve as one of the principal evacuation hospitals for wounded from the south face of the salient.1 Between September 12 and 15 the two units taken together admitted 2,750 wounded.2 The daily admissions from September 12 to the end of that month varied from 460 to 570.1
There is nothing special to record in respect to the operation of these hospitals, as their procedure was essentially that of all similar hospitals. Upon arrival of a patient all data were taken from his diagnosis tag or field medical card and his name and official status verified from his identification tag. Valuables were placed by the registrar in the hospital safe and the patient, clothed in pajamas, went to the preoperative ward. Here morphine, strychnine, and antitetanic serum were administered if indicated and the patient was pre-
508
pared for operation, except that shock cases were sent immediately to the special ward provided for them. Radiographic examination was made in cases of probable bone injury or retained missiles. These patients then went either to the operating room or to a surgical ward, according to the decision of the operating surgeon based on radiographic findings. A separate operating room was provided for patients with injury to the eye or ear, while appropriate jaw injuries were treated by the dental surgeon. It was not found practicable, however, to assign special types of cases to certain operators; the several teams attended to all cases admitted during their respective tours of duty.1
Cooperating with Evacuation Hospital No. 1 at Sebastopol Barracks during the St. Mihiel operation, Mobile Hospital No. 3 maintained 200 beds and brought up to a total of eight the number of operating teams there on duty.1
JUSTICE HOSPITAL GROUP
The group of hospitals at Toul, where later a hospital center was organized—Justice hospital group—was formed in part to meet needs imposed by the St. Mihiel operation. Numbers of extensive permanent barracks were taken over by the Medical Department, and medical organizations were installed in them as follows:9
|
|
Beds |
|
Base Hospital No. 45, Caserne La Marche |
2,300 |
|
Base Hospital No. 51. Caserne Fabvier |
2,000 |
|
Evacuation Hospital No. 3, Caserne Perrin-Brichambault |
1,000 |
|
Evacuation Hospital No. 14, Caserne Perrin-Brichambault |
1,000 |
|
Army Red Cross Hospital No. 114, Caserne Luxembourg |
1,500 |
|
Provisional Gas Hospital, Annex Caserne La Marche |
650 |
|
Contagious Hospital, Caserne A. R. |
600 |
|
Neurological Unit No. 2, Caserne Fabvier |
700 |
With the exception of Caserne Luxembourg, these barracks were situated close together on the Rue Justice, about 1.6 km. (1 mile) from the center of the city ofToul.9
Twelve hundred reclassified enlisted men of the line from the 1st Depot Division at St. Aignan were ordered to Toul for distribution to the various hospitals on both sides of the St. Mihiel salient; most of them were then sent to Souilly for further distribution. These men were quite untrained, a number were in rather poor physical condition, most were poorly equipped, and the incompleteness of their personal records was a source of considerable correspondence.
The greatest difficulties of the hospitals at Toul arose from the following causes: (1) Inadequate personnel—officers, nurses and enlisted men; (2) limited medical supplies; (3) delay in procuring suitable articles for diets; (4) incompleteness of the personal records accompanying reclassified men received from the 1stDepot Division to reinforce the personnel of the several hospitals; (5) lack of organization of a suitable triage.8
There was some lack of surgical instruments at first, but surgical teams sent to help out brought their own supplies, and it was possible to keep instruments in continuous use during the 12-hour tours of duty of each team.10
509
A triage system, extemporized for service during the St. Mihiel operation, proved so adequate to the needs existing at that time that it was continued for several months. Almost all patients admitted to the hospitals at Toul were wounded who were easily classified, and numerous evacuations by hospital train prevented congestion. It was not until later, when epidemic diseases appeared in considerable numbers, that triage difficulties became serious and a formal sorting station for the Toul hospital group was established.11
By September 14, 11,000 patients had been admitted to this group of hospitals. In the interval September 1 and September 11, inclusive, 1,998 surgical cases incident to trench warfare had been received, while the number of battle casualties admitted in the interval September 12 to September 26 was 8,340. Most of the work done at Toul during this period was similar to that of field and evacuation hospitals. Simultaneously the evacuation and mobile hospitals nearer the front were sending in operated cases, and many secondary closures of wounds were also performed.12
The surgical services suffered, particularly during the early active periods, from lack of sufficient enlisted men of the Medical Department. Ultimately, convalescent patients and Class B and Class C men accumulated in sufficient numbers to relieve this personnel of heavy labor. Because of its situation the inflow and outgo of patients of the hospital group at Toul was very great, so that the physical labor involved in admission and evacuation was extremely heavy. For weeks the admissions were over 1,000a day, and on one day 1,544 wounded and gassed patients were received. Many of the buildings housing surgical hospitals were four stories high and without elevators. The great majority of admissions were stretcher patients who had to be transported recumbent, making thousands of trips for stretcher bearers who carried them up the stairways. Not only patients, but all water, food, clothing, bedding, laundry, and surgical materiel, as well as patients’ excreta, were carried either down or up or both. The surgical service alone required a large force of stretcher bearers.13 The fracture cases always came to the hospital well splinted.
Despite limited facilities the X-ray service was always efficient. Because of the frequency with which wounds were complicated by fractures or retained missiles, either X-ray photographs or fluoroscopic views had to be taken of over two-thirds of the operative cases. Difficulty was experienced at first in obtaining a complete X-ray plant for each hospital, and later some trouble arose from the uncertainty of the electrical supply from Toul, but, despite these embarrassments, no operative case had to be delayed on account of deficiencies in the X-ray department.13
Every hospital had its own laboratory, and there was also a group laboratory where Wassermann tests, blood cultures, and elaborate pathological work could be performed. Autopsies were regularly performed in the hospital laboratories. A wound bacteriological count could be made from cultures in 24 hours, and from a smear in a few minutes. Laboratory supplies were scant at first, and much improvisation was necessary. The group laboratory
510
prepared Dakin solution and also the gum-salt solution. Very little of the latter was used, however, as it was decided that a citrate transfusion was preferable and that its use should be adopted as a routine practice in all the hospitals at Toul.
Evacuations from the various hospitals here were coordinated by one office, which consolidated their individual statements of evacuables and made arrangements for hospital trains.
From the time of the organization of the Toul group to the latter part of September, 1918, personnel of the medical service was diverted to the care of surgical and gassed patients.
Total admissions in this group during September were divided as follows:
|
Hospital |
Medical |
Surgical |
Gas |
Contagious |
Neurological |
Total |
|
Base Hospital No. 45 |
6,303 |
1,595 |
73 |
663 |
123 |
8,757 |
|
Contagious hospital |
--- |
--- |
--- |
914 |
--- |
914 |
|
Base Hospital No. 51 |
1,387 |
2,225 |
16 |
--- |
--- |
3,628 |
|
Evacuation Hospital No. 3 |
--- |
1,300 |
--- |
--- |
--- |
1,300 |
|
Evacuation Hospital No. 14 |
--- |
2,200 |
--- |
--- |
--- |
2,200 |
|
American Red Cross Hospital No. 114 |
100 |
800 |
--- |
--- |
--- |
900 |
|
Gas hospital |
824 |
--- |
1,070 |
--- |
--- |
1,894 |
|
Base Hospital No. 78 |
--- |
117 |
--- |
--- |
--- |
117 |
|
Neurological No. 2 |
--- |
--- |
--- |
--- |
230 |
230 |
|
|
|
|
|
|
|
|
Base Hospital No. 45 (the "Richmond unit") had reached Toulon August 20, when it relieved Evacuation Hospital No. 14 and Field Hospital No. 355, taking over at the same time some 350 patients in the main hospital building assigned to it and 300 others in the annex for contagious cases, about 0.8 km. (0.5 mile) distant. There was almost no equipment available after the former units moved and for several days thereafter, when a meager supply of essentials was accumulated; difficulties in caring for patients were therefore very acute at first. The buildings utilized were four stories high, without light or plumbing, but in spite of these and other handicaps, especially shortage of labor and an increasing number of patients, 2,300 beds were soon installed. Not until September 21 did this hospital receive the equipment which it had accumulated in the United States prior to departure for France. During the St. Mihiel operation it furnished three operating teams to Evacuation Hospital No. 3. No figures are available concerning the number of patients Base Hospital No. 45admitted resulting from that operation, but the number received during September is given as 8,757, with 142 deaths. The functions of the hospital at this time were essentially those of an evacuation hospital.15
Base Hospital No. 51 had arrived in Toul on August 27 and was located near Evacuation Hospital No. 14 in a centralized group of four-story barracks and otherbuildings.16 By intensive effort these were prepared for the reception of patients, and some supplies were received from the French stores in the group. On September 5the unit began to receive patients and, as its nurses had not yet arrived, 100 enlisted men from the orthopedic battalion and certain convalescent patients were assigned to it to assist inward service. Deficiencies in equipment were met to a certain extent, the surgical instruments
511
employed in this emergency being supplied from belts of the officers and enlisted men. Prepared dressings were employed and a sterilizer extemporized. The X-ray plant was installed by September 11. From September 10 to 17 admissions were: 300medical and 807 surgical; total, 1,107; and from September 17 to 24, 197 medical, 501 surgical, and 2 gassed; total, 700.17
Evacuation Hospital No. 3 was located in the Perrin-Brichambault Barracks of the Justice group, 2 km. (1.2 miles) west of Toul, where it was to care for the seriously wounded; while Evacuation Hospital No. 14, to the west, was to receive both the seriously and the slightly wounded, chiefly the latter.
A spur from the railway ran to the rear of the main building of Evacuation Hospital No. 3, and it was from this point that all evacuations from the hospital were made. The organization had reached its location August 24 and within one week had 12 operating tables and 1,000 beds in readiness. An exchange for litters, blankets, and splints brought in by patients was organized. Several additional operating and shock teams had joined, and a splint team was organized. During emergencies the teams were on duty for 12 hours each. An adequate supply of instruments was available. Patients entered with either diagnosis tags or field medical cards. Eventually the latter were provided in the hospital for all cases, although at times they had to be improvised. Of the 1,178 patients received from September 12 to 16, inclusive, the majority arrived in the first 24 hours. During this period there were 693 operations and 42 deaths.18
Patients were admitted to a receiving ward where a medical officer quickly sorted the cases into three classes, as follows: Walking wounded(sent to the dressing room); gassed and medical cases (sent to special wards); wounded, on litters (the majority), sent to a second triage or preoperative ward. These patients received 80 percent of the professional care given in the hospital.
At the preoperative ward the wounded were undressed and sorted. Dressings were removed, wounds carefully examined, and decision reached concerning further disposition of the individual patient. The officer in charge of this ward proved to have great responsibility, for on the accuracy of his decisions depended to a large degree the success of the hospital. From this point patients passed to one of several destinations: (a) Evacuation wards: Simple bullet wounds or other uncomplicated, relatively slight injuries.(b) Wards for retained cases: Perforating and non aspirating wounds of the chest.(c) X-ray room: Fractures; retained missiles. (d) Shock ward: Suitable cases, including all those with blood pressure below 100. (e)Operating room: Hemorrhage cases and those with perforating aspirating wounds too serious to evacuate.19The majority of cases passed to the X-ray department, but if findings there were negative in suitable cases the patient went at once to the evacuation ward.
The dressing room constituted a third sorting station, whither ambulant patients were sent from the receiving ward. Here also great care was necessary in the classification of patients, for some with apparently slight injuries were actually found to be seriously or even dangerously wounded. Occasionally a man walked in who had received an injury to the large blood vessels of the arm, or a compound fracture of the skull. At the dressing room all
512
patients were dressed, and those thought to require immediate operation were sent to the preoperative ward.
Note was made at each sorting station whether tetanus antitoxin had been given. The hour when the wound was received and the time of admission to hospital were entered on the field medical card. The shock ward provided for patients whose blood pressure on admission was below 100 and also received certain cases from the operatingroom.20
Briefly, the procedure in caring for patients was as follows: Waiting patients were kept warm by the use of blankets and hot drinks. Patients were bathed and their clothing changed—a procedure not possible at most places where this hospital had served. The anesthetic of choice was ether, administered by the drop method. Thorough removal of devitalized tissue was the rule, and there were no primary closures except in a few early cases of knee-joint injuries. Injuries of this joint were thoroughly debrided and any foreign body found removed in its bed of bone. If infected, free drainage was established by lateral incision and early passive movement given, followed in a few days by active movement. These joints were never immobilized. Whenever possible, foreign bodies in other localities also were removed. Head injuries were always operated under local anesthesia. Perforating rifle wounds of the chest were usually not operated unless of the aspirating type, but such cases were carefully observed for hemothorax and infection. Retained missiles were removed at the primary operation only when superficial in the lungs or free in the pleural cavity. Abdominal injuries were given preference in the operating room, the operative procedure being the same as in civil practice. Injuries to the long bones were treated by removal of all ragged tissue and loose bone fragments and the limb was then immobilized in either a Thomas or a posterior Cabot splint. Extensive injuries of soft parts were debrided and immobilized. Nerves were sutured at the primary operation. Dressings were applied loosely, as a rule, and seldom were drainage tubes employed, but frequently dressings were saturated with Dakin’s solution. Amputation was performed only when the nerve and blood supply was completely destroyed, or in case of progressive gas bacillus infection. The skin was conserved as much as possible, and the stump never closed. Postoperative progress was corroborated by frequent laboratory examinations.21
Arriving at Toul on August 16, Evacuation Hospital No. 14 was located in the Perrin-Brichambault Barracks, a group of buildings formerly occupied by a French regiment. After proper policing it made a very good location for hospital purposes, except that the height of the buildings, without elevators, incommoded service in their upper stories, and the water supply, though fairly good, was limited in quantity. There were no facilities for storage of water, with the result that at times the supply was entirely exhausted. The buildings were lighted by electricity, with special lighting facilities for the operating pavilion.22 The personnel included:23
|
|
Officers |
Nurses |
Enlisted men |
|
Assigned |
34 |
40 |
234 |
|
Attached |
36 |
7 |
24 |
513
During periods of greatest activity the number of nurses proved very inadequate. This evacuation hospital had not functioned prior to this time and it was as yet without experience. Its equipment was not more than 60 percent complete.
As this hospital was designated for the treatment of both slightly and seriously wounded, more particularly the former, special attention was given to the arrangement of the receiving ward, and of the sorting and the operating rooms, with a view to lessening the distance patients would have to be carried by litter. Eleven operating tables were made available. As a rule, X-ray examinations were made, if necessary, of all seriously wounded patients, although, as only one X-ray machine was available, the work was much retarded. All splinting was done by special teams, after the operators had completed their work. Jaw cases were operated by the dental surgeon or by other members of the surgical staff after consultation with him. Shock was treated by specially trained medical officers.24
The most active period for operations was between September 12 and 18,inclusive, during which time five teams operated during the day and four at night. A 12-hour shift for teams was found to be satisfactory in reference to the quantity and quality of their work and to their welfare.
As the loading platform for trains was but 182 meters (200 yards) from the hospital, evacuation was simple, and nearly all patients were carried directly to the trains by litter. This was very arduous work, particularly when patients had to be carried down the narrow stairways from the second or third story. At first a nominal check list was required for all patients sent by train, but as making this list, with the limited clerical facilities then available, delayed evacuations, its use was abandoned.
The following table shows the classes of patients treated by this hospital:23
|
|
September- | |||||||
|
12 |
13 |
14 |
15 |
16 |
17 |
18 |
Total | |
|
Total admissions |
6 |
510 |
308 |
198 |
264 |
139 |
34 |
1,459 |
|
Operations |
0 |
99 |
143 |
177 |
171 |
86 |
31 |
707 |
|
Evacuations |
0 |
43 |
328 |
130 |
160 |
419 |
79 |
1,159 |
|
Prisoners |
0 |
64 |
14 |
8 |
10 |
1 |
0 |
97 |
|
Deaths |
0 |
4 |
2 |
1 |
1 |
2 |
3 |
15 |
Army Red Cross Evacuation Hospital No. 114 had formerly consisted of 7 medical officers and 35 nurses and nurses’ aides. It then occupied 30 buildings and cared for French orphans and maternity cases. It was taken over by the Army, reenforced by Red Cross personnel (McCoy unit) and by a field hospital, and equipped by the Red Cross as a military hospital, with between 1,000 and 1,500 beds.8
The provisional gas hospital of the Justice group was organized August 2, 1918, to meet the emergency occasioned by the St. Mihiel operation.25 Its personnel consisted, at first, of 3 officers permanently assigned, 6 others who
514
joined, 14 nurses and 9 noncommissioned officers of the Medical Department, and of 50 Class B men from the training battalion depot at St. Aignan. Forty more men from that battalion joined on September 19, and twenty French women were employed as cooks, waitresses, laundresses, etc. The formation occupied a part of Caserne La Marche, originally constructed for hospital purposes and used in peace time by the French as a hospital for the local garrison here. For this reason these buildings were perhaps better suited for hospital purposes than were other buildings of the Toul group. The four buildings made available gave adequate provision for 650 patients, with suitable rooms for stores and service. A Bessonneau tent was used as a receiving ward and sorting station. In one corner of this was a screened-off section for the treatment of patients intoxicated by phosgene, thus providing for the immediate administration of oxygen or treatment by phlebotomy, etc. Mustard gas cases were sent to a building equipped with two French portable bathing machines supplied with running water. The marked shock of phosgene gas cases and the sloughing of the respiratory mucosa of mustard gas cases were the most striking clinical phenomena noted by the gas service here. Other buildings were used for an officers’ ward, for mild cases of mustard gassing, and for convalescents recovering from the effects of phosgene.25
The hospital administration was embarrassed by lack of stenographers, typewriters, blank forms, bed linen, and other equipment.25
From September 10 to October 7 the unit admitted both medical and gas cases, 1,336 of the former and 1,351 of the latter.
Neurological Unit No. 2 was established in Caserne Fabvier to care for psychoneurotic cases. Its personnel consisted of 4 medical officers, 10 nurses, and 15 enlisted men from Base Hospital No. 117. The capacity of this hospital was 700 beds, but only 259 neuropsychiatric cases were treated at Toul during the first month of the hospital’s operations there. The number admitted during the St. Mihiel operation is not reported in the medical history of this unit, but of the number mentioned above 63 percent were returned to duty. Practically all the cases received were psychoneuroses, the psychoses being exceptional.
OTHER ARMY HOSPITALS IN ST. MIHIEL OPERATIONS
Evacuation Hospital No. 13, which had landed at Brest on August 26, was quickly transferred to Chaligny, southwest of Nancy. Here from September 2 to 23 it occupied buildings and was prepared to receive patients, but because of its location only 105 cases were sent to it during this period.4
Mobile Hospital No. 4,assembled and organized in Paris August 13 to 31, was rushed by rail to Trondes, where it arrived early in September. It here received patients from September 14 to 30 and was then moved to the Meuse-Argonne area. At Trondes, with Field Hospital No. 171 and Ambulance Company No. 310, it functioned as a provisional evacuation hospital. It furnished from its own equipment hospitalization for approximately 350 patients. Field Hospital No. 161 furnished tentage for about 200 more, but there were only 235 admissions during the period mentioned. Eighty-five operations were per-
515
formed, with no deaths. Cases received here did not include the seriously wounded.5
Evacuation Hospital No. 12, which had reached France August 31, 1918, moved immediately to Pagny-sur-Meuse, arriving there September 3. Here ten Adrian barracks and a large Bessonneau tent were found ready for its occupancy. A section from Base Hospital No. 117 and Evacuation Ambulance Company No. 4 were already located at the same place and a few patients had accumulated.
Ten days were spent at Pagny-sur-Meuse by Evacuation Hospital No. 12, during which time only a few cases were received, most of them being slightly wounded. The hospital, however, was organized and gained much experience. The location was a poor one for a hospital, and on the evening of September 13 preparations were begun for a movement to Royaumeix. The unit was established in the new location on the 6th, in an old French hospital consisting of four groups of Adrian barracks. Here it performed its first professional services of an important character, receiving patients direct from the front, some 24 km. (15 miles) distant. There were, however, relatively few cases, as the operation had by this time been completed and there were not many casualties in the sector which the hospital was serving.6
The hospitals at Aulnois and Sorcy formed in effect one group composed of Mobile Hospital No. 39, at Aulnois, and Evacuation Hospital No. 11 and Field Hospital No. 41, at Sorcy Gare. Ambulance Company No. 41 carried patients from the first named to the latter, and if necessary was to remove the overflow to Toul.
In August, Mobile Hospital No. 39 was functioning at Aulnois with a personnel of 15 officers, 19 nurses, and 80 enlisted men operating a hospital of 85 beds. On the 14th of the month orders were received to increase the hospital to its maximum capacity, yet to be prepared to withdraw at a moment’s notice. On August 15 the work of constructing six new barracks and an enlarged operating pavilion, erecting additional tents, and other incidental enlargements, including shelter for a personnel of 150, was begun. The work, performed by enlisted men of the medical department, was completed by September 10. A hundred casuals (reclassified) had arrived on August 30 from special training battalions. When the work was finished it was found that 524 beds could be installed, and the chief surgeon was notified on September 10 that all was in readiness. An additional personnel of 33 officers, 46 nurses, and 100 enlisted men was asked for, but not all of these reported. The actual personnel received was: Officers in operating teams,14; officers in resuscitating teams, 2; operating-room nurses, 5; ward nurses, 9; enlisted men, 180. Six additional officers also became available. It was estimated that 144 major operations could be performed daily, this hospital being designated to receive only the seriously wounded, though preparations were made with a view to caring expeditiously for any slightly wounded patients who might be received.3
The organization and methods of this unit are discussed in the chapter on mobile hospitals and mobile surgical units.
516
From Aulnois, evacuation to Sorcy, a railhead of the Paris—Nancy main line, was effected by ambulances and by a narrow-gauge railway, and proved fully adequate. Four recumbent or eight sitting cases could be evacuated by ambulance in one hour and a quarter for the round trip. A narrow-gauge train of 5 cars could carry 45recumbent cases, requiring 35 minutes to load, 20 minutes to make the trip, and 35 minutes for unloading. By such a train 80 patients were evacuated in one and one-half hours, thus rendering service equivalent to that given by 20 ambulances during one and one-quarterhours.26
Evacuation Hospital No. 11 moved on September 11 from Rimaucourt to Sorcy Gare, where it was to act in conjunction with Mobile Hospital No. 39 and Field Hospital No. 41. It remained at this place about 10 days.27
Its procedure of receiving, caring for, and evacuating patients was like that of other similar units, for as this was the hospital’s first experience in campaign it adopted the methods of older organizations, more especially those of Mobile Hospital No. 39.
Among the interesting professional methods adopted, the following are worthy of mention: Abdominal cases were held 10 days and then not evacuated unless so directed by the chief of the surgical service. In head cases where the dura was opened, seven days’ retention was the minimum. Perforated chest wounds were evacuated as soon as complicating hemothorax permitted. Patients with retained missiles were held 10 to 14 days. Joint cases and compound fractures were held 3 to 7 days. Simple fractures were evacuated at once. All amputations were held from7 to 10 days. Spinal cases were held 7 days at first; as they reacted badly it was then ordered that they be evacuated at once.27
No statistical data were furnished by this unit.
The principal evacuation hospitals on the western front of the St. Mihiel salient, viz, No. 6 and No. 7, were located at the railhead at Souilly. Here the Medical Department had secured possession of a French evacuation hospital having a capacity rated by the French at 1,000 beds, by occupying both barracks and tents. Passageways between buildings were floored and roofed and there were concrete shelters(abris) instead of dugouts. With this hospital the French turned over all equipment except instruments, yet it was far from being thoroughly equipped from the American point of view. The French plan of a double hospital made it practicable for Evacuation Hospitals No. 6 and No. 7 to work in conjunction here, and it was planned to increase the capacity of the combined units by tents. The personnel was increased by a company of class B men transferred from the Justice group, who were used chiefly as litter bearers.
The consolidated hospital was ready for operation on August 27, but it received no considerable number of patients until September 12-18, during which it admitted nearly all the battle casualties of this front. At this time the capacity of Evacuation Hospital No. 6 was 1,200 beds, and that of No. 7 somewhat greater. Lack of facilities for caring for the slightly wounded and the sick (no camp for their proper care having been prepared) necessitated evacuation to the rear of patients who could with better arrangements have been returned to duty in a few days. Attempts had been made to provide such camp,
517
but they had failed. This caused overcrowding of these hospitals, but not to such a degree as later during the Meuse-Argonne operation.7
Both organizations here had the same layout, but whereas No. 7 had more space, No. 6 had the more complete equipment. The receiving station was common to both, the two hospitals receiving alternately. A large preoperative space allowed the centralization of appropriate cases, which were not distributed to the wards until after operation. All evacuable cases were sent through the "evacuating area," where the more rapid teams worked and through which the slightly wounded passed. Patients were segregated at the receiving ward into "seriously wounded," "slightly wounded," and "medical." Seriously wounded patients were undressed, bathed, X-rayed, and prepared for operation. Except the shock cases, which were sent promptly to the appropriate ward, no surgical case was sent to a ward until operation or dressing was completed.
There were 2 operating rooms for the seriously wounded, each having 3 tables, and 1 room with 4 tables for the slightly wounded. To the latter were assigned two of the best teams, with increased personnel. In this manner it was possible to operate many slight cases in a day, and during the period of most stress the average number cared for daily was 175. Splint teams, which applied splints to all fracture cases, were notably helpful and contributed materially to the output of operating rooms. The schedule for operating teams was 7 a. m. to noon; 1.30 to 6.30 p. m., and 7 p. m. to 6.30 a. m., the teams alternating. This routine, by allowing a full night’s sleep every second night and time for meals, helped to keep up the strength of the teams over long periods. At first chloroform was used, but later this was discontinued and ether was the only anesthetic employed.28
On August 27, 1918, Mobile Hospital No. 1 moved from Rouceux to Petit Maujouy, where it had been ordered to report to the commanding officer of Evacuation Hospital No. 8. As the latter unit was using in its entirety the old French hospital, the former chose a site at a crossroads a short distance to the west. After preparing this site, but without having spread more than a minimum of canvas, the unit was ordered to La Morlette to occupy an old French gas hospital consisting of eight semi permanent huts. No tentage was to be erected until after the operation began, and the personnel was ordered to remain under cover during daylight. The location was a good one for an advance hospital, with graveled roads, a good water supply, and electric lights. It secured considerable French equipment and supplies, including beds. To supplement the bed space, if necessary, tent frames were erected but no canvas was spread. Shelter trenches were dug to afford protection against bombing by airplanes or artillery fire, the location being only 6.4 km. (4 miles) behind the lines. Gas alarms were provided and gas drills were conducted.29
The move to La Morlette separated the unit from Evacuation Hospital No.8, and thereafter it operated independently.
The St. Mihiel operation did not occasion the activity anticipated byt his unit. At about 11 a. m. on September 12 four American wounded were
518
brought in by ambulance, the first active indication that the offensive had begun, no prior notice having been received. With the arrival of the wounded, tents were hurriedly put up, but these were not needed, as the number of patients received was only 141. Twenty-four of the casualties died in hospital and were buried in a cemetery on top of the hill behind the hospital. Many of the wounds were the result of bombing, a fact which accounts for the high mortality rate.30
On September 21 orders were received for the hospital to move to LaClaire Chene, adjoining Blercourt, Meuse, and on the 24th the movement was accomplished.
Evacuation Hospital No. 8, which had reached Petit Maujouy by truck on August 26, occupied Adrian barracks and tents and set up 1,000 beds. It remained at this location during both the St. Mihiel and the Meuse-Argonne operations, receiving for the most part only the more seriously wounded. An operating room was provided in an Adrian barrack and furnished with 18 operating tables, one-half the building being used for clean cases, for the preparation of dressings, instruments, etc., and the other half for infected cases. Patients were brought in on litters at one end of the structure, and the litter bearers, after receiving instructions from the chief of the surgical service, carried them to the operating tables indicated. Although the hospital was prepared for work on a large scale, no great number of patients were received until the Meuse-Argonne operation began on September 26.31
A special department of this hospital was that in which dental surgery for lesions of the jaw was performed. Special types of splints were necessary to meet the needs of particular cases, and these were made of vulcanite, wire, or metal in some other form. Primary union was the rule if patients were seen early, and results were satisfactory in a series of 72 cases. No case of infection by gas-forming bacilli was found among injuries of this character.
The unit sought to maintain on hand a large supply of instruments and appliances, especially hemostats, debridement scissors, bandage scissors, gloves, and Carrel-Dakin tubing. After teams, temporarily assigned, were advised to bring their own instruments, the acute need for them was met. Prepared dressings proved indispensable. One of the most difficult problems was the provision of fresh linen, for the portable laundry employed by the French for their evacuation hospital was inadequate for our larger units, and another was securing sufficient personnel to perform the arduous duties of carrying litters and digging graves.32
The field bacteriological laboratory issued the hospital met all requirements and made invaluable reports on wound bacteriology. Other important sections, in addition to the ones specially discussed, were the eye, ear, nose, and throat department, and those pertaining to general service supply, subsistence, and salvage.32
EVACUATION HOSPITAL NO. 9
On the night of August 28 Evacuation Hospital No. 9 arrived at Vaubecourt, where it occupied a plant not yet entirely completed, but lying near a highway and provided with a railroad loading quay. The structures taken
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over consisted of 9 wooden buildings 22 by 110 feet, 3 wooden ward buildings of approximately the same dimensions, 24 Bessonneau ward tents, 16 by 50 feet, 2 wooden operating pavilions 45 by 45 feet, 3 Singer hangars, 40 by 100 feet, 1 wooden H-shaped building 66 by 110 feet, and a mess hall 30 by 80 feet. Other buildings were provided for a disinfecting plant (with baths), an engine room, an electric service station, a gasoline storage room, and latrines. The demands made on the hospital were constant and increased.33
This was not the case during the St. Mihiel operation, however, as this unit admitted but 13 surgical cases, none of which was a battle casualty, and a small number of medical cases, only a very few of whom were seriously ill. Immediately after this action, as other divisions entered the area, admissions to the medical wards increased rapidly and steadily, many of the cases being very severe.
NEUROLOGICAL UNIT NO. 1 (FROM BASE HOSPITAL NO.117), BENOITE VAUX
Base Hospital No. 117 was a special neurologic hospital located at LaFauche. On September 2, 4 medical officers and 15 enlisted men were transferred to Benoite Vaux to establish a temporary neurologic hospital of 200 beds for the coming St. Mihiel operation, their number being augmented September 15 by 15 additional enlisted men sent from the parent hospital. No account of the work of this detached unit is of record.
As previously mentioned, another unit from this base hospital operated a neurologic hospital in the Justice group at Toul for the same class of patients from the southern front of the St. Mihiel salient.34
REFERENCES
(1) Report of Medical Department activities, Evacuation Hospital No. 1, A. E. F., prepared under the direction of Col. G. H. R. Gosman, M. C., commanding officer, undated. On file, Historical Division, S. G. O.
(2) Report of Medical Department activities, Mobile Hospital No. 3, A. E. F., prepared under the direction of Lieut. Col. H. C. Coe, M. C., commanding officer, undated. On file, Historical Division, S. G. O.
(3) Report of Medical Department activities, Mobile Hospital No. 39, A. E. F., St. Mihiel operation, prepared under the direction of Col. T.M. Flint, M. C., commanding officer, undated, 1. On file, Historical Division, S. G. O.
(4) Report of Medical Department activities, Evacuation Hospital No. 13, A. E. F., prepared under the direction of Lieut. Col. D. R. Snyder, M.C., commanding officer, undated. On file, Historical Division, S. G. O.
(5) Report of Medical Department activities, Mobile Hospital No. 4, A. E. F., prepared under the direction of Lieut. Col. M. B. Clopton, M.C., commanding officer, undated, 1. On file, Historical Division, S. G. O.
(6) Report of Medical Department activities, Evacuation Hospital No. 12, A. E. F., prepared under the direction of Col. H. D. Bloomberg, M. C., commanding officer, undated, 3. On file, Historical Division, S. G. O.
(7) Report of Medical Department activities, Evacuation Hospital No. 6, prepared under the direction of Col. F. C. Baker, M. C., commanding officer, undated, 4. On file, Historical Division, S. G. O.
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(8) Report of Medical Department activities, Toul Hospital Center, by Col. H. C. Maddux, M. C., commanding officer, undated, 4. On file, Historical Division, S.G. O.
(9) Ibid., 7.
(10) Ibid., 24.
(11) Ibid., 5.
(12) Ibid., 23.
(13) Ibid., 25.
(14) Ibid., 13.
(15) Report of Medical Department activities, Base Hospital No. 45, A.E. F., prepared under the direction of Lieut. Col. S. McGuire, undated, 2. On file, Historical Division, S. G. O.
(16) Report of Medical Department activities, Base Hospital No. 51, A.E. F., prepared under the direction of Lieut. Col. H. W. Goodall, M. C., commanding officer, undated, 4. On file, Historical Division, S. G. O.
(17) Ibid., Table 1.
(18) Report of Medical Department activities, Evacuation Hospital No. 3,A. E. F., prepared under the direction of Lieut. Col. R. W. Kerr, M. C., undated, 13. On file, Historical Division, S. G. O.
(19) Ibid., 75.
(20) Ibid., 79.
(21) Ibid., 87.
(22) Report of Medical Department activities, Evacuation Hospital No.14, A. E. F., prepared under the direction of Lieut. Col. George H. McLellan, M. C., commanding officer, undated, 14. On file, Historical Division, S. G. O.
(23) Ibid., 19.
(24) Ibid., 18.
(25) Report of Medical Department activities, gas hospital, Toul Hospital Center, A. E. F., prepared under the direction of Lieut. Col. H. W. Goodall, M.C., commanding officer, undated. On file, Historical Division, S. G. O.
(26) Report of Medical Department activities, Mobile Hospital No. 39, A.E. F., St. Mihiel operation, Tables I, II, III, prepared under the direction of Col. T. M. Flint, M. C., commanding officer, undated. On file, Historical Division, S. G. O.
(27) Report of Medical Department activities, Evacuation Hospital No.11, A. E. F., prepared by Col. D. F. Duval, M. C., commanding officer, undated. On file, Historical Division, S. G. O.
(28) Ibid., 21.
(29) Report of Medical Department activities, Mobile Hospital No. 1, A.E. F., prepared under the direction of Maj. D. Macrae, M. C., commanding officer, undated,45. On file, Historical Division, S. G. O.
(30) Ibid., 47.
(31) Report of Medical Department activities, Evacuation Hospital No. 8,A. E. F., prepared under the direction of Col. J. F. Hall, M. C., commanding officer, undated, 9. On file, Historical Division, S. G. O.
(32) Ibid., 11.
(33) Report of Medical Department activities, Evacuation Hospital No. 9,A. E. F., prepared under the direction of Lieut. Col. R. Reynolds, M. C., commanding officer, undated, 11. On file, Historical Division, S. G. O.
(34) Report of Medical Department activities, Base Hospital No. 117, A. E. F., prepared under the direction of Maj. W. J. Otis, M. C., commanding officer, undated. On file, Historical Division, S. G. O.
