CHAPTER VIII
SUPPLIES AND UTILITIES
SUPPLIES FOR HOSPITALS
In 1917 the Quartermaster Corps was charged with the means of providing transportation of every character, except motor ambulances for the Medical Department, either under contract or in kind, in the movement of troops or material.a It was also charged with the duty of providing clothing, camp and garrison equipage, barracks, storehouses and other buildings; supplies, subsistence for enlisted men and others entitled thereto; and with the giving of instructions for procuring, distributing, issuing, selling, and accounting for all quartermaster and subsistence supplies.1The Medical Department was charged with furnishing all medical and hospital supplies.2
For the purpose of the system of procurement of quartermaster supplies, they were classified under the designations A, A-1, B, C, and D, respectively, which collectively included supplies of every kind furnished by the Quartermaster Corps.3The supplies included under the several classifications named are as follows:
Class A-1 supplies: Subsistence stores (consisting of articles composing the ration, those for other authorized issues, and those furnished for sale to officers and enlisted men).4
The ration was the allowance for the subsistence of one person for one day.5
Class A supplies: Articles connected with the use and equipment of troops.
Class B supplies: All supplies required for repairs to public buildings, including furniture and officers` quarters and messes, window screens, screen doors, refrigerators, electric-bell fixtures, heating stoves, ranges, cooking stoves, steam cooking systems, ovens and equipment pertaining to bakeries; and all repairs to the following within the building, viz, plumbing, lighting systems and fixtures, and steam, hot-water, or hot-air heating systems.
Repairs to and maintenance of lighting and heating systems exterior to buildings, including central plants pertaining thereto, ice and refrigerating plants.
Repairs to and maintenance of sewer systems, including purification plants, crematories, and water systems ,including reservoirs and pumping plants.
Repairs to roads and walks; drainage and improvement of grounds.
Class C supplies: Articles of clothing authorized by the Secretary of War to be issued to enlisted men and charged against the established clothing allowance, the authorized extra or special issuance of such articles not charged, and for authorized sales.
Class D supplies: All other supplies.
aFor changes which were effected in the Quartermaster Corps during the war the reader is referred to Volume I (pp. 115-116) of this history.
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SUBSISTENCE
The Quartermaster Corps maintained in storage the articles of the ration, together with exceptional articles of food for sale. The ration of the enlisted patient was commuted;6that of the enlisted personnel and others entitled thereto, on duty at the hospitals, was drawn in whole or in part, the difference between the value of the subsistence drawn and the value of the subsistence credited, if any, was paid in cash to the officer in charge of the hospital, some time after the end of each month.7The commutation of rations was money paid in substitution of the ration.
The subsistence stores drawn in kind from the local quartermaster usually consisted of such articles as fresh beef, flour, potatoes, onions, coffee, sugar, etc.8
The list of special articles varied in its component elements and was principally an augmented supply of groceries.
In camps at which hospitals were located articles of subsistence were stored in the camp storehouses maintained by the quartermaster of the camp. In hospitals located at places where there were no posts or camps, facilities for handling the articles of the ration were provided.
Regulations for the government of United States Army general hospitals provided, in the administrative division, personnel for the operation of the supply department.9The regulations also governed, in so far as they were adaptable, the interior administration of base hospitals.
Operations which pertained to the purchase, storage, preparation, and distribution of food to those within the hospital entitled thereto were made the function of the mess officer-an officer of the Medical Department.
It was the duty of the mess officer to establish and conduct such messes and furnish such diets as the commanding officer of the hospital desired to direct. He submitted, for the approval of the commanding officer, all permanent orders or directions for the care and conduct of his department. He was accountable for and expended the hospital fund, under the supervision of the commanding officer. He purchased from the Quartermaster Corps whatever kind of food supplies it had on hand. When it so happened that the quartermaster was unable to fill the orders submitted by the mess officer, the desired articles were purchased from local markets.
The value of the ration to which the enlisted personnel on duty at hospitals was entitled varied from time to time and was established monthly by the quartermaster.8The commuted value of the ration for the enlisted sick in hospitals was, until December 31, 1917, at the rate of 40 cents, except at the general hospital, Fort Bayard, where it was commuted at 50 cents.6
On December 31, 1917, the ration for sick in hospitals was commuted at the rate of 60 cents, except at stations, posts, or camps where the Quartermaster Corps carried no stock or sales articles, the rate being 75 cents a ration.10
Late in the year 1918, because of the constant increase in cost of food, the commuted value of the ration for sick in hospitals was modified on the basis of two considerations. It was recognized that feeding the tuberculous was ordinarily more costly than feeding the average patient. Therefore, it was so provided that there would be ample funds for the tuberculous by adding 50per cent to the value of the ration, regardless of bed capacity. In all other hospitals the added amount varied with the bed capacity. Hospitals of 100
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beds or less received the actual cost of the ration plus 50 percent; those having a bed capacity of more than 100 but less than 500 received the actual cost of the ration plus 40 percent; those with a bed capacity between 500 and 1,000, the actual cost of the ration plus 25 per cent.11
One year later the ration of the sick in tuberculosis hospitals was commuted at the actual cost of the ration plus 100 per cent.12
OTHER QUARTERMASTER SUPPLIES
At all hospitals storage facilities were provided wherein an adequate stock of clothing and equipage was stored and from which it was issued.
General hospital regulations contemplated having a medical officer act as quartermaster of the hospital and to have charge of and be accountable for Quartermaster, Medical, Ordnance, and Signal Corps property and funds; to have charge of the construction and repair of buildings and property and the necessary shops; charge of transportation; police and care of grounds, disinfecting and sterilizing plants, heating, lighting, and ice plants; and charge the clothing and baggage storerooms of thepatients.9
To assist him in this work, the detail of an adequate number of specially trained noncommissioned officers and privates, Medical Department and Quartermaster Corps, as well as civilian employees of the Medical Department were provided for. The duties of the several grades of the Quartermaster Corps were prescribed in general orders.13
In practice during the war, an officer of the Quartermaster Corps was assigned to duty at all general and camp base hospitals.14
CLOTHING AND EQUIPAGE
Tables showing the price of clothing and equipage for the Army, the allowance for each year and an enlisted man`s clothing money allowance for each year, month, and day, also the allowance of equipage to officers and enlisted men, were published in orders by the WarDepartment.15
On July 11, 1917; the President of the United States directed that during the period of the war a soldier`s allowance for clothing would be the quantity necessary and adequate for the service upon which he was engaged.16
Those in hospitals entitled to draw clothing from the quartermaster were of two classes-nurses and enlisted men on duty, and enlisted patients. The enlisted men of each class automatically became a member of the detachment, Medical Department, or detachment of patients, respectively, both of which were under the command of officers attached to the hospital staff.
When clothing was required, issue was made by the quartermaster, either to the individual enlisted man, or in bulk to the detachment commander, or officer representing him, for use of the enlisted men of his detachment.
MEDICAL SUPPLIES
Hospital supplies during the war were secured by the Supply Division of the Surgeon General`s Officea and the medical supply depots under its direc-
aOn Nov. 15, 1918, Medical Department supplies were turned over to the Purchase, Storage, and Traffic Division, General Staff.
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tion.17 It was early found that with the establishment of the various camps would come the need for the development at each of a local depot, equipped to meet all the needs of the camp, regimental organizations, sanitary trains, and base hospitals. In many instances supplies arrived at camps before there were buildings to receive them, and it was necessary to store them wherever space could be secured in existing buildings, farmhouses, in the open, or under canvas.
The Sanitary Corps was authorized, June 30, 1917, to provide technical and nonmedical personnel for the various activities of the Medical Department,18and it was for this corps that officers for duty in medical supply offices were obtained.
Medical supplies included medicines, antiseptics, and disinfectants; stationary, miscellaneous supplies(including instruments, appliances, special equipment for wards, operating rooms, messes, etc.), laboratory, X-ray, and dental supplies.19
Supplies were sent from one or more medical supply depots for the institution of the hospitals. Although the supply of drugs and other remedies for dispensaries and ward equipment was not equal to the demand for base hospital uses in the early months of the war, eventually these were reasonably ample,20with the exception of a few substances from abroad. These latter were superseded by domestic products.20
AUXILIARY SUPPLIES
By act of Congress approved April 24, 1912,21organized voluntary aid was provided for through the instrumentality of the American National Red Cross.
Each large hospital had, as a part of its personnel, one or more representatives of the Red Cross, who, besides acting as a medium of communication between the people and their relatives, at the hospital, distributed Red Cross property intended for the comfort of the patients or personnel. These Red Cross articles were in the nature of a refinement and consisted of such things as sweaters, mufflers, woolen helmets, socks, and comfort kits.
Frequently, in emergency-or upon the request or suggestion of an officer in charge-the Red Cross procured for hospitals, articles of medical supplies not otherwise obtainable at the time. These articles were taken up and accounted for on returns of medical property.22
UTILITIES
As has already been stated, the Quartermaster Corps was charged not only with the erection of hospital buildings but with their upkeep. The upkeep included general repairs to the buildings and to the technical, movable property within them; the physical care of exteriors; and the operation of the facilities which permitted the existence of the institution as a whole, viz, water supply, sewerage, lighting, heating, etc.
Primarily, the control of upkeep constituted a function of a local quartermaster, but with the institution of means directed toward a more scientific civic management on the part of the War Department, in various directions, the Utilities Department became an entity.23
A utilities officer was assigned as a member of the staff of the camp commander, his duties being defined as those formerly performed by a camp or
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post quartermaster, excluding the handling of supplies, finance, and the conservation and reclamation service.23The operation of the utilities connected with hospitals-with the exception of central heating plants, when such existed-remained directly under the supervision of quartermasters of hospitals, but their control was assumed by the camp utilities officers, who furnished the required technical enlisted men.
LIGHTING
The electrical energy for hospitals was obtained from public service electric companies in the form of alternating current.24Where hospitals were located as a part of a camp, the current was obtained through the main camp source of supply. In hospitals which were located apart from the concentration of troops, the electrical energy was obtained directly from public service companies.
In exterior lighting, series systems were used with 6.6 ampere, 100 candle power lamps and radial-ray reflectors on gooseneck bracelets attached to poles. The lamps were from 250 to 350 feet apart, according to requirements.24 For interior lighting a standard arrangement of 40-watt lamps was in general use. Those buildings requiring especially good lighting were furnished larger-sized lamps. The general wiring method for the frame hospital buildings was concealed knot and tube; and for buildings with fireproof walls, concealed rigid conduits. Ceiling receptacles and sockets were of brass shell with glass reflectors or opalescent globes.24
A nurses` calling system, consisting of a set of calling stations with reset provisions and pilots at beds, arranged to signal the nurse`s office and designed to operate at 115volts, was installed in some of the later constructed wards. The lamps were of10-watt capacity, color dipped. In the two-story buildings a set of signals from the first floor was installed in the second-floor office, with a switch for disconnections when it was not required; and similarly a system to take care of the first-floor calls was installed in the first-floor office.25
HEATING AND HOT WATER SYSTEMS
Two general systems of heating hospitals were primarily adopted, viz, steam, generated at a centrally located heating plant; and stoves, placed directly in buildings.
Steam heating of the National Army hospitals was provided for in the original plans,26 but because of the primary intention to discontinue the use of hospitals at National Guard camps at a comparatively early time stoves only were provided them.26 The disapproval of the Secretary of War of the installation of central heating plants of steam in the base hospitals of National Guard camps27was based upon the fact that they were located in the southern portion of the United States where it was expected a mild winter temperature would prevail. For heating the wards and other buildings, stoves, room furnaces, etc., were utilized. Later, the Secretary of War authorized the installation of central heating plants for portions of some of the National Guard camp hospitals, viz, operating pavilion, X-ray laboratory, administrative building, etc.28
The large central heating plants for hospitals, when installed, consisted of a battery of horizontal, nonreturn, tubular boilers. The boiler plants were
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FIG. 64.-Central heating plant National Army base hospital
FIG. 65.-Method of heating National Guard hospital
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standardized as much as possible, those for steam radiation being designed to run at a low pressure, and usually one for the purpose of steam sterilization, cooking, etc., at a higherpressure.29The distributing system of piping usually consisted of high or medium pressure mains, condensation returns from the heating system, and steam line drip piping. The steam distributing lines were overhead, suspended from poles, and were insulated by means of built-up covering, consisting of 1-inch asbestos air-cell covering and 1-inch hair felt or other suitable material. The hair felt was covered by 2-ply roofing paper, the whole bound together with wire and painted with asphaltum paint.
Experience demonstrated the impracticability of the nonreturn type of distributing lines in the central heating plants, and these were generally changed to the return type.30
The design of hot-water supply systems for hospitals presented a special problem, and two methods of furnishing hot water to the various parts of the hospitals were used. In the case of comparatively small buildings, widely separated, such as those at general hospitals for tuberculous patients, individual hot-water tanks with steam coils were provided for each building. If, on the other hand, the buildings were compactly grouped, hot water was usually furnished from the central heating plant-in the event that there was one-from large storage tanks with steam coils. In the latter case water was circulated to the various buildings by centrifugal pumps.30
WATER SUPPLY
As a rule this essential provision had already been arranged-and-satisfactorily-in hospitals partially or wholly constructed before 1917. Even subsequently enlarged and converted buildings had, with rare exception, an abundant supply of pure water. The water supply of the large camp base hospitals was a part of the main camp supply,31but almost as often the source of potable and other water was independent wells, town or village waterworks, lake areas-all these were drawn upon for the supply of water to hospitals. Its distribution and prophylactic treatment by some form of chlorination, filtration, or sedimentation were, as a rule, satisfactorily accomplished. Although it was necessary in some instances to husband the supply, and occasionally to ration it, few proper criticisms are to be found in the histories of individual hospitals. In most cases the supply was stored in reservoirs or in tanks on hillsides, or in some way raised above the roofs of the hospital group, so as to give the needed hydraulic force for distribution.
SEWAGE DISPOSAL
In new construction, and especially in the base hospitals of camps, sewage disposal was usually a part of the camp problems32and, in consequence, it was variously treated. For the details in connection with the treatment the reader is referred to Volume VI of this history. It is of interest herein merely to note that, as an economic measure, no sewerage systems were primarily provided the base hospitals of the National Guard camps. Latrines were used at these places for the disposal of excretions until during the year 1918, when sewerage systems were authorized and installed.33
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GARBAGE DISPOSAL
Generally speaking, kitchen refuse and other forms of garbage were carefully collected in screened containers, awaiting disposal. Galvanized-iron cans were early employed for the reception of the more readily decomposed material, food, etc., and these cans were duly sterilized each time they were filled and emptied.34 Sometimes these procedures included sorting stations where salable matter was separated and sold to contractors, the remainder being set aside for removal to dumps or incinerators. Occasionally the methods formed part of the general camp disposition of garbage; more frequently, however, a plan was adopted for the hospital group alone.
The following are examples of the greatly varied garbage-disposal methods employed at the base hospitals of the camps:35At the base hospital, Camp Custer, a garbage storage house with cement floor and screened windows, 8 by 20 feet, was constructed in the rear of the kitchen. To this house garbage was brought from each ward and mess, weighed by an inspector, sorted, and the weights and character of the garbage noted. A report of this was then sent to the desk of the mess officer, the dietitian, and the commanding officer. Undue waste for any ward or mess was noted and comment made locally or at officers` call. By thus fixing individual responsibility the daily waste of edible food was reduced to as low as 0.17 ounce per day. The waste in the detachment mess was at times as low as 0.06 per ration. The garbage, except that from the contagious-disease wards, was hauled away in cans and turned over to a contractor. Sputum cups and articles containing discharges of similar nature were collected in a pail lined with newspapers and burned in the furnace, as were infected dressings. Garbage from the isolation wards was separated and burned. At the base hospital, Camp Cody, the waste from the kitchen was disposed of by the reclamation service.36 Trash and other waste were placed in galvanized-iron containers for storage until incinerated at the dump. At the base hospital, Camp Beauregard, the kitchen refuse was disposed of through a contractor, who hauled it away each day to a hog pen some distance from the hospital. If the garbage accumulated at any time it was burned.37
FIRE PROTECTION
As many of the hospitals were constructed of highly inflammable material, it was obvious that their use would result in an excessive conflagration hazard. In designs provisions were made for the inclusion of fire breaks and the establishment of standards for the individual separation of the buildings.38All walls and partitions were provided with fire stops at foundations and eave lines and blind attics, with draft stops at 50-foot intervals.38Where it was found necessary to install stoves and room heaters, plans were made for the construction of proper hearths, consisting of fire brick or sand, and for room heaters, of sheet metal or asbestos.38
Fire companies were organized, made up of trained fire-fighting personnel, as far as practicable, and furnished with fire-fighting apparatus of the small automobile type.38
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First-aid fire-extinguishing apparatus was also distributed throughout the buildings, including fire pails, chemical extinguishers, water buckets, and hand pump tanks.38
FIG. 66.-Base hospital fire station
Provision was made for fire-alarm service, consisting of an automatic fire alarm system.38
There was a remarkable freedom from extensive fire losses in any of the larger hospitals.38
REFRIGERATION
The base hospitals of National Army camps, except that at Camp Funston, were supplied with small refrigerating plants, each having a capacity of 1 ton of refrigeration per day. Many of the general hospitals were likewise supplied with refrigerating plants, some of which were equipped with ice-making apparatus sufficient to meet the needs of the hospital.39
Where refrigerating plants were not provided, as at the National Guard hospitals, ice boxes were used, the ice being obtained from the camp refrigerating plant or by purchase from local dealers.
LAUNDRY
It was originally planned to have laundry units a part of all semi permanent hospitals. Buildings were erected, and in some instances partial laundry equipment was provided.40 It was soon determined, however, that it would be more practical to have the hospital laundry done by the camp steam laundries or by local contract. In a few instances the base hospitals equipped their own laundries and managed the operation of them.41
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HOSPITAL GROUNDS
The site chosen for the hospital hinged upon primary considerations, which, in the instance of camps, and aside from military reasons, were high ground, adequate detachment from the concentrated troops when present, and a well-drained area with good sun exposure. Frequently virgin sites were selected which necessitated much clearing.
The construction activities-building, sewerage system installation, etc.-left much to be desired, from an attractiveness viewpoint; and with the early concentration of efforts on organization, and a correlative, greater expenditure of time on the care of patients, little or no time could be devoted to the eradication of the glaring ugliness of most of the hospital exteriors. With the advent of the spring and summer of 1918, however, there was opportunity to grade, where necessary, or fill in, and plant grass seed, flower beds, andtrees.42Truck gardens were made on available neighboring space, in many instances, which proved of twofold value-a considerable source of revenue for the hospital fund, and, with the general upkeep of the hospital exterior, a valuable recreation for convalescents.43
FIG. 67.-Portion of a base hospital farm
ROADS AND WALKS
The main road leading from camp to hospital was improved at a comparatively early date, and usually consisted of a concrete or macadam structure.44Within the hospital area the improvement in roads was left to the resources of the officer in command. Where cinders were available, as from the central heating plant, these were used;45in some instances crushed stone was used;46 and frequently they remained of dirt.
Most wards were joined together by covered corridors provided for in the original construction.47There were many buildings in the hospital group, however, which were not connected by means of these covered corridors.48In the early weeks of their occupancy, nurses were obliged in rainy weather to
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walk to and from their quarters through mud and water, and likewise the officers encountered this trouble in visiting detached wards, such as those of the isolation group. All members of the personnel, as well as visitors, tracked into the various buildings more or less dirt from these muddy walks,
FIG. 68.- Covered, or "umbrella" walk
all tending to make it difficult or impossible to keep corridors, wards, etc., reasonably clean.
These difficulties were eventually overcome by the construction of footpaths of various materials, or sidewalks of boards.49
REFERENCES
(1) A. R. 1,000, 1913.
(2) A. R. 1386, 1913.
(3) Manual for the Quartermaster Corps, 1916, Vol. II, 2223.
(4) A. R. 1195, 1913.
(5) A. R. 1202, 1913.
(6) A. R. 1212, 1913.
(7) A. R. 1220, 1913.
(8) A. R. 1221, 1913.
(9) Regulations for the Government of United States Army General Hospitals, War Department, Surgeon General`s Office, 1914.
(10) A. R. 1212, 1913 (C. A.R. No. 66, W. D., 1917).
(11) A. R. 1212, 1913 (C. A.R. No. 82, W. D., 1918).
(12) A. R. 1212, 1913 (C. A.R. No. 99, W. D., 1919).
(13) G. O., No. 40, W. D., Oct. 25, 1912.
(14) Letter from the Surgeon General of the Army to the Quartermaster General of the Army, September 6, 1917.Subject: Quartermasters for base hospitals. On file, Record Room, S. G. O., 211(Quartermasters, Base Hospitals) J.
(15) Special Regulations No.40, W. D., 1917.
(16) G. O., No. 89, W. D., July 11, 1917.
(17) Annual Report of the Surgeon General, U. S. Army, 1918, 320.
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(18) G. O., No. 80, W. D., June 30, 1917.
(19) Manual for the Medical Department, 1916, Art. XVII.
(20) Supply Letters, Nos. 1to 23, W. D., S. G. O., December 5, 1917.
(21) 37 Stats., 90.
(22) Supply Letter No. 28,W. D., S. G. O., October 9, 1918.
(23) G. O., No. 72, W. D., August 6, 1918.
(24) Report of the Chief of Construction Division, W. D., 1919, 12.
(25) Manual of the Construction Division of the Army, Section C, Engineering Division, 1918, 91.
(26) Annual Report of the Surgeon General, U. S. Army, 1918, 317.
(27) Second indorsement from The Adjutant General to the officer in charge Cantonment Construction Division, July 8, 1918. Subject: Disapproval of heating plants for National Guard camp base hospitals. On file Mail and Record Division, A. G. O., 674.1 (Misc. Sec.).
(28) From statements on the subject of heating in the separate Histories of Base Hospitals at National Guard Camps. On file, Historical Division, S. G.O.
(29) Manual of the Construction Division of the Army, Section C, Engineering Division, 1918, 106. Also: From statements on the subject of heating in the separate Histories of Base Hospitals at National Army Camps. On file, Historical Division, S. G. O.
(30) Report of the Chief of Construction Division, W. D., 1919, 21.
(31) Ibid., 15.
(32) Ibid., 30 to 35.
(33) Ibid., 14.
(34) Ibid., 36.
(35) History of Base Hospital, Camp Custer, Mich. On file, Historical Division, S. G.O.
(36) History of Base Hospital, Camp Cody, N. Mex. On file, Historical Division, S. G. O.
(37) History of Base Hospital, Camp Beauregard, La. On file, Historical Division, S. G. O.
(38) Report of the Chief of Construction Division, W. D., 1919, 16 to 19.
(39) Ibid., 24.
(40) Annual Report of the Surgeon General, U. S. Army, 1918, 318.
(41) From statements on the subject in Histories of Base Hospitals at Camp Cody, N. Mex., and Camp Grant, Ill. On file, Historical Division, S. G.O.
(42) From statements on the subject in the separate Histories of Base Hospitals. On file, Historical Division, S. G. O.
(43) From statements on the subject in the separate Histories of Base Hospitals. On file, Historical Division, S. G. O.
(44) Report of the Chief of Construction Division, W. D., 1919, 24.
(45) From statements on the subject in the separate Histories of Base Hospitals. On file, Historical Division, S. G. O.
(46) From statements on the subject in the separate Histories of Base Hospitals. On file, Historical Division, S. G. O.
(47) Letter from the Surgeon General to the Quartermaster General. May 26, 1917. Subject: Estimates for base hospitals for cantonments. On file, Record Room, S. G.O., 176796 R.
(48) Letter from the Surgeon General to the Quartermaster General, December 26, 1917. Subject: Hospital increase at National Army base hospitals. On file, Record Room, S. G. O., 632-11 (General).
(49) From statements on the subject in the separate Histories of Base Hospitals. On file, Historical Division, S. G. O.
