105th Sanitary Train, 30th Division Field Hospital and Ambulance Companies Nos. 117, 118, 119, 120, A. D. 106th Sanitary Train, 31st Division, Field Hospital and Ambulance Companies Nos. 121, 122, 123, 124, A. D. 107th Sanitary Train, 32d Division, Field Hospital and Ambulance Companies Nos. 125, 126, 127, 128, A. D. 108th Sanitary Train, 33d Division, Field Hospital and Ambulance Companies Nos. 129, 130, 131, 132, A. D. 109th Sanitary Train, 34th Division, Field Hospital and Ambulance Companies Nos. 133, 134, 135, 136, A. D. 110th Sanitary Train, 35th Division, Field Hospital and Ambulance Companies Nos. 137, 138, 139, 140, A. D. 111th Sanitary Train, 36th Division, Field Hospital and Ambulance Companies Nos. 141, 142, A. D., 143, 144. 112th Sanitary Train, 37th Division, Field Hospital and Ambulance Companies Nos. 145, 146, 147, 148, A. D. 113th Sanitary Train, 38th Division, Field Hospital and Ambulance Companies Nos. 149, 150, 151, 152, A. D. 114th Sanitary Train, 39th Division, Field Hospital and Ambulance Companies Nos. 153, 154, A. D., 155, 156. 115th Sanitary Train, 40th Division, Field Hospital and Ambulance Companies Nos. 157, 158, 159, 160, A. D. 116th Sanitary Train, 41st Division, Field Hospital and Ambulance Companies Nos. 161, 162, 163, 164, A. D. 117th Sanitary Train, 42d Division, Field Hospital and Ambulance Companies Nos. 165, 166, 167, 168, A. D. 301st Sanitary Train, 76th Division, Field Hospital and Ambulance Companies Nos. 301, 302, 303, 304, A. D. 302d Sanitary Train, 77th Division, Field Hospital and Ambulance Companies Nos. 305,306, 307, 308, A. D. 303d Sanitary Train, 78th Division, Field Hospital and Ambulance Companies Nos. 309, 310, A. D., 311, 312. 304th Sanitary Train, 79th Division, Field Hospital and Ambulance Companies Nos. 313, 314, 315, 136, A. D. 305th Sanitary Train, 80th Division, Field Hospital and Ambulance Companies Nos. 317, 318, A. D., 319, 320. 306th Sanitary Train, 81st Division, Field Hospital and Ambulance Companies Nos. 321, 322, A. D., 323, 324. 307th Sanitary Train, 82d Division, Field Hospital and Ambulance Companies Nos. 325, 326, 327, 328, A. D. 308th Sanitary Train, 83d Division, Field Hospital and Ambulance Companies Nos. 329, 330, A. D., 331, 332. 309th Sanitary Train, 84th Division, Field Hospital and Ambulance Companies Nos. 333, 334, 335, 336, A. D. 310th Sanitary Train, 85th Division, Field Hospital and Ambulance Companies Nos. 337, 338, 339, 340, A. D. 311th Sanitary Train, 86th Division, Field Hospital and Ambulance Companies Nos. 341, 342, 343, 344, A. D. 312th Sanitary Train, 87th Division, Field Hospital and Ambulance Companies Nos. 345, 346, 347, 348, A. D. 313th Sanitary Train, 88th Division, Field Hospital and Ambulance Companies Nos. 349, 350, A. D., 351, 352. 314th Sanitary Train, 89th Division, Field Hospital and Ambulance Companies Nos. 353, 354, 355, 356, A. D. 315th Sanitary Train, 90th Division, Field Hospital and Ambulance Companies Nos. 357, 358, 359, 360 A. D. 316th Sanitary Train, 91st Division, Field Hospital and Ambulance Companies Nos. 361, 362, A. D., 363, 364. 317th Sanitary Train, 92d Division, Field Hospital and Ambulance Companies Nos. 365, 366, 367, 368, A. D. 318th Sanitary Train, 93d Division, Field Hospital and Ambulance Companies Nos. 369, 370, 371, 372. 319th Sanitary Train, 94th Division, Field Hospital and Ambulance Companies Nos. 373, 374, 375, 376. 5. SECTION OF SELECTION, CONSTRUCTION AND REPAIRS. A. STATUS AT CLOSE OF FISCAL YEAR 1917. 1. At the close of the fiscal year on June 30, 1917, there were about 10,000 hospital beds, distributed as follows: Army posts..... General hospitals. Base hospitals along the Mexican border about. 5, 100 1,500 3, 400 2. The character of construction of the post hospitals referred to is well known to be usually of brick or concrete and of the permanent type construction. The character of construction in the general hospitals was similar and they differed mainly in size and in the grouping of buildings and the more elaborate installation of surgical and medical appliances and specialties. The character of construction in the base hospitals along the border was temporary in type, consisting of frame buildings usually ceilled and mostly heated by stoves and with scant plumbing. B. THE WORK OF FISCAL YEAR 1918. 1. At the opening of this fiscal year, beginning July 1, 1917, the plans prepared for the hospitals for the National Army and National Guard camps were being turned over to the Quartermaster Department for execution. These plans as prepared in the Surgeon General's office were working drawings only, such as have always been prepared in this office. Some construction detail was gone into, but in the main the plans were working drawings quite free from detail as to wiring, plumbing, heating, sewer lines, lighting, etc., yet were comprehensive enough to serve in the field as construction drawings for the temporary character of construction which they represented. Due to the antiquated printing apparatus in the construction branch of this office, there was some delay experienced in printing the large numbers of plans required in the field for erection purposes, and it was necessary for weeks to run the printing machine 21 hours per day and demand overtime labor with no increase of pay possible. Therefore a modern motor-driven printer and a motor-driven gasheated drier were installed. Some blue printing was done by outside firms, but this method was slow, costly, and generally very unsatisfactory. The majority of the printing firms were constantly well stocked with work due to the various Government construction activities which found it feasible to turn over for printing a certain class of work. 2. As above referred to, the character of these hospital buildings was temporary, yet differed materially from the temporary hospital construction at the so-called base hospitals on the border, in that there was more plumbing installation, there were central heating plants usually, and the hospitals were provided with sewage disposal systems. 3. In the preparation of these plans medical officers representing the various services and specialties, such as surgery, medicine, laboratory, eye, ear, nose, and throat, dental, X-ray, nervous, and mental, were consulted, and as far as time, necessary construction, standardization, and funds permitted plans were worked up to embody the essential features desired. These features were incorporated with other usual hospital features and activities and a general plan was thus evolved for the so-called typical 1,000-bed hospital. A 500-bed hospital was drawn by a similar process. In order to standardize equipment, materials, personnel, construction, and administration problems as much as possible, it was thought best to do this, and the 1,000-bed and the 500-bed types were thought to comply with the majority of conditions. The 500-bed hospital differs from the 1,000-bed hospital not only in the number of wards, which are the same in type, but in the size of the administration building, receiving building, general mess hall, kitchen, and certain other service features. 4. There were certain differences between National Army and National Guard hospitals as constructed. The National Army hospitals were built with central steamheating plants, the buildings were lined throughout with wall board, and there was plumbing and sewage. The National Guard hospitals were without these features and the buildings were constructed with a somewhat lower clearance overhead. Both the National Guard and the National Army buildings had ridge ventilation from end to end. Later on, changes were made in the type of ventilating device to reduce cost and construction time. A modified ridge ventilator, full length of buildings, was adopted, which was inexpensive, easy to construct, and which so far has proven satisfactory. The differences in construction between the National Army and the National Guard hospitals was the result of instructions from higher authority based on the assumption that the National Guard camps where the National Guard hospitals were located would not exist in the winter. This, however, did not prove to be the case. Requests had been made for interior lining and for plumbing and sewage, and late in the fall, too late for health, comfