MAJ. GEN. MERRiTTE W. IRELAND, M. C, CHIEF SURGEON, A. E. F., MAY 1, 1918,
TO OCTOBER 9, 1918
TShe
MEDICAL DEPARTMENT
OF THE UNITED STATES ARMY
IN THE WORLD WAR
VOLUME II
ADMINISTRATION
AMERICAN EXPEDITIONARY FORCES
PREPARED UNDER THE DIRECTION OF
MAJ. GEN. M. W. IRELAND
The Surgeon General By
Colonel Joseph H. Ford, M. C.
UNITED STATES GOVERNMENT PRINTING OFFICE : 1927
■4
ADDITIONAL COPIES
OF TfflS PXTBLICA-nON MAT BE PROCtTRED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. 0. AT
$3.40 PER COPY
LETTER OF TRANSMISSION
I have the honor to submit herewith a portion of the history of the MEDICAL DEPARTMENT OF THE UNITED STATES ARMY IN THE WORLD WAR. The portion submitted is Vokime II, and is entitled "AdMiN- isTRATioN, American Expeditionary Forces."
M. W. Ireland, Major General, the Surgeon General.
The Secretary of War.
3
Lieut. Col. Frank W. Weed, M. C, Editor in Chief LoY McAfee, A. M., M. D., Assistant Editor in Chief EDITORIAL BOARD"
Col. Bailey K. Ashford, M. C.
Col. Frank Billings, M. C.
Col. Thomas R. Boggs, M. C.
Col. George E. Brewer, M. C.
Col. W. P. Chamberlain, M. C.
Col. C. F. Craig, M. C.
Col. Haven Emerson, M. C.
Brig. Gen. John M. T. Finney, M. D.
Col. Joseph H. Ford, M. D.
Lieut. Col. Fielding H. Garrison, M. D.
Col. H. L. Gilchrist, M. C.
Brig. Gen. Jefferson R. Kean, M. D.
Lieut. Col. A. G. Love, M. C.
Col. Charles Lynch, M. C.
Col. James F. McKernon, M. C.
Col. R. T. Oliver, D. C.
Col. Charles R. Reynolds, M. C.
Col. Thomas W. Salmon, M. C.
Lieut. Col. G. E. de Schweinitz, M. C.
Col. J. F. SiLER, M. C.
Brig. Gen. W. S. Thayer, M. D.
Col. A. D. TUTTLE, M. C.
Col. William H. Welch, M. C. Col. E. P. Wolfe, M. C. Lieut. Col. Casey A. Wood, M. C. Col. Hans Zinsser, M. C.
» The highest rank held during the World War has been used in the ease of each officer. 4
PREFACE
This volume considers only the more important administrative activities of the Medical Department in the American Expeditionary Forces, for the scope of these and their ramifications were such as to preclude, in the space available, a more thorough discussion. On the other hand, since there is a degree of overlapping of this and other volumes, for example. Volumes VI and VIII, certain administrative matters already covered in these other volumes are not taken up in detail herein. Thus the administrative matters which related to the evacuation service of the Medical Department at the front are considered in Volume VIII; the administrative matters closely connected with sanitation will be found in Volume VI. The purely professional services, though covered briefly in this volume, have been assigned greater space in volumes appropriate to each subject. The fact that the service of but one hospital center is discussed at some length, though such formations were among the most important of the Medical Department enterprises, illustrates the necessity for compressing the material available.
Certain subjects and activities may seemingly have been unduly slighted. This has been due, on the one hand, to the necessity to avoid unnecessary duplication, or, on the other hand, to the fact that official reports concerning the subjects in question were too fragmentary. Thus, to the chief surgeon's office, line of communications, the chief surgeon's office, American forces in France, and the medical activities of some of the sections of the Services of Supply it has been impossible to give the consideration which their importance warrants.
Acknowledgment is made to Lieut. Frank Steiner, M. A. C, for arranging the chapters on the brief histories of hospital centers, base, and camp hospitals.
» For the purpose of the history of the Medical Department of the United States Army in the World War, the period of war activities extends from April 6, 1917, to December 31, 1919. In the professional volumes, however, in which are recorded the medical and surgical aspects of the conflict, as applied to the actual care of the sick and wounded, this period is extended, in some instances, to the time of the completion of the history of the given service. In this way only can the results be followed to their logical conclusion.
TABLE OF CONTENTS
Page
Preface 5
Introduction I3
Section I. Organization and Administration of the Chief Surgeon's Office
Chapter I. General organization and development of the chief surgeon's office 39
II. Representation of the Medical Department on the general staff,
A. E. F 59
III. Liaison of the Medical Department, United States Army, with the med-
ical services of the Allies 71
IV. The administration division 85
V. The personnel division 89
VI. The dental section 105
VII. The nursing section; reconstruction aides 125
VIII. The division of sanitation and inspection 133
IX. The division of laboratories and infectious diseases ^ 137
X. The division of laboratories and infectious diseases continued — Central
Medical Department laboratorv 157
XI. The di vision of laboratories and infectious diseases continued — The sec- tion of laboratories; technical work of laboratories 167
XII. The division of laboratories and infectious diseases continued — Section
of infectious diseases; section of wound bacteriology 203
XIII. The division of laboratories and infectious diseases continued — Section of water supplies; section of food and nutrition; museum and art sec- tion; laboratory of surgical research 213
XIV. The division of hospitalization 229
XV. The division of hospitaUzation continued — Hospital construction; pro- curement 241
XVI. The di vision of hospitalization continued — Hospitalization of sick and
wounded 283
XVII. The division of hospitalization continued — Medical Department trans- portation 317
XVIII. The division of hospitalization continued — The professional services 351
XIX. The finance and supply division 387
XX. The veterinary service 419
Section II. Medical Activities of Territorial Sections
Section III. Hospitals
Chapter XXI. Hospital centers ' 473
XXII. A typical hospital center 489
XXIII. Other hospital centers 537
XXIV. Base hospitals 629
XXV. Camp hospitals 749
Section IV. Evacuation of Patients to the United States; Discontinuance of
Hospitals
Chapter XXVI. Evacuation of patients to the United States 791
XXVII. Discontinuance of hospitals 807
7
8
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Section V. The Army of Occupation in Germany
Page
Chapter XXVIII. The American forces in Germany 813
XXIX. Department of sanitation and public health, German occupied
territory 821
Section VI. Medical Department Activities, American Forces in France
Appendix:
Report on organization, equipment, and functions of the Medical Department 835
Circulars promulgated by the chief surgeon, A. E. F 903
The more important memoranda promulgated by the division of laboratories and
infectious diseases, A. E. F 1057
The more important forms used in the laboratory service, A. E. F 1081
Index 1089
LIST OF TABLES
Table 1. Personnel, Medical Department, A. E. F., January 11, 1919 94
2. Personnel, Medical Department, A. E. F., July 12, 1919 96
3. Consolidated daily field report of Medical Department personnel, S. O. S.,
August 31, 1919 96
4. Types and numbers of laboratories in operation in the American Expedi-
tionary Forces, May, 1917, to April, 1919-. ■ 168
LIST OF PLATES
Frontispiece. Maj. Gen. M. W. Ireland, M. C, chief surgeon, A. E. F., May 1, 1918, to October 9, 1918
Plate 1. Brig. Gen. Alfred E. Bradley, M. C, chief surgeon, A. E. F., to April 30, 1918. 40 2. Brig. Gen. Walter D. McCaw, M. C, chief surgeon, A. E. F., October 10,
1918, to July 15, 1919 41
LIST OF CHARTS
Chart I. Showing organization of chief surgeon's office, A. E. F., March 6, 1918 51
II. Scheme for organization of Medical Department, A. E. F., corrected to
November 11, 1918 55
III. Scheme for organization of division of sanitation and inspection, chief
surgeon's office, A. E. F 133
LIST OF FIGURES
Figure
1. Lines of communication, A. E. F., showing also the sections comprising the
Services of Supply Facing 31
2. Wing B, of group of three main buildings, general headquarters, A. E. F., in
which the office of the chief surgeon, A. E. F., was located prior to its removal to Tours. This wing also was the location, subsequently, of the medical group, G-4, general staff, A. E. F 4q
3. Headquarters, Services of Supply, A. E. F., at Tours. The chief surgeon's
office occupied practically the entire first floor of the wing on the right 53
4. Building in Tours in which the finance and accounting division of the chief
surgeon's office was located
5. Ground plan, headquarters, division of laboratories, A. E. F., and Central
Medical Department Laboratory, Dijon
6. Floor plan of the office of the director, division of laboratories, A. E. F . 148
7. Central Medical Department Laboratory, Dijon. The main building is in the
center of the background ^g-,
8. Diagram showing types of laboratories in the American Expeditionary Forces]] 168
9. Pathological room in the laboratory, Vichy hospital center ~ i7fi
TABLE OF CONTENTS 9
Page
10. Bacteriological laboratorj^ Vichy hospital center 178
11. Field laboratory car 183
12. Front of interior of field laboratory car 184
13. Rear of interior of field laboratory car 185
14. Interior of field laboratory car, showing water still, autoclave, and sterilizers 186
15. Transportable laboratory in eight chests 188
16 to 19. Chests of transportable laboratory opened to show contents 189-192
20. Showing preparations for shipping portable laboratories from the Central Medical
Department Laboratory, Dijon 193
21. General layout of hospital unit, type A (base hospital) with wards 20 feet wide.
Demountable buildings 242
22. General layout of hospital unit, type A, with wards 20 feet wide. Permanent
buildings 243
23. General layout of hospital unit, type A, with wards 36 feet wide 244
24. Ward building (20 feet wide), hospital unit, type A. Demountable 245
25. Ward building (36 feet wide), hospital unit, type A 245
26. Administration building, hospital unit, type A 245
27. Nurses' quarters, hospital unit, type A 246
28. Nurses' dining room and kitchen, hospital unit, type A; for use with demountable
buildings 246
29. Officers' quarters and dining room, hospital unit, type A; for use with demount-
able buildings 247
30. Officers ' quarters, hospital unit, type A; for use with permanent type of buildings. 248
31. Receiving and evacuating hall, hospital unit, type A; for use with demountable
buildings 249
32. Receiving and evacuating hall and patients' bath, hospital vmit, type A. Perma-
nent type 249
33. Patients' bath, hospital unit, type A, for use with demountable buildings 249
34. Recreation hall, hospital unit, type A; permanent building type 250
35. Nurses recreation club, hospital unit, type A; demountable 251
36. Laboratory and morgue, hospital unit, type A; demountable 251
37. Operating and X-ray building, hospital unit, type A; demountable 252
38. Operating, X-ray, and clinic building, hospital unit, type A 253
39. Dispensary and clinic building, hospital unit, type A; demountable 254
40. Clinic and surgical dressings building, hospital unit, type A 254
41. Patients' kitchen, hospital unit, type A; temporary type 254
42. Patients' kitchen and dining halls, hospital unit, type A; permanent type 255
43. Patients' dining hall, hospital unit, type A, for use only when demountable
buildings were furnished 256
44. Quartermaster's storehouse, hospital unit, type A; demountable 256
45. Quartermaster's and medical storehouse, hospital unit, type A; permanent 257
46. Barrack building, hospital unit, type A; demountable 258
47. Personnel dining hall, hospital unit, type A; demountable 258
48. Medical storehouse, hospital unit, type A; demountable 259
49. Disinfector building, hospital unit, type A; demountable 260
50. Ablution building, hospital unit, type A; demountable 260
51. General layout, hospital center, Bazoilles 261
52. General layout, hospital center. Mars 262
53. General layout, hospital unit, type B (camp hospital) 263
54. Ward, hospital unit, type B 264
55. Administration building and officers' quarters, hospital unit, type B 264
56. Patients' mess, hospital unit, type B 265
57. Bath and disinfector, hospital unit, type B 265
58. Operating and clinic building, hospital unit, type B 266
59. General layout, hospital unit, type C (convalescent camp), 2,000 beds 267
60. Administration and clinic building, hospital unit, type C 268
10 AD]\riNISTRATION, AMERICAN EXPEDITIONARY FORCES
Page
61. Officers' quarters and mess hall, hospital unit, type C
62. Standard barrack, hospital unit, type C
63. Kitchen, hospital unit, type C
64. Quartermaster building, hospital unit, type C
65. Shops and disinfector building, hospital unit, type C 272
66. Laundry building, hospital unit, type C
67. Dining hall, hospital unit, type C
68. Bathhouse, hospital unit, type C ^''^
69. Venereal and skin clinic, hospital unit, type C — 274
70. Perspective of a Bessonneau tent in a two-tent unit 275
71. Perspective of a Bessonneau tent, showing framing and double walls 275
72. Plan of a two-tent (Bessonneau) ward 275
73. Showing heating arrangements in a Bessonneau tent 276
74. Perspective of a marquee tent ward, showing a unit of three tents 277
75. Plan of a marquee tent ward of three tents 278
76. Showing heating arrangements in a marquee tent ward 278
77. Perspective of closet in a marquee tent, showing construction 279
78. Plan of a two-tent ward, United States hospital ward tent 279
79. Outhne map of France showing the location of the various fixed hospitals of the
American Expeditionary Forces Facing 288
80. American Red Cross Military Hospital No. 21, Paignton, Devon, England 289
81. American Red Cross Convalescent Hospital No. 101, Lingfield, Surrey, England
(for officers) 290
82. Hospital train obtained from the French, at Base Hospital No. 9, Chateauroux. _ 321
83. French hospital train, with continental type of carriage 322
84. Interior of one of our hospital trains (British built) 328
85. Hospital train at Base Hospital No. 27, Angers 331
86. Entraining class D patients at Base Hospital No. 30, Royat 335
87. Map of AUerey hospital center and vicinity 490
88. Reservoir, AUerey hospital center 492
89. Exterior view of warehouse, AUerey hospital center 501
90. Interior of receiving ward, AUerey hospital center 508
91. Delousing apparatus, AUerey hospital center 512
92. Clothing preparatory to delousing process, AUerey hospital center 513
93. Interior of one of the quarters for enlisted men, AUerey hospital center 514
94. Heating apparatus for patients' baths, AUerey hospital center 515
95. An operating room, AUerey hospital center 523
96. Sterilization room, AUerey hospital center 524
97. A surgical ward, AUerey hospital center 525
98. A psychiatric ward, AUerey hospital center 526
99. Eye and ear clinic in one of the hospitals, AUerey hospital center 527
100. Center medical laboratory, AUerey hospital center 529
101. View of Bazoilles hospital center 53g
102. Covered walk connecting the wards at Base Hospital No. 18, Bazoilles hospital
center g^j
103. Airplane view. Beau Desert hospital center g^g
104. Beau Desert hospital center, showing railway facilities 549
105. An operating room, Beaune hospital center
106. A view of part of Kerhuon hospital center gg-r
107. A view of part of Limoges hospital center g-r^
108. General view of Mars hospital center, looking northeast from tower at west end
of center
109. One of the operating rooms. Mars hospital center
110. View of convalescent camp (east end) looking north from water tower Mars
hospital center
111. A view of part of Mesves hospital center, during the construction period. . 580
TABLE OF CONTENTS 11
Page
112. A row of wards, Mesves hospital center, during construction period 581
113. Rock quarry, used in construction of Mesves hospital center 582
114. Base hospital. No. 99, Hyeres, Riviera hospital center 594
115. Base hospital No. 93, Cannes, Riviera liospital center 595
116. Evacuation Hospital No. 49, Menton, Riviera hospital center 596
117. Airplane view, Savenay hospital center 597
118. Hotel des Bains, part of Vichy hospital center 619
119. Hotel Lilas, part of Vichy hospital center 620
120. A ward. Base Hospital No. 1, Vichy hospital center 621
121. Officers' mess at the Hotel Sevigne, Vichy hospital center 622
122. Casino, used as the officers' club, Vichy hospital center 623
123. Building used as the noncommissioned officers' club, Vichy hospital center 624
124. Two small hotels used for the enlisted men, Vichy hospital center 625
125. Base Hospital No. 3, Vauclaire 631
126. Airplane view of Base Hospital No. 7, Joue-les-Tours 635
127. Base Hospital No. 9, Chateauroux 637
128. A general medical ward, exterior. Base Hospital No. 12, operating British
General Hospital No. 18 639
129. Exterior, surgical ward. Base Hospital No. 12 640
130. Base Hospital No. 15, Chaumont 643
131. Base Hospital No. 17, Dijon 644
132. A view of part of Base Hospital No. 21, operating British General Hospital No. 12,
Rouen 648
133. A view of part of the temporary buildings. Base Hospital No. 27, Angers 653
134. Base Hospital No. 28, part of Limoges hospital center 654
135. Surgical building. Base Hospital No. 29 656
136. Airplane view. Base Hospital No. 30, Royat 657
137. Base Hospital No. 33, Portsmouth, England 660
138. Contagious disease ward. Base Hospital No. 40, Sarisbury Court, Hants, England- 666
139. A view of the grounds, Base Hospital No. 41, St. Denis, Paris 667
140. View of part of Base Hospital No. 43, Blois 669
141. Base Hospital No. 57, Paris 682
142. Base Hospital No. 85, Paris 704
143. Part of Base Hospital No. 94, Pruniers 713
144. Main building. Base Hospital No. 103, Dijon 721
145. Main kitchen. Base Hospital No. 106, Beau Desert hospital center 724
146. Interior, detachment mess. Base Hospital No. 106 725
147. Base Hospital No. 236, Carnac 747
148. Camp Hospital No. 2, Bassens 750
149. Camp Hospital No. 4, Joinville 751
150. A ward interior. Camp Hospital No. 7, Humes 752
151. Camp Hospital No. 22, Langres 757
152. Camp Hospital No. 24, Langres 759
153. Interior, officers' ward. Camp Hospital No. 28, Nevers 760
154. A group of wards, Camp Hospital No. 29, Le Courneau 761
155. Camp Hospital No. 33, Camp Pontanezen l 762
156. Camp Hospital No. 41, Is-sur-Tille 766
157. Camp Hospital No. 42, Bar-sur-Aube 767
158. Camp Hospital No. 45, Aix-les-Baines 769
159. Camp Hospital No. 46, Landerneau 770
160. Camp Hospital No. 48, Recey-sur-Ource 771
161. One of the buildings. Camp Hospital No. 56, Avoine 774
162. Camp Hospital No. 59, Issoudun 776
163. Camp Hospital No. 64, Chatillon-sur-Seine 777
164. Camp Hospital No. 68, Bourges 779
165. Camp Hospital No. 72; Chateau-du-Loir 780
f
INTRODUCTION
MILITARY ATTACHES AND OBSERVERS, MEDICAL OFFICERS WITH SPECIAL DUTIES, HOSPITAL UNITS AND CASUAL PERSONNEL ON DUTY WITH ALLIES
MILITARY ATTACHES AND MILITARY OBSERVERS
When war was declared by Germany on July 30, 1914, there were on duty with the principal American embassies and ministries accredited to European governments military attaches who were charged with the duty of procuring and forwarding military information to the chief of the War College division of the Army General Staff. ^ In some countries their efforts were supplemented later by those of military observers — officers who occupied a status somewhat different from that of attaches but who, like them, w^ere assigned to duty with the respective embassies and accredited to the governments concerned.^ Gen- erally speaking, the observers enjoyed greater opportunities for investigations at the front than did the attaches, for they were .assigned, as their designation would indicate, with that end in view, though in some instances the opportu- nities afforded them were strictly limited by the government to which they were accredited.^ Though the military attaches were the military advisers of the ambasssadors under whom they served, and were charged more definitely with reporting to the Army War College current military events and military policies in so far as these were divulged,^ they also submitted many reports covering a wide range of other subjects.
On August 12, 1914, the Secretary of War requested the Secretary of State to learn whether or not England, France, Germany, and Austria would accept as observers six officers of the line and two of the Medical Department.^ The Secretary of War was notified, on August 17, that the Austro-Hungarian Government was willing to accept two line officers and two medical officers.^ Later this authorization was so modified as to replace one medical officer by another officer from a different branch of the service.^ On August 19 the military attache in London notified the War College division of the General Staff that two military observers, in addition to the military attaches, would be permitted to accompany the British Army in the field. ^
The Chief of Staff informed the Surgeon General, on August 12, 1914, that medical officers who might be detailed as observers should be governed by General Orders, No. 60, War Department, August 8, 1914, which requested and advised all officers to refrain from public comment upon the military or political situation where other nations were involved.''
On September 1, 1914, an officer of the Medical Corps, then in Europe, together with three officers from other branches of the Army, was directed to report to the American ambassador in Vienna for duty as military observer with the Austro-Hungarian Army.''' He served in this capacity at various places along the Russian and Serbian fronts until October 27, 1915.
14
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
On September 9, 1914, another officer of tlie Medical Corps, then in London, was assigned as military observer with the French Army,'- and served in that capacity until November 23 of that year.'^
On January 30, 1916, Sir William Osier, regius professor of medicine, Oxford University, England, recommended that three medical officers of our Army and and an equal number of our Navy be detailed to study professional procedures in British base hospitals.'^ The recommendation, having been referred to him, the Surgeon General, on March 6, 1916,'" selected three members of the Medical Corps, who were then assigned and accredited as military observers."^ After reporting in London in May, these officers made extensive observations in matters pertaining to the British medical service both in England and on the continent.
No officer of the Medical Corps w^as a member of the group assigned as military observers with the German Army.'^
The medical officers assigned as military observers w^th the British Army remained in this status until the arrival of General Pershing in June, 1917,''* when they vacated their assignments and joined the American Expeditionary Forces,'^ except one, who retained his status as observer and his consequent affiliation with the American Embassy,-" on June 9, 1917, in addition to his other duties, being made liaison officer for our Medical Department with the British forces, with office in London.^' Shortly thereafter he was assigned as chief surgeon of the American forces serving with the British, his status in this matter being analogous to that of a department surgeon in the United States.
