Field Operations, Table of Contents
MANUAL FOR THE MEDICAL DEPARTMENT, 1916
ARTICLE XII.- THE THEATER OF OPERATIONS, GENERAL
REQUIREMENTS FOR AN EFFICIENT SANITARY SERVICE
627. The mobility of an army may be the factor which determines its success or its failure. It is therefore highly important (1) that the army should be relieved as promptly as possible of the encumbrance of its sick and wounded; (2) that this should be accomplished without obstructing other military operations in progress, and with the minimum of transportation and personnel.
(a) In view of these requirements, it is evident that the sanitary service must be thoroughly organized; that it must operate systematically, and that its personnel should have had thorough preliminary training.
628. Efficient medical administration should therefore provide: (1) In the zone of the advance, only emergency treatment for the wounded and their prompt transportation to the rear; (2) in the zone of the line of communications, a service so complete in equipment, supplies, and personnel that it will afford the sick and wounded all the facilities and comforts of the service of the interior, rendering it unnecessary to transport farther to the rear such patients as will later be able to rejoin their commands; (3) in every sanitary station from the firing line to the base, a careful classification of the sick and wounded according to the nature and severity of their disabilities, with a view to such disposition as will prevent any unnecessary depletion of the combatant forces.
629. For the evacuation of the sick and wounded to the rear it will be necessary for the Medical Department to utilize all available transport. In addition to that normally assigned to the department, combat wagons and field train wagons when authorized by competent authority, automobiles, and other impressed civilian transportation of all kinds, should be obtained and used when the situation demands.
ARTICLE XIII -THE ZONE OF THE ADVANCE
CLASSIFICATION OF THE SANITARY SERVICE
630. The sanitary personnel of the zone of the advance may be divided into two general groups, as follows: First, that attached to line organizations smaller than a brigade, which functions under the immediate orders of the organization commanders; second, that comprising the sanitary trains, which functions under the orders of division surgeons in accordance with such general or specific instructions as they may receive from their division commanders.
SANITARY TROOPS ON DUTY WITH LINE ORGANIZATIONS
(See also Field Service Regulations)
631. Sanitary troops with line organizations, including detachments with regiments, battalions, trains, etc., vary in personnel with the strength of the organization served and the nature of the duties they are required to perform. (See Tables of Organization: War-Regimental Organizations.)
632. When a regiment is operating independently the Medical Department equipment available for its use consists of the first-aid packet carried by each officer and enlisted man of the Army as a part of his individual equipment; the articles carried as
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individual equipment by each medical officer (par. 864) and by each member of the Hospital Corps (par. 865); the combat equipment (pars.866 and 867); the camp infirmary equipment (pars. 869 and 870); and the additional articles necessary for the establishment of a regimental hospital(par. 872).
(a) The additional articles for the regimental hospital will be taken to the field only under circumstances requiring the organization to provide hospital care for its own sick and wounded.
633. When a regiment or other line organization is operating as a part of a division the Medical Department equipment provided for its exclusive use consists of the first-aid packets and individual equipments mentioned in the preceding paragraph, and the combat equipment (pars. 866 and867). A small box of surgical dressings (par. 954) and one or more litters are carried on each ammunition wagon. The requisite articles for the establishment of the aid station are carried on the pack mule allotted the sanitary service, which marches with the combat train of the organization. The medical officer responsible for this equipment will see that it is complete and that it is maintained intact for service in combat.
(a) On the march and in camp, with the exceptions noted in paragraph 601, the medical supplies and dispensary service required by regimental organizations are provided through the medium of the camp infirmary.
(b) In combat it is contemplated that the expenditures of dressings, etc., from the equipment of regimental organizations will be replenished from the reserve supplies of the nearest ambulance company or camp infirmary. (See par. 551.)
634. The surgeon of a line organization is both an advisory and an administrative officer (par. 361).
(a) He commands the sanitary troops on duty with the organization.
(b) He is the adviser of the organization commander in medical and sanitary matters and, to the extent of his authority, is responsible for the execution of sanitary measures in connection with the organization.
(c) He provides care and treatment for the sick and wounded, and is responsible for the efficient performance of the entire sanitary service of the organization.
(d) He makes such sanitary inspections as may be necessary. In connection therewith he supervises the water supply and its purification, the sanitation of kitchens, the disposal of garbage and waste water, the police of latrines and urinals and the filling in and marking of the same when discontinued, the police of bathing places and picket lines, the measures taken for the destruction of flies and mosquitoes, and all other sanitary procedures necessary to preserve the health of the command.
(e) He instructs, at suitable times designated by the commanding officer, the entire personnel of the organization in personal hygiene and first aid.
(f) He trains his subordinates in all departments of field sanitary work.
(g) He makes timely requisition for necessary supplies and equipment.
635. On the march the duties of the sanitary personnel are to render first aid where required, to transport the sick and wounded, and to make suitable disposition of them on arrival in camp.
636. Ordinarily the surgeon marches with the regimental commander, and one medical officer marches in the rear of each battalion. Each officer is mounted and accompanied by a mounted orderly. The remaining regimental sanitary personnel usually march with the battalion units.
637. When out of the presence of the enemy, ambulances are ordinarily ordered distributed by the division commander throughout the column, in the rear of regiments, battalions, etc. Unless otherwise ordered these ambulances join their companies at the end of the day`s march or at the beginning of an engagement. When a regiment operates independently it may be assigned its full quota of four ambulances. (See pars. 673 and 721.)
638. A soldier falling out of the marching column from sickness or injury is sent to a medical officer in the rear, with a pass from his company commander, showing the soldier`s name and organization. The medical officer returns the pass, showing the
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disposition made of the soldier. The man may be given authority to ride in the ambulance at the rear of the regiment, or his arms and personal equipment may be carried in the ambulance, and he may march at the rear of the regiment with the sanitary detachment.
639. When an ambulance at the rear of a regiment is filled it may fall out and join its company at the rear of the column, and the director of ambulance companies or the ambulance company commander may send forward another ambulance to take its place; or the ambulance may remain with the regiment, and men requiring transportation may be given diagnosis tags authorizing their transportation by the ambulance company in the rear. In the latter case the men fall out and report to the commander of the ambulance company for transportation.
640. The arms, personal equipment, and clothing of a soldier who falls out are taken with him in the ambulance. The horse, saber, and horse equipment of a soldier admitted to the ambulance or otherwise separated from his organization because of sickness or injury are taken back to the troops by the noncommissioned officer who accompanied him.
641. Upon halting for the night all but the trivial cases are taken in charge by a field hospital designated by the division surgeon, or they are sent to the rear, as the conditions may warrant. It may be necessary to leave them under shelter-in houses, if practicable-with the necessary food and attendants until taken in charge by sanitary troops from the line of communications.
642. In combat the duties devolving on the sanitary personnel are to render first aid to the wounded; to establish and operate an aid station, and to collect the wounded thereat; to direct those with trivial wounds to return to the line, and to direct others with slight wounds to the station for slightly wounded; and in exceptional cases to transport the severely wounded to the dressing station.
643. The detachment invariably accompanies its line unit in combat, rendering first aid to as many as possible of those who fall out, without losing touch with the command. It is assisted by the band if the latter is assigned to duty with the sanitary troops.
644. Unless medical assistance is available, the wounded apply their first-aid packets, if practicable. With this exception the care of the wounded devolves upon the sanitary troops, and no combatant, unless duly authorized, is permitted to take or accompany the sick or wounded to the rear.
645. With dismounted troops the aid station, not more than one for each regiment or smaller independent unit, will be established as the engagement develops and the number of wounded warrant it providing it is probable that the command will remain, for a short period at least, near the proposed location of the station. With a mounted command the sanitary detachment accompanies the troops during the whole course of the engagement, pausing only so long as is necessary to render first aid and to collect the wounded at someplace where they can be turned over to an inhabitant of the country to be cared for. The commander of the advancing foot troops or of the advance section should be promptly notified of the location of the wounded thus collected.
646. In locating the aid station it is of the highest importance that advantage be taken of any shelter from fire which the terrain affords. To a large extent the distance of the station from the firing line must depend upon this consideration. It will be borne in mind that any building which offers a good target for artillery fire is worse than no shelter at all, and that the nearer the station is to the front the safer it will be from dropping projectiles.
647. The surgeon remains, as a rule, at the aid station, with a noncommissioned officer and the necessary number of privates, for to this station the commanding officer will send information or orders which he may have to communicate to the surgeon, and through this station the surgeon gains contact with the units of the sanitary train in the rear. The other medical officers and the remainder of the detachment keep in touch with the firing line, tending the wounded as far as possible and conveying the helpless to the station, if practicable. If the enemy`s fire is such that the wounded can not reach the station, advantage is taken of trenches, ravines, and other inequalities of the ground affording
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temporary shelter, and the wounded are brought in during intervals in the firing or after nightfall.
648. No one belonging to the sanitary personnel of an organization will go farther to the rear than the aid station, except by authority of the surgeon.
649. The aid station, which will often be but little more than a place for assembling the wounded, should not undertake elaborate or fixed arrangements for their care and treatment, as its personnel must keep in touch with the regiment and be prepared to close or move the station without delay when the regiment moves. The treatment given will usually be limited to first aid and to the readjustment of dressings. Occasionally it may become necessary to ligate an artery or to perform an emergency operation. Fractures, if not previously immobilized, should be put in splints. Diagnosis tags will be attached to all wounded and the duplicates disposed of as directed in paragraph 571. The arms and equipment of wounded separated from their companies and taken in charge by the Medical Department should, so far as practicable, accompany them until they reach the line of communications.
650. In the course of battle the advance of troops may result in the aid station being separated so far from the line that it can no longer fulfill its purpose. In this case it must be advanced to a more favorable location. Ordinarily the wounded left behind will be looked after by the advancing ambulance company, but if it is apparent that this will be long delayed a small portion of the regimental personnel may be detailed to remain with them. Similar action will be taken in case of retreat. The closing or moving of the station rests on the decision of the regimental surgeon. In reaching his decision he should be governed by the primary necessity of always keeping in touch with the regiment.
THE SANITARY TRAIN
651. The sanitary train is composed of camp infirmaries, ambulance companies, and field hospitals. It is commanded by the division surgeon.
THE DIRECTOR OF AMBULANCE COMPANIES
652. For each division a medical officer of the grade of major is designated as director of ambulance companies, and there is assigned under him one sergeant and one private first class or private, Hospital Corps, both mounted. The relation of the director of ambulance companies to the division surgeon and to the ambulance companies is similar to that of a major of the line to the colonel of his regiment and to the companies of his battalion. He maintains no office of record, but communications from the division surgeon to the ambulance companies and vice versa are sent through him for his information.
653. The director of ambulance companies will make frequent inspections to ascertain whether all the companies have their regulation allowance of personnel and equipment, whether the personnel are properly instructed, and whether the equipment is in good condition, and will take the necessary measures to correct any deficiencies found therein.
654. On the march the director will ordinarily accompany one of the ambulance companies on duty with the marching troops and will superintend the ambulance service of the march. He will keep the division surgeon advised as to where communications will reach him.
655. His duties during and immediately after combat comprise supervision of the removal of the wounded from the aid stations (and in emergencies from the front) and their care and treatment en route, via the dressing stations, to the field hospitals. His activities cover, therefore, the entire zone between the firing line and the field hospitals, with the terrain of which he should make himself familiar, and he will proceed from point to point thereof as his presence may be required. As far as practicable he will keep the division surgeon apprised of his movements.
(a) He will, under the division surgeon`s authority, direct the opening of dressing stations at the places decided upon. Under the same authority he will direct such changes
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in the location of these stations as may be necessary during the battle, and their closing, and the reassembling of the several units for movement with the division as soon as practicable after its conclusion.
656. The director of ambulance companies also commands the camp infirmaries of the division, as outlined in paragraph 659.
CAMP INFIRMARIES
657. Each regiment of a division has assigned to it in time of peace one camp infirmary equipment (pars. 869 and 870), including one wagon belonging to the divisional sanitary train. (See Tables of Organization: Peace-Regimental Organizations.)
658. When the division is assembled the camp infirmary equipments authorized for the service of the mobilized division (usually on the basis of one for each brigade) are retained for duty as camp infirmaries. The remaining camp infirmary equipments, except transportation, are turned in to the officer in charge of medical supplies and the wagons thus released are assigned to those units of the sanitary train for which no transportation is provided in time of peace.
659. The camp infirmaries retained for the service of the division will be placed by the division surgeon under the immediate charge of the director of ambulance companies. This officer will receipt and account for the property and will be held responsible for its condition and completeness at all times. He will have general charge of the assignment of the infirmaries to the troops which they are intended to serve and he will keep the service records and accounts of the permanent personnel on duty therewith. (C. M. M. D., No.3.)
660. For permanent duty with each infirmary there will be required one sergeant, Hospital Corps, in immediate charge of the property, and one driver. The men and animals of the camp infirmary will usually be attached, for rations and forage, to one of the regiments served by the infirmary or to an ambulance company.
661. The camp infirmaries with each division will be numbered from one upward consecutively, and the wagon belonging to each infirmary will be marked as prescribed in Tables of Organization. (See also par.545.)
662. The primary function of the camp infirmary is to furnish dispensary facilities to one or more organizations during field service when other provision is made for the hospital treatment of all sick and wounded or for their prompt evacuation to the rear. When such provision is not made and the camp infirmary becomes the nucleus around which a camp hospital (see par. 604)is developed, it becomes an immobile unit, and if the organization to which it is attached should move, another camp infirmary will be required to accompany it.
663. The senior medical officer of the units served by the infirmary assumes charge of the infirmary service and is authorized to call directly on the other organizations for their proportionate share of medical officers and sanitary personnel for such service.
664. The sergeant on permanent duty with the infirmary, after reporting to the senior medical officer of the units served, remains insubordinate charge of the equipment as the representative of the director of ambulance companies.
665. When the camp infirmary is to be opened for service the surgeon in charge will, with the approval of the camp commander, notify the surgeon of each other unit which the infirmary is to serve of the time at which it will be available for his use to hold sick call. He will mainain such service at the infirmary as the conditions may warrant.
666. In combat the equipment of the camp infirmary may be utilized for the establishment of a station for slightly wounded. (See par. 710b.)
THE AMBULANCE COMPANY
667. The ambulance companies will be numbered from 1 upward in a single consecutive series for the entire Military Establishment.
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668. The vehicles of the ambulance company will be marked as prescribed in Tables of Organization. (See also par 545.)
669. The commanding officer of the ambulance company is under the immediate orders of the director of ambulance companies, when there is one; otherwise, he is under the immediate orders of the division surgeon.
670. The personnel of an ambulance company at war strength, as given in Tables of Organization, are ordinarily distributed as follows:
(a) With the dressing station, including the litter bearers: 4 officers, 1 sergeant first class, 6 sergeants, 1 acting cook, 40privates first class and privates, all of the Medical Department.
(b) With the wheeled transportation: 1 officer, 1 sergeant first class, 1 sergeant, 1 acting cook, 28 privates first class and privates (1as farrier, 1 as saddler, 2 as musicians, 12 as ambulance drivers, and 12 as ambulance orderlies), all of the Medical Department; also 1 sergeant(blacksmith) and 3 privates (drivers) of the Quartermaster Corps.
671. The function of the ambulance company is to collect the sick and wounded, to afford them temporary care and treatment, and to transport them to the next sanitary unit in the rear.
672. In camp the ambulance company operates an ambulance service between the camp infirmaries and the field or other hospitals.
673. On the march ambulances are distributed among the marching troops, usually one to each regiment, for the purpose of supplying transportation to those who become unable to march. (See pars. 637 and 721.)
674. In combat the company operates in two parts (par. 670).The first establishes and operates a dressing station and collects the wounded there at; the second operates the wheeled transportation in evacuating the wounded.
675. The dressing station party, including the litter bearers, with its equipment on pack mules, moves forward in rear of the troops ready to establish the dressing station.
676. The location of the dressing stations and the number to be established will be determined by the division surgeon acting under the instructions of the division commander. The director of ambulance companies will supervise their opening, giving the necessary orders therefor to the commanders of the ambulance companies. He will report their opening to the division surgeon.
677. Exact rules can not be formulated as to the time when the dressing station shall be opened. Generally speaking, when the advance has ceased and the wounded are so numerous that they can no longer be cared for by the regimental personnel, the time has come for the opening of the station.
678. It is desirable that the site selected for a dressing station have the following advantages: (1) Protection from rifle fire, (2)protection from direct artillery fire, (3) accessibility for wheeled transportation, and (4) a supply of water. Effective shelter from fire is the chief desideratum. A site inaccessible to ambulances on account of exposure to fire need not invariably be condemned, for the greater part of the work of the ambulances is done after the close of the battle or after nightfall. The station will always be pushed as far to the front as possible to reduce to the minimum the distance over which the wounded must be carried on litters.
679. In some cases in which the establishment of the dressing station has been delayed, or in which the troops are about to move forward, it may be possible to locate the dressing station at the aid station, thus practically eliminating one station. Under these circumstances the dressing station assumes the work of the aid station and the personnel of the two stations cooperate until the aid station moves forward.
(a) The requirement that the sanitary personnel with the combatant organizations keep in touch with those organizations may make it necessary for them to leave the wounded where they fall, pausing only to administer such aid as may be absolutely essential. Cases thus left will be collected and cared for by the dressing station party as it advances. (See par.650.)
680. As soon as the dressing station is opened its bearers under the direction of a medical officer proceed to the front as far as the enemy`s fire permits. Ordinarily they
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will be divided into as many sections as there are aid stations, each under a noncommissioned officer, and one section will proceed toward each aid station.
(a) They direct wounded who are able to walk to the station for slightly wounded. They transport other wounded from the aid station to the dressing station. When practicable they also assist the regimental medical personnel in the care and removal of wounded from points in advance.
(b) Meanwhile the commanding officer of the company with the dressing station personnel proceeds to put the dressing station in condition to receive patients. When possible for wheeled transportation to reach the dressing station, a message should be sent to the officer in charge of the ambulance train directing him to report at the station with the ambulances.
681. The work of the dressing station is carried on under the following departments:
Dispensary.
Kitchen.
Receiving and forwarding.
Slightly wounded.
Seriously wounded.
682. All wounded will pass through the receiving and forwarding department. Those whose injuries are not sufficient to incapacitate them for the present performance of their military duties will, after receiving the necessary treatment, be directed to return to their units, and the fact that such directions have been given them will be noted upon their diagnosis tags. Other slightly wounded, able to walk, will, after like treatment, be immediately directed to the rear in command of their highest ranking officer or soldier. Generally they will be sent to the station for slightly wounded.
683. At the dressing station only such operations will be performed as may be immediately required to save life or to render the patients fit for farther transportation. Permanent occlusive dressings may be applied if time permits. The rules to be followed generally are that no operative or other interference should be attempted under conditions unfavorable for asepsis or antisepsis, and that no wounded for whom transportation is available should be delayed at the dressing station. Conditions in these respects must vary widely in different battles; when there are good facilities for the surgical treatment of cases and at the same time lack of transportation for wounded, it would manifestly be proper to give them definitive treatment.
684. A memorandum showing the number of patients received and their disposition will be kept in the receiving and forwarding department. Diagnosis tags should be applied to all wounded not previously tagged and supplemental entries made on tags as required. For further records of sick and wounded required of ambulance companies, see paragraph 575 et seq.
685. The ambulances and wagons remain farther to the rear than the dressing station (usually in proximity to some unit or station through which communication with division headquarters may be maintained) until it is practicable to determine a line of evacuation for the wounded. As soon as the dressing station is established and the location of the field hospital is determined, a safe route for the ambulance service between these two establishments is sought, and, when found, the ambulances advance to begin the removal of wounded from the dressing station. The wagons of the ambulance company, carrying a reserve of dressings, may remain at a field hospital, whence the supplies may be sent forward by ambulances returning to the dressing station. (See par. 728.)
686. Ambulances must reach the station as early as possible even at the risk of losses. Ordinarily ambulances will carry wounded only from the dressing station to the nearest field hospital, immediately returning to the former; any other destination for wounded must be prescribed by the division surgeon.
687. When the ambulances are insufficient the division surgeons hould request the division commander to permit the Medical Department to make use of part or all of the transportation of the division on its return from the front.
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688. During the daytime when a battle is still in progress it will rarely be possible for ambulances or other wheeled vehicles to advance farther to the front than the dressing station. Opportunity to have them do so will sometimes occur at night, and on the conclusion of an engagement they should always be used, as far as may be, at all points on the battle field.
689. To prevent further injury, it is important that the wounded should be handled or otherwise disturbed as little as possible in the course of their transportation to the rear. No wounded man once placed on a litter should be removed from it without evident necessity until he reaches the field hospital, whether he is transported by ambulance or otherwise.
690. While authority to close a dressing station or to move it must ordinarily be obtained from the division surgeon, nevertheless under exceptional conditions, when communication with the division surgeon is interrupted, the director of ambulance companies may, if he deems the emergency requires it, close or move the station at discretion. In this case the division surgeon will be notified as soon as possible of the action taken.
(a) Should it be impossible to evacuate the wounded at a dressing station before it is closed or moved, by reason of retreat or otherwise, the commanding officer of the ambulance company will leave with the wounded, according to their number and condition, sufficient medical personnel and supplies to provide for their immediate necessities, and will advance or withdraw with the division the remainder of the personnel and equipment.
THE DIRECTOR OF FIELD HOSPITALS
691. For each division (except cavalry divisions) there is designated as director of field hospitals one medical officer of the grade of major and there is assigned under him one sergeant and one private first class or private, Hospital Corps, both mounted.
692. The director of field hospitals is, like the director of ambulance companies, immediately under the division surgeon and is the latter`s executive in respect to the field hospitals of the division. His supervision over the field hospitals is similar to that exercised by the director of ambulance companies over those companies.
693. He will ordinarily accompany the field hospital in advance on the march and remain with it in camp. He will keep the division surgeon informed of his movements.
694. He should maintain communication with the director of ambulance companies, to enable that officer to make suitable arrangements for the removal of patients from the front, and with the surgeon in charge of the sanitary column from the advance section to promote the rapid evacuation of patients to the rear.
THE FIELD HOSPITAL
(Capacity 216)
695. The field hospitals will be numbered from 1 upward in a single consecutive series for the entire Military Establishment.
696. The wagons of the field hospital will be marked as prescribed in Tables of Organization. (See also par. 545.)
697. The commanding officer of the field hospital is under the immediate orders of the director of field hospitals, when there is one; otherwise he is under the immediate orders of the division surgeon.
698. The personnel of a field hospital at war strength, as given in Tables of Organization, are ordinarily assigned as follows: 1 major(commanding); 5 captains and lieutenants (1 adjutant and quartermaster, 4 ward surgeons); 3 sergeants first class (1 acting first sergeant in general supervision of the hospital and in charge of medical property and records, 1 in charge of transportation and quartermaster property and records, 1 in charge of mess supplies and cooking); 6 sergeants (1 in charge of the dis-
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pensary, 1 in charge of operating equipment, 1 in charge of patients` clothing and effects, 3 in charge of wards); 3 acting cooks; 55 privates first class and privates (46 attendants, 1 dispensary assistant, 1 artificer, 4 orderlies, 3supernumeraries); and of the Quartermaster Corps, 1 sergeant (wagon master) and7 privates (drivers).
699. The function of the field hospitals is to keep in touch with the combatant organizations and to provide shelter and such care and treatment as are practicable for the sick and wounded of the division who are brought in by the ambulance companies until the sanitary service of the line of communications takes charge of them. A field hospital can meet these requirements only when it is relieved so promptly by the sanitary units in the rear that its mobility is not interfered with. Prompt evacuation of the sick and wounded is necessary also to secure for them the facilities for treatment and the comforts which are available on the line of communications.
700. On the march and in temporary camps, however, the field hospitals are the nightly collecting points for the divisional sick and injured who are unable to continue the march, and must provide for the care of such patients until they can be turned over to the medical service of the line of communications or to a local hospital or hospitals. (See par. 641.) The use of the field hospitals for this purpose should be carefully regulated by the division surgeon.
(a) So far as practicable in each division only one field hospital at a time will be used in this service, leaving the others entirely free of patients. Furthermore, only so much of the equipment of the field hospital assigned to this work should be unpacked as is required to care properly for the patients actually in the hospital and their necessary attendants who are to remain behind when the division moves on. The number of personnel detailed to remain will be as small as possible.
(b) The equipment which has not been unpacked and the personnel who have not been detailed to remain with the patients will move with the division.
(c) Every effort will be made by the division surgeon to dispose of the patients left behind. Should unusual delay in turning them over to the medical service of the line of communications supervene, temporary provision for them should be arranged in civil hospitals of the locality or otherwise as may be most practicable until the medical units of the line of communications can take charge of them.
(d) As soon as the patients are disposed of, the personnel detailed for the temporary care of such patients will immediately rejoin the hospital.
701. For service in combat, the locations of the field hospitals and the number to be opened will be determined by the division surgeon acting under the instruction of the division commander. The director of field hospitals will supervise their opening, giving the necessary orders therefor to the commanders of the field hospitals. He will report their opening to the division surgeon.
(a) It is desirable that they be centrally located and beyond the zone of conflict, which will usually necessitate placing them 3 or 4miles in rear of the dressing stations.
(b) Field hospitals should be easily seen and reached from front and rear and yet not be in the way of troops and trains. An ample supply of good water is necessary, and suitable buildings are of great advantage. Such buildings should be utilized first, and only so much tentage put up as may be required.
(c) If the enemy retires, field hospitals will be established, if possible, near the dressing stations having the greatest number of wounded.
(d) A field hospital may be moved forward under the direction of the division surgeon to replace a dressing station and to take over the patients.
702. The time when field hospitals should open will be communicated by the division surgeon to the director of field hospitals, should there be one, or, there being none, to the commanding officers of the hospitals concerned.
(a) Only one will, as a rule, be opened early in the battle. This will be done as soon as the number of wounded justifies it. The other field hospitals should not be set up until the necessity for them is apparent. If the conditions are such that the wounded can be evacuated directly to the line of communications, the opening of field hospitals will be unnecessary.
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703. On the receipt of an order to open a field hospital the following departments will be established:
Dispensary.
Kitchen.
Receiving and forwarding.
Slightly wounded.
Seriously wounded.
Operating room.
Mortuary.
704. All wounded arriving at the field hospital will be received at the receiving and forwarding department, which is the administrative office of the hospital.
(a) The slightly wounded, able to walk, will be immediately directed to the rear or to the station for slightly wounded, as the circumstances may indicate.
(b) The seriously wounded, and the slightly wounded unable to walk, will be assigned to the proper department for treatment.
(c) Records of the wounded will be made as prescribed in paragraph 575 et seq.
705. Under ordinary battle conditions operations at the field hospitals should be such only as are needed to fit the patients for transportation to the rear. Many extensive dressings will, however, be required under all circumstances. All operations should be done under the strictest antiseptic or a septic precautions, and every effort made to dress cases so that they will not require redressing for some time. Patients should be fed, if practicable, before being sent to the rear.
706. Every opportunity should be taken to transport the wounded to the rear. Ordinarily they will be turned over to the transportation of the line of communications, but the returning transport of the division may be utilized for this purpose in the same manner as at the dressing stations (par. 687).
707. When the number of wounded is very great and the transportation facilities are bad, with no rear hospitals to relieve field hospitals, the latter will, despite all efforts, become crowded with wounded which they can not dispose of. In this case the division surgeon may be compelled to concentrate all wounded in one or two field hospitals so as to free the others for an advance. The hospitals left behind should be cleared as soon as possible, in order that they may rejoin their division.
(a) When no adequate provision is made for the evacuation of the sick and wounded and a field hospital becomes the nucleus around which a camp hospital(par. 604) is developed, it becomes an immobile unit, and, if the troops to which it is attached should move, another field hospital will be required to accompany them.
708. Field hospitals ordered to close or to move will dispose of their patients as directed by the division surgeon.
(a) If by reason of retreat or otherwise a field hospital is required to move before it can evacuate its patients, its commanding officer will take action similar to that prescribed for dressing stations in the like contingency.(See par. 690a.)
709. The opening, moving, and closing of field hospitals will be reported by their commanding officers through the director of field hospitals to the division surgeon, who will report the same when necessary to the surgeon of the advance group of the line of communications.
THE STATION FOR SLIGHTLY WOUNDED
710. The station for slightly wounded is a transient divisional organization on the battle field; it has no permanent personnel or definitely prescribed equipment.
(a) The personnel required for the station, usually one medical officer, two non-commissioned officers, and eight privates, will be detached from such unit of the sanitary train as the division surgeon may elect. In some instances it may be practicable to utilize personnel sent forward from the line of communications.
(b) For the equipment of the station one of the camp infirmaries of the division may be utilized, or a medical and surgical chest and such other supplies as are necessary may be temporarily detached from one of the field hospitals.
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711. The functions of the station for slightly wounded are(1) to afford a place where men who are unable to accompany their units into combat may be assembled; (2) to relieve dressing stations and field hospitals of the congestion incident to the presence of the slightly wounded who can walk and who require but little attention.
712. The station, usually one for each division, is established when combat is imminent. It should be about the same distance from the firing line as the field hospitals. A building should be selected for its use when practicable. It should preferably be located on the route over which the troops have advanced, as this route is the one which the disabled are most likely to follow in working their way to the rear. In any case it should be so conspicuously marked that it can be found readily.
713. Extensive preparations at this station are unnecessary. A tent should be erected, if no building is available, where dressings may be applied or readjusted and arrangements made for the preparation of simple nourishment. Diagnosis tags should be attached to all wounded not already tagged. The duplicates of the tags will be disposed of as directed in paragraph571. A list of sick and wounded will be prepared as prescribed in paragraph580.
714. As soon as possible wounded at the station who are notable to return to their commands will be collected into groups and directed to the rear in charge of one of their number.
(a) Minor cases requiring no further treatment or only slight treatment will, however, be directed to return to their organizations, and the fact that such directions have been given them will be noted on their diagnosis tags. Men who arrive at the station without authority and are able todo duty will be turned over to the provost guard for return to their organizations.
(b) Should any of the sick or wounded be found too much exhausted or too badly hurt to go farther afoot, the commanding officer of the station will report them to the nearest field hospital.
715. Upon the conclusion of the engagement the personnel and equipment of the station will be disposed of as directed by the division surgeon.
THE ADMINISTRATION OF THE SANITARY SERVICE OF THE DIVISION
716. In administrative matters the division surgeon bears a relation to the units of the sanitary train similar to that of a regimental commander to the battalions and companies of his regiment.
717. In order that the sanitary service may attain its highest efficiency, flexibility in the distribution of sanitary personnel and equipment is essential. The elements comprising the sanitary train are, therefore, not ordinarily assigned to units smaller than a division unless the unit is operating independently. They are, however, frequently attached to smaller units as, for example, when a division marches by two roads, apart of the sanitary train may accompany each detachment of the division. Under these circumstances the units of the sanitary train are subject to the general control of the senior line officer present with the immediate command which they accompany.
718. When, by divisional orders, units of the sanitary train are temporarily separated from direct headquarters control and placed with line organizations or trains, the senior medical officer present with the units will report them to the line officer in command without further orders and will receive his instructions in such matters as the conduct of the march and the location and security of the units in camp. Units so separated from headquarters are not regarded as detached unless they are specifically ordered to report to the commander of the line troops for duty.
719. The method of control of the sanitary train varies according to circumstances. For example, at a camp where arrangements have been made in advance for an adequate supply of water and forage, an entire division may be assembled, in which case all the elements of the sanitary train will be directly controlled by the division surgeon (par. 651). On the other hand, to facilitate loading on ships, for example, the troops of a division may be concentrated at one port and the trains at another port, in which
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case the entire sanitary train is under control of the commander of the divisional train and under the immediate command of the senior medical officer with the sanitary train.
720. When the division is on the march the sanitary train is ordinarily divided. The division surgeon will advise the division commander as to which units of the sanitary train he considers necessary for service with the marching troops and which units may be placed under the commander of the divisional train. When the latter units are released from the divisional train they remain under the immediate command of their senior medical officer until the division surgeon assumes control.
721. On a march not in the immediate presence of the enemy, conditions may warrant placing an entire ambulance company with the advance guard and the distribution of the ambulances of one or more companies through the main body, an ambulance following each regiment or independent battalion.(See pars. 637 and 673.)
722. A field hospital will ordinarily be needed to care for the disabled brought in by the ambulances at the end of the march, and should be placed in the marching column with due regard for this requirement. A field hospital used for this purpose will be promptly evacuated in order that it may proceed with the troops when they advance.
723. In order that the men needing medical attention may be cared for as soon as practicable after camp is established, the camp infirmaries may be distributed through the marching column, one in proximity to each group of organizations which will camp together. When for any reason this is not practicable they will march with the field trains of the units which they are to serve.
724. When combat is imminent, elements of the sanitary train scattered through a marching column may be ordered to fall out, allowing the troops to pass forward. It is essential at this juncture that no sanitary unit hamper the movement of combatant organizations.
725. In combat, the operation of the divisional sanitary units will be governed in general by the character of the engagement, whether defensive, offensive, or retrograde, and in each particular case by the immediate conditions incident to the locality.
726. When the mission of the command is defensive, and particularly if a line of fortifications or some natural barrier, such as a river, can be taken advantage of, it may be practicable to make, in advance, a definite outline of the sanitary service. Under these circumstances the zone within which casualties will probably occur can be determined with sufficient accuracy to enable the division surgeon to make definite recommendations concerning the announcement in the battle order of the location of the station for slightly wounded, the dressing stations, and the field hospitals. As soon as the distribution of the troops on the line of defense is indicated the aid stations may be located and routes from them to the dressing station may be selected. The sanitary service of the line of communications may send forward evacuation ambulance companies and evacuation hospitals, into the zone of the advance in readiness to evacuate the wounded immediately.
727. When the command takes the offensive the difficulties of the sanitary service are greatly increased. The station for slightly wounded is established at once for assembling the sick who are not able to accompany their organizations into battle. As the situation develops the organizations, followed by their sanitary detachments, move forward. Wounded are given first aid, but no aid station is established until the organization has ceased, temporarily at least, to advance, and until the number of wounded in that vicinity justifies it. (See par. 645.) The time and place for the opening of the station is determined by the organization commander, unless he has authorized the surgeon to use his discretion in the matter. Dressing stations are established when required by the number of wounded on any sector of the line. The division surgeon, with the approval of the division commander, gives directions for the opening of the station to the director of ambulance companies. The dressing station, as soon as it arrives at its location, sends forward bearers to establish communication with the aid stations of organizations serving on its sector of the line. (See par. 680.)
728. The wagons of the ambulance companies may be left at field hospitals, in order that the supplies which they carry may be forwarded to the dressing stations by means of the ambulances as they go back and forth. (See par. 685.)
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729. All the field hospitals may be held in readiness to establish until definite information can be secured as to the progress of the engagement and the number of casualties, or when conditions warrant it one field hospital may be established as soon as the dressing stations are located (par.702a). Ordinarily the work of field hospitals will not commence until several hours after the engagement has begun.
730. In a retrograde movement, whenever practicable, transportation and supplies precede the troops. The sanitary service will require some ambulances held as near as possible to the rear guard, which should be accompanied by a liberal allowance of sanitary personnel. So far as practicable the wounded in rear-guard actions should be placed on litters and promptly carried forward to the ambulances.
731. The defensive, offensive, and retrograde movements practically cover the entire field of the activities of the sanitary service in combat. The rencontre engagement necessarily develops into one of these three by the time a definite course of procedure for the sanitary service must be determined.
732. Whatever the form of the engagement the division surgeon arranges, as soon as practicable, for the publication in orders of the information necessary for the operation of the sanitary service. In order that divisional orders may not be burdened with details, he recommends for inclusion in these orders only such information as is required by combatant organizations and their attached sanitary personnel, and he issues orders direct to the units of the sanitary train embodying the details of the service which concern these units only.
733. Combatant troops desire to know (1) the location of the aid station for their organization, and (2) the location of the station for slightly wounded. The location of the aid station is published by the organization commander as soon as it has been determined, while the location of the station for slightly wounded should be published in the battle order.
734. It is important that the surgeons of combatant organizations should know as early as practicable the location of the dressing station serving their sector of the line, in order that they may so locate the aid stations as to reduce to the minimum the distance that patients will have to be carried by litter bearers. The surgeons of combatant organizations also require information as to the location of the station for slightly wounded.
735. The divisional battle order usually furnishes information in paragraph 4 as to the location of the station for slightly wounded, and in defensive operations it may announce the locations of dressing stations and possibly of field hospitals, though the latter, as a rule, does not directly concern the combatant troops. When it is impossible to determine in advance of an engagement the locations of the dressing stations, that information is furnished the combatant organizations through military channels as soon as practicable. In any case the surgeons of combatant organizations finally learn the locations of the dressing stations through the litter bearers who are sent forward to the aid stations.
736. In defensive engagements, as indicated above, the division surgeon may recommend that paragraph 4 of the battle order state that a station for slightly wounded is established at a designated point; that dressing stations will be located at designated points to serve certain sectors of the line; for example, one to serve the sector extending from the left flank to a certain road, house, creek, or other landmark indicated on the maps, with which the troops are supplied; another to serve the sector extending from the point above mentioned to the right flank; and, in case conditions warrant such an announcement in advance, that one or more field hospitals will be established at designated places.
737. In offensive movements it may be impracticable to include in the divisional order anything more than the statement of the location of the station for slightly wounded, and, if deemed expedient, some information concerning the places at which ambulance companies and field hospitals will hold themselves in readiness. (See par. 685.)
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738. If the locations of the dressing stations and field hospitals have not been announced in the battle order, the division surgeon, with the approval of the division commander and ordinarily after consultation with the directors of field hospitals and ambulance companies, will issue orders concerning the locations of these units and will usually designate by number the field hospital and ambulance company units which are to open at the locations specified. He also transmits such information necessary for the operation of the sanitary units as he may have received from the division commander; e. g., the routes vehicles may take between front and rear.
739. In a retrograde movement a formal order may not be issued. In this case the sanitary units not rendering service with troops will be governed by the general instructions given the commander of trains; those serving the troops will be governed by the orders of the officer in immediate command on whom devolves the responsibility for meeting emergencies as they arise.
740. In service with mounted commands pertaining to an infantry division it is ordinarily impracticable to establish aid stations in combat. The sanitary personnel continue with the organization. When any of them pause to render first aid, they rejoin the command as soon as possible. (See par. 645.)
741. When a cavalry division is operating as a screen, the sanitary service is confronted by many difficulties. The cavalry may be one or more days` march in advance of the infantry divisions and, in a hostile country, may make no effort to continue in control of the territory over which it has passed. The mission of the sanitary service under these conditions will be to render first aid and to transport the wounded as rapidly as possible to the nearest place accessible to the sanitary service of the infantry or of the line of communications. For this reason a cavalry division is provided with a greater number of ambulances in proportion to the divisional strength than an infantry division. In case it is deemed impracticable to take hospital equipment into the area in advance of the infantry divisions a field hospital pertaining to the cavalry division may be established within the line controlled by the foot troops, and under these circumstances the additional ambulance facilities provided will be required to transport the wounded to the field hospital. On the other hand, if conditions warrant advancing the field hospital into the area between the infantry and cavalry, abundant ambulance facilities will be required to transport wounded to the field hospital from the broad front which the cavalry when acting as a screen may occupy. Under these circumstances the use of a portion of the ambulance for transportation of the unmounted Hospital Corps attached to the field hospital may be unavoidable to enable the field hospital to keep in touch with the mounted troops. When opposing armies approach each other cavalry is finally withdrawn from the intervening space and may take position on the flanks of the infantry, in which case the sanitary service is operated as in an infantry division and may be directed by the commander of the field forces to cooperate with the sanitary units of the infantry or of the line of communications.
742. The service of sanitary detachments with organizations of the cavalry division is similar to that of the sanitary troops with the cavalry of an infantry division. When difficulties of communication render it impracticable for the division surgeon to direct personally the sanitary service with the cavalry division, much will necessarily be left to the initiative and judgment of the director of ambulance companies and the senior medical officer with each individual unit.
DUTIES OF THE DIVISION SURGEON
743. The division surgeon is both an advisory and an administrative officer. (See par. 361.) In his advisory capacity he makes recommendations concerning all matters pertaining to the sanitary welfare of the command and concerning matters pertaining to the personnel and equipment of the sanitary service under organization commanders. In his administrative capacity he is in immediate command of the Medical Department personnel attached to division headquarters, of the sanitary train, and of American
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National Red Cross units, and other voluntary aid personnel should they be authorized in exceptional cases to perform service with the division.
744. The duties of the division surgeon that may be specifically stated are as follows:
(a) He will take action on all official papers passing through his office in a manner similar to that prescribed for department surgeons (pars. 365 and 368). The channels through which papers pertaining to the Medical Department go forward will be determined by the chief surgeon of the field army according to circumstances. (See par. 828.)
(b) He will render to the chief surgeon, field army, the consolidated daily field report of sanitary personnel and transportation and the consolidated daily field report of patients (Form 84) and the weekly noneffective curve chart (Form 85).
(c) He will see that proper inspections are made of sanitary conditions in the division and of the medical units of the division. These inspections will ordinarily be made by the sanitary inspector.
(d) He will arrange a systematic and orderly service for the care and disposal of the sick and wounded of the division in camps, on the march, and in battle, having in view the retention of effectives at the front and the prompt removal of non effectives to the rear.
(e) He will keep the surgeon, advance group, advised as to the probable requirements of the sanitary service of the division and as to the number of patients for whom provision will be required on the line of communications.
(f) He will keep the chief surgeon of the field army advised as to the efficiency and requirements of the divisional sanitary service.
(g) On the march the division surgeon ordinarily accompanies the division commander, giving such advice and information regarding the sanitary service as may be called for, and securing all information necessary concerning the disposition of troops to enable him to formulate plans for the sanitary service which these dispositions will require.
(h) When battle is imminent he will utilize all facilities available to familiarize himself with the terrain which will probably be covered and will obtain and distribute to the officers of the sanitary train such information of a general nature as will assist them to determine their course of action.
(i) After an engagement he will immediately report losses in medical personnel to the division commander and will take proper measures to replace the supplies and equipment of the sanitary troops of the division. He will free field hospitals of patients as promptly as possible in order that they may be ready for another engagement or a forward movement.
745. The senior medical officer of a brigade or detachment acting independently will perform for the command such of the duties of a division surgeon as the circumstances may render necessary.
THE DIVISION SANITARY INSPECTOR
746. As an assistant to the division surgeon a medical officer of the rank of lieutenant colonel is assigned to each division for duty as sanitary inspector. He is primarily an advisory officer (par. 362) but may in addition be assigned certain executive duties.
747. A sanitary inspector is charged especially with the supervision of the sanitation of the command to which he is assigned. In this connection he inspects and reports upon the sanitary conditions within the command, upon the occurrence of preventable diseases and the sufficiency of the measures taken for their prevention, and in general upon all matters affecting the sanitary care of troops.
(a) At the end of every month each sanitary inspector will forward to the Surgeon General, through military channels, a report of the inspections made by him during the month under the provisions of this paragraph, indicating the sanitary defects, if any, observed and the measures taken for their prevention. This report will be made on Form 50, modified if necessary to suit the case.
748. Sanitary inspectors also inspect and report upon the administration of the units of the sanitary train; the efficiency, instruction, and adequacy of the medical personnel;
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the condition of hospitals; the character and sufficiency of medical supplies; the facilities for transporting medical supplies and time sick and wounded; and in general all matters affecting the care, well-being, and comfort of the sick and wounded.
(a) A report of each formal inspection made under the provisions of this paragraph will be made on Form 50b, and will be forwarded within five days after the inspection is made through military channels to the Surgeon General. A duplicate will be filed in the office of the division surgeon. Should this report indicate any irregularities or defects of medical administration, the sanitary inspector will furnish a triplicate through military channels to the medical officer commanding the Medical Department organization concerned, who will, without delay, report by indorsement thereon what remedies he has applied or will apply to correct each of the irregularities or defects noted. Such reports so indorsed will also be forwarded through military channels to the Surgeon General.
749. Organization commanders are usually required by divisional orders to remedy sanitary defects reported to them by the sanitary inspector. To facilitate the attainment of satisfactory sanitary conditions the sanitary inspector may be authorized by the division commander to direct, in the name of the latter and within such limitations as he may prescribe, the prompt correction of conditions prejudicial to the health of the troops.
750. For the purpose of supervising or executing sanitary measures in divisional camps of more or less duration, sanitary squads may be organized and placed under the control of the sanitary inspector. (See pars. 774to 777.)
(a) Manure and refuse dumps used by the division in common, the water supply, measures for the prevention of mosquitoes and flies, the policing of areas outside the jurisdiction of organization commanders, etc., may be placed in charge of such squads.
(b) In the employment of sanitary squads in divisional camps the provisions of paragraph 777 will be strictly complied with.
ARTICLE XIV.-THE LINE OF COMMUNICATIONS
GENERAL
751. The line of communications is the connecting link between the service of the interior and the zone of the advance. It is established when an important force is about to engage in field operations involving a movement from a base unless the territory through which the supply services extend can be safely occupied without military operations of an extensive character. In the latter case administration and supply are accomplished as in the service of the interior.
752. The point at which the base of a line of communications is to be established is fixed in War Department orders. The zone of the line of communications embraces all territory from and including the base to the point or points where contact is made with the trains of the combatant forces. Certain of its activities, including those of the sanitary service in evacuating the wounded, extend forward into the zone of the advance when necessary.
753. The line of communications is ordinarily divided into abase section and an advance section. In certain cases, due to prolongation of the line of communications, an intermediate section may be required. An advance section is required at the head of each important route of supply diverging from the base.
754. The mission of the sanitary service of the line of communications is (1) to provide such adequate facilities for the treatment of the sick and wounded that those not permanently disabled may be returned to the front with the least practicable delay; (2) to furnish such an efficient evacuation service as will promptly relieve the fighting forces of the encumbrance of their sick and wounded and allow the sanitary units in the zone of the advance to maintain contact with their combatant organizations; (3) to organize and maintain a system of supply that will enable the sanitary troops in the theater of operations to replenish their equipment and supplies by direct methods and
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without delay; (4) to maintain satisfactory sanitary conditions among the troops on the line of communications and, if necessary, to take entire charge of sanitation among the inhabitants of the occupied territory.
755. When the military conditions in occupied territory are such as to impair the usual agencies of medical relief among the inhabitants thereof, the Medical Department may take such measures, not incompatible with the necessities of the occupying forces, as may be necessary to relieve the distress and suffering of the sick.
756. The Medical Department units pertaining to the line of communications are the following:
Base group -A medical supply depot, one or more base hospitals, and when required, convalescent camps, contagious disease hospitals, hospital trains and trains for patients, hospital ships and ships for patients, casual camps, sanitary squads, field laboratories, and organizations of the American National Red Cross.
Intermediate group -Rest stations, organizations of the American National Red Cross, and such other sanitary formations as may be necessary.
Advance group -Two evacuation hospitals and one evacuation ambulance company for each division at the front supplied from the advance section, and an advance medical supply depot. The evacuation hospitals and evacuation ambulance companies of the advance section are collectively known as the sanitary column.
THE BASE HOSPITAL
(Capacity 500)
757. Base hospitals are Medical Department units of the line of communications under the supervision of the surgeon, base group. They will occupy buildings if suitable ones are available.
758. The base hospitals will be numbered from 1 upward in a single consecutive series for the entire Military Establishment. They will be further distinguished by adding the designation of the field army to which they belong, as "Base Hospital No. 9, 3d Field Army."
759. These hospitals should be established at the base and, when necessary, in accessible situations along the line of communications. The number to be assigned to each line of communications when first established is determined on the basis of the number of troops to be served and the percentage of sick and wounded which may reasonably be anticipated in the particular campaign in question. (See par. 152.)
(a) New base hospitals may be established when those already in operation have become too far separated from the Army, when they are needed to supplement the services of more advanced hospitals, or when new sites will be more convenient to handle wounded.
(b) On the eve of battle it may be necessary for the surgeon, base group, to open additional base hospitals near the front or to augment the personnel and supplies of those already established there.
760. The personnel allowed a base hospital, as given in Tables of Organization, are ordinarily assigned as follows: 20 medical officers, 1 colonel(commanding), 1 major (operating surgeon), 18 captains and lieutenants (1adjutant, 1 quartermaster, 1 pathologist, 1 eye, ear, nose, and throat specialist, 2 assistant operating surgeons, 12 ward surgeons); 1 dental surgeon; 8 sergeants first class (1 general supervision, 1 in charge of office,1 in charge of quartermaster supplies and records, 1 in charge of kitchen and mess, 1 in charge of detachment and detachment accounts, 1 in charge of patients` clothing and effects, 1 in charge of medical property and records, 1 in charge of dispensary); 16 sergeants (1 in dispensary, 2 in storerooms, 1 in mess and kitchen, 4 in office, 2 in charge of police, 6 in charge of wards); 14 acting cooks; 115 privates first class and privates (68 ward attendants, 3 indispensary, 5 in operating room, 1 in laboratory, 14 in kitchen and mess, 6 in storerooms, 4 orderlies, 5 in office, 4 outside police, 1 assistant to dentist,4 supernumeraries); 46 nurses, female1 (1 chief nurse, 1 assistant to chief nurse, 41 in wards, 2 in operating room, 1 dietist).
1When female nurses are not available, additional enlisted men will be assigned in their stead.
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761. So far as adaptable the regulations for general hospitals will govern the interior administration of base hospitals. (See pars.283 to 316.)
762. The base hospitals are designed to receive patients from the field and evacuation hospitals, as well as cases originating on the line of communications, and to give them definitive treatment. They should be well equipped for such treatment and there should be sent to the home territory only those patients who require special treatment or whose condition is such that they may be regarded as either permanently disabled or likely not to recover within a reasonable time. If, however, the number of new cases from the front is taxing the base hospitals beyond their capacity or the facilities thereof are inadequate from any cause to meet the demands upon them, more extensive evacuation of patients must be effected. On the eve of battle the base hospitals near the front should be cleared as far as possible to make room for new patients.
763. Unless otherwise provided, the personnel, supplies, and equipment for the evacuation of patients from advanced base hospitals to the rear will come from the hospitals receiving them.
764. The commanding officer of the hospital will indicate under "Remarks" in his daily report made on Form 83, the number of patients who require transfer so that arrangements may be made accordingly. He should himself supervise the selection of patients for further transfer in order to keep down to the lowest possible figure the number of men lost to the Army.
765. Base hospitals ordered to close will dispose of their patients as directed by the surgeon, base group.
THE CONVALESCENT CAMP
766. In appropriate cases convalescent camps may be established in the vicinity of base hospitals. Such camps will be branches of the base hospital near which they are situated.
THE CONTAGIOUS DISEASE HOSPITAL
767. Ordinarily cases of infectious disease occurring among troops in the theater of operations will be cared for in the isolation wards of base or other hospitals and so far as practicable at or near the place of origin of the disease. In the presence of a serious epidemic, however, special facilities for the isolation of cases may be required. In this event the surgeon, base group, with the authority of the commander of the line of communications, will organize such contagious disease hospitals as may be necessary to meet the emergency.
768. No definite organization for these hospitals can be prescribed in advance of their establishment. The personnel for their operation will be procured from the home territory or provided from the line of communications, as circumstances may warrant.
TRAINS, BOATS, AND SHIPS
769. The general regulations governing the organization, personnel, materiel, and operation of hospital trains, trains for patients, hospital ships, and ships for patients in the service of the interior will apply also to the similar Medical Department units on the line of communications, except that the duties performed by the Surgeon General with respect to the former will devolve in the latter case upon the surgeon, base group. (See pars. 613 and 619.)
770. As hospital trains are permanent Medical Department units, when their organization on the line of communications is necessary, timely measures to procure the prescribed personnel therefor from home territory should be instituted. Pending the arrival of such personnel the medical officers and Hospital Corps men needed to operate these trains should temporarily be drawn from other Medical Department units on the line, exclusive of the evacuation hospitals and evacuation ambulance companies, whose personnel should under no ordinary circumstances be diminished.
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(a) When it is necessary to organize trains for patients they may also obtain their medical personnel temporarily from other units on the line of communications, exclusive of the evacuation hospitals and evacuation ambulance companies, but permanent details from the service of the interior should be requested for their continued operation.
771. General arrangements for the running of hospital trains and trains for patients will be made by the surgeon, base group, with the officer in charge of the base. Details in regard to the loading and unloading of patients at railway stations will be arranged between the officers in charge of such stations and the commanding officers of the evacuation ambulance companies or hospitals which are to transfer or receive the patients.
772. Circumstances will rarely be such that hospital ships will be available on the line of communications. But navigable streams will often offer opportunities for the more comfortable and expeditious transportation of the sick and injured than can be had by land, and the surgeon, base group, should in such event avail himself thereof by organizing the necessary boat service. The personnel and supplies for such service will be drawn from the line of communications as in the case of trains for patients.
CASUAL CAMPS FOR SANITARY TROOPS
773. These camps are designed for the reception, shelter, and control of Medical Department personnel on their arrival and during their stay at the base pending assignment. They will, with the approval of the commanding officer of the line of communications, be established by the surgeon, base group, at or near the base. They will be under the immediate command in each case of the senior medical officer on duty therein, and their administration will be governed by general military principles.
SANITARY SQUADS
774. For the purpose of giving attention to sanitary matters not within the control of regimental or other military organizations, sanitary squads will be organized on the line of communications at such places as may be necessary.
775. The personnel of such squads will consist of enlisted men of the Hospital Corps augmented by such number of other enlisted men and civilian laborers as the amount and character of the work may justify. Each squad will be in immediate charge of a medical officer.
776. The function of sanitary squads is to supervise or execute, as the case may be: (1) The necessary measures for the sanitation of camp sites, towns or villages not occupied or garrisoned, or of such parts of the same as may be otherwise unprovided for; (2) sanitary work that may be necessary for the general welfare but that can not be performed conveniently or profitably by individual organizations; (3) the operation of sanitary apparatus used by troops in common and not under control of any one organization.
777. Sanitary squads will not be employed to relieve regimental and other similar organizations of the duty of providing for the sanitation of their own camps.
FIELD LABORATORIES
778. One or more field laboratories will be established on the line of communications where most convenient for the work to be accomplished. A suitable building should be chosen in each case, preferably in a town provided with water and gas supply.
779. The technical supplies for a field laboratory are listed in paragraph 896. Such additional equipment will be supplied as the surgeon, base group, may deem necessary.
REST STATIONS
780. Rest stations are organized for the purpose of giving temporary care and treatment to sick and wounded en route. When on railway lines those established on the line of communications are similar in every way to those pertaining to the service of the
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interior and their personnel should, if practicable, be obtained in like manner. (See par. 618.)
781. In exceptional cases the distance between the hospitals in the zone of the advance and the advance section of the line of communications may be so great that it will be necessary to establish rest stations on the route of the evacuation ambulance companies. Under these circumstances the rest stations will usually be of a temporary character and their personnel and supplies will be provided by the evacuation ambulance companies. At such stations provision should be made for temporary but comfortable shelter, nourishing food, and readjustment of dressings or other treatment necessary to enable the patients to proceed comfortably to their destination.
THE BASE MEDICAL SUPPLY DEPOT
782. A medical supply depot will be established at the base. The officer in charge of this depot will prepare in quadruplicate a list of all supplies required, showing the maximum and minimum quantities of each article which should be kept on hand in the depot, having due regard in formulating this estimate to the number of troops to be supplied, the time required by the depot to replenish supplies, the character of the military operations in prospect, etc. In stating the minimum quantity of supplies the supply officer should include at least one medical reserve unit (par. 891) for each division at the front, in addition to the supplies likely to be required by the sanitary formations on the line of communications. Three copies of the above-mentioned list will be forwarded through military channels to the commander of the military forces. When approved, one copy will be retained at the headquarters of the commander of the field forces, one copy will be sent to the Surgeon General, and one copy will be returned to the officer in charge of the depot.
(a) When the supply on hand of any article exceeds or falls below the specified maximum or minimum, the fact will be reported in writing to the commander of the line of communications and to the senior medical officer on the staff of the commander of the field forces, with appropriate explanatory remarks.
783. Stock to replace issues from these depots will be maintained without formal requisition. (See F. S. R.: Zone of the Advance, General.) When such replenishment is desired single copies of the invoices on which supplies were issued, stamped "Replenishment requested," will be forwarded direct to the designated source of supply. Any articles shown on an invoice for which replenishment is not desired will be erased therefrom before the invoice is stamped and forwarded. Invoices stamped and forwarded as above described will be acted upon as if they were approved requisitions.
784. Requisitions from the depot for other than the replenishment of issues, if within the limits of the maximum and minimum table, will be forwarded induplicate to the surgeon, base group. He will modify them at his discretion, forward one copy to the issuing depot in the home territory, and return the other copy to the base depot with his modifications, if any, noted thereon.
785. Requisitions for supplies not provided for in the maximum and minimum table require the approval of the Surgeon General.
786. In emergencies the surgeon, base group, may authorize local purchases to supply the immediate needs of the depots on the line of communications. (See par. 819g.)
THE ADVANCE MEDICAL SUPPLY DEPOT
787. The stock on hand at this depot will be considered a part of the available supply of the base depot, as far as the table fixing the maximum and minimum stock limits is concerned.
788. Maximum and minimum limits of stock to be maintained at this depot will be determined by the commander of the line of communications on recommendation of the surgeon, base group, to whom any variation of stock above or below the prescribed limits will be reported at once with appropriate explanatory remarks. In making his recommenda-
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tions the surgeon, base group, should include in the minimum quantity of supplies to be maintained at this depot at least one medical reserve unit (par.891).
789. Issues from the advance depot will be replenished from the base depot without formal requisition, in the manner provided under base supply depots(par. 783).
790. Requisitions from the advance depot for supplies other than those required to replace issues will be forwarded in duplicate to the surgeon, base group. He will modify them at his discretion, send one copy to the base supply depot for issue, and return the other copy to the writer with his modifications, if any, noted thereon.
791. The advance depot is intended as a source of supply for troops in the zone of the advance, and it should not, except in emergency, be depleted by issues to evacuation hospitals, evacuation ambulance companies, and other units on the line of communications.
792. The operations of this depot will necessarily be controlled by the military situation in the zone of the advance. If the troops are occupying defensive positions with little probability of an immediate advance, the depot may be established in buildings, if they are available, or under canvas; if they are advancing, the depot may be maintained on barges, in box cars, or on motortrucks. In the latter case the prescribed stock of supplies may temporarily have to be reduced to such essentials as surgical dressings, medicines, and other articles of that class. In determining the character of the articles that maybe eliminated under these circumstances much will depend upon the facility with which supplies can be obtained from the base.
THE EVACUATION HOSPITAL
(Capacity 432)
793. The evacuation hospitals are Medical Department units belonging to the line of communications. Ordinarily two evacuation hospitals will be assigned to a line of communications for each division which it serves in the zone of the advance. They will be numbered and designated like the base hospitals (par.758).
794. The personnel of an evacuation hospital at war strength, as given in Tables of Organization, are ordinarily distributed as follows: 16 medical officers, 1 lieutenant colonel (commanding), 1 major (operating surgeon), 14captains and lieutenants (1 adjutant, 1 quartermaster, 2 assistant operating surgeons, 10 ward surgeons); 8 sergeants first class (1 in general supervision,1 in charge of office, 1 in charge of quartermaster supplies and records, 1 in charge of kitchen and mess, 1 in charge of detachment and detachment accounts,1 in charge of patients` clothing and effects, 1 in charge of medical property and records, 1 in charge of dispensary); 20 sergeants (1 in dispensary, 2 in storerooms, 1 in mess and kitchen, 4 in office, 1 in charge of police, 10 in charge of ward, 1 in operating room); 10 acting cooks; 141 privates first class and privates (98 ward attendants, 3 in dispensary, 5 in operating room, 10 in kitchen and mess, 4 in storerooms, 4 orderlies, 5 in office, 6 outside police,6 supernumeraries).
795. The primary function of the evacuation hospital is to replace field hospitals so that the latter may move with their divisions, or to take over their patients with the same object in view. So far as it would not interfere with this function the evacuation hospital may be used for ordinary hospital purposes on the line of communications.
796. An evacuation hospital is preferably established on a railway or navigable stream, but this preference must, of course, yield to the military situation. Care should be taken to choose a site accessible to wheeled transport and with an abundant supply of water and fuel. When suitable buildings are available they will be utilized.
797. The places where evacuation hospitals are to be established or to which they are to be moved will be determined by the surgeon, advance group, under the authority of his commanding officer.
798. Before a battle all evacuation hospitals will be brought as far forward as possible and will remain in readiness for opening or further advance.
799. The duties of an evacuation hospital when opened are similar to those of a field hospital in combat (par. 701) and corresponding departments will be created (par. 703).
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800. The character of the surgical treatment to be given to wounded therein will vary widely under different conditions. When during battle many wounded are being received the treatment afforded will hardly be more extensive than that at field hospitals, viz, emergency operations and better preparation for transport. When few wounded are coming in and there is no probability of an early move, complete treatment may be given even during battle.
801. Serious cases requiring protracted treatment and all patients permanently incapacitated should be sent to the rear from evacuation hospitals as soon as their condition permits.
(a) When battle is expected active measures of evacuation should be employed to clear the evacuation hospitals in use so that they may be ready for movement toward the front.
(b) During battle all patients in evacuation hospitals who are fit for transportation should be hurried to the rear as soon as possible to make room for new cases from the front. It will rarely be possible for evacuation hospitals to send slightly wounded back to their organizations during combat, but every opportunity should be taken to do so in order that such wounded shall not become further separated from their commands.
802. The necessary transportation for moving patients to the rear from evacuation hospitals will be provided by direction of the commanding officer of the advance section of the line of communications.
803. The commanding officer of the evacuation hospital will indicate, under "Remarks" in his daily report made on Form 83, the number of patients who require transportation to the rear.
THE EVACUATION AMBULANCE COMPANY
804. Evacuation ambulance companies are organized only in time of war or when war is imminent. They are allowed in the proportion of one for each division at the front. They will be numbered consecutively from 1upward for each field army to which they belong, as "Evacuation Ambulance Company No. 1, 3rd Field Army."
805. The commanding officer of the company is under the immediate orders of the surgeon, advance group.
806. The allowance of personnel and equipment for an evacuation ambulance company will be that provided for an ambulance company with such modifications as the conditions under which the former is serving may warrant. Motor ambulances should, if practicable, be substituted for horse-drawn vehicles. Ordinarily pack mules will not be required and, owing to the fact that the company normally operates from the head of the line of communications where there is a supply depot, the quantity of reserve surgical dressings provided for the ambulance company may be largely reduced.
807. The primary function of the evacuation ambulance company is the evacuation of field hospitals and the transportation and care of patients en route therefrom to evacuation, base, or other hospitals on the line of communications or to points with train or boat connections for rail or water transport to such hospitals.
808. On the march the company will be brought up to clear field hospitals of patients collected by the latter (par. 700), and to take them to points on the line of communications.
809. When battle is soon to occur it will usually be necessary to greatly increase the number of vehicles and bearers of the company. This increase will be provided by the officers in charge of the advance section on the recommendation of the surgeon, advance group.
810. Just before a battle commences all evacuation ambulance companies should be located as far in advance as the conditions permit.
811. At the proper time or times during or after the battle each company, under instructions given therefor by the surgeon, advance group, will proceed to the field hospitals which it is to evacuate, will report to the commanding officers thereof, will receive
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the patients who are to go to the rear, and in due course will deliver them to the Medical Department organization which is designated for their further care.
(a) The evacuation ambulance company will receive and provide for all patients turned over to it by a field hospital. (See also par. 706.)
(b) It will also receive and provide for the slightly wounded, able to walk who report to it by proper authority from the dressing stations, the station for slightly wounded, or other places on the field.
812. The assignment of the sick and wounded to the various kinds of transport(automobiles, ambulances, wagons, country carts, bearers, etc.) will be made by the commanding officer of the company according to their condition. In doubtful cases the authorities of the hospital should be called upon for necessary information.
ADMINISTRATION
813. For administration and control the line of communications is organized as follows:
(1) A service of defense.
(2) A supply, sanitary, and telegraph service.
(3) A service of military railways.
814. The commander of the line of communications is responsible, under existing regulations, for the defense of the zone and for the government of that portion of the zone placed under military control. All troops, military establishments, and personnel in the zone of the line of communications are under his control. He is responsible that the reserve of supplies on hand in his various depots shall be maintained between the maximum and minimum amounts fixed by the commander of the field forces.
815. All personnel pertaining to the sanitary service of the line of communications report at the base for assignment to duty. Here advance and intermediate sections are organized and sent forward as required.
816. Base, intermediate, and advance sections are each commanded directly by the commander of the line of communications through an assistant chief of staff authorized to issue orders in his name.
817. The senior medical officer assigned to duty at the base section of the line of communications (surgeon, base group) acts in a dual capacity. (1) He is the technical adviser of the commander of the line of communications on all matters relating to the operation of the Medical Department within the zone of the line of communications. In this capacity he transacts his business directly with the headquarters of the line of communications. (2) He acts in an executive capacity, controlling directly all Medical Department establishments pertaining to the base. In this relation all communications between the surgeon, base group, and the commander of the line of communications pass through the officer in charge of the base.
818. As adviser to the commander of the line of communications the duties of the surgeon, base group, and the relation he bears to the medical personnel in the zone of the line of communications, are analogous to those of a department surgeon, and he will be governed by the regulations for the latter (see pars.364 to 370) with such modifications as the different conditions demand. To the extent of his authority the surgeon, base group, is responsible for the efficiency of the entire medical service of the line of communications, and for the accomplishment by such service of its mission as outlined in paragraph754.
819. The duties of the surgeon, base group, that may be specifically stated are as follows:
(a) He will direct and control personnel of the American National Red Cross on duty with the line of communications.
(b) He will decide whether personal service individually volunteered shall be accepted (par. 537); and, when accepted, he will direct how it shall be employed.
(c) He will devise appropriate measures for the shelter, supply, treatment, and transport of the sick and wounded, including suitable provisions to secure the retention
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of effectives at the front and for the sending of noneffectives to the rear; and will consult with the chief of staff and the heads of other staff departments in reference to the details of such measures.
(d) He will coordinate the Medical Department administration of the line of communications, and to that end will keep continuously in touch with the surgeons of advance and intermediate groups.
(e) He will communicate with the Surgeon General regarding medical arrangements for the movement of patients from the base to home territory and the provision of Medical Department personnel and supplies from the home territory for the line of communications.
(f) He will act on requisitions for Medical Department supplies as provided in paragraph 552.
(g) With the approval of the Surgeon General he may give authority for the purchase in local markets of medical supplies immediately necessary for the care of the sick and wounded and the prevention of the spread of disease.
(h) With the approval of the Surgeon General he may receive voluntary contributions in money or kind for the benefit of the sick and wounded and he may expend the same as he deems fit.
(i) With the approval of the Surgeon General he may make contracts with surgeons and employ or authorize the employment of other civilians for emergency service under the Medical Department on the line of communications.
(j) When battle is impending he will take such steps as are necessary to insure that mobile units of the line of communications are free to advance when required; that hospitals are cleared for new cases; that sufficient medical supplies are collected in the immediate rear of the army to meet the exigencies of combat; and that personnel available for assistance in the zone of the advance are assembled and held in readiness as far forward as practicable.
(k) He will make timely recommendations to the commander of the line of communications regarding transportation required for medical supplies and for patients.
(1) He will render to the chief surgeon of the field army the consolidated daily field report of sanitary personnel and transportation and the consolidated daily field report of patients (Form 84) and the weekly noneffective curve chart (Form 85).
820. The relations of the senior medical officer assigned to duty with the advance section (surgeon, advance group) and of the senior medical officer of any intermediate section that may be established, to the surgeon, base group, are similar to those of post surgeons to department surgeons.
821. The surgeon, advance group, under the supervision of the officer in charge of the advance section, controls directly all sanitary units at the head of the line of communications.
822. The surgeon, advance group, has general charge of the transportation of patients from the field hospitals or other units in the zone of the advance to the evacuation hospitals or other places on the line of communications prepared for their reception.
823. During or after battles of any magnitude the transportation included in the sanitary column will usually be found greatly inadequate for the evacuation of the wounded. It will be the duty of the surgeon, advance group, to anticipate these conditions and to make timely provision for obtaining the increased transportation necessary. Under competent authority, vehicles belonging to the civilian population may be impressed, and use made of the supply column of the advance section. He should direct the operation of such additional transportation until the emergency is past.
824. Under all circumstances the surgeon, advance group, should maintain close touch with the division surgeons and medical organizations at the front and make suitable arrangements to relieve them promptly of the sick and wounded left behind.
825. When battle is impending, he will clear his evacuation hospitals as far as necessary, so that room may be available for wounded from the front; he will assemble near the front his evacuation ambulance companies and one or more evacuation hospitals, and
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he will advance supplies to points where they may be readily available for the divisional units.
826. One of the most important duties which devolve upon all medical officers in the zone of the line of communications is careful exercise of judgment in making recommendations regarding the transfer of the sick and wounded to the home territory in order that hospitals on the line of communications may not be burdened with patients who are permanently disabled and that soldiers who are likely to be able to rejoin their commands within a reasonable time be not sent too far to the rear.
827. The duties of sanitary inspectors assigned to the service of the line of communications are analogous to those of department sanitary inspectors, and they will be governed by the regulations for the latter(pars. 371 to 374) with such modifications as the different conditions demand.
ARTICLE XV.-ADMINISTRATION OF THE SANITARY SERVICE OF THETHEATER OF OPERATIONS
THE CHIEF SURGEON OF A FIELD ARMY
828. The chief surgeon of a field army belongs to the technical and administrative group of the staff of the commander. During the period of grand tactical operations when a line of communications is in operation the chief surgeon is, in general, an advisory officer, administering directly only the limited personnel of the Medical Department attached to headquarters. In his advisory capacity he concerns himself only with the broad principles underlying sanitary administration. His recommendations are such that, when promulgated by the commander, the details of the sanitary service will be left to subordinate commanders. Under these conditions the chief surgeon maintains no office of record. He may, however, direct that all or any of the Medical Department reports from the zone of the advance pass through the office of the surgeon, base group, before being forwarded to the War Department, in order that the information contained therein may be tabulated for his use or that the reports may be returned for correction.
829. Upon the completion of the grand tactical operations and upon the discontinuance of an organized line of communications, or if no line of communications has been been organized, he assumes a more direct control of such Medical Department personnel, depots, hospitals, etc., as the War Department may place under the command of the officer upon whose staff he is serving. Under these circumstances the chief surgeon will maintain an office of record in so far as he is assigned the duties which devolve upon the surgeon, base group, when a line of communications is operated.
830. The duties of the chief surgeon include those outlined in paragraph 362. He is specifically charged with the following:
(a) He will keep the Surgeon General advised of the condition and efficiency of the sanitary service of the command.
(b) He will take the necessary steps to insure coordination of the sanitary service of the zone of the advance and the zone of the line of communications, and to that end will keep continually in touch with the division surgeons and the surgeon, base group.
(c) He will make recommendations relative to the adequacy of the table of maximum and minimum supplies to be maintained in the depots on the line of communications. (See par. 782.)
ARTICLE XVI.-RSUM OF THE OPERATIONS OF THE SANITARY SERVICE IN WAR
831. When war is imminent, the Regular Army is mobilized at its permanent posts or stations and the Organized Militia at mobilization camps. Little is required of the Medical Department at the time of mobilization in connection with the preparation of organizations of the Regular Army for active service. Field equipment is maintained
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at designated stations or depots in readiness for service at all times; the men of the Hospital Corps available for service with line organizations and with the sanitary train are designated in time of peace and are in readiness to join their respective units. The men composing the line organizations have been given thorough physical examinations which have been made of record, and they have been vaccinated against smallpox and typhoid fever. Each man is equipped with a first-aid packet and has been instructed in its use. So far as the Medical Department is concerned, therefore, these troops should be in readiness to proceed from their points of mobilization to the camps of concentration on short notice.
832. Mobilization camps for the Organized Militia are provided in each State. An officer of the Regular Army commands each camp and has on his staff a camp surgeon, usually a medical officer of the Regular Army. Mobilization camps are operated under the control of department commanders, who are responsible for the complete preparation and equipment of the troops which assemble there. The work of the Medical Department at these camps is supervised by the department surgeon and the sanitary inspector of the department. The camp surgeon is provided with an adequate corps of assistants. Physical examinations of troops mobilized are made and recorded in accordance with specific instructions from the War Department. Vaccinations against smallpox and typhoid fever are administered and records made thereof. Individuals and organizations are furnished such portions of their equipment as pertain to the Medical Department; and such training in sanitary matters is given both the line troops and the sanitary troops as is possible, and appropriate to each (par. 594). When for any reason it is impracticable to fully prepare individuals and organizations for service at the front, so far as this preparation devolves upon the Medical Department, the camp surgeon will furnish a full report to the department surgeon showing what remains to bed one in order that the latter may take the necessary steps to have the preparation of such individuals and organizations completed at the camp of concentration.
833. After mobilization, equipment, and preliminary training, the troops are assembled at concentration camps for immediate use against the enemy or for transport to an oversea theater of operations. At camps of concentration the general instruction and training of the line and sanitary troops in connection with the work of the sanitary service is conducted under the direction of the camp surgeon.
834. On leaving camps of concentration, troops pass from the service of the interior to the theater of operations, where they come under the control of the commander of the field forces. They may pass directly into the zone of the advance or they may traverse the zone of the line of communications before reaching the zone of the advance, or they may be assigned to duty on the line of communications. In the latter case they may be assigned either to the service of defense, to the supply, sanitary and telegraph service, or to the service of military railways. The relations and duties of the sanitary personnel in this zone are described in paragraphs 751 to 827.
835. The sanitary service of the zone of the advance is treated in detail in paragraphs 630 to 750. The purpose of the service in camp, on the march, and in combat is to render temporary aid to the sick and wounded and to expedite their transportation to the rear, always making such disposition as will secure the retention at the front of all men fit for duty and relieve the fighting force of the impediment incident to the presence of men incapacitated for duty. To that end the service of the advance is assisted by the service of the line of communications, if one has been organized; otherwise, directly by the service of the interior. In either event it cooperates with the advance station of the service in its immediate rear. When battle is imminent, the resources of the sanitary service behind the zone of the advance are placed in readiness to meet the demands for the care and transportation of the wounded which may reasonably be expected, and personnel and supplies are advanced as near the seat of operations as practicable, reaching forward into the zone of the advance if conditions warrant it.
836. The troops engaged in combat are accompanied by medical officers and Hospital Corps attendants; ordinarily a medical officer with a detachment of Hospital Corps men accompanies each battalion into combat, and the surgeon of each regiment with the equip-
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ment carried on a pack mule (par. 866) establishes an aid station. The wounded apply their own first-aid dressings, if practicable, and the sanitary personnel attached to organizations render first aid as soon as possible. The sanitary personnel with each battalion collect the wounded ingroups and transport those who are unable to walk to the regimental aid station. Men with trivial wounds are sent back to their commands when their wounds are dressed, and those slightly wounded but able to walk are directed to the station for slightly wounded several miles in the rear, in order that dressing stations and field hospitals may not be unnecessarily congested by the presence of this class of men.
837. At the aid stations the sanitary service with troops connects with the service of the sanitary train. Each ambulance company establishes a dressing station in a protected location, usually some distance in rear of the aid station. The dressing stations send forward bearers to remove the wounded who have been brought in to the aid stations. At the dressing stations light nourishment is provided, dressings are examined and adjusted or reapplied, as conditions may require, and the patients who require transportation are made as comfortable as possible until it is practicable to transport them to the rear, usually to the field hospitals. Whenever possible the dressing stations are so located that they can be reached by wheel transportation, and the wounded are sent to the field hospitals in ambulances.
838. The field hospitals do not perform the functions of civil hospitals or of base or general hospitals, in that their equipment is limited to those things necessary to provide shelter, nourishment, and emergency treatment for patients until they can be transferred to the immobile units at the rear. At the field hospitals no beds or cots are provided. The patients are placed on straw over which blankets are spread. The service of the zone of the advance controlled by the division surgeon terminates with the field hospitals. The units of the line of communications pushed forward into the zone of the advance (par. 825) relieve the field hospitals of their sick and wounded as rapidly as possible.
839. One of the evacuation hospitals held in readiness at the head of the line of communications will ordinarily receive the patients from the field hospitals. In some cases an evacuation hospital is pushed forward and takes charge of the patients at the location of the field hospital; in other cases transportation from the advance section of the line of communications is sent forward to the field hospital to receive the patients, and in many cases the wagons going to the rear for supplies will transport the patients back to the refilling point where they will be turned over to the wagons sent forward from the advance section. The evacuation hospital is the first sanitary unit in which provision is made to retain patients for any length of time. It is equipped with cots, blankets, and a liberal supply of comforts for the sick, but ordinarily the evacuation hospitals will be cleared of patients as early as practicable in order that they may be ready to receive others from the front. The patients are usually sent back by trains or boats to the base hospitals where all possible comforts and facilities for their care are provided. All sick and wounded who will be able to return to duty within a reasonable time will be retained in these hospitals rather than turned over to the service of the interior. Patients who no longer need medical attention are placed in convenient camps operated in connection with the base hospitals until they regain sufficient strength to return to their commands. The base is the great center of medical activity of an army. Personnel and supplies intended for the Army are accumulated here and sent forward as required. The sick and wounded are sent back to the base and cared for. Records of both supplies and personnel are kept at the base, and such abstracts and tabulations as the chief surgeon of the field army may require from time to time are made here and supplied to him.
840. The losses at the front are being constantly replaced by men sent forward through the channels above described. New recruits are sent to the mobilization camps where they are equipped and drilled and pushed forward to meet the demands in the zone of the advance.
841. Supplies furnished by the Medical Department for troops at the front are ordinarily obtained from the supply depot at the head of the line of communications on requisitions approved by the division surgeon. Each sanitary formation may make its
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own requisition, and its supplies may be sent forward from the advance section to the refilling points where the transportation furnished by the line of communications turns over the supplies to the transportation sent back from the divisional organizations. The stream of supplies coming forward, consisting of rations, clothing, and ammunitions, is constant, and ample opportunity is afforded to bring up the articles required by the sanitary service with the other supplies. When found to be more convenient the regimental sanitary supplies may be replenished from camp infirmaries or from the supplies carried by ambulance companies, these latter making requisitions for the supplies which they require. The supply depot at the advance section draws its supplies from the depot at the base, the stock of which is automatically maintained by the service of the interior.