Another of these medical officers, after joining the American Expeditionary Forces, was assigned, on July 4, to duty at Base Section No. 1 (St. Nazaire), where he had been conducting an inspection when headquarters, A. E. F., arrived;^* the third or senior medical officer become chief surgeon, A. E. F., on May 26, 1917, by General Orders, No. 1, headquarters, A. E. F., Washington, D. C.
Meanwhile, on February 23, 1917, the British had recommended that a veterinary officer of the United States Army be detailed to observe the oper- ations of his branch of the service in their army.^^ Accordingly, a veterinarian attached to the 6th Field Artillery, who had been assigned as a military observer with the French Army, December 27, 1915,^*^ was relieved from further duty in France on March 10, 1917, and directed to report to the American ambas- sador at London for the purpose of carrying out instructions of the War Depart- ment.^^ On June 14, 1917, this officer was relieved from further duty in London ordered to Paris, and assigned to duty in the American Expeditionary Forces.-*
These several observers with the British Army submitted numerous reports many of which w-ere very thorough and elaborate, and all of w^hich were tech- nical, concerning organization, administration, equipment, and tactics of the British Army medical service, sanitation, preventive and curative medicine surgical and orthopedic technique, offensive and defensive measures in gas warfare, transportation of wounded, care of animals, and many other subjects. A few^ of their reports pertained to the British Navy; e. g., hospital ships
On June 5, 1915, the chief of the War College division of the General Staff approved and forwarded to the Surgeon General a letter from the Amer-
INTKODUCTION
15
ican military attache, Paris, requesting detail of a medical officer as an observer with the French Army.^* On June 12, the Surgeon General, concurring in this proposal, recommended a medical officer,^" who was assigned on November 15, 1915, as military observer with the French armies in the field.^^
In conformity with a request from the German Government dated Sep- tember 1, 1916, that two medical officers of the United States Army be detailed to inspect depots for prisoners of war in France,^^ the Surgeon General, on September 12, recommended that a medical officer be assigned to that duty to supplement the activities of the one who already was available for that service.^^ On September 25, 1916, the newly assigned medical officer was detailed as a military observer.^* This was not in order that he might perform the functions of an officer regularly so accredited, but in order that his status might be fixed while on detached duty, and that he might receive an allotment from the appro- priation for military observers abroad.^^ The primary purpose in sending him to France was that he might assist in the inspection of depots for military prisoners, but in point of fact he not only did this but also made a number of such observations as were regularly incumbent upon a military observer.
In addition to the two medical officers referred to above other officers belonging to different branches of our Army were serving as military observers accredited to the French Government.^^ On July 19, 1916, six of these officers joined in signing a letter addressed to the chief of the War College division, General Staff, recommending that they be organized into a mission.^^ This letter noted the advantages that would accrue from the recognition of an American military mission by the French War Department and stated that they were all recognized as being members of such a group but that they had no designated head who could represent them in their transactions with the French Government.^^
The mission was organized by authority of the following letter of November 21, 1916, from the acting chief of the War College division. General Staff
By authority of the Secretary of War, the officers now on duty in Paris as military ob- servers have been organized into a mission of which you are hereby appointed chief.
The Secretary of War directs that in the performance of your duties as chief of this mission you be guided by the following instructions:
(a) You will cooperate in the fullest possible manner with the military attache at Paris in the work of procuring military information, to the end that there be no duplication of work.
(b) You will show to the military attache all reports of the military observers prepared for transmittal to the War College division. Such reports will be numbered serially in the office of the military observers in such a manner that they will not be confused with the numbered reports of the military attache. Reports of the military observers will be acknowl- edged by the War College division directly to the chief of the military mission once a month.
(c) All requests from the War College division for information to be compiled by the military observers will be directed to you, and it will be your duty to inform the other military observers of the information that is desired.
(d) All the arrangements between the office of military observers covering all questions or requests will be carried on directly between you as chief of the mission and the military attache.
(e) The retained reports of the individual military observers will be accessible at all times to the military attache, and conversely all reports of the military attache covering mat- ters of routine military interest will be open to the military observers.
13901—27 2
16
ADMINISTRATION, AMERICAN EXPEDITIONARY KOHCES
(/) As chief of this mission you are authorized to coiuinuiiicate directly with tlie trench War Department to such an extent as may be permitted by the hitter department. ou will, liowever, keep the military attache informed of such matters as are taken up directly by you with the French War Department.
(g) In order that the greatest possible advantage may be taken of all possible channels to procure military information, you are directed to cooperate to the fullest extent with the military attache.
(h) Instructions have been issued to the military attache at Paris to officially present you to the chief of the second bureau of the French General Staff as chief of the American military mission upon the receipt of the acknowledgment by the French authorities of your assignment as such, which is being communicated to them through the Department of State.
(i) The Secretary of War authorizes you as chief of this mission to issue such instructions to the members thereof as may be necessary for the proper performance of their duties.
Before the severance of the diplomatic relations between the United States and Germany, February 3, 1917, members of the mission were not given such opportunities as they later enjoyed,^* for prior to that event the French were not certain where the sympathies of our Government lay, and naturally hesitated to permit American officers to make thorough inspections.^ During that period, nevertheless, members of the mission did enjoy certain facilities and submitted a number of reports on many subjects.^ After Feb- ruary 3, 1917, the mission's facilities for study of military methods and activi- ties were greatly extended and it forwarded to the War College a great quantity of information, much of it highly technical in character.^ Revised instructions for the guidance of Medical Department military observers were sent to the chief of the mission and to the medical observers in England on February 10, 1917.^^
On February 14, 1917, the chief of the mission reported that at his request General Lyauty had given directions so greatly amplifying the privileges here- tofore granted the American mission that it enjoyed practically ''blanket" permission for obtaining any information it might seek.^^ It was arranged that the two medical members would visit the French Army school of asphyx- iating gases and all medical depots, and would study on the ground the whole system of evacuation of wounded from the trenches to the base hospitals.^* Accordingly, these medical officers took the full course of instruction at the French gas school and submitted a voluminous report covering confidential matters concerning the chemistry of gases employed, their manufacture, tactical employment, defenses against them, and the organization of the gas services of the French and German Armies. A study of the evacuation service was prosecuted, but as indicated below was not completed until after the United States entered the war. On February 9, one of the medical officers in question reported at length, among other subjects, on the organization of the French sanitary service and the operation of that service in campaign. He also compiled additional data concerning French and British defensive gas service which he later submitted to the chief of the Gas Service, A. E. F., when headquarters arrived in France.
A report submitted by the two medical members of the American military mission April 25 gave the results of a study of Medical Department organi- zation required for any expeditionary force that might be sent to France. This document included statistics of wounded and a detailed description of
INTRODUCTION
17
the i-adical reorganization of our service that would be required, and was accompanied by inclosures which discussed the general organization and admin- istration of French medical service, with particular reference to their depots for the slightly sick and wounded and convalescent camps. Another report considered the utilization of volunteer American sanitary units in France.
Following the declaration of war, on April 6, 1917, the War Department called upon the mission through the miUtary attache for specific information on many subjects, and the facilities afforded members of the mission by the French, in order that they might furnish promptly and thoroughly any data required, were further extended by the detail to service with it of several officers of the French General Staff.^ They assisted in preparing surveys of ports, reports on condition and capacity of railways, location of training camps, depots, and other installations.
The mission reported to the War Department, on June 1, that for various reasons St. Nazaire and Nantes appeared to offer the best facilities for debarka- tion for the first American forces, and recommended on that date that such troops should be disembarked at St. Nazaire.*" Accordingly, the French were requested to construct at this place a cantonment adequate to shelter a division of 20,000 men.^ It was also reported that because of the great con- gestion of this port it was advisable that our main central supply stations be located at Nevers where the French were prepared to transfer the station ware- houses to the United States forces.^ It was recommended that training camps be located in the vicinity of Nancy and Toul. The following day two officers of the mission left for St. Nazaire to lay out the camp site and establish water supply services.^ The explicit applied problems of the Medical Department in France now began, for the water supply at St. Nazaire was not sufficient for the number of troops to be encamped here, and provision had to be made to overcome the deficiency.^ This was accomplished temporarily by placing water boats in service on the Loire to carry water from points some miles inland.^ One of the medical members of the mission had been charged with initiating necessary measures for rendering potable the water supply for our forces in France, and on May 19 had reported on the service of water in the French Army. As soon as the provision of a suitable water supply at St. Nazaire was settled the French harvested such of the crops on the prospective camp site as were sufficiently matured and began to erect the huts required and to install the camp water system.^ It was arranged that the sick would be cared for in a double-walled barrack hospital accommodating 300 beds, but after construction was well advanced word was received that the strength of a division had been increased to some 28,000 men, and it became evident that the buildings intended for hospital purposes would have to be utilized as bar- racks by the incoming troops.^ In this emergency the French were appealed to and at once turned over in St. Nazaire a military hospital with a capacity of 250 beds, the only military hospital in that community, and another of 500 beds at Savenay, a few miles inland.^ Arrangements w^ere also made for the transfer of a hospital of 500 beds at Nantes and for the eventual transfer of several others, notably one of 1,100 beds at Bordeaux, but, as no personnel had yet arrived, definite arrangements concerning the latter institutions were held in abeyance until after the arrival of the commander in chief.^
18
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Meanw hile, other activities also engaged members of the mission. A medical member of the mission, continuing investigations begun several months pre- viously, visited the front, where he made an exhaustive stud}^ of the organiza- tion of the French Medical Department, its system of field hospitalization, classification of nonevacuable sick, evacuation of wounded by hospital tram, medical supply, use of motorized sanitary organizations of various kinds (e. g. ambulance companies, surgical hospitals, radiologic, laundry, and other units) and related subjects. On May 31, he reported his observations, but the most valuable result of this study accrued from the fact that when our troops began their offensives, in May of the following year, he was able, because of his then assignment with G-4, G. H. Q., to give direct application to the results of these observations, and thus secure to the medical service at the front better cooperation than might have been possible from others not personally acquainted with the study made at this time.^' With a view of avoiding delay when our troops would begin to arrive, studies by the members of the American military mission, accompanied by officers of the French General Staff, were continued and new ones undertaken. These included further inspections of the railway systems and selection of locations for temporary supply depots.^ It was also decided, tentatively, that the first division that arrived should go into the training area around Gondrecourt. Here a small barrack hospital w^as taken over from the French who evacuated their patients.^ Construction to expand this unit to 300 beds was begun immediately and the French reequipped it with new material throughout, for it was realized that our own supplies would not at once be available.^
The members of the mission continued their activities in their assigned capacities until the arrival of General Pershing in Paris on June 13. In con- formity with instructions received by the chief of the mission on June 5,*^ that officer reported at the time in question to General Pershing with a view of informing him as fully as possible concerning existing conditions.^ At this time all members of the mission joined the staff of the commander in chief and began the performance of new duties, continuing, however, a number of investigations which they had commenced prior to his arrival.
MEDICAL OFFICERS CHARGED WITH SPECIAL DUTIES IN FRANCE
On October 18, 1916, the Surgeon General requested that he be authorized to detail one of our medical officers for duty as superintendent, or officer in charge of a hospital at Passy, France, which was under the direction of the French Benevolent Society of New York, and requested that this officer be granted leave of absence for four months for that purpose.*^ The leave was granted,*^ and the officer in question was informed that he would go to France in a personal capacity, would have no connection with the United States Service and could not wear the uniform while in that country.*^ On May 7, 1917 the United States having declared war, he was formally assigned to duty at the hospital mentioned,*^ but on May 22, the Surgeon General notified the French Benevolent Society that this officer had been placed on a duty status, the United States having entered the war, and that all officers were needed.*"' He also requested information as to when he might be replaced. This officer
INTBODUCTION.
19
retained this assignment until October 3, 1917.^^ A few days later he was transferred to Blois and assigned as sanitary inspector of the line of com- munications, A. E. F."
Previous, but unsuccessful, efforts had been made by the Surgeon General to have another medical officer assigned to duty at the above-mentioned hospital at Passy, but at that time (June, 1916) this assignment was disapproved by the President on the ground of neutrality. The officer, however, was selected later to serve as chief medical officer of a hospital at His Orangis, France. This officer was instructed to apply for leave and was assigned in the same status as the one referred to in the preceding paragraph, but while en route his orders were changed because of the entry of the United States into the war,^° and he was definitely assigned to duty at this hospital May 7, 1917.^^ Here he served as chief medical officer and conducted a large surgical clinic until assigned to duty at general headquarters, A. E. F., on March 7, 1918,^^ meanwhile dis- charging a number of other duties pertaining to the standardization and pro- curement of splints, manufacture of nitrous oxide, and instruction of newly arrived medical officers in surgical technique.
On April 9, two additional medical officers ^^-^^ were granted leave for service in the hospital at Ris Orangis." On May 7, they were definitely assigned thereto," but on July 6, one was made one of the assistants to the chief surgeon, A. E. F.," and on August 15, the other was detailed as commanding officer of United States Army Hospital No. 2.^^
BASE HOSPITAL PERSONNEL AND CASUAL MEDICAL OFFICERS, UNITED STATES ARMY, WHO SERVED WITH THE BRITISH EXPEDITIONARY FORCE BEFORE THE ARRIVAL OF HEADQUARTERS, A. E. F.
Prior to the entrance of the United States into the war a number of Amer- ican citizens served individually in various capacities in the allied armies. A number of others were members of organizations, composed largely, if not entirely, of Americans, which were under the military control of some European government.^' Several of these formations were later absorbed or taken over by the American Expeditionary Forces (e. g., the Ambulance Americaine, later American Red Cross Hospital No. 1, the ambulance field service, and American Red Cross Ambulance, later incorporated in the United States Army Ambulance Service), but until that time were not a part of our forces.^°
The elements of the American Army, other than the military attaches, military observers, and the military mission to France (discussed above), which first served in Europe after the declaration of war, were six base hospitals which had been organized by the American Red Cross, and inducted into service soon after the United States entered the war,''' and were now assigned to duty with the British Expeditionary Force in France.^^ Also certain casual medical officers were assigned to duty with the British or French armies.®^
The circumstances which led up to the rendition of such prompt service and the composition and equipment of these units are discussed in Volume I, Chapter II, of this history.
When the British and French missions arrived in Washington in April, 1917, Col. Thomas H. Goodwin, of the Royal Army Medical Corps, requested
20
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCEJ?
that six base hospitals and 116 casual medical officers be assigned to the British Expeditionary Forces.''* The War Department called on the American Red Cross to furnish the hospital units for immediate transportation to France.''^ On May 1, 1917, the Surgeon General wrote The Adjutant General that it was the former's expectation that in the next three or four months, his department would send about 1,000 medical officers to Europe for service with the British Army and that they would begin to go over as rapidly as the Quartermaster Department could furnish transportation.'*'' The hospitals selected sailed in the following order, between the 8th and 25th of May:
Base Hospital No. 4, organized at the Lakeside Hospital, Cleveland, Ohio.
Base Hospital No. 5, organized at Harvard University, Boston, Mass.
Base Hospital No. 2, organized at the Presbyterian Hospital, New York City.
Base Hospital No. 10, organized at the Pennsylvania Hospital, Phila- delphia.
Base Hospital No. 21, organized at the Washington University, St. Louis, Mo.
Base Hospital No. 12, organized at the Northwestern University, Chicago.
To some of these units additional personnel was attached; e. g., a group of orthopedic surgeons was attached to Base Hospital No. 21.^^
After arrival in France the hospitals operated until after the signing of the armistice as general hospitals, British Expeditionary Force in France. They were located as follows:"^
No. 4, Rouen — operating British General Hospital No. 9.
No. 21, Rouen — operating British General Hospital No. 12 .
No. 2, Etretat — operating British General Hospital No. 1.
No. 10, Treport — operating British General Hospital No. 16.
No. 12, Dannes Camiers — operating British General Hospital No. 18.
No. 5, Dannes Camiers — operating British General Hospital No. 11.
On November 1, 1917, Base Hospital No. 5 was transferred to Boulogne where it operated as British General Hospital No. LS."^
On May 21, 1917, the American attache at London recommended that our senior medico-military observer there be designated as chief surgeon for all American medical units and personnel serving with British medical service, such assignment being urgently indicated in order to coordinate and systematize the relations which must exist between the two services."**
Some weeks prior to the arrival of General Pershing, the medical officer referred to in the preceding paragraph reported to the Surgeon General that he had assumed an unauthorized supervisory control over the American Medical Department personnel which had arrived in England before the commander in chief, for service with the British forces."^ He stated that his position under these circumstances was such that he could neither act nor advise in any authoritative manner, and that his relation with British authorities had been purely advisory."^ No instructions of any kind concerning this personnel had been received from Washington, though by June 11, 1917, 6 base hospitals and 52 casual medical officers had reported.^^
INTEODUCTIOX
21
On May 26, 1917, by General Orders No. 1, headquarters, A. E. F., Washington, D. C, he was designated as chief surgeon of the United States forces in Europe,^" to exercise over the forces under his control the same author- ity as the Suregon General holds over the entire Medical Department.'''
Control of the Medical Department personnel serving with the British was taken up by the chief surgeon, A. E. F., with General Pershing after the latter's arrival, and this responsibility, on June 25, was vested in the liaison officer for the Medical Department with the British.
GENERAL ORGANIZATION AND DEVELOPMENT OF THE AMERICAN
EXPEDITIONARY FORCES
The provision of a suitable organization for the American Expeditionary Forces by the creation of a staff which could give it intelligent direction was one of the first subjects that, from the outset, had engaged the attention of the commander in chief."' He had formulated a tentative plan for this essen- tial even before he embarked, and his headquarters had continued to study this subject while on shipboard and after arrival in Paris.'- Our Field Service Regulations provided certain guiding principles, but the experience and theory upon which they were based antedated the beginning of the war in Europe, and it was necessary that they be revised in the light of its developments." It was essential not only that the necessary staff services, as determined by developments of the war, be created, but also that the general scope of their individual and collective activities be defined, that the responsibilities of each staff service be fixed specifically, that overlapping or conflict of jurisdiction be eliminated, and that work be decentralized and individualized in designated offices.
In several important respects our position was different from that of any of the allied nations, and this fact had its influence in the application of the results of the comprehensive study, begun on the S. S. Baltic and now inten- sively continued, of British and French staff" organizations.^' The French Army was fighting on its own soil, had immediate access to its War Depart- ment and to its civil government, and was close to the territory from which it procured most of its supplies."' The British Army, though organized on an overseas basis, was also in close contact with its home Government and base."' But the American Army was based on a continent 3,000 miles distant, with which communication was much more difficult; its organization, administra- tion, and supply, therefore, offered peculiar problems.
It was foreseen that the uncertainties incident to ocean transport in the face of the growing submarine menace, the limited, though yet unknown, quantity of ship tonnage that would be available, and a line of land commu- nications some 400 miles in length through a foreign country already strained by protracted war, would give rise to problems of organization, administration, and supply that would be almost insuperably difficult." At the outset the commander in chief had made the announcement that the expedition was to be under control of its general staff, which was charged with its orderly, sym- metrical, and balanced development.^^ No one arm, bureau, or department was to be developed in advance of its needs or at the expense of others, but, as shown below, this ideal had to be modified because of military necessities."^
22
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Study of present and prospective problems in their intrinsic and extrinsic aspects led to the promulgation, on July 5, 1917, of General Orders, No. 8, G. H. Q., A. E. F., which provided for the creation of a general staff and technical administrative bureaus of the American Expeditionary Forces. This order, which was to form the basis of coordinated activities, directed that the general staff be divided into three major sections, intelligence, operations, and admin- istration, each under an assistant chief of staff; apportioned various duties among them ; provided for an administrative and technical staff, consisting of the chiefs of nine staff departments — adjutant general, inspector general, chief surgeon, and others — created the line of communications, and specified the duties of the American Red Cross. The organization of the American Expe- ditionary Forces was yet in a formative state, however, and a corrected copy of General Orders, No. 8, G. H. Q., A. E. F., published August 14, 1917 (but as of July 5), provided for a chief of staff, a secretary to the general staff, a general staff divided into 5 sections, an administrative and technical staff consisting of 15 departments, and a headquarter's command.
Both editions of this order provided that the distribution of staff duties at the headquarters of subordinate commands should conform in principle to the distribution of duties prescribed for headquarters. It is sufficient here to state that duties assigned to the several sections of the general staff at this time were as follows: First section, administration; second, intelligence; third, opera- tions; fourth, training; fifth, coordination. The duties of the several sections, as they applied especially to the Medical Department are discussed more fully below.
The administrative and technical staff designated by this order consisted of the following: Adjutant general, inspector general, judge advocate, chief quartermaster, chief surgeon, chief engineer officer, chief ordnance officer, chief signal officer, chief of Air Service, general purchasing agent, chief of Gas Serv- ice, director general of transportation, commanding general line of communi- cations, chief of Red Cross, provost marshal general.
The chiefs of the administrative and technical staffs were the local repre- sentatives of those bureaus of the War Department who were entitled to mem- bership in the headquarters of our forces in the field or the chiefs of several newly created staff organizations, viz, the general purchasing board, the department of transportation, the line of communications, the American Red Cross." These services were given staff representation in order that new situa- tions might be met. Like the heads of other bureaus composing the technical staff, their chiefs were equivalent in rank, and were coordinated with one another, and with the chiefs of previously existing staff departments whom they divested of some of their duties." Activities of ah these administrative staff b ureaus were directed and coordinated by the general staff, whose mem- bers as representatives of the commander in chief, communicated his plans with a view to their execution to the chiefs of the bureau concerned." By analogy to bureau chiefs in the War Department, their similars in the American Expeditionary Forces were charged with duties incident to administration statistics, records, inspection, construction and operation in their respective jurisdictions, including the procurement of the necessary supplies and material
INTRODUCTION
23
and forwarding these as required to the forces in the field/^ They were the advisers and executives of the commander in chief and his general staff in all matters, including those of a technical character incident to the operation of their respective departments.^^
In the early period of the American Expeditionary Forces the Medical Department was concerned chiefly with the first and fifth sections of the general staff/* The first, among its other duties pertaining to general matters of administration, was then charged with replacements, evacuation of sick and wounded, the ratio of combat troops to those serving on the line of com- munications, the respective ratios of staff and combat troops, supplies and transportation.^* The fifth was charged at this time with coordination and application of administrative staff policies.^* The importance to the Medical Department of the first section was incident especially to its control of allow- ances of ocean transport for personnel and supplies, and that of the fifth to its control of all hospitalization and depot projects — determining their need, size, location, installation, and other attributes.^* Not infrequently several staff departments sought the same facilities and the fifth section coordinated these conflicting demands.^*
The duties of the several sections of the general staff and of the technical staff departments varied somewhat in accordance with successive reorganiza- tions, especially those prescribed by Memorandum 129, published November 19, 1917; General Orders, No. 31, published February 16, 1918; General Orders, No. 114, published July 11, 1918; and General Orders, No. 130, published August 6, 1918.
Coincident with the organization of the general staff of the American Expeditionary Forces reorganization of the Army units was effected. As such units provided by our Tables of Organization when we entered the war were so small that they were quite inadequate for the service now required, an entirely new organization was prescribed. This provided that an Infantry combat division should consist of 28,172 officers and men, and should be com- posed of 2 infantry brigades, 1 field artillery brigade, 1 machine-gun battalion, 1 regiment of engineers, 1 field signal battalion, military police, train headquarters, and ammunition, supply, and sanitary trains." The sanitary train originally consisted of train headquarters, 4 field hospitals, 4 ambulance companies, and 8 infirmaries,^^ but from time to time other organizations and equipment were added, e. g., a medical supply depot, a mobile laboratory, and as occasion required and resources permitted a mobile surgical unit and professional teams were attached to it." Similarly there later developed great expansion in corps and armies and in organizations which served in the line of communications."" For example, the depot division at Aignan (the 41st Divi- sion) attained a strength of over 50,000 officers and men,^^ and the capacity of base hospitals was increased from 500 to 1,000 beds, or to 2,000 beds in emergencies — the so-called ''crisis" expansion. In point of fact many of these hospitals exceeded 3,000 beds during the Meuse-Argonne operation. New agencies in practically all services were developed and some reached a degree of importance which caused them to be made autonomous staff depart- ments, their chiefs becoming members of the administrative staff of the Ameri-
24
ADMINISTRATION, AMERICAN KXPEDITIONAHV FORCES
can Expeditionary Forces, e. g., the Motor Transport Corps. Throughout its history there was a progressive development of the administrative services of the American Expeditionary Forces, the direction of this evohition being, with but one exception and that transient, toward decentraUzation.**"
The prospective disembarkation of several million men, their movement to training areas, provision for their shelter and the handling, storage, and distribution of the supplies and equipment required, called for an extraordinary and immediate effort in construction.*'
To provide the organization for this purpose, a project for engineer services of the rear, including railw^ays, docks, depots, hospitals, etc., was cabled to Washington, August 5, 1917, followed on September 18, 1917, by a complete project for the rear, which listed by item the troops considered necessary for the Services of Supply.*' Under this project the strength of the rearward services, from the firing line to base ports, w^ould constitute about 35.5 per cent of the entire expeditionary force, for it included divisional, corps, and army trains and similar noncombatant organizations at the front, as well as the personnel operating ports, depots, transportation, and other facilities.**^ Despite our longer line of communications this percentage was less than that of the British whose rearward services absorbed 37.5 per cent of their total expeditionary strength, while steps were being taken to increase this to 40 per cent.^^ To the strength called for by the organization project (1,000,000 men), this project added 329,653 men, bringing the total for a balanced force, con- forming to the organization project, to 1,328,448 men.*- The line of com- munications projects called for approximately 25 per cent of this total, but because of military exigencies that command never received the full quota of troops required for its installations and activities. *-
Beginning on July 6, 1917, a series of cables was sent to the War Depart- ment fixing the order in which troops should arrive, but it was evidenct that these cables were of but transient value and that the W^ar Department should be furnished a comprehensive statement of the personnel and supplies needed, in order that there might be built up a balanced and symmetrical force, appro- priately supplied and equipped.*' Therefore, a schedule of priority shipment of personnel was prepared covering the order in which the troops should be sent to Europe.*' This schedule, approved by General Pershing and forw^arded to the War Department on October 7, divided the initial force called for into six phases, corresponding m general to combatant corps of six divisions each.*^
The French minister of war assigned to duty with headquarters of the American Expeditionary Forces, than at Chaumont, a special liaison officer who w^as the channel of communication between his office and the commander in chief, A. E. F.*^ The French high command also estabhshed at Chaumont a French mihtary mission which was organized with the same divisions or bureaus as the French General Staff.** One of its sections was charged with Medical Department matters. This mission had full authority to act for the French Ministry of War and the French commander in chief in all matters concerning the relations of the various American services and those of the French armies, both in the French zone of the armies and the zone of the in- terior.»* The chiefs of the administrative and technical services of the Ameri-
INTRODUCTION
25
can Expeditionary Forces were authorized to communicate directly with this French mission in all matters that concerned the operation of their particular services, except such as involved questions of policy. Communications on subjects in that category were prepared for the signature of the chief of staff and submitted to him.^^ All questions of whatever nature affecting the medical services in the zone of the army were handled through the office of the medical member of this mission.^'
The commanding general, Services of Supply, A. E. F., the general pur- chasing agent and the director general of transportation were authorized to communicate directly with the various services in the French zone of the in- terior in all matters coming under their own particular control providing such correspondence did not involve questions of policy.^^ If it did, they prepared, initialed, and submitted letters for the signature of the chief of staff, A. E. F., but when the question at issue required the action of any French service in the French zone of the armies, the letter was prepared for the signature of the commander in chief.
Both before and after the provision of our liaison service, conferences con- cerning problems of importance, were held from time to time between high officers of our service and those of our allies. Among these were the confer- ences held by General Pershing with the commander in chief of other forces and those conducted by members of the general staff or the chiefs of admin- istrative staff departments.^"
The American forces were also represented on a number of interallied councils which were chiefly concerned with procurement. The Allied Mari- time Transport Council was engaged primarily in provision of tonnage in relation to the four main requirements, viz, food, munitions, raw materials, and fuel supply of the American Expeditionary Forces during 1918-19.*^
The resources of our allies in men and material had been taxed to very grave limits, but they always stood ready to furnish us with needed supplies, equipment, and transportation when these were at all available. The develop- ment of our program for construction, transportation, hospitalization, and other essential activities predicated the highest degree of cooperation between the American and allied services.**
With the growth of the American Expeditionary Forces the activities of the several sections of the general staff not only became greatly intensified but also widely extended in scope. The first section engaged in development of policies, and the fifth (which, as is explained below, later became the fourth charged with supply and coordination) continued to be of special interest to the Medical Department.*' The fifth section necessarily supervised more and more closely the activities of the various supply bureaus with a view of balancing effort and keeping all establishments on a corresponding footing.*' As problems increased in number and complexity it developed that the division of duties • and responsibilities between the coordination and administration sections were not fully understood outside of the sections themselves.*^ These were redis- tributed to a degree, by Memorandum No. 129, H. A. E. F., November 19, 1917, in which the duties of each of these sections were carefully defined.*^ The same order which decentralized and simplified staff methods of adminis-
26
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
tration, also indicated the direction in which the fifth, or coordination section, was developing by specifying its duties as follows: ^°
All questions concerning supply and transportation in France. Operations of the technical services except the Red Cross, Y. M. C. A., and other similar agencies, the General Pershing Board, War Risk Bureau, auditors, and Field Ambulance Service. Operations of the line of communications and the transportation department. Statistics concerning supply, construction, and transportation. Supply and transportation arrangement for com- bat. Assignments of labor and labor troops. Location of railway and supply establish- ments. Hospitalization and evacuation of sick and wounded. Orders for assignment of new units.
In the meantime, studies of the British and French systems of staff organiza- tion as well as our own were continued with the result that a system giving more thorough staff coordination and control of the important services of con- struction, transportation, and supply was evolved.^*' Among other changes, the evolved system restricted the jurisdiction of the coordination section in the supply of the American Expeditionary Forces to matters intrinsic to that command and delegated to the first (administrative) section the supervision of procurement from the United States, the allotment of tonnage, and the arrangements for transportation to France, while the coordination section con- tinued to deal with questions of supply and transportation in France.^" Matters arising under these two latter subjects included operations of the technical and supply services, operations on the line of communications, and activities of the transportation department. Studies and recommendations for the location and character of railway and other establishments required for the transporta- tion and service of our troops continued to come to this section for appro val.^^ The same was true with regard to all depot and hospitalization projects, includ- ing not only the location of these installations, but also the storage capacity of depots and the bed capacity of hospitals. Arrangements for the evacua- tion of sick and wounded and orders for the original assignment of troops arriving in France were also made in this section. In the course of time, how- ever, as the armies began to take shape, the procedure involved in such assign- ment became practically automatic.
By the middle of January, 1918, it became evident that some important, if not radical, reorganization of general headquarters was necessary.^^ Accord- ingly, on January 22, 1918, the following letter was sent by direction of the commander in chief to the heads of all staff departments
1. General Orders No. 8, G. H. Q., A. E. F., 1917 (corrected), prescribing the distri- bution of staff duties at these headquarters has been in operation long enough to give the system a fair trial. While it is believed that the fundamental principles of the order are generally sound, cases have arisen where there is an overlapping of functions. In some cases experience may have shown that certain subjects have been incorrectly assigned or not distinctly defined.
2. The principles of the order seem to be well understood by those primarily concerned with its operation, but, on the other hand, it does not seem to be so drafted as to give a clear presentation of the system to the outsider.
3. With a view of taking advantage of the experience thus far gained in the operation of this order, it is desired that you submit, not later than February 5, a report with vour recom- mendations embodjdng the following:
(a) What changes, if any, do you recommend for your own section or department?
INTRODUCTION
27
(6) What changes, if any, do you recommend in any section or department, other than your own, which would facilitate the work of your section or department?
(c) Any suggestions which would make the order more clear to an outsider who has to deal with the system.
(d) Any other suggestions or recommendations on the subject of organization of these headquarters and the line of communications.
To the questions raised in the foregoing, the chief surgeon, A. E. F., under date of February 4, 1918, replied as follows:
1. It is believed that the assignment of duties in tWs order so far as it concerns the Medi- cal Department are substantially correct, and so far as can be ascertained there is no over- lapping of functions. Some of the duties which were not exactly clear when the orders were issued have been settled completely, and it is believed that the assignments are satis- factory to the Medical Department at present. Since the order was issued much of the technical work of the Medical Department has been assigned to the coordinating section of the general staff instead of the administrative section. This is perfectly satisfactory to the Medical Department. Frankly, it is believed to be a step in advance.
2. The chief surgeon is pleased to present certain recommendations in regard to the work of his office:
(A) 1. Since headquarters have come to Chaumont, we have been handicapped in the hospitalization section of this office by reason of the fact that our hospital construction is done by the chief engineer, line of communications, and the running repairs and certain materials for these hospitals are furnished by the chief quartermaster, line of communications, and by further fact that we must correspond with those officers through their chiefs at these headquarters. There has also been a delay in the transaction of business by reason of the fact that investigation from this office of contemplated hospital sites and of construction, the making of leases, etc., is diflRcult by reason of the great distance to many of our hospital- ization sites. For this reason it is believed to be good administration to remove a part of the hospitalization section from this office to the line of communications, and to request authority to transact business with the chief engineer, line of communications, and the chief quartermaster, line of communications, through this branch of the hospitalization service. This, it is believed, will facilitate business and lessen to a great extent the necessary official correspondence. This part of the hospitalization section can make a great many of the inspections of contemplated hospital sites, inspections of construction, leases, etc., without taking an officer from this office — a saving of time and mileage.
2. It is believed that the statistical section of the sanitary and statistical division (the sick and wounded) of this office can be detached from this office without loss of efficiency. In my opinion this section should be in Paris where it will be in close touch with the French bureau of statistics where necessary data for American patients in French hospitals must be obtained. If for any good and sufficient reason this location can not be approved it should be separated from general headquarters and attached to chief surgeon's office, headquarters, line of communications.
3. The time has come when the question of general sanitary inspectors for the American Expeditionary Forces must l)e taken up. This subject has not been presented before, because suitable officers were not available for this very important work. As officers with the required cjualifications will soon arrive in France this question will be presented in a very short time.
(B) 1. The coordinating section of the general staff is modeled after the fourth bureau of the French War Department, but in accepting this organization, a very important part of the fourth bureau, as far as the Medical Department is concerned, was omitted, namely. Medical Department representation. The fourth bureau of the French War Department works in a most satisfactory manner to its medical department for several medical officers are constantly on duty at general headquarters with that bureau. I strongly urge that the Medical Department be given representation on the general staff. It seems so clear that this should be done that it is believed specific failures of coordination under the present organization need not be presented. Moreover the time is rapidly approaching when the demand for this representation will become more urgent.
28
ADMINISTRATION, AMERICAN EXPEDITIONARY ?T)R('ES
2. It is believed a part of the hospitalization section should be sent to the line of commu- nication and that this office should be authorized to transact business direct through this section with the chief engineer, line of communications, and chief ciuartermastcr, line of communications, in regard to all cjuestions of approved hospitalization.
3. It is believed that the activities of the American Red Cross so far as they relate to the Medical Department should be transacted through the coordinating section instead of the administrative section of the general staff.
(C) 1. No suggestions to make under this heading.
(D) The following recommendations are made:
1. It is strongh^ urged that the Medical Department be given representation on the general staff.
2. That an officer of the Medical Department be appointed liaison officer with the French service de sante. Practically all the hospitals that we possess to-day in France have been transferred to us by this service and ^ve have been greatly handicapped by not having a liaison officer in the office of the sous-secretaire du service de sante. They consider this of such great importance that they have repeatedly asked for this representation from the Medical Department.
3. That the supervision of the activities of the American Red Cross so far as they relate to the Medical Department be transferred from the administrative section to the coordinating section, general staff.
4. That authority be given for the transfer of a unit of the hospitalization office to the line of communications and that this office be authorized to conduct its correspondence with the chief engineer, line of communications, and chief quartermaster, line of communi- cations, on all approved projects through this unit.
5. That the statistical section of the sanitary and statistical division of this office be transferred elsewhere.
6. That a statistical unit be stationed in Paris in close liaison with the statistical division of the French War Department for the collection and transmission to Washington of the sick and wounded data required by the Pension Bureau. This is believed to be necessary by reason of the great number of sick we will have in French hospitals for many months to come and by the further fact that we will also have in our hospitals many French patients.
A board appointed to meet and consider the replies of the various staff chiefs met on February 8 and heard the chiefs of staff departments and other interested officers. It reduced all views and suggestions to the following questions :
(1) What changes, if any, should be made in the administration of supply in order to reheve the commander in chief from the immediate direction thereof, and place direct and complete responsibility therefor upon some competent authority?
(2) What changes, if any, should be made in the organization of the General Staff, in order to insure greater efficiency and more harmonious relations?
(3) What further changes, if any, should be made as a result of the disposition of the foregoing questions?
An analysis of the situation as developed by these inquiries was made with a view of effecting necessary improvements. It was found that diversity of opinion and practice existed among the different chiefs of the administrative services with respect to the degree of personal responsibility assumed and methods employed in details of supply; also, in decentralizing to secure a dis- tribution of the heavy burdens of administration and the execution of the tasks incident thereto, there had been an undesirable division of responsibility and authority which at times led to uncertainty and hesitancy which might prove disastrous in an emergency The analysis also indicated the immediate necessity for providing a single and direct line of responsibility for all matters
INTRODUCTION
29
of supply with coincident full utilization of the services of the experienced chiefs of the various administrative and supply departments. The board made a number of important findings and recommendations, which were approved by the commander in chief and given practical application by the publication of General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918.'^ Other impor- tant recommendations having been submitted later, a corrected copy of this order was published March 13, 1918, but as of the date of the original.^^ Some of its most important provisions may be mentioned here; e. g., control of com- batant troops was separated from that of all supply departments and of miscel- laneous organizations in rear of them, the whole American Expeditionary Forces being divided into the zone of the armies and the Services of Supply (designated in the first copy of this order as the Service of the Rear). Over the former, comprising the organizations at the front (armies, corps, divisions, etc.) the general staff exercised direct control while over the latter its control was indirect, through the commanding general, Services of Supply. The general staff remained at headquarters, A. E. F., at Chaumont, but headquarters of the Services of Supply was located at Tours where it absorbed headquarters of the preexisting line of communications.
The general staff was reconstructed as follows: A chief of staff, secretary of the general staff, and five sections of the general staff, each under an assistant chief of staff, were provided for, and among these specific duties were allocated. The numerical designation of each section now corresponded closely to that of the section of the French General Staff which was charged with similar duties. Though this correspondence was incidental to the reorganization, it facilitated the transaction of business between the two armies.
The administration section became the first section, the intelligence section became the second, and the operations, coordination, and training sections became, respectively, the third, fourth, and fifth sections of the general staff. For convenience the names of the sections were abbreviated to G-1, G-2, and so forth.
As to the duties assigned to these several sections it is sufficient here to state that G-1 was charged, among other duties, with ocean tonnage, priority of overseas shipments, replacements, organization, and equipment (in consulta- tion with G-3) and with control of the American Red Cross, Young Men's Christian Association, and similar agencies; G-2 was charged with procurement of information, secret service, topography, and censorship; G-3 with operations, liaison, general organization, and equipment; G-4 with supply, construction, and transportation in France, statistics concerning the above, supply and transportation for combat, hospitalization, and evacuation of the sick and wounded, all operations of the Services of Supply not assigned to other sections of the general staff and assignment of all new units arriving in France; G-5 was charged with all activities pertaining to training, and it cooperated with the third section in matters affecting organization and equipment.
As the first, fourth, and fifth sections of the general staff were now of especial interest to the Medical Department, some further discussion concerning them is deemed necessary.
It was not intended that the administrative section of the general staff should directly control an}' of the supply bureaus, nor supplant the executive
30
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
heads of these important services, nor Hniit them in the exercise of their authority in the internal administration of their own departments."^ The sole function of this section of the general staff was to supervise the general policies of the American Expeditionary Forces, in so far as this section was concerned, to coordinate the activities of those departments and troops wliich were engaged in the services of administration, supply, and evacuation, to preserve a just balance between them, and to insure that their operations as a whole har- monized with one another and w^ith the plans of campaign.
The fourth section of the general staff was the connecting link betw een the general staff on the one hand and the Services of Supply on the other in all matters affecting the Services of Supply w^hich were not assigned to other sec- tions of the general staff. Its functions in maintaining intimate relations between the office of the chief of staff, G. H. Q., and these various agencies in the Services of Supply were both executive and advisory. It kept available the latest information regarding supplies, state of construction, and efficiency of rail transportation, studying and frequently reporting upon the practical working of all technical staff and supply departments. Projects of any impor- tance, especially those involving location of facilities, were examined by this section to assure their harmony with the general scheme.^^ This section, which had become of especial interest to the Medical Department after the publication of Memorandum No. 129, H. A. E. F., 1917, which charged it, among other duties, with, the provision of hospital facilities and the evacuation of sick and wounded, continued to exercise jurisdiction over a larger number of the interests of the Medical Department than did any other section of the general staff.^^ Its greatest importance to the Medical Department arose from its control of policies and programs for hospitalization, storage, transportation and supply, evacuation of wounded, assignment of units newly arriving in France, and staff control of labor.^*'
Also, the fact that it was charged with supervision of all operations of the Services of Supply, not assigned to other sections of the general staff, brought under its control a number of other matters, in which the Medical Department was interested.®^ Because of the importance to the Medical Department of the American National Red Cross, particularly in matters pertaining to hospitaliza- tion and supply, an effort was made to have control of this society transferred to this section, but this was unsuccessful.®"
The fifth section, general staff, was charged with instruction and training throughout the American Expeditionary Forces.®^ These included technical training, preparation of manuals on that subject, promulgation of training bulletins and courses of instruction, supervision of centers of instruction, and staff schools. After the armistice was signed it was vested with control of edu- cation, athletics, and entertainment.®^ This section w^as of especial interest to the Medical Department through the supervision it exercised over the Army sanitary school at Langres, the Joinville training area, where medical units awaiting assignment were concentrated, and over the training of medical units and detachments in divisional training areas.®^
After the reorganization prescribed by General Orders, No. 31, the general staff continued to concern itself with the broader phases of control. Under the
13901—27. (Face p. 31.)
Fig. 1.— LilH■^^ of comnviinicfition, A. E. F., showing also the sections comprisinR the Sei vices of Supply
INTRODUCTION
31
supervision of the commander in chief and pursuant to clearly determined policies, the assistant chiefs of staff at the head of their respective sections, sever- ally coordinated by the chief of staff, issued instructions and gave general direction to the great combat units and to the Services of Supply, keeping always in close touch with the manner and promptness of compliance.^^ Thus a system of direct responsibihty was put into operation which contemplated secrecy in preparation, prompt decision in emergency, and coordinate action in execution.^^ This supervision by the general staff included matters relating to new troops and new equipment, excepting only such details as pertained to the troops in the Services of Supply.''^ General headquarters, A. E. F., also retained immediate control of military transportation and supply in the zone of the armies and control of war material required in the conduct of military operations.
The plans for operations of the Allies were communicated only to the com- mander in chief and by him to a small number of higher staff officers under his immediate command.^^ Arrangements for the employment of American troops in conformity therewith were necessarily made at general headquarters, and G-4 being responsible for supply and transportation arrangements for combat, was obliged to keep in close touch with the Services of Supply in order that the activities of that command might be fully coordinated with the prosecution of the plans of the commander in chief.^'
The chiefs of the three purely administrative staff services were retained with the general staff at general headquarters, which remained at Chaumont, but the chiefs of the other staff departments were transferred to headquarters of the Services of Supply at Tours.^^ The departments whose chiefs were re- tained at general headquarters were those of the adjutant general, the inspector general, and the judge advocate.
As previously stated, the jurisdiction known as the line of communications was replaced by the Services of Supply.®^ The commanding officer of this jurisdiction, whose headquarters remained at Tours and whose official status remained unchanged, was charged with transportation, construction, territorial command, and control of supply, sanitary, and telegraph service throughout the territorial area of the Services of Supply. The Services of Supply was divided for administrative purposes into an advance section, an intermediate section, eight base sections in France, England, and Italy, the district of Paris, and the Arrondissement of Tours. After the armistice was signed a ninth base section was established with headquarters at Antwerp for the service of the Third Army."^
While the chiefs of the purely administrative services (the adjutant general, the inspector general and the judge advocate general) were retained with the general staff at headquarters, A. E. F., at Chaumont, the chiefs of what were now designated the "technical and administrative" staff departments, were transferred to the headquarters of the Services of Supply at Tours.^^ The de- partment whose chiefs were thus transferred were the following: The Quarter- master Corps, Medical Corps, Corps of Engineers, Ordnance Department, Signal Corps, Air Service, general purchasing board, Gas Service, service of utilities (newly created by this order) and the provost marshal service. The 13901—27 3
32
ADMINISTRATION, ArVFEHICAN EXPEDITIONARY FORCES
chiefs of these staff departments retained their former duties and authority as members of the staff of the commander in chief but exercised their duties in matters of procurement, transportation, and construction and supply under the direction of the commanding officer, Services of Supply, who coordinated their activities in these matters. They were directed so to organize their offices that the efficiency of their service would not be impaired by necessary absences for conferences with the commander in chief or for other duty assigned them by him.
Each was authorized and expected to travel throughout the American Expeditionary Forces to supervise and direct the activities of his department in all its elements, including combat units. The duties of these chiefs of staff departments were therefore of a dual character. Thus the chief surgeon, A. E. F., was, on the one hand, the chief surgeon of the Services of Supply, supervising Medical Department activities throughout its area, and, on the other, w^as the chief surgeon of all the American troops in Europe from the Murman coast to Italy.
In so far as the Services of Supply is concerned, it is sufficient to state here that the staff organization of that jurisdiction consisted of a general staff, divided into four sections (later reduced to three), and of an administrative staff whose departments rapidly increased in number.^^
Besides effecting the changes already mentioned, General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918, further directed that the distribution of staff duties in army, corps, divisions, and other commands subordinate to general headquarters, correspond in principle to that prescribed for general headquarters. General Orders, No. 9, G. H. Q., A. E. F., January 15, 1918, which had created the First Army had provided for that organization a chief of staff, a general staff of 4 sections and 12 administrative and technical serv- ices, but by General Orders, No. 120, G. H. Q., A. E. F., July 24, 1918, its staff was made to consist of a chief of staff, 5 general staff sections, a chief of artillery, and 13 administrative and technical services. The same organization was prescribed for the Second Army, created by General Orders, No. 175, G. H. Q., A. E. F., October 10, 1918, and for the Third Army, created by General Orders, No. 198, G. H. Q., A. E. F., November 7, 1918, except that for the last mentioned no tank service was provided.
The headquarters staff of the First Corps as organized by General Orders, No. 9, G. FT. Q., A. E. F., January 15, 1918, consisted of a chief of staff, a general staff of 4 sections (administrative, intelligence, operations, and training, and coordination), and 12 administrative and technical services. The same organization was prescribed for the Second, Third, and Fourth Corps by Gen- eral Orders, No. 102, G. H. Q., A. E. F., June 25, 1918, but by General Orders, No. 136, August 19, 1918, the organization of a corps was made to conform to Tables of Organization 102, series B, War Department, corrected to April 20, 1918. Thereafter the headquarters staff of each corps consisted of a chief of staff, 3 general staff sections (1, operations; 2, administration and coordination; and 3, intelligence), and 12 administrative and technical services until a thirteenth staff service (the motor transport) was added, by General Orders, No. 219, G. H. Q., A. E. F., November 29, 1918. Similarly, the headquarters
INTRODUCTION
33
of an Infantry division as prescribed by Table 2, series A, Tables of Organiza- tion, dated October 1, 1918, provided for a general staff with the same sections as those authorized for the corps and for nine administrative and technical staff departments.
The system of general staff control and subdivision prescribed for head- quarters of the American Expeditionary Forces thus was applied to lower echelons of the field forces, except that in corps and divisions, the fourth section was merged with the first and the fifth section with the third. Control of the field activities of the Medical Department which were vested in the fourth section of the general staff at headquarters, A. E. F., was thus assigned to the control of G-1 in corps and divisions — a circumstance which proved to be undesirable and confusing.®*
REFERENCES
(1) List of militarj^ attaches. On file, Army War College (2279).
(2) Personnel cards of officers assigned as military observers, filed under the individual's
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(3) Wadhams, Sanford H., Col., M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Problems - of the Medical Department, American Expeditionary Forces. The Military Surgeon, Washington, D. C, December, 1919, xlv, No. 6, 636.
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(5) Memorandum from the Secretary of War, to the Secretary of State, August 12, 1914.
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(6) Cablegram from the Military Attache, London, to the Secretary of War, August 17,
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(8) Cablegram from the Military Attach^, London, to Chief of the War College Division,
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(9) Memorandum from the Chief of Staff, to the Surgeon General, August 12, 1914, Subject
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(10) Letter from The Adjutant General, to Maj. J. H. Ford, M. C, September 1, 1914.
Subject: Detail as military observer. On file, Commissioned Personnel Division, S. G. O.
(11) Special Orders No. 250, War Department, October 27, 1915. Paragraph 15.
(12) Telegram from Assistant Secretary of War, to American Ambassador, Paris, September
9, 1914. On file, Commissioned Personnel Division, S. G. O.
(13) Letter from the chief of the War College Division, General Staff, to the Surgeon General-
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(14) Letter from Sir William Osier, to the President of the United States, Woodrow Wilson,
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(16) Letter order from The Adjutant General, to the Surgeon General, April 10, 1916.
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(17) Based on card index, showing details to the German Army. On file, Army War College.
(18) Letter from Col. A. E. Bradley, M. C, to the Surgeon General, June 11, 1917. Subject:
Medical personnel serving with British Forces. On file, Record Room, S. G. O., 9795 (Old Files).
34 ADMIXISTRATIOX, AMERICAN EXPEDITIONARY FORCES
(19) Letter orders from The Adjutant General, to Col. A. E. Bradley, M. C, and Maj.
Clyde S. Ford, M. C, May 29, 1917. Subject: Assignments. On file, Record Room, S. G. O., 9795 (Old Files).
(20) Personal report of Maj. W. J. L. Lyster, M. C, to the Surgeon General, June 30, 1917.
On file, Commissioned Personnel Division, S. G. O.
(21) Telegram from chief of staff, A. E. F., to Maj. W. J. L. Lyster, M. C, Paris, June 9,
1917. On file, Record Room, S. G. O., 9795 (Old Files).
(22) Letter from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, liaison officer,
London, June 25, 1917. Subject: Instructions. The administration of American medical personnel with the British in relation to the A. E. F. On file. Record Room, S. G. O., 76278 (Old Files).
(23) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., June 21,
1917. Subject: Report of personnel of chief surgeon's office. On file, A. G. O., World War Division, chief surgeon's files, 321.6.
(24) Special Orders No. 26, Headquarters, A. E. F., July 4, 1917. Paragraph 2. On file,
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(25) Letter from the British War Office, to the American Ambassador, London, February 23,
1917. Subject: Veterinary observer. On file, x\rmy War College, 6467.
(26) Letter from The Adjutant General, to Veterinarian William P. Hill, 6th Field Artillery,
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(27) Letter from The Adjutant General to Veterinarian William P. Hill, March 10, 1917.
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(29) Letter from Chief of War College Division, General Staff, to the Surgeon General,
June 5, 1915. Subject: Detail of medical observer with French armies. On file, Record Room, S. G. O., 150021 (Old Files).
(30) Second indorsement from the Surgeon General to The Adjutant General, June 12, 1915,
on letter from Chief of War College Division, General Staff, to the Surgeon General, June 5, 1915. Subject: Detail medical observer with French armies. On file, Record Room, S. G. O., 150021 (Old Files).
(31) Letter Order from The Adjutant General to Maj. James R. Church, M. C, November
15, 1915. Subject: Detail. On file, Commissioned Personnel Division, S. G. O.
(32) Letter from the Secretary of State to the Secretary of War, September 1, 1916. Subject:
Request medical officer visit prisoners of war in France. On file, Record Room, S. G. O., 150021 (Old Files).
(33) Second indorsement from the Surgeon General to The Adjutant General, September
12, 1916, on letter from the Secretary of State to Secretary of War, September 1, 1916. Subject: Request medical ofl^icer visit prisoners of war in France. On file, Record Room, S. G. O., 150021 (Old Files).
(34) Letter from The Adjutant General to Maj. S. H. Wadhams, M. C, September 25, 1916.
Subject: Detail as military observer. On file, Record Room, S. G. O., 76283 (Old Files).
(35) Letter from Acting Chief, War College Division, General Staff, to Maj. S. H. Wadhams,
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(36) Letter from Maj. James Robb Church, M. C, Maj. James A. Logan, jr., Q. M. C, Capt.
J. M. Barker, 3d Inf., Capt. Frank Parker, 11th Cav., Capt. M. Churchill, Field Art., Veterinarian W^m. P. Hill, 6th Field Art., to Chief, War College Division, General Staff, July 19, 1916. Subject: Recommendation as to organization of militarj^ observers. On file, Army War College (8679).
(37) Letter from Acting Chief of War College Division, General Staff, to Maj. James A.
Logan, jr., Q. M. C, Paris, November 21, 1916. Subject: Organization of military mission. On file. Army War College (8679). • (38) Letter from the chief of the American military mission, Paris, to the Chief of the War College, General Staff, February 14, 1917. Subject: Increased opportunities for military observers. On file. Army War College (8719).
INTRODUCTION
35
(39) Letter from officer in charge of military intelligence to Col. A. E. Bradley, M. C, Maj. Clyde S. Ford, M. C, Maj. W. J. L. Lyster, M. C, Maj. Sanford H. Wadhams, M. C, and Maj. James A. Logan, jr., Q. M. C, February 10, 1917. Subject: Medico- military information. On file. Army War College (8679).
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(41) Report from chief of medical group to assistant chief of staff, 4th section of general
staff, December 31, 1918. Subject: Activities of medical group, 4th section, general, staff, General Headquarters, A. E. F. Copy on file, Historical Division, S. G. O.
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1917, Subject: Reporting to General Pershing. On file. Army War College (10050)
(43) Letter from the Surgeon General to The Adjutant General, October 18, 1916. Subject:
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(45) Telegram from the Surgeon General to Maj. Robert M. Culler, M. C, October 27,
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(46) Special Orders No. 105, War Department, May 7, 1917. On file. Record Room,
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(47) Letter from the Surgeon General to Mr. L. Jouvard, president of French Benevolent
Society, French Hospital, New York City, May 22, 1917. Subject: Major Culler's status. On file. Record Room, S. G. O., 104882 (Old Files).
(48) Special Orders, No. 115, Headquarters, A. E. F., October 3, 1917. Paragraph 6.
(49) Special Orders, No. 60, Headquarters, Line of Communications, A. E. F., October 7,
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(50) Personal report from Maj. William L. Keller, M. C, to the Surgeon General, April 3,
1923. On file. Commissioned Personnel Division, S. G. O.
(51) Special Orders, No. 105, War Department, May 7, 1917. Paragraph 28.
(52) Special Orders, No. 66, Headquarters, A. E. F., March 7, 1918. Paragraph 48.
(53) Special Orders, No. 81, War Department, April 9, 1917. Paragraph 17.
(54) Special Orders, No. 81, War Department, April 9, 1917. Paragraph 18.
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(56) Special Orders, No. 105, War Department, May 7, 1917. Paragraph 28.
(57) Special Orders, No. 28, Headquarters, A. E. F., July 6, 1917. Paragraph 9.
(58) Special Orders, No. 68, Headquarters, A. E. F., August 15, 1917. Paragraph 11.
(59) Annual Report of the Surgeon General, U. S. Army, 1916, 18-19; 1917, 22.
(60) Report from Col. Percy L. Jones, M. C, Chief of the U. S. Army Ambulance Service
with the French Army, to the Surgeon General, U. S. Army, April 15, 1919. Subject: U. S. Army Ambulance Service with the French Army. On file, Historical Division, S. G. O.
(61) Memorandum from Col. Jefferson R. Kean, M. C, to the Surgeon General, April 4,
1917. Subject: Organization of base hospitals. On file, Record Room, S. G. O., 15542 (Old Files).
(62) Report on origin and organization of base hospitals and other sanitary units (undated)
by Col. Jefferson R. Kean, M. C. On file. Historical Division, S. G. O.
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S. G. O., 9795 (Old Files) ; also, telegram from the Surgeon General to Maj. Robert M. Culler, M. C, October 27, 1916. On file, Record Room, S. G. O., 104882 (Old Files); also, personal report from Maj. William L. Keller, to the Surgeon General, April 3, 1923. On file, Historical Division, S. G. O.; also. Special Orders No. 81, War Department, April 9, 1917.
36 ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
(64) Letter from the Surgeon General to the Chief of Staff. May 1, 1917. Subject: Memo-
randum from Col. T. H. Goodwin, R. A. M. C. Copy on file, Record Room, S. G. O., 172158 (Old Files).
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(82) Memorandum from Gen. John J. Pershing, to The Adjutant General, U. S. Army,
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(83) Memorandum from the commander in chief to The Adjutant General, U. S. Armv,
October 7, 1917. Subject: Priority of shipment (personnel). On file. General Headquarters, A. E. F. Records.
(84) General Orders, No. 40, G. H. Q., A. E. F., September 20, 1917.
(85) Organization of the Services of Supply, A. E. F., Monograph No. 7, 19.
(86) Statement based on the final report of General Pershing, September 1, 1919, and report
of the assistant chief of staff, fourth section, general staff. General Headquarters, A. E. F.. to the chief of staff, June 1, 1919. On file. General Headquarters, A. E. I- ' Records. '
(87) Minutes of the Allied Maritime Transport Council, September 27 1918 On file
Historical Branch, War Plans Division, General Staff.
(88) Final report of Gen. John J. Pershing, 90.
INTRODUCTION
37
(89) Report from the assistant chief of staff, fourth section, G. H. Q., A. E. F., appendix "J."
(90) Ibid., 15.
(91) Ibid., 16.
(92) Letter from commander in chief, to chiefs of staff departments, A. E. F., January 22,
1918. Subject: Reorganization. On file, A. G. O., World War Division, chief surgeon's file, A. E. F. (321.6).
(93) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., February
4, 1918. Subject: Reorganization. On file, A. G. O., World War Division, chief surgeon's file, A. E. F. (321.6).
(94) Report from the chief surgeon, A. E. F., to the commanding general, S. O. S., A. E. F.,
July 1, 1918. Subject: The medical department in the A. E. F., to May 31, 1918. Copy on file, Historical Division, S. G. O.
(95) General Orders No. 31, General Headquarters, A. E. F., February 16, 1918.
(96) Final report of Gen. John J. Pershing, September 1, 1919, 12.
(97) Ibid., 68.
(98) Organization of the Services of Supph', A. E. F., Monograph No. 7, 25.
(99) Reports from the assistant chief of staff, fourth section. General Headquarters,
A. E. F., 22.
SECTION I
ORGANIZATION AND ADMINISTRATION OF THE CHIEF
SURGEON'S OFFICE
CHAPTER I
GENERAL ORGANIZATION AND DEVELOPMENT
On May 10, 1917, the Surgeon General wrote The Adjutant General of the Army as follows: ^ I recommend:
That Col. Alfred E. Bradle}- , Medical Corps, in addition to his present duties as observer with the English Army, be designated as chief surgeon United States forces in Europe.
That, as chief surgeon of United States forces in Europe, Colonel Bradlej^ be authorized to exercise over the forces under his control the same authority as the Surgeon General holds over the entire Medical Department. Similar authority was granted, on the approval of the Secretary of War February 18, 1899, to the chief surgeon of the Department of the Pacific and Eighth Army Corps (now the Philippine Department) .
In conformity with the foregoing request, The Adjutant General wrote to the officer in question, on May 28, as follows: ^
The Secretary of War designates you, in addition to your present duties as chief surgeon, United States forces in Europe.
The Secretary authorizes you, as chief surgeon of the United States forces, to exercise over the forces under your control the same authority as the Surgeon General holds over the entire Medical Department.
Meanwhile, on May 26, 1917, this officer had been designated chief surgeon of the American Expeditionary Forces in General Orders, No. 1, of that organi- zation, which was published in Washington, D. C, but neither the foregoing letter nor a copy of the order mentioned was received by him prior to the arrival of headquarters, A. E. F., in London, on June 9, 1917.^
The Medical Department personnel which accompanied the commander in chief consisted of 4 officers, 2 enlisted men, and 4 civilian clerks.* On arrival in London they were joined by the chief surgeon, who had been serving as military observer with the British, but who, on May 29, had been relieved from that assignment.^ One of his first duties as chief surgeon, A. E. F., was the formulation of instructions for the liaison officer for the Medical Depart- ment with the British, who also had been serving as a military observer and who was now charged with supervision of the base hospitals and casual per- sonnel of the American Expeditionary Forces which were under British control.^
On June 13, headquarters, A. E. F., moved to Paris,^ where, by the 17th, it was joined by three other medical officers who had been serving as military observers with the French or British forces.^ When headquarters, A. E. F., established itself in Paris the chief surgeon's office force, now consisting of
39
PLATE I
PLATE 2
42
ADMIXISTHATIOX, AMERICAX EXPEDITIONARY FORCES
seven medical officers and about twice that number of clerks, was located, with other bureaus, in a small residential building where it occupied three small rooms. ^ Almost immediately the chief surgeon and certain members of his staflf began tours of inspection in order to determine matters concernmg hospitalization at base ports and along the line of communications.^" On July 4, a medical officer was relieved from duty in the chief surgeon's office and assigned as surgeon of base section No. 1 (St. Nazaire), w-here the first contingent of troops was expected to debark.
When the staff of the American Expeditionary Forces was organized and its several duties were defined by General Orders, No. 8, Headquarters, A. E. F., July 8, 1917, the functions assigned to the Medical Department were as follows:
Sanitation of camps, quarters, and occupied territory; health of command; care of sick and wounded; collection and evacuation of sick and wounded; medical personnel; medical supplies; veterinary personnel; veterinary supplies; laundries and baths (medical aspect); disinfection of clothing, etc.; supply of personnel and material for gas defensive under super- vision of director of gas service; technical inspection of medical organizations and estab- lishments, etc., etc.
Until the administrative structure of the American Expeditionary Forces was radically changed, as noted in the preceding chapter, by General Orders, No. 31, General Headquarters, A. E. F., February 18, 1918, the staff organi- zation in general was comparable to that existing in the War Department. The relationship of the chief surgeon's office to the general staff and to the chiefs of administrative staffs was similar to that existing between the Surgeon General's office, on the one hand, and the General Staff and the several bureaus of the War Department, on the other."
Until the American Expeditionary Forces w^as reorganized by the order mentioned the chief surgeon w^as located at headquarters with the general staff and the chiefs of other administrative staff departments, and he or his assistants, therefore, were enabled to transact business directly with the staff offices concerned.
As the general staff w^as charged with approval and coordination of all policies and projects for the American Expeditionary Forces the chief surgeon or his assistants took up directly with appropriate sections of that body all matters pertaining to the medical service which required its authoritization, coordination, or execution.
The more important policies usually were placed on record and then dis- cussed verbally. 12 It was quickly realized that very close cooperation of all elements was necessary at general headquarters and that only through cen- tralized control could prompt results be secured conforming to changing con- ditions.** Careful studies w^ere made of future needs and these after being approved by the general staff, w^ere cabled to the United States. «
Communication between the chief surgeon's office and that of the Surgeon General was carried on by letter direct, or, if circumstances required, through official channels, or by cable. Communications cabled from one office to the other passed through the respective cable offices in headquarters, A. E. F., and in
° Such relationship is described in Volume I of this history.—
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 43
the War Department. Copies of cables which the chief surgeon's office wished to send were submitted to the adjutant general, A. E. F., if they pertained to administrative matters, or if to other matters, to the Chief of Staff who referred them for examination to the appropriate section of the General Staff. A section in the office of the adjutant general edited all cables for clearness, arranged them for logical sequence with previous telegrams, and incorporated them with drafts of other cables on the same subject from other departments into one long message signed, "Pershing." The avenues for transaction of business with the medical service of the Allies are discussed in Chapter III.
After the arrival of headquarters of the 1st Division on June 26, 1917, and that of considerable casual personnel, the work of the chief surgeon's office had so multipled that the office space in headquarters, A. E. F., had become over- taxed.® Therefore, about the middle of July that office, with some other special branches of the headquarters group, moved to more commodious in the Hotel St. Anne, in the street of that name.*
Here some of the more important policies of the Medical Department were developed and adopted and considerable creative and constructive work was accomplished.® Problems which arose during the earlier stages of the American Expeditionary Forces when headquarters was located at Paris, and later at Chaumont, included determination of general policies, such as location and size of hospitals, percentage of hospital beds to total strength of the Ameri- can Expeditionary Forces; estimates of quota, distribution and training of personnel; amount and character of Medical Department supplies required; relative priority of Medical Department personnel and supplies in shipments from the United States; the tonnage such supplies would require; character and quantities of supplies that could be procured advantageously overseas; size and location of storage depots; provision of hospital trains; arrangements for care of casualties at the front, for their removal from the lines, distribution and treatment in the rear, and, if need be, sending them home; organization of gas defense; standardization of splints; provision of agencies for transaction with the Allies of business which was of mutual interest, e. g., procurement of sites for hospitals and other installations; procurement of facilities from or through the American Red Cross; control of infectious diseases, especially of venereal diseases; organization of the laboratory system and of the professional services; and many cognate subjects.'^ These policies of the Medical Department were determined at conferences attended by the few medical officers available at headquarters, or at more general conferences in which representatives of the Medical Department participated with those of other staff departments of the American Expeditionary Forces or with representatives of the French Army.®
A long step toward decentralization of medical service was taken when a chief surgeon was designated for the line of communications.'® The necessity for such an organization arose when the 1st Division arrived in July, and moved to its training area in the Vosges. The geographical limits of the line of com- munications extended from the sea to the point where supplies were delivered to the field transportation of the combat forces less such areas as might be excepted. Headquarters of this jurisdiction, while undergoing organization, was located in Paris, whence it moved January 13, 1918, to Tours.®
44
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
A colonel, Medical Corps, who arrived with a small force on July 18 was assigned as chief surgeon, line of communications,'^ and was vested with immedi- ate supervision of Medical Department personnel and transportation, base hospitals, sanitation, and suppHes, in its jurisdiction. As his office was located in the same building as that occupied by the chief surgeon, A. E. F ., numerous conferences occurred between their representatives'® until September 1, when the latter's office moved with headquarters, A. E. F., to Chaumont.''
A medical supply officer for the American Expeditionary Forces arrived on July 20 and proceeded to the base medical supply depot being established at Cosne.'^ As additional personnel was now^ necessary in the office of the chief surgeon, A. E. F., and that of the chief surgeon of the line of communica- tions the adjutants of the six American base hospitals already serving with the British (as mentioned in Chapter I) were relieved from duty therewith and ordered to Paris, where two of them were assigned to the office of the chief surgeon, A. E. F., and four to the office of the surgeon, line of communications.* Also an American medical officer who had been serving at a French hospital at Ris Orangis and one who had been studying the organization of gas warfare in England were ordered to join the office of the chief surgeon, A. E. F.^°
Until the latter part of Juh^, 1917, the chief surgeon's office, A. E. F., had not been divided into sections and none of its personnel had been assigned to particular duties exclusively.'^ Nearly all of the work transacted had been of a character which required determination of broad general policies which were part of or conformed to the three important basic projects of the American Expeditionary Forces discussed in the preceding chapter.
As troops began to arrive in increasing numbers, more specific alloca- tion of duties became necessary in the chief surgeon's office, in order that proper action might be taken promptly both on routine reports and on a number of diversified matters.'' For example, base hospitals which were arriving con- stantly had to be promptly and suitably located, arrangements had to be made with the French for the care or evacuation of American sick until our Medical Department establishments could care for them, the considerable numbers of casual personnel who were arriving had to be suitably classified and assigned, and many questions of policy on a w^ide range of subjects were now pressing for decision.^
After the arrival of a number of casual medical ofiicers in the latter part of July the chief surgeon's office, A. E. F., was organized on the 28th of that month, as follows :
(1) An executive officer, who assisted the chief surgeon in supervision and coordination of the sections of his office, represented him when absent at conferences or on tours of inspec- tion, and under the chief surgeon was in general charge of the administration of the medical service, A. E. F.
(2) Hospitalization.— In charge of location, construction, and repair and all other ques- tions relating to hospitals; hospital trains; and the care of sick and wounded.
(3) Sanitation and statistics. — Sanitation of camps, quarters, and occupied territory, laundries, disinfection and disinfestation, collection and evacuation of sick, health of com- mand, reports of sick and wounded, statistics and sanitary reports.
(4) Personnel— Medical, Medical Reserve, Dental, and Veterinary Corps, enlisted force, schools of instruction, and civilian emploj^ees. '
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 45
(5) Supplies. — Hospital equipment, medical, dental, and veterinary supplies, settlement of accounts, ambulances, and all motor transportation.
(6) Records and correspondence.
(7) Chemical Warfare Service. — Defensive gas, gas school, and all professional questions relating to gas.
There was but one officer on duty with each of the sections mentioned above except that the head of the hospitalization section (who was also charged with Franco-American liaison which is discussed in Chapter III) had a commissioned assistant.^ These officers also handled general estimates of personnel and equipment.^ Associated with this headquarters group was another officer who had been designated attending surgeon.^
During the week ending August 4, 1917, a liaison officer was appointed to function between the Medical Department and the coordination section of the general staff, an innovation which it was anticipated would greatly promote transaction of business between the two offices.
The chief surgeon was also represented by a liaison officer at the head- quarters of the American Red Cross and of the Young Men's Christian Associa- tion in Paris. He also maintained close contact with the other societies serving the American Expeditionary Forces and availed himself of their cooperation as circumstances indicated.
So much of the American Red Cross in Europe as was called into the service of the American Expeditionary Forces came under the immediate jurisdiction of the chief surgeon, A. E. F., though in the last analysis that and other hke societies serving the American Expeditionary Forces were under the control of the first section of the general staff The activities of the American Red Cross in the military service were quite diversified, but in very general terms they pertained especially to hospitilization and medical supply.
On August 23 a dental officer was assigned to duty in the chief surgeon's office and began, in the personnel division, the organization of the dental service of the American Expeditionary Forces.^*
After the chief surgeon's office had been moved from Paris to Chaumont, September 1, 1917, in the zone of the armies, it occupied the upper floors in the west end of the south barracks at that place. The floor space allotted here to the chief surgeon's office was many times as great as that which had just been vacated in Paris, for it was appreciated that a large increase in its personnel would soon be necessary.^ The chief surgeon's office when established in Chaumont included 10 commissioned officers of the Medical Department." Before leaving Paris, 4 officers were detached to remain in that city, 1 with the water service of the line of communications, 2 as liaison officers with the Ameri- can Red Cross and the Young Men's Christian Association, respectively, and 1 who served both as the medical member of the general purchasing board, A. E. F., and later as liaison officer with the French Medical Department."
The Chemical Warfare Service was established as a separate bureau by General Orders, No. 31, G. H. Q., A. E. F., September 3, 1917, and to this a medical officer in close touch with the chief surgeon's office was later assigned.
On September 13, 1917, the chief surgeon was directed to submit at as early a date as practicable a project for the Medical Department for the next
46
ADMIXISTRATIOX, AMEHICAX EXPEDITIOXAK Y FORCES
six months covering the proposed location of medical depots, laboratories, hospitals, other establishments, and sanitary units, and his project for supplies and material.
On October 9, 1917, the chief surgeon submitted the following plan of organization of his office and that of the army surgeon at army headquarters in the field: "
Fig 2.-M-ing B of group of three iiiaiii buildings, general headquarters, A. E. F., in which the ofRce of the chief surgeon ^roup, geSftafl!°I ^'""^ subsequently, of the Sai
Chief surgeon
Assistant to chief surgeon
Personnel division
Sanitation and statistics
Records and correspondence
Hospitals, construction and assignment Supplies
Major general
Total.
Briga- dier general
Colonel
Lieuten- ant colonel
Major
Captain or lieu- tenant
Clerks
or soldiers
22 .50 80 100
3
Dental and veterinary service to be represented in this personnel section by an officer ot the highest rank in these corps.
1 brigadier general. 1 colonel.
1 lieutenant colonel.
FOR ARMY HEADQUARTERS
1 major. 7 soldiers.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 47
In reply to a communication from the adjutant general, the chief surgeon, on November 7, 1917, submitted the following statement of the subdivision of duties in his office, and of the personnel that would be requu-ed to staff them,, viz, chief surgeon (1 officer), assistant to chief surgeon (1 officer), personnel division (5 officers, including 1 dental and 1 veterinary, and 22 clerks), sani- tation and statistics (3 officers and 50 clerks), records and correspondence (1 officer and 80 clerks), hospital construction and administration (6 officers and 100 clerks), supplies (1 officer and 3 clerks).-*
On November 13, 1917, a chief nurse of the American Expeditionary Forces was designated and was assigned, with an assistant, to duty in the office of the chief surgeon, line of communications. She and her assistant were not incor- porated in the office of the chief surgeon, A. E. F., until it moved to Tours. This designation of the chief nurse later was changed to "director of nursing service," but her duties remained unchanged.
The fofiowing data concerning the chief surgeon's office formed a part of the table of organization for headquarters, A. E. F., office of the commander in chief, approved by General Pershing on December 22, 1917:
Tables of organization, general headquarters, A. E. F. CHIEF SURGEON'S SECTION
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Remarks |
|
Unit |
OflBcers |
Inter- preters |
Clerks |
Sol- diers ' |
Sol- diers <• |
Total 1 3 5 9 12 2 |
|
|
General officer |
1 3 5 9 12 |
(o) Carried in headquarters battalion. (6) 1 chauffeur, 1 orderly for general officer. (c) All from Medical Department but attached to headquarters battalion for rations, pay, and clothing. (d) Clerks. (e) 3 chauffeurs, 5 clerks. (/) 5 motorcyclists, 5 chauffeurs. ig) Pistols for 9 chauffeurs, 5 motor- cyclists, 15 orderlies. f |
|||||
|
Colonels |
|||||||
|
Lieutenant colonels |
|||||||
|
Majors |
|||||||
|
Captains or lieutenants Commissioned interpreters |
|||||||
|
2 |
|||||||
|
Total commissioned. - Field clerks |
|||||||
|
30 |
2 |
32 |
|||||
|
5 |
5 |
||||||
|
M. H. sergeants |
5 5 |
5 5 5 25 58 28 73 52 |
|||||
|
Hospital sergeants |
|||||||
|
Sergeants major or bat- talion sergeants major |
|||||||
|
Sergeants, first class |
25 52 20 63 40 |
||||||
|
Sergeants |
o 4 |
h 2 •8 no * 5, 12 |
|||||
|
Corporals |
|||||||
|
Privates, first class |
|||||||
|
Privates |
|||||||
|
Total enlisted _ |
4 |
210 |
37 |
251 |
|||
|
Aggregate |
30 |
5 |
210 |
37 |
288 |
||
|
Closed cars.— _ |
1 3 5 |
1 3 5 2 3 5 15 29 |
|||||
|
Touring cars |
|||||||
|
Light cars |
|||||||
|
Motor cycles, with side cars |
2 3 5 5 ' 29 |
||||||
|
Horses, riding |
10 |
||||||
|
Pistols |
|||||||
|
RED GROSS SECTION (SERVICES VOLUNTEERED) |
|||||||
|
1 |
2 |
3 |
4 |
Remarks |
|||
|
Unit |
Officers |
Others |
Total |
||||
|
Captain - |
1 |
1 |
|||||
|
Total commissioned Not commissioned ..- |
1 |
I |
1 1 |
||||
|
Aggregate-- - |
1 |
I |
2 |
||||
|
1 |
1 |
||||||
13901—27 4
48
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
With the development of the American Expeditionary Forres, decentraliza- tion had been necessary in practically every department. This movement was investigated and the following report on this subject in so far as it pertained to the chief surgeon's office w^as forwarded to it by the adjutant general, A. E. F.,
on January 10, 1918:=^'
Statement of organization and personnel
|
Division |
Officers 1 •5 5 2 2 2 2 2 |
Clerks |
Soldiers |
|
MO 3 2 10 18 9 2 |
|||
|
4 |
|||
|
21 |
4 |
54 |
"»Two Veterinary Corps (temporary duty). ''Sorting mail.-
Personnel division. — This division keeps record of all the personnel of the Medical Corps, regular or otherwise, hospital corps sergeants, and nurses, on duty in France. Most of the records concerning personnel are kept on cards; these cards give name of college, date of graduating; whether medicine, dental or veterinary surgery; previous military service and date of appointment and call into active service; and special character of professional work; also specialty and ability to speak or translate French. These cards are made out in cases of all Medical Reserve Corps men. All medical personnel arriving in France are now assigned to duty from this office. When the system of automatic replacements is put into effect this work should be decentralized to the line of communication .
Hospitalization. — This division handles all questions relating to the establishing of hospi- tals in France. The selection of sites are passed upon by the general staff at these headquarters after conference with the French mission. It is not seen how this can be divorced from the office of the chief surgeon. The actual building and plans, etc., are now decentralized to the line of communications.
Sanitation and statistics. — All reports concerning sanitation, sick and wounded, etc., from the medical sections of all units come to this office. Statistics and reports are made up concerning them; also the weekly report to the commander in chief. If the statistical bureau is established at these and other headquarters, it is believed with representative of the Medical Department serving thereat that most sanitary reports and reports of sick and wounded could come to this bureau.
There is a certain amount of data though which should, in my opinion, come to the chief surgeon, who after all is responsible for the evacuation of sick and wounded and their care, and it is beheved that in case of heavy casualties or epidemic the chief surgeon at these head- quarters should receive the necessary data in order to enable him to understand the situation. Practically, the evacuation of sick and wounded will be automatic, but in times of emergency, the chief surgeon may have to act and exercise supervision over situations, and he must be kept informed as to the general situation. It is not necessary for him to have all the informa- tion in detail that is required for final reports to Washington. Data required for furnishing reports to the commander in chief should come to the statistical bureau at these headquarters. Others which are only required for the chief surgeon's office in Washington could be sent to the statistical bureau at the headquarters, line of communications, it is believed.
Records and correspondence. — When the automatic replacement is put into effect much of the records and correspondence work will naturally go from the chief surgeon's office to the depots of the line of communications.
There is a post office here in which is distributed all the mail for the personnel of the Medical Department serving in France. It is recommended that immediate steps be taken to have the mail distributed elsewhere, and that only mail for the personnel on duty in the Medical Department at these headquarters be forwarded here.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 49
To this the chief surgeon rephed as follows, on January 12:
1 . The receipt is acknowledged of your letter of January 10th (4773-F) .
2. Personnel division. — -Every effort has been made since arriving in France to keep the amount of work in the personnel division in this office down to the minimum. As the inspector says, there is a card in this office for everj^ member of the Medical Department. It contains only the minimum amount of information. I protest most emphatically against any proposi- tion to remove this information from my office. It is utterU^ impossible for the chief surgeon of the American Expeditionary Forces to administer his office without knowing the personnel he has available. I am not at all concerned in regard to the automatic assignment of personnel arriving in France except in such instances where it is absolutely necessary that it shall be done from these headquarters. It wish to emphasize again that I would consider it the greatest misfortune to bring details into my office which can be handled elsewhere: These details have been given to the line of communications and to the different divisions wherever it was possible to do so. This has been carried to such an extent that personal complaints have actually been made from two of the divisions that they felt very materially the loss of contact with the chief surgeon's office.
3. Hospitalization. — This paragraph hardly calls for remark except that I am not prepared to state now that I agree with the statement of the inspector that the hospital divi- sion should rest entirely in this office. This is a question that had been up many times since these headquarters moved to Chaumont. It is being studied now and if improvement on present conditions can be made it will be promptly reported to proper authorities.
4. Sanitation and statistics. — I am perfectly willing to remove from this office as much of this division as is possible, having in mind particularly routine sick and wounded reports, with the understanding that I be furnished with the information necessary to administer the office. Attention is invited to the fact that the chief surgeon can not carry out his functions without knowing the sick rate, the prevalence of epidemic diseases and the sanitary conditions of the troops.
5. Record and correspondence. — It is hoped that the automatic replacement will relieve this office of a great deal of the record and correspondence, and I will welcome any change in this respect which will not decrease efficiency,
6. Mail. — The distribution of mail which is being done in this office was not of my choice; it was forced upon the Medical Department. The condition which exists in this respect to-day is almost intolerable and I will welcome any proposition which will take this matter out of my office. It appears to me that this is a serious matter in the American Expeditionary Forces. Attention is invited to the great dissatisfaction which will be continued throughout the command if the delivery of mail, now so much delayed, is not accomplished with greater expedition.
Until February 14, 1918, there had been no general medical inspectors in the American Expeditionary Forces, but on that date two experienced officers were assigned to this duty. Though these officers functioned in the division of sanitation, chief surgeon's office, their reports considered the entire range of Medical Department responsibilities.^*
On February 16, the date General Orders, No. 31, was pubhshed, reorganiz- ing the American Expeditionary Forces, the chief surgeon's office included 19 officers, 55 clerks, and 4 orderlies. These were distributed as follows : Chief surgeon; personnel section, 2 officers, 11 clerks; dental, 1 officer, 1 clerk; hospi- talization, 5 officers, 5 clerks; supplies, 1 officer, 3 clerks; sanitation and statistics, 4 officers, 13 clerks; records and corespondence, 2 officers, 17 clerks, 4 orderlies; veterinary, 2 officers; mail, 4 clerks; property, 1 officer, 1 clerk.
On February 22, the chief surgeon's office reported that in conformity with the order mentioned above, 16 officers, 47 enlisted men, and 4 civilians, would move to Tours.'^
50
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
By General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918, the Medical Department was charged with the following duties : Sanitary inspection ; health of command; care of sick and wounded; collection and evacuation of sick and wounded; medical supplies; veterinary supplies; supply of personnel and material for gas defense under supervision of director of gas service; technical inspection of medical organizations and establishments.
In reply to a query from the general staff, A. E. F., concerning the personnel that would be required by the chief surgeon's officers the tables of organization for the Services of Supply, the chief surgeon, on March 8, 1918, submitted the following estimate:
Tables of organization, chief surgeon's office, A. E. F., Services of Siipplij
|
Unit |
Officers |
Inter- preters |
Clerks |
Sol- diers ' |
Sol- diers |
Total |
Remarks |
|
General officer. |
1 15 20 15 |
1 15 20 15 2 |
(a) Carried in headquarters battalion. (b) 1 chauffeur, 1 orderly for general OffiCGI". (c) All from Medical Department, but attached to headquarters battalion for rations, pay, and clothing. (d) Clerks. (e) 3 chauffeurs, 5 clerks. (/) 5 motorcyclists, 5 chauffeurs. (g) Pistols for 9 chauffeurs, 5 motor- cylists, 15 orderlies. |
||||
|
Colonels and lieutenant col- onels. Majors |
|||||||
|
Captains or lieutenants |
|||||||
|
Commissioned interpreters - Total commissioned.. Field clerks |
2 |
||||||
|
51 |
2 |
53 |
|||||
|
1- - |
5 |
||||||
|
Master hospital sergeants |
|||||||
|
5 5 |
5 5 5 25 58 28 73 52 |
||||||
|
Sergeants major or battalion |
•i 5 |
||||||
|
25 52 20 63 40 |
|||||||
|
Sergeants |
»4 |
1. 2 « 8 rio 12 |
|||||
|
Total enlisted |
|||||||
|
4 |
210 |
37 |
251 |
||||
|
Aggregate Closed cars..- |
|||||||
|
51 |
6 |
5 |
210 |
37 |
309 |
||
|
1 3 5 |
1 3 5 2 3 5 15 27 |
||||||
|
Touring cars __ |
|||||||
|
Light cars |
|||||||
|
Motor cycles with side cars. Motor cycles |
2 3 I '27 |
||||||
|
Bicycles |
|||||||
|
Horses, riding |
10 |
||||||
|
Pistols |
|||||||
In compliance with General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918, the chief surgeon's office arranged for removal of most of its personnel, records, and property, on the night of March 20, to Tours, where it was installed March 21.^^ Here it absorbed and superseded the office of the chief surgeon, line of communications. On March 24, the office force of the chief surgeon, A. E. F., included 33 officers and 2 nurses.
The organization prescribed by the chart approved by the commander in chief on March 6, 1918, was in general that followed in subsequent develop- ments.^'' The section charged with combat organization and new equipment was taken over by the representatives whom the chief surgeon left with the gen- eral staff at Chaumont, before he moved his office to Tours on March 21.*'* The nomenclature of the records division was later changed to administrative division, but its duties were unchanged.*^
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ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
The chiefs of the 10 technical staff departments of headquarters, A. E. ¥., who were transferred by General Orders, No. 31, 1918, to Tours, were now under the immediate jurisdiction of commanding general, Services of Supply, in all matters pertaining to procurement, supply, transportation, and construc- tion, but retained their titles and authority as members of the staff of the commander in chief, A. E. F.*^ They were directed so to organize their offices that the efficiency of their departments would not be impaired by absences for conferences or other duties assigned them, and though their headquarters were at Tours they were authorized and expected to travel throughout the American Expeditionary Forces to investigate, direct, and supervise the work of all ele- ments of their services, including those with combat units. The chief surgeon thus occupied a dual status, for he was at once the chief surgeon of the American Expeditionary Forces and of the Services of Supply.
In the Services of Supply the position of the chief surgeon in relation to the general staff of that command, and with the heads of its administrative staff departments, was altogether analogous to that which as chief surgeon, he formerly had held with the corresponding departments of general headquarters, A. E. F., at Chaumont.^^ In fact, as stated in the preceding chapter, the chiefs of all administrative staff departments, A. E. F., except the adjutant general, the judge advocate, and inspector general, A. E. F., had also been transferred to Tours where they had the same dual status as had the chief surgeon.*^ With the adjutant general, judge advocate, and inspector general of the Services of Supply his relations were the same as with the chiefs of the other staff depart- ments, but the scope of the Medical Department matters upon which they took definitive action pertained to the Services of Supply only.*^ Though the chief surgeon was represented on the general staff, A. E. F., at Chaumont, by medical officers assigned to several of its sections, he was not represented on the general staff of the Services of Supply at Tours except for a short period when a medical officer was assigned to its first section.*^ Over his subordinates in the several geographical sections (advance, intermediate, and base) into which the Services of Supply was divided, the chief surgeon exercised super- vision through the section surgeons who were members of the staffs of the officers commanding those sections.^^ His office had direct control, except in a few matters (especially discipline) over certain Medical Department forma- tions which were removed from the jurisdiction of the commanding officer of the section in which they were located; e. g. hospital centers, detached base hospitals, medical supply depots, the central Medical Department laboratory, Dijon, and such hospital trains as were assigned to his office.
The chief surgeon's office, after its location at Tours and its absorption of the office of the surgeon, line of communications, was organized into the following divisions (1) General administration, records and correspondence ; (2) hospitalization, evacuation, and hospital administration; (3) sanitation, sanitary inspection, and medical statistics; (4) personnel; (5) medical supplies'; (6) finance and accounting.
Under the chief surgeon and his executive officer, the commissioned per- sonnel of the chief surgeon's office was distributed among its several divisions on March 24, 1918, as follows Sanitation, 7; hospitalization, 6; personnel 4; supplies, 4; records and correspondence, 4; finance and accounts, 6.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 53
A chief nurse and assistant chief nurse were at the head of the nursing service in the personnel division, but members of the nursing staff were not yet commissioned.
The assistant to the chief surgeon examined all papers going to the chief surgeon for his signature and was authorized to sign these in his absence." The finance and accounting section was composed of personnel recently arrived, who had been selected from a unit that had been organized in the United States to audit property and money accounts of the Medical Department in France."
By June 3, 1918, the clerical force in the office of the chief surgeon had grown materially, but was inadequate and on that date he recommended that because of the great number of technical questions reaching his office and the
Fig. 3. -lleadnuartirs, Sirvicos of Supply, A. E. F., at Tours, viewed from within. The chief surgeon's office occupied practically the entire first floor of the wing on the right
consequent necessity for trained noncommissioned officers, the enlisted per- sonnel on duty therein should be authorized in the following proportions:*^ Master hospital sergeants, 2; hospital sergeants, 12; sergeants, first class, 35; sergeants, 60; corporals, 26; privates, first class, 40; privates, 27; total, 202. This number was exceeded by the latter part of July, 1918, for at that time the personnel then on duty in the chief surgeon's office was 43 officers and 220 clerks.*^
A seventh section ,of the veterinary service, was organized in the chief surgeon's office after the promulgation of General Orders, No. 139, on August 29, 1918.^" Before publication of that order, this activity had been under the control of the remount service of the Quartermaster Department, its chief being
54
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
without administrative authority and having virtually the status of a technical adviser only.'"' The general order mentioned, provided that the veterinary service be transferred to the Medical Department and that a new section charged with direction of veterinary affairs be created in the chief surgeon's office of which the chief veterinarian was, therefore, placed in charge.^"
After its expansion by the addition of the veterinary division the chief surgeon's office retained the general organization then provided though its personnel steadily increased in number until after the armistice was signed.^"
On November 9, 1918, 58 officers were on duty in the chief surgeon's office, distributed as follows: Chief surgeon, 1; assistant to chief surgeon, 1; general administration, 1 ; detachment of enlisted men, Medical Department, 1 ; records, 1; library, 4; hospitalization, 13 (transportation, 7; sick and wounded, 5);
Fig. 4.— Building in Tours, in which the finance and accounting division of the chief surgeon's office was located
sanitation, 4 (sanitary inspection, 1); personnel, 4 (dental, 5; promotions, 1); supplies, 5; finance and accounts, 4; veterinary, 6.
Other personnel who were in charge of specialties in the chief surgeon's office but who were not commissioned included nurses and dietitians. It will
be noted that 25 of the 61 officers whose duties were classified above i. e.
more than 40 per cent — were serving in the hospitalization division.*^
The personnel serving in the chief surgeon's office or in immediate con- nection therewith on November 11, the date the armistice was signed were distributed by rank as follows Officers: Brigadier generals, 2; colonels (one being the chief surgeon, later promoted), 6; lieutenant colonels,' 12 ; majors 6; captains, 9; first lieutenants, 27; second heutenants, 6. Total, 68.
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ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Nursing service: Nurses, 2; enlisted men: Master hospital sergeants, 1; hospital sergeants, 21; sergeants, first class, 55; sergeants, 83; corporals, 46; cooks, 3; privates, first class, 26; privates, 43. Total, 278. Civilian em- ployees, 76; grand total, 424.
PERSONNEL
(July 28, 1917, to July 15, 1919) CHIEF SURGEON, A. E. F.
Brig. Gen. Alfred E. Bradley, M. C, to April 30, 1918.
Maj. Gen. Merritte W. Ireland, M. C, May 1 to October 9, 1918.
Brig. Gen. Walter D. McCaw, M. C, October 10, 1918, to July 15, 1919.
DEPUTY CHIEF SURGEON
Brig. Gen Jefferson R. Kean, M. C. Brig. Gen. Francis A. Winter, M. C.
REFERENCES
(1) Letter from the Surgeon General, U. S. Arm\', to The Adjutant General of the Army,
May 10, 1917. Subject: Designation of Col. Alfred E. Bradley, M. C, as chief surgeon. United States forces in Europe. On file, Record Room, S. G. O. (9795).
(2) Letter from The Adjutant General of the Army, to Col. Alfred E. Bradley, M. C,
American Embassy, London, May 28, 1917. Subject: Designation as chief surgeon of the United States forces in Europe. On file, Record Room, S. G. O. (9795).
(3) Letter from the chief surgeon, A. E. F., to the Surgeon General, S. Army, June 11,
1917. Subject: Status. On file. Record Room, S. G. O. (9795).
(4) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F. (undated).
Subject: Outline report of chief surgeon, A. E. F., for use in preparation of the report of the commander in chief. On file. Historical Division, S. G. O.
(5) Letter from The Adjutant General of the Army, to Col. A. E. Bradley, M. C, May
29, 1917. Subject: Assignment. On file, Record Room, S. G. O. 9785 (Old Files).
(6) Memorandum from the chief surgeon, A. E. F., to Maj. W. J. L. Lyster, M. C, American
Embassy, London, June 11, 1917. Subject: Administration of American medical personnel serving with British Forces. On file. Record Room, S. G. O., 9795 (Old Files).
(7) Final report of Gen. John J. Pershing, September 1, 1919, 5.
(8) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., June 21,
1917. Subject: Report of personnel of chief surgeon's ofl^ice. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(9) Wadhams, Sanford H., Col., M. C, and Tuttle, Arnold D., Col., M. C: Some of the
Early Problems of the Medical Department, A. E. F. The Military Surgeon, Wash- ington, D. C, 1919, xlv, No. 6, 636.
(10) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 14,
1917. Subject: Weekly war diary. Copy on file, Historical Division, S. G. O.
(11) Special Orders, No. 26, Headquarters, A. E. F., July 4, 1917, par. 2.
(12) Report from Col. Sanford H. Wadhams, M. C, the Representative of the chief surgeon,
A. E. F. with the General Staff G-4-"B" to the chief of the fourth section, general staff, general headquarters, A. E. F., December 31, 1918. Subject: Activities of the medical group, fourth section, general staff, A. E. F., for the period embracing the beginning and end of America's participation in hostilities. Copy on file, Historical Division, S. G. O.
ORGANIZATIOX AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 57
(13) Final report from the adjutant general, A. E. F., to the commander in chief, A. E. F.,
from May 28, 1917, to April 30, 1919. On file, General Headquarters, A. E. F. Records.
(14) General Orders, No. 42, G. H. Q., A. E. F., September 26, 1917.
(15) Memoranda from the chief surgeon, A. E. F., to the chief of staff, A. E. F., from July
14, 1917, to and including December 29. 1917. Subject: Weekly war diaries. On file, Historical Division, S. G. O.
(16) General Orders, No. 20, G. H. Q., A. E. F., August 13, 1917; also memorandum from
the chief surgeon, A. E. F., to the chief of staff, A. E. F., July 21, 1917. Subject: Weekly war diary. On file, Historical Division, S. G. O.
(17) War diary, chief surgeon's office, A. E. F., July 21, 1917.
(18) Report of medical activities, line of communications, A. E. F., during the war period
(undated), by Brig. Gen. Francis A. Winter, M. C. On file. Historical Division, S. G. O.
(19) Report on medical supply, A. E. F. (not dated), by Maj. A. P. Clark, M. C. On file,
Historical Division, S. G. O.
(20) War diary, chief surgeon's office, A. E. F., July 28, 1917.
(21) War diary, chief surgeon's office, A. E. F., August 4, 1917.
(22) War diary, chief surgeon's oflfice, A. E. F., September 2, 1917.
(23) General Orders, No. 8, G. H. Q., A. E. F., July 8, 1917.
(24) War diary, chief surgeon's office, A. E. F., August 26, 1917.
(25) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1,
1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919. On file, Historical Division, S. G. O.
(26) Memorandum from the adjutant general, A. E. F., to the chief surgeon, A. E. F.,
September 13, 1917. Subject: Project of Medical Department. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(27) Memorandum from the chief surgeon, A. E. F., to the chief of staff, October 9, 1917.
Subject: Tables of organization. On file, A. G. O., World War Division, chief surgeon's files (320.2).
(28) Memorandum from the chief surgeon, A. E. F., to the adjutant general, A. E. F.,
November 7, 1917. Subject: Chart showing subdivisions in his office. On file, A. G. O., World War Division, chief surgeon's files (320.2).
(29) Personnel records. On file. Army Nurse Corps, S. G. O. (Bessie S. Bell).
(30) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., April
17, 1917. Subject: Activities of the Medical Department, A. E. F., to November 11, 1918. On file. Historical Division, S. G. O.
(31) Tables of organization for general headquarters, A. E. F., in France, approved by
Gen. John J. Pershing, December 22, 1917. On file, A. G. O., World War Division, chief surgeon's files (320.2).
(32) Letter from the adjutant general, A. E. F., to the chief surgeon, A. E. F., January 10,
1918. Subject: Report on investigation of methods of decentralization. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(33) Letter from the chief surgeon, A. E. F., to the adjutant general, A. E. F., January 12,
1918. Subject: Report of investigation of methods of decentralization. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(34) List of officers and clerks on duty in the chief surgeon's office, February 16, 1918. On
file, A. G. O., World War Division, chief surgeon's files (321.6).
(35) Memorandum from the chief surgeon, A. E. F., to the post quartermaster, February 22,
1918. Subject: Transfer to Tours. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(36) Memorandum from assistant chief of staff, G-3, A. E. F., to the chief surgeon, A. E. F.,
February 26, 1918. Subject: Tables of [organization for the service of the rear. On file, A. G. O., World War Division, chief surgeon's files (320.2).
(37) Letter from the chief surgeon, A. E. F., to the commanding general, S. O. R., A. E. F.,
March 8, 1918. Subject: Tables of organization. On file, A. G. O., World War Division, chief surgeon's files (320.2).
58 ADMINISTRATION, AMKKICAN EXPEDITIONARY FORCES
(38) War diary, chief surgeon's office, A. E. F., March 24, 1918.
(39) Scheme for organization of the medical department, submitted by the chief surgeon,
A. E. F., February 22, 1918, and approved by the commander in chief, A. E. F., :March 6, 1918. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(40) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., March 15,
1918. Subject: Organization. On file, A. G. O., World War Division, chief sur- geon's files (320.2).
(41) Report on the administrative section of the chief surgeon's office, A. E. F., by Capt.
R. A. Dickson, M. A. C. On file. Historical Division, S. G. O.
(42) General Orders, No. 31, G. H. Q., A. E. F., February 16, 1918.
(43) Report from Col. N. L. McDiarmid, M. C., to the Surgeon General, U. S. A., May 1,
1919. Subject: Activities of the supply division, chief surgeon's office, A. E. F. On file, Historical Division, S. G. O.
(44) Report from the chief surgeon, A. E. F., to the commanding general, A. E. F., July 1,
1918. Subject: The Medical Department in the American Expeditionary Forces to May 31, 1918. On file. Historical Division, S. G. O.
(45) First indorsement from the chief surgeon, A. E. F., to the assistant chief of staff, G-1,
A. E. F., June 3, 1918, on memorandum from assistant chief of staff, G-1, A. E. F., to chief surgeon, A. E. F., May 31, 1918. Subject: Table of organization. On file, A. G. O., World War Division, chief surgeon's files (320.1).
(46) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-4, A. E. F.,
July 4, 1918. Subject: Office personnel and space. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(47) Circular No. 54, chief surgeon's office, A. E. F., November 9, 1918. On file, Historical
Division, S. G. O.
(48) Memorandum from the chief surgeon, A. E. F., to assistant chief of staff, G-1, A. E. F.,
December 2, 1918. Subject: Personnel and transportation. On file, A. G. O., World War Division, chief surgeon's files (321.6).
CHAPTER II
REPRESENTATION OF THE MEDICAL DEPARTMENT ON THE GENERAL STAFF, A. E. F.
Before the organization of the American Expeditionary Forces little atten- tion had been given to the subject of Medical Department representation on the general staff, but as early as July, 1917, it became apparent that such repre- sentation was essential for coordinated action.' A memorandum was formu- lated on this subject at this time but no action resulted.' In February, 1918, in conformity with a request of the commander in chief for frank discussion, another memorandum was prepared, again inviting attention to the necessity for Medical Department representation on the general staff and stating the reasons for this.' But until February 16, 1918, when General Orders, No. 31, general headquarters, A. E. F., was published, representatives of the chief surgeon's office continued to take up with the section of the general staff con- cerned, all Medical Department matters which required their coordination or execution.'
When the American Expeditionary Forces were reorganized, as described in Chapter I, the chiefs of the 10 technical staff services (including the Medical Department) which were transferred from headquarters, A. E. F., at Chaumont, to that of the Services of Supply at Tours, were authorized in their discretion to designate officers of their respective services to represent them with each general staff section at general headquarters.^ In conformity with this plan the chief surgeon, on February 22, 1918, recommended that certain officers of the Medical Department remain at general headquarters to represent him with the several sections of the general staff.^ As his immediate representative he designated a medical officer who was also the liaison officer with the central bureau of the Franco-American section and with the French mission at general headquarters. The office force left to assist this officer consisted of two officers of the Sanitary Corps and eight clerks.^ The medical officers who were assigned as assistants to the chief surgeon's representative were attached to the several sections of the general staff as follows: One to G-1, 1 (who was also attending surgeon at general headquarters) to G-2, 1 to both G-3 and G-5, and 2 to G-4.^ The chief surgeon stated that when more medical officers were available one would be attached to G-3 and another to G-5 instead of having one officer attached to both these sections, but this plan was never realized.^ By May, 1918, representation with the second section of the general staff was found to be unnecessary and was discontinued.*
There was also assigned to duty with the chief surgeon's representative at Chaumont, an officer who was designated director of professional services.* He was not attached to any section of the general staff, but was stationed at Chaumont largely to lend him the facilities needed in administering his important activities.*
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ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Technically the medical officers who were assigned to duty with the several sections of the general staff at general headquarters were assistants to the chiefs of those sections, but from another point of view they were, as stated above, assistants to the chief surgeon's representative there.'
On March 15, 1918, the chief surgeon endeavored to have created a Medical Department section of the general staff. His letter on the subject is as follows
Recently there has been a considerable readjustment in the organization of these head- quarters. It is stated in General Orders, 31, c. s., that the organization there prescribed had been arrived at after a careful study of both the French and British Armies. The American Expeditionary Forces organization recently adopted resembles very closely the French organization which has been in existence for some time.
It is pertinent to review briefly a few of the more important steps in the development of the French organization since the beginning of the war especially in reference to its sani- tary service. It was early found necessary to provide for Medical Department representation in the Government, and this was done by creating the office of sous secretaire d'etat du service de sante. Gradually it was learned by bitter expeiience that in order to insure coordination of effort and the prevention of unnecessary sacrifice of life actual medical department par- ticipation in the plans for combat activities was necessary; that is, representation on the general staff. Consequently, several medical officers were assigned to the general staff of the G. Q. G. and one to the general staff of each army.
While better coordination was secured the results were not entirely satisfactory. Since the Champagne offensive of April, 1917, which was accompanied with a terrible death toll and very great unnecessary suffering there has been a growing feeling that steps should be taken to prevent the recurrence of a similar catastrophe. It was well recognized that a repe- tition of this unfortunate occurrence might well have a profound and possible disastrous effect on the morale of a people already exhausted and harassed by the unavoidable hardships of a long war.
During the past three and one-half years many changes in organization have been found necessary, changes which viewed in the light of pre-war days seem radical. All of these changes have tended toward a more complete autonomy of the medical service, and it is believed by the best thinkers in the French Army that a high degree of autonomy is essential if the Medical Department is to successfully meet the conditions which modern warfare have imposed upon it.
The latest change in the Medical Department organization in the French Army has very recently been published under date of February 26, 1918 (see inclosures). This change is so fundamental in character and so far-reaching in its consequence that I feel impelled to bring it to your attention. By this change the Medical Department had been removed from the close administrative control of the fourth bureau of the general staff. I am informed that M. Clemenceau and General Petain have decided, in order that the medical service may have everjr possible opportunity to accomplish the difficult task with which it is confronted, to constitute a new section of the general staff of the G. Q. G. This section is designated the service de sante, and has as its chief an experienced officer of the Medical Corps who is an assistant chief of staff.
It seems particularly fitting at this time that inasmuch as our present organization is modeled so closely on that of the French that we should not appear as having begun our mili- tary effort with a medical organization which has been found wanting and has been discarded by the French. Undoubtedly this step has been taken by the French after most mature study, and with the experience of three and a half years of war as a guide. I feel it incumbent upon me to urge careful consideration of this matter and to recommend that a similar organiza- tion be adopted for the A. E. F. If this recommendation is approved, as I feel it must be sooner or later, it is my intention to request the detail of one of the several experienced senior officers of the Medical Corps now in France as chief of this section. I am convinced that while the recently prescribed organization is a vast improvement over that which has been in effect, the gain in saving of life and the prevention of unnecessary suffering which may reasonaVjly be expected from adopting the proposed change will be immeasurably
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 61
greater. The present organization in the American Expeditionary Forces places a line officer of the general staff in position to pass upon or present for higher consideration all matters of fundamental policy affecting the Medical Department. He can nullify the most carefully worked out program having for its object Medical Department efficiency. I am convinced that proper coordination of the medical service with the troops in the zone of the armies can be secured in no other way than that outlined above.
This matter was referred to the chief of the fourth section, general staff, who reported upon it adversely;^ however, the chief surgeon, on April 30, renewed his recommendation in the following letter:^
On the 15th of March, 1918, a letter was sent you from this office calling attention to the fact that the Medical Department was handicapped in its extensive and complex operations by being cut off from direct access to the chief of staff and having to operate through two divisions of the general staff, and suggesting that a remed\' be found in the creation of a medical section of the general staff.
In the six weeks which have elapsed since that letter was forwarded, the transfer of the chief surgeon's office to the Services of Supply has been tested in actual operation, and has in many ways greatly facilitated the transaction of business, especially in matters concerning supplies, the distribution and training of personnel, and the construction of the hospital accommodations for the great Army which is being transferred from the camps of mobilization at home to France.
It Vjecomes daily more apparent, however, that it has resulted in a disconnection of the chief surgeon's office from the medical administration of the front to an extent which makes it practically impossible for the chief surgeon to meet his responsibility for the conduct of medical affairs in the zone of the army.
It is requested, therefore, that a reply be made to this letter, stating the action taken with regard to it and, if unfavorable, the reasons which rendered favorable action inexpedient. It is hoped that by a study of these reasons a solution may be arrived at which may be accept- able to the commander in chief and may relieve the very serious administrative difficulties which now exist.
As the chief surgeon was never informed officially of the objections, he was not in a position to discuss them. This matter lapsed and no Medical Depart- ment section of the general staff, comparable to that of the French Army was, created at this time or later. ^
None of the medical officers attached to the general staff became members of that body until some time later. By General Orders, No. 73, G. H. Q. A. E. F., May 10, 1918, two of them were detailed acting general staff officers, and by General Orders, No. 138, G. H. Q., A. E. F., August 23, 1918, the same official status was given two others.
The representative of the chief surgeon, at general headquarters, established his office with that of the two medical officers assigned to the fourth section of the general staff This section as described in Chapter I, was concerned with supply and transportation in the American Expeditionary Forces, initial troop movements, hospitalization, evacuation, utilities, and labor. ^ It formulated policies in these matters; the Services of Supply or other agency executed them.^ The assistant chief of staff, G-4, organized in his office a subsection, the medical section, designated "G-4-B." which was charged with Medical Department affairs, and it was with the group composing this section that the chief surgeon's representative identified himself.^
Composition of the medical section, G-4, varied according to circumstances, but on the average included four medical officers of field rank, two officers of the Sanitary Corps for office management, and a small clerical force. ^
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ADMINISTRATION, AMERICAN KXI'EDITIONARV FORCES
On May 2, 1918, the Medical Departmont officers on duty at head- quarters consisted of the representative of the chief surgeon and one assistant, one officer attached to G-1, one attached to G-3 and to G-5, two attached to G-4, an assistant to these last mentioned, who was in charge of records, a director of professional services and his assistant.*
With the separation of the chief surgeon's office from general headquarters, A. E. F., the chief surgeon's relations with the combat forces virtually ceased, but no agency was formally provided for the control, direction, or supervision of Medical Department activities in the zone of the armies.' Therefore, his representative at general headquarters supervised all activities of the Medical Department during combat.' Demands upon the medical section, G-4, con- stantly grew, for it soon became the center to which were referred all matters affecting the Medical Department, whether they arose at headquarters, A. E. F., or were referred to it from other sources for recommendation or suitable action.' Except in matters pertaining to priority shipments of supplies and personnel from the United States, training, equipment, and operations, this fourth section controlled most of the policies of the Medical Department, not only in the Services of Supply, but throughout the American Expeditionary Forces, including the zone of the armies.' It was for this reason that the repre- sentative of the chief surgeon had identified himself intimately with this section.' Gradually nearly all the Medical Department activities at general headquarters were coordinated under the medical section, G-4, and no impor- tant questions of policy were decided until they had been examined by this group.' The medical officer assigned to G-1 actually served as a member of this group, but was placed with G-1 to handle certain specific problems per- taining to ocean tonnage which were under control of that section.' All actions initiated in the group were of course executed over the signature of the assistant chief of staff, G-4. This system was followed, even with questions involving another section.' In this case a memorandum was usually prepared for the other section of the general staff involved, and transmitted to it through the assistant chief of staff, G-4.'
Orders affecting Medical Department activities in the Services of Supply were promulgated from that headquarters at the direct instance of the chief surgeon, A. E. F., while those affecting service of the Medical Department in the American Expeditionary Forces as a whole, as well as in the zone of the armies, were issued, on request of the chief surgeon's representative, from general headquarters at Chaumont.^
Before they made recommendations concerning the establishment of pohcies or took action upon them, the representatives of the chief surgeon mvariably submitted them to him for approval.* Daily at 8 a. m., andoftener in emergencies, the chief surgeon and his deputy discussed by long-distance telephone the problems demanding solution.* Mail sent by courier from one office to the other reached its destination in 12 hours. By these means and by semimonthly visits to Chaumont for the purpose of attending conferences, the chief surgeon kept constantly in touch with the activities and interests of the Medical Department at general headquarters, and was able to supervise Medical Department activities in the zone of the armies and in the American Expeditionary Forces as a whole.*
ORGANIZATION AXJ) ADMIXISTRATIOX OF CHIEF SURGEON'S OFFICE 63
The medical officers assigned to duty with G-4 previously had been iden- tified with the hospitalization division of the chief surgeon's office, and in that capacity had dealt with G-4 directly in matters pertaining to hospital procure- ment.' As a part of such procurement they had sought to make provision for field and evacuation hospitals as well as for the base hospitals in the Services of Supply.' Also they had supervised and directed evacuation of patients from divisions in training areas and in quiet sectors. Therefore, it developed that the medical section, G-4, handled all questions relating to hospitalization, evacuation, ■ and other interests of the Medical Department throughout the American Expeditionary Forces which required the attention of general head- quarters.' One very important detail of its service was the prosecution of construction and procurement program, in its relation to hospitalization and depot policies of the chief surgeon's office.' Another was support of Medical Department interests when in certain projects these conflicted with those of another branch of the service.' After American troops began to participate in active operations the duties of this group underwent a tremendous increase in scope for it was then charged with general control of Medical Department activities in the field.' Questions continued to arise in connection with the hospitalization and evacuation policies of the Services of Supply, but aside from these the group now became occupied chiefly with matters pertaining to field operations and combat activities.'
When the medical section, G-4, was organized it had not been anticipated that control of field operations of the Medical Department would devolve upon it, but no other agency was provided and such devolution was in fact a logical development for the reasons noted above.** The deputy of the chief surgeon at general headquarters, and the other members of the group attached to G-4, constituted the only connecting link between the chief surgeon, A. E. F. and the medical service of armies, corps, and divisions.^
From the beginning of our military operations the medical section, G-4, was called upon to meet the daily emergencies of battle situations as they arose, and to cooperate in developing and applying the general policies of the entire Medical Department of the rapidly growing American Expeditionary Forces.^ During the more important operations two officers of the group were almost constantly at the front where they represented G-4 in the coordination of hos- pitalization, evacuation, and medical supply.^ Before corps and armies of the American Expeditionary Forces were organized they performed, in addition to their other duties, duties comparable to those of a corps or army surgeon, for at that time there was no other agency through which the higher coordi- native functions of the Medical Department could be exercised during combat. For example, representatives of the medical section, G-4, supervised and directed hospitalization and evacuation of the 1st Division at Cantigny; of the divisions and corps constituting the Paris group in the Marne area; and of the 42d Division in the Champagne sector.^ Before a chief surgeon for the First Army was designated in July, 1918, members of G-4-B, therefore, dis- charged such duties as then devolved upon that office.^ They also effected evacuation from corps and divisions serving under control of the French or British and provided for their supply of Medical Department materiel.^ 13901—27 5
64
ADMINISTRATION, AMERICAN EXPEDITIONARY' FORCES
So far as their jurisdiction extended the chief surgeons of the First, Second, and Third Armies relieved the deputy of the chief surgeon at G-4 of the duties pertaining to hospitalization, evacuation, and medical supply which the latter previously had discharged for corps and divisions at the front.
The hospitalization and evacuation plans for the St. Mihiel and Meuse- Argonne operations, in so far as procurement and evacuation were concerned, were largely prepared in G-4-B and placed into effective operation through personal consultation with the chief surgeons of the First and later the Second Armies.' Careful estimates of prospective battle casualties were formulated and every available resource drawn upon to care for them. Owing to limited resources, it frequently became necessary to move sanitary formations and resources from one army to another, or to the service of detached divisions.'
The difficulties of contact, between the general staff and the Medical Department engaged in the service of the front, which had occurred during the battles in the Marne area, were greatly ameliorated when medical officers were detailed to the various sections of the general staff at general headquarters, and when a newly appointed assistant chief of staff took over the duties of G-4.* This officer now uniformly acquainted members of the medical section G-4 with plans, situations, and policies so that they were able to make preliminary arrange- ments to the best advantage and to promote intelligently the efforts of the chief surgeons of the various armies, corps, and divisions concerned.^ As the group kept in close contact with those officers, and learned their facilities and needs for future requirements it was thus in a position to render them prompt assistance when required.*
The machinery for coordination of effort, consolidation of resources, and elasticity of control of limited resources, as reffected in the authority of the assistant chief of staff, G-4, permitted the maximum utilization of facilities.* Without the interest which was manifested by the assistant chief of staff, G-4, in the activities of this subsection and his practice of notifying it of impending battles, or movements of troops, it would have been impossible for G-4-B to have met emergencies which continually arose.*
The geographical location of general headquarters permitted the mainte- nance of close contact between members of G-4-B and the surgeons of divisions, corps, and armies.* It was possible for a member of this group not only to reach rapidly almost any part of the front occupied by American troops, but also through an excellent system of telephone and telegraph communication to know at all times exactly the conditions to be met.* Largely because of this fact the representatives of the chief surgeon with G-4 were able to meet the daily problems which arose from the lack of authorized personnel, sanitary units and equipment with the troops; such problems they met by moving from one sector to another, on orders which G-4 initiated, casual personnel, operating teams, and sanitary units, ambulance companies, field, evacuation, and mobile hospitals.* Limitations of personnel were such that without this machinery for coordination of effort and consolidation of resources, evacuation, and hospitafiza- tion of battle casualties would have been well nigh impossible.* The activities of this group which pertained to supervision of medical service at the front are further discussed in Volume VIII of this history.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 65
G-4-B was also closely in touch with the American Red Cross, especially in projects concerning hospitalization, and convalescent homes.* The relations of that society to G-4-B were so intimate and so important that an attempt was made to have it transferred from the jurisdiction of G-1 (which had control of all such societies operating in the service of the American Expeditionary Forces), to that of G-4, in order to expedite transaction of business between the two of- fices, but this was unsuccessful.^ The representative of the Medical Depart- ment with G-1 coordinated the activities of the American Red Cross with the policies of the Medical Department, in so far as they pertained to that depart- ment, the hospitalization enterprise of the American Red Cross being under- taken in conformity with requests of the medical group with G-4.*
On September 20, 1918, the chief surgeon's deputy, general headquarters, submitted the following memorandum to the acting chief of staff, G^, concern- ing the organization of the medical section, G-4 : ^
The following table exhibits the personnel that I believe will be necessary to carry on the functions now devolving upon this subsection of your office. It contemplates no radical de- parture from the organization which has been in effect.
Brigadier general, 1; colonels, 2; lieutenant colonels, 2; majors, 2; captains or first lieutenants, 4; total commissioned, 11. Civilian clerk, 1; master hospital sergeant, 1; hospital sergeants, 2; sergeants, 1st class, 3; sergeants, 3; corporals, 2; privates, 1st class, 4; pri- vates, 1; total enlisted, 16.
The table proposed off hand may appear to be top heavy. As a matter of fact the personnel estimated will barely be sufficient to carry on the work which is now coming to this subsection. As G-4 handles practically all the medical matters coming to general head- quarters; it is believed that all technical matters affecting the Medical Department should be referred to this subsection. While General Orders 31, contemplated that we should have a representative in each section of the General Staff, it is believed that better results will accrue if we concentrate all the authorized personnel in this section excepting the officer assigned to G-5 for training purposes. Until recently we had attached to G-1 a medical officer who was assigned to the General Staff. Instead of replacing him in that section it is believed that the work carried on by him there should be performed by an officer in this sub- section of G-4.
Until the organization of the First Army headquarters, this office was in fact the office of the chief surgeon of the army. At the present time it is carrying some of the duties of that army, and all of such duties in connection with certain other more or less detached combat units. The chief surgeon's office is, from the point of view of distance, remote from the front, and its contact with combat units is correspondingly slight. The necessity of providing the details of organization, instruction, mobilization of new equipment and personnel for combat units, the initiation of movement orders, etc., must all originate from this section. As a matter of fact the duties which have devolved upon and are now being performed by this subsection have been much broader in scope than it was believed by the chief surgeon was contemplated in the plan of organization at the time General Orders 31 was adopted.
Every effort has been made to decentralize, as far as possible, all details concerning the Medical Department and to devote the time of officers on duty here to constructive work, which is gradually assuming greater and more pressing proportions. Up to the present, with the number of officers now available this has practically been impossible, as the entire time of officers now connected with the subsection have been taken up with routine daily matters. It is daily becoming more evident that the chief surgeon's office, per se, has become what might properly be called a surgeon's general's office in France, and is occupied with the provision of materiel and personnel necessary to secure proper functioning of the Medical Department of the American Expeditionary Forces. There is another and most important side to the Medical Department's activities, and this is the relation of the department to combat operations. From a Medical Department viewpoint, supply is a comparatively
66
ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
minor consideration. The care of the sick and wounded and the evacuation and h(jsi)itali- zation of these cases is always more or less an emergency measure and recj wires very com- plicated machinery to secure the desired results. The present organization, as prescribed by General Orders 31, does not provide the elasticity or necessary facilities for this most impor- tant part of the Medical Department duties. It is understood that General Orders 31 is now being rewritten with a view of correcting its organizational defects and incorporating features which have been the outgrowth of our experience under its operation.
The necessity of having a deputy of the chief surgeon at these headquarters has become generally recognized. Under our present scheme of organization it is necessary that the chief surgeon should have at these headquarters an officer who truly represents him and whose duties are more particularly those which pertain to Medical Department functions with and relations to combat troops. To produce satisfactory results requires a considerable organization. In every action of magnitude representatives from these headquarters must leave for the front for the purpose of coordinating hospitalization and evacuation until activities again assume a normal trend. It seems only logical that, inasmuch as all Medical Department activities are coordinated by G-4 of the general staff, its senior medical officer with that section of the general staff should be the chief surgeon's deputy. That is the situation which has gradually evolved since the chiefs of the services were divorced from these headquarters. As stated above, the desirabihty of not only continuing this organiza- tion, but recognizing the responsibilities and duties of the senior medical member of G-4 seems apparent. Because of the nature of the work and responsibilities devolving upon the chief surgeon's deputy, it is believed that the officer who occupies that position should have the rank of a general officer. On a recent visit to these headquarters the chief surgeon an- nounced that it was his intention to recommend that his deputy here be a brigadier general. For that reason one brigadier general is shown on the above table. If the functions to be carried out b^* this subsection of your office are to be successfully accomplished the personnel indicated will be absolutely essential. The enlisted personnel given function largely in the same capacity as do field clerks in other subsections.
On August 14, 1918, the commander in chief, upon being advised by the chief of staff that the Medical Corps had asked for fuller representation on the general staff, stated he desired this request to be complied with.^" Accordingly, a medical officer who had been on duty with G-1 was made an acting general staff officer," and all divisions of the general staff were advised that he should be consulted on:
(a) All affairs of the Red Cross that have any possible connection with the Medical Department; (6) all Tables of Organization of medical units or which should show medical personnel attached; (c) changes in the type of equipment or clothing or ration, so far as they may affect health, or where, in the case of equipments, it is for the Medical Corps; (d) miscel- laneous questions affecting the Medical Department.
The representative of the Medical Department with G-3 was concerned chiefly with movement of medical units ; e. g. , evacuation hospitals. It appeared advisable that the Medical Department should be represented on G-3 in order that its plans might be coordinated with combat operations in general.^ This representative of the chief surgeon also served with G-5, and, in that assign- ment, was in charge of the training of Medical Department personnel whether they were members of units in the Joinville training area, of units or detach- ments with divisions, or in attendance at the Sanitary School at Langres.'
In his final report the deputy of the chief surgeon at General Headquarters wrote concerning Medical Department representation on the general staff with especial reference to that with its fourth section as follows: ^
ORGANIZATION AND ADMIN'ISTBATION OF CHIEF SURGEON'S OFFICE 67
Tlie jiresent method of providing for Medical Department representation on and with the general staff is ideal, and is favored over all other previous propositions. Medical Department representation on the general staff as conceived by the acting chief of staff, G-4, more nearh" approaches the ideal of organization than any other plan which has been proposed. It is hoped that the policy inaugurated by the chief of the fourth section in this respect will have demonstrated its value, and will be perpetuated in any future reorganiza- tion of the general staff. It is also hoped that the results obtained by this section of the general staff have amply demonstrated the wisdom of having adequate Medical Department representation on the general staff.
Under this organization (General Orders, No. 31) the chief surgeon's office became merely an agency for the procurement and distribution of supplies and personnel and wa^ completely separated from the Medical Department activities connected with the Zone of .\ctive Operations.
The classification of the Medical Department among the supph' services is question- able. Its functions are so intimately connected with combat activities that it becomes a very difficult matter to administer this branch of the service if it is placed on the same basis as the purely supply departments.
In providing the necessary medical supplies for an army only one of the comparatively unimportant functions of the Medical Department has been fulfilled. The demands made upon the Medical Department by combat activities can not be satisfied if the prevailing conception of that department as a supply department is adhered to.
The organization of headquarters, general headquarters, A. E. F., as first outlined in General Orders, No. 8, 1917, followed very closely that in operation in the French Army at the time, except that for the latter army generous provision was made in the way of Medical Department representation on the fourth bureau of the general staff and none was provided for ours. As stated above, this defect was corrected some months later, after representation had again been made by the chief surgeon.
In the meantime a reorganization of the French general staff went into effect in March, 1918. This change created an additional or fifth bureau of the general staff, which was made up entirely of medical officers and was known as the Medical Department bureau. The senior officer of the section was a major general, with the title of assistant chief of staff, with the same responsibilities and privileges as his brother officers of the line of other bureaus of the general staff.
A short time before the French had published this change in staff organization, a memo- randum for the commander in chief had been prepared in the office of the chief surgeon recommending this identical organization. This recommendation was never approved or disapproved, and the lack of action in the matter was a source of bitter disappointment to tlie chief surgeon.
In so far as general representation on the general staff is concerned, not only at headquarters, A. E. F., but also at headquarters, Services of Supply, the chief surgeon expressed his opinion on March 24, 1919, as follows
It is not believed at this time that a separate or medical section of the general staff should be created, but the medical services of the American Expeditionary Forces should be placed under G-4, general headquarters. The chief surgeon should be represented by a fleputy on G-4, of high rank. In his relations with the general staff, general headquarters, he should be represented by one or more assistants on G-1, G-3, and G-5, as well as the necessary additional medical officers on G-4. It is not believed that there is any necessity for representation on G-2, general headquarters.
The chief surgeon has no executive jurisdiction over his own corps in the armies except through the executive branches of the general staff, general headquarters. He also is so dependent upon the other supply departments for operating hospitals, supplies, and evacua- tion as to make it impossible for him to function without the executive assistance of the general staff. Services of Supply.
Therefore, in order to make the machinery move rapidly and smoothly, it is absolutely necessary to have general staff representation in both general headquarters and Services of
68
ADMIXISTRATION, AMERICAN EXPEDITIONARY FORCES
Supply so as to insure the rapid and coordinate dissemination of information of daily changes at the front and to meet all demands intelligently and rapidly with the proper cfiuipnient, personnel, etc.
Under the present arrangement, in which the deputy chief surgeon is attached to G-4, general headquarters, the operation has functioned in an admirable manner, but this is recognized as being due in a large measure to the admirable cooperation given to the deputy chief surgeon on G-4 by the assistant chief of staff, G-4.
In this connection, attention is called to the fact that there was no medical representative on G-3, the G-4 group performing the functions that should have been delegated to the G-3 representatives. It is believed that representation on G-3 is necessary.
In connection with the headquarters, Services of Supply, the chief surgeon should have had an office with a deputy in charge to operate the Services of Supply activities of supply, hospitalization, statistics, finance and accounting. Services of Supply personnel, dental service, and veterinary service.
The office of the chief surgeon should be represented by assistants on G-1 and G-4 of the general staff. Services of Supply, this in view of the fact that the hospitalization division is intricately connected with and dependent upon every other supply department, and in order to maintain the proper service, should be represented on G-1 and G-4 of the general staff with such executive power as to be able to secure hospital construction or procurement by lease or rent, as well as transportation of supplies, personnel, and sick and wounded.
THE CHIEF SURGEON IN CONNECTION WITH THE ARMIES
It is well understood that orders of execution can only be given to the army through the different sections of the general staff at general headquarters, but in view of the chief sur- geon's responsibility for the sanitary personnel, equipment, professional services, hygiene, etc., of the armies, he should be in close touch with the surgeons of the armies, army corps, and divisions. The chief surgeon of an army should have a medical representative on each G-1 and G-4 of the army.
The following table is submitted:
Location.
Operations — G. H. Q. Chief surgeon.
Personnel (for army areas only).
Army equipment, medical, from advance medical supply depots. Evacuation of sick and wounded. Hospital trains.
Ambulance and motor transport. Operations of same.
Supplies — S. O. S.
Deputy chief surgeon. Hospitalization. Supply department. Statistics — sick and w^ounded. Personnel (S. O. S.).
Hospital trains, ambulances, and motor transport.
Supply and equipment of same. Finance and accounting. Dental service. Veterinary service. Professional services.
Ge;ieral sanitation — inspecting, epidemiology, laboratories. Relations with the general staff.
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 69
The chief surgeon's representation on the general staff should be as follows: G. H. Q.:
G-1. An assistant in connection with supply problems, railway and automatic overseas tonnage.
G-3. An assistant to coordinate the chief surgeon's office with combat operations in general, and change of stations of army units.
G-4. A deputy chief surgeon and necessary assistants in connection with the evacuation of sick and wounded, hospitalization, all construction and pro- curement of buildings, assignment of units.
G-5. An assistant in connection with Medical Department training. S. O. S.:
G-4. One or more assistants in connection with hospitalization and evacuation of
sick and wounded. G-1. One assistant in connection with all tonnage and problems. Army headquarters :
G-1. An assistant to the chief surgeon of the army. G-2. An assistant to the chief surgeon of the army.
Corps and division headquarters: No representation of general staff deemed necessary.
REFERENCES
(1) Report from Col. S. H. Wadhams, M. C, the chief of the medical group, fourth section,
general staff, general headquarters, A. E. F., to the chief of G-4, general staff, general headquarters, A. E. F., December 31, 1918. Subject: Activities of G-4 "B," 4.
(2) General Orders, No. 31, General Headquarters, A. E. F., February 16, 1918.
(3) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., February
22, 1918. Subject: Designation of medical officers to represent chief surgeon at general headquarters. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(4) Memorandum from the representative of the chief surgeon, A. E. F., with general
headquarters, A. E. F., medical section, general staff, to the chief of staff", A. E. F., May 2, 1918. Subject: Duties of officers of Medical Department at general head- quarters, A. E. F., G-4-B. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(5 Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., March 15, 1918. Subject: Organization. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(6) Memorandum from acting assistant chief of staff, G-4, to the chief of staff, April 6,
1918. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(7) Letter from the chief surgeon, A. E. F., to the commander in chief, A. E. F., April 30,
1918. Subject: Need for medical section, general staff. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(8) Wadhams, S. H., Col., M. C, and Tuttle, A. D., Col., M. C. : Some of the early problems
of the Medical Department, The Military Surgeon, Washington, D. C, 1919, xlv. No. 6, 636.
(9) Memorandum from the medical representative of the chief surgeon, general headquarters,
A. E. F., fourth section, general staff, to the acting chief of staff", G-4, September 20, 1918. Subject: Plan of organization for the medical or "B" division of G-4. On file, A. G. O., World War Division, chief surgeon's files (321.6).
(10) Report from the commander in chief, A. E. F., to The Adjustant General of the Army
(undated), part 8, Vol. I, "Activities of G-1," 29. On file. General Headquarters, A. E. F. Records.
(11) General Orders, No. 138, General Headquarters, A. E. F., August 23, 1918.
(12) Letter from the chief surgeon, A. E. F., to the chief of staff, A. E. F., March 24, 1919.
Subject: Relation of chief surgeon's office to S. O. S., G. H. Q., and the armies. On file, A. G. O., World War Division, chief surgeon's files (321.6).
CHAPTER in
LIAISON OF THE MEDICAL DEPARTMENT, UNITED STATES ARMY, WITH THE MEDICAL SERVICES OF THE ALLIES
LIAISON WITH THE BRITISH MEDICAL SERVICE
On June 9, 1917, the chief of staff, A. E. F., notified one of our medical officers, who had been serving as military observer, of his assignment as liaison officer with the Director General, British Medical Service, in connection with the administration of American medical units serving wdth the British.' The necessity for such an assignment is indicated by the chief surgeon, A. E. F., who, on June 11, 1917, w^rote the Surgeon General in part as follows, concerning his relationships with the above-mentioned units and with casual American personnel assigned to the British forces:^
As already reported to your office, I assumed some weeks ago an unauthorized super- visory control over American medical personnel arriving in England, for service with British forces.
My position was such I could neither act nor advise in any authoritative manner and my relations with the personnel and the British medical officials has been purely advisory.
Many points had arisen which required decisive action or opinion, and I laid the whole matter before General Pershing with my recommendations and suggestions. These he approved and a memorandum has been issued as the result * * *
It is General Pershing's understanding that this medical personnel with the British is not at this time under his control. If this understanding is erroneous, information is re- quested by cable, for I will sever my connection with this personnel, and the British medical service on my departure for France, and as chief surgeon, A. E. F., will exercise no super- vision unless it is explicith- directed by the War Department. * * *
Before headquarters moved to Paris the chief surgeon wrote the liaison officer with the British as follows:^
Inclosed herewith is a copy of a memorandum prepai'ed this date. Copies have been supplied to the following officers:
Commanding officer, United States Army, Base Hospitals Nos. 2, 4, 5, 10, 12, 21. Director general, British medical service. Surgeon General, United States Army, Washington, D. C. Liaison officer, Adastral House, Victoria Embankment. *******
Adjutant general, American Expeditionary Forces. The Adjutant General, United States Army, Washington, D. C. Judge advocate, American Expeditionary Forces. Quartermaster, American Expeditionary Forces.
This memorandum covers in a general way the results of all that has been done in con- nection with this personnel.
In so far as the British War Office is concerned it is the result of conferences with the director general and his asststant, General Babtie, and it has the approval of the commanding general.
There has been no word of instruction of any kind received at this embassy from Wash- ington regarding this personnel. They have been ordered to report to Lieut. Col. A. E. Bradley, M. C, for instructions and have all been reported by him to the War Office for duty.
71
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ADMINISTRATION, AMERICAN EXPEDITIONARY FORCES
Lacking instructions and information, no office has been organized nor established for administrative purposes. The matter was placed before General Pershing on his arrival and recommendations made which are embodied in the accompanying memorandum.
It is suggested that you look to the base hospitals for such office enlisted personnel as may be needed for the administration of the American necessities. No doubt some British assistance will be forthcoming on your proper representation of the necessity therefor.
Fifty-two medical officers, unattached to organized units, have reported up to date. Many of these have gone to France and some have been assigned here in England. Others are awaiting assignments. * * *
The Surgeon General has written me a personal letter that besides the six base hospitals already here, he proposes to send, in June, 200 medical officers and 200 nurses, and similar numbers in July and August.
The commanding officer of Base Hospital No. 2 has made inquiries as to promotion of men of his enlisted force, and steps should be taken promptly to obtain the necessary authority from the Surgeon General to promote privates, and to conduct examinations for the making of noncommissioned officers.
Personal reports have been forwarded, but some personnel returns, etc., have been held until some check could me made by an authorized central office which is established by this action of the commanding general. These held papers and some little correspondence have been left for you in the embassy office.
* * *****
After the chief surgeon had received from The Adjutant General, United States Army, the letter quoted in Chapter II, which prescribed the scope of his authority,^ he wrote our liaison officer in London on June 25, as follows: ^
Inclosed herewith is a copy of order making the assignment of "Chief surgeon. United States forces in Europe," which has been received since the preparation of memorandum and letter of instruction to you dated June 11, 1917.
It will be noted that authority in all matters in Europe pertaining to the Medical Department is vested in the chief surgeon, A. E. F., and you will be guided accordingly.
The instructions contained in the letter referred to above are therefore modified as follows:
(a) You will in future, in general, in your relations with this office and the American medical units and personnel with the British medical service, act as w-ould a surgeon of a department in the United States.
(6) All reports, requisitions, returns, etc., of whatever nature will be forwarded to this office. The number of copies in each case will be that fixed by regulations governing under war conditions.
(c) It is directed that for all commissioned personnel and all unattached enlisted and civilian personnel, you make, in your office, nominal monthly check lists showdng the address and duty of each individual. After making these lists you may transmit direct to the Surgeon General the personal reports received by you instead of forwarding them to this office, sending only to the chief surgeon the check lists above referred to.
(d) It is desired that all United States Army hospital units make reports each month, through United States medical channels, of the work being done by them — a numerical report of all cases treated by the organization in the hospital served by them.
All instructions contained in the memorandum and letter of June 11 conflicting with these instructions of this date are revoked.
The liaison officer with the British medical service, with office in Adastral House, kept the records, reports, and pay accounts, and cared for the mail of all American officers, nurses, and enlisted men of the American Expeditionary Forces on duty with the British.*' He was later assisted by two commissioned officers and four clerks. In discharging these duties he kept trace of the assign- ment of those members of our medical department who were assigned to duty
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 73
with the British, assisted them in obtaining pay and allowances, procuring leaves of absence or sick leave, and promoted their interests in other matters.^ For example, when any were taken prisoner, he reported that fact to the Ameri- can Red Cross, which undertook to send them packages of food and to com- municate with them and their families in the United States.^ He also reported to the chief surgeon, A. E. F., those officers under his jurisdiction who were recommended for promotion and assembled the records on which these recom- mendations were based. This was an important subject in which the personnel concerned so interested themselves that there was almost constant agitation in connection with it. For this reason this subject engaged a large proportion of the efforts of the liaison officer and of those of his office force.^ Another of his duties was to arrange when necessary for the transfer, to the direct control by the headquarters, A. E. F., of those members of the Medical Department under his supervision, who required discipline.'^ He investigated such cases, procured witnesses, and reported them to the chief surgeon, American Expeditionary Forces.*^
Through the liaison officer for the Medical Department in London, the medical officers serving with the base hospitals assigned to the British were in much closer contact with the chief surgeon's office than were the casual American medical officers assigned to British units. As mentioned in the chapter on *' Personnel," there was great difficulty at first in reaching these casual officers, and because of their ignorance of regulations, general orders, etc., they seldom reported changes of status. In many cases officers served with the British for months before they became of record in the chief surgeon's office, A. E. F.
The liaison officer procured the records, statement of cause of disability, whether in line of duty or not, and other data required for our sick and wounded report in the case of each individual of the American Expeditionary Forces, who became incapacitated while assigned to the British, whether in France or Great Britain.^ A great amount of this work was carried on in cooperation with the chief surgeon of base section No. 3 (the British Isles), and after March, 1918, most of these data were returned to him;** but prior to January 14, 1918, the liaison officer discharged the duties of chief surgeon of this base section, in addition to the others more properly pertaining to his office.^
The liaison officer cooperated in securing buildings and sites for hospitals, especially before July 1, 1918.^ He investigated and reported upon properties which were offered to the American Expeditionary Forces for hospitalization purposes. It is of interest to note that in the course of these activities he found it necessary to decline Windsor Castle, which was offered for our hospital purposes by the King of England; without extensive alteration, that historic structure could not be adapted to our needs." The King, therefore, offered to build a hospital in the castle grounds, and this offer was accepted.^ The liaison officer inspected other residences and estates offered us for hospitalization purposes, and his reports led to the acceptance of a number of these." Sites for the location of our base hospitals were thus selected throughout England, and to these American casualties were sent " until in the spring of 1918, when it became necessary to send a number of them to British hospitals.'
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ADMINISTRATION, AMKKKAN EXPEDITIONARY FORCES
Another duty of the Haison officer was the selection of those ports where American casualties from the continent would be received, the creation of machinery for their reception, and the determination of their destination when placed on British hospital trains.*' The ports selected included some of those in the Channel, on the Thames, in Scotland, and in Ireland.*'
The liaison officer supervised the assignment in Great Britain of American officers of the Medical, Dental, and Sanitary Corps for the study and treatment of gassed cases, and of cardiac conditions, the study of the methods and standards used in examinations of fliers of the Royal Air Force, of food and nutrition, and of general, orthopedic and maxillofacial surgery.^ He investigated the treat- ment and care during convalescence of injuries caused by mustard gas, and the findings made in cases that came to autopsy.® He was liaison officer with the Royal Air Force.® The chief surgeon, A. E. F., frequently asked that certain specialists who were on duty in our hospitals which were under British con- trol, be transferred to the service of our troops in France, and the liaison officer was charged with transactions with the British authorities which would effect the release of the specialists.® The needs thus created in British hospitals he then sought to meet by assignment of untrained personnel.® Our six base hospitals serving with the British were constantly in need of specialists and replacements, and these needs w'ere handled by the liaison officer.®
The liaison officer not only cooperated in effecting the transfer to the Ameri- can Expeditionary Forces of those American physicians who were serving in the British Army and now sought transfer to ours, but he also advised the director general of the British Army medical service, concerning the many quacks, alleged physicians, and practitioners of various pathies who went to England from the United States to enter the British Army.®
In addition to cooperating with the American Red Cross in its efforts to assist personnel under his jurisdiction who had been captured, the liaison officer cooperated with the representatives of that body in London.® He assigned medical officers to hospitals established by that society, and was designated by the commander in chief as personal adviser and aide to the director general of the American Red Cross, when that officer conducted an inspection tour through Great Britain.®
One of the duties of the liaison officer was the procurement in Great Britain of supplies for our Medical Department, both before and after a purchasing agent for this department was assigned to service in Great Britain.® In this duty he not only promoted procurement from civil firms but also obtained large quantities of supplies from the British Government.® The liaison officer served as a member of the purchasing board for the Medical Department in Great Britain, from October, 1917, until the middle of December of that vear.®
The British brought up for his consideration and action many questions which pertained to the British Expeditionary Force in France, and to the American Expeditionary Forces as entities.® The liaison officer was the channel of communication between the chief surgeon, A. E. F., and the chief surgeon, base section No. 3, on the one hand, and the Royal Army Medical Corps on the other.® The chief surgeon's office, A. E. F., also transacted business with the British through the British mission established at Tours, and through the liaison
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 75
officer pertaining to G-1, who represented the American Expeditionary Forces at headquarters of the British Expeditionary Forces.®
Deaths occurring among American units or detached personnel serving with the British were reported direct to the headquarters, American Expedi- tionary Forces.^
After the base section No. 3 was organized and a chief surgeon was assigned to it, the Haison officer continued to be charged with supervision of the six base hospitals and casual American medical personnel assigned to the British, but his activities did not extend to the medical organizations of our Second Corps.*^ That command which consisted of American troops serving under British con- trol was provided with a corps surgeon who was directly responsible to the chief surgeon, A. E. F., or in some matters to the latter's deputy at general headquarters.®
The average personnel of the Medical Department, A. E. F., constantly on duty with the British Army approximated 800 officers, 600 nurses, and 1,100 enlisted men.® On November 23, 1918, there were serving with the British, 888 officers, 1,311 enlisted men, 676 nurses, and 24 civilian employees.®
American Medical Department organizations which participated in the North Russian expedition were under British command, but occupied, in reference to the liaison officer with the British, a position comparable to that of the base hospitals assigned to the British Expeditionary Force in France.® The official methods of the Medical Department organizations of the North Russia expedition were made to conform, therefore, to British requirements in so far as they w^ere relevant to British control, but other reports and returns conformed to American requirements.®
LIAISON WITH THE FRENCH MEDICAL SERVICE
The increasing number of American troops which entered the lines, mingled with the French, brought the two armies into very close relationship, until March, 1918, when under military exigencies the two services operated as one.^ The chief surgeon's office had to have a clear knowledge of the organization of the French Army and especially that of its medical department, from the Min- istry of War to the field sanitary units, for French methods required that business be transacted only through definitely authorized agents.^ Therefore, it was necessary that the Medical Department, A. E. F., maintain the closest contact possible with the French authorities, for their cooperation was essential in a number of matters including the development of our program for hospital procurement.^
The French realized more clearly than had the Americans, this necessity for close cooperation and provided liaison officers for every branch of endeavor.^ Very shortly after the arrival of the first American troops the French Govern- ment established at the Ministry of War the special Franco-American bureau with subbureaus, know^n as sections, wherever needed." It thus provided an agency through which all matters affecting the two services could be studied and handled. In the subsecretariat of state, French medical service, a sub- section of this Franco-American service was established." Also, in this sub- secretariat a special technical division charged with American hospitalization
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was organized. The object of this latter division was to assist in every way possible the procurement of hospitals, hospital sites, and medical supplies for the American Expeditionary Forces, and to facilitate the transfer to our medical service of those existing French hospital installations and buildings which our service needed.^
Owing to the shortage of medical officers, the chief surgeon, A. E. F., was unable to comply with the request of the French that he place one of his subordi- nates as liaison officer in this Franco-American section but he did direct the chief of the hospitalization division in his office to effect close liaison service therewith, in addition to his other duties.** At this time when the great prob- lems of the Medical Department were those pertaining to the hospitalization and supply and were concerned almost exclusively with the Services of Supply, this plan worked very satisfactorily.^
On August 25, 1917, in anticipation of the movement of General Head- quarters of the American Expeditionary Forces to Chaumont, the chief surgeon designated the purchasing officer for the Medical Department, in Paris, as Haison officer for the French medical service,'" and on the same date requested that a French officer be attached for liaison purposes to his own office after this had been established at Chaumont."
Therefore, after the chief surgeon's office arrived at Chaumont an experi- enced French medical officer was assigned to liaison service with it, but after this officer had reported the French commander in chief required that he be placed under his jurisdiction.'^ This the undersecretary refused to permit; and as the French commander in chief would allow no French officer to remain in the zone of the armies who was not entirely under his control, this liaison officer was relieved.'^ The result was that the chief surgeon, A. E. F., lost a valuable adviser, and the close and direct relations between his office and the subsecretary of state, medical department, in Paris, were severed.'^
On September 15, 1917, the chief surgeon and the chief of the hospitalization division of his office visited the French headquarters at Compeigne, for the purpose of making arrangements concerning the transaction of business relating to our Medical Department in the zone of the armies, and on the 17th they held a conference in Paris to determine the manner in which the Medical Department should transact business with the secretariat, now that our head- quarters had moved into the zone of the armies.'^
After headquarters, A. E. F., were established at Chaumont, the French high command established there a military mission which was organized with the same bureaus as the French General Staff This organization provided a medical section under a French medical officer, who was charged with trans- action of all business of whatever nature affecting the Medical Department in the zone of the armies.^ The chief of the hospitalization division in the chief surgeon's office was designated liaison officer between that office and the French mission.^
As questions pertaining to procurement of hospitals and other facilities were of immediate concern to the Services of Supply, in whose jurisdiction base hospitals and supply depots were being located in great numbers, it was expe- dient that the chief surgeon of that command also be in close touch with the
ORGANIZATION AND ADMINISTRATION OF CHIEF SURGEON'S OFFICE 77
French subsecretary of state, medical service.'^ The chief surgeon, A. E. F., therefore, notified the chief of the French mission at Chaumont, on October 19, 1917, that he had designated the chief surgeon. Services of Supply, as his representative for all matters of Medical Department interest outside the zone of the armies.'^ He also asked that a French liaison officer be attached to the latter's office, which was then in Paris.'* This was done, and after headquarters of the Services of Supply moved to Tours in January, 1918, a French liaison officer was attached to the office of its chief surgeon there.''
On February 9, 1918,'^ in compliance with a request of the subsecretary of state, medical service,'^ a senior medical officer of the American Expeditionary Forces was assigned to liaison duties with his office, and other officers to each of the 11 regions in which Americans were then conducting their most import- ant activities.'®
The officer selected for this assignment as liaison officer with the subsecre- tary of state, medical service, was the chief of the hospitalization division of the chief surgeon's office, who was performing liaison duty with the French mission at general headquarters.^ The cumulation of such duties upon one individual was necessitated by the shortage of officers and, in fact, worked out well, for the great majority of questions which required negotiations with the French continued to pertain to procurement of hospitals and medical supplies.^
After the chief surgeon's office, A. E. F., moved to Tours, in March, 1918,'^ it transacted some business direct with the French mission established in that city,'^ but contact was maintained chiefly through the officer referred to above, who remained with general headquarters at Chaumont as representative of the chief surgeon.^" Relieved from duty in the hospitalization division, he now in addition to his other duties, maintained liaison between the Medical Depart- ment, A. E. F., on the one hand, and, on the other, with the subsecretary of state, medical service, in Paris, and the French mission at Chaumont.^ Part of this duty was his supervision of the liaison effected by other medical officers assigned to that duty, whether for armies, corps, or divisions in the field, or for regional subsections in the Services of Supply.^
In compliance with a circular letter from the Minister of War, dated December 30, 1917, Franco-American sections had been instituted in connec- tion with the large French services.^' These sections were charged with the study of all Franco-American affairs transmitted to them and the solution of problems incident thereto.^'
Eventually, sections of the Franco-American service were established at each headquarters of the military regions (approximately 20) into which France was divided, and a local medical officer of the A. E. F. was assigned to each, in addition to his other duties, as liaison officer for the chief surgeon.** All matters of policy were determined between the Franco-American section in Paris, and the chief surgeon's office, but, when policies had been declared the execution of details conforming thereto was made a duty of the regional subsections.^ The activities of these regional officers are discussed at greater length below.
The matters which the liaison officer for the Medical Department conducted with the office of the subsecretary of state, medical service, may be classified as follows (a) Procurement of French hospitals for the American Expeditionary
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ADMINISTRATION', AMKHICAX KXI'KDITION A K V FORCES
Forces; (b) procureineiit of existing l)uildiiigs, such as hotels and schoolhouses, for hospital purposes; (c) all questions of standard medical supplies obtained from the French medical service; (d) the execution of contracts for the purchase of sanitary formations from the French medical service, such as mobile hospitals and mobile surgical units, etc. ; (e) formulation of policies regarding the exchange of the necessary data covering American patients in French hospitals and French patients in American hospitals; (f) formulation of policies regarding control of communicable diseases, particularly with a view of protecting the French civil population; (g) miscellaneous matters.
The above classification practically outlines the scope of duties which devolved upon the American liaison officer with the French medical service.^'^ The matters which required the greatest amount of work were those connected with procurement of hospitals of the American Expeditionary Forces, and the hospital supplies which could be secured better in Europe than in the United States. From the very beginning of our effort it was necessary that the American Expeditionary Forces take over from the French certain hospitals and their equipment, in order to meet the needs of arriving American troops, and this need continued until our barrack hospitals could be constructed.^^ At first the procedure for taking over these hospitals was by direct request upon the office of the subsecretary of state, through the liaison officer attached to his office. Later this duty was performed through the regional liaison officers for the Medical Department.^ Each of these officers acted on all routine matters as an intermediary between the local American authorities and the director of the French medical service for the region concerned.'' Matters of policy continued to be determined between the representative of the chief surgeon, A. E. F., and the office of the subsecretary of state, medical service, in the Ministry of War, but the details conforming thereto were carried out by the regional liaison officers.^
As noted above. Franco- American sections were established as need arose at headquarters of each of the 20 military administrative regions into which France was divided.^ A medical officer of the American Expeditionary Forces in each of these regions was accredited to the respective Franco-American section estabhshed at headquarters of each, and, in his liaison duties, which he discharged in addition to others, was under the control of the liaison officer for the Medical Department.^
These officers were given definite rules concerning acquisition of hospital sites and of buildings suitable for hospital purposes, the taking over of existing French hospitals, and the coordination of the medical services of the two coun- tries in many other respects, but the greater part of their duties was concerned with hospitalization.^^ They were directed to maintain contact and cordial relations with the regional medical director of the French Army, with whom they conducted initial negotiations for the transfer of projects and installations; to exert every effort to avoid friction; and to arrange with the medical director the local policies which would guide them in future liaison activities.^ In their instructions these officers were informed that the French had manifested a desire to cooperate in every way possible and already had given us many of their best hospitals. They familiarized themselves with all hospitalization
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prospects in their regions in order that in emergencies appropriate request could be made for their procurement.*^ From time to time they were directed to inspect and report upon hospital properties made available by the French, to conduct such investigations, as were prescribed, of certain projects or instal- lations, and were given instructions concerning further development of the liaison service.^ Also, they were guided by general orders concerning liaison. They not only notified the chief surgeon, A. E. F., of their liaison activities but also the chief surgeon, Services of Supply, until the office of the former absorbed that of the latter in March, 1918, promptly furnishing the latter any hospitaliza- tion data he desired and assisting him in the acquisition of buildings. The liaison officer for the district of Paris was concerned with the proper distribution of American patients in that jurisdiction, for certain hospitals had been desig- nated for the reception of A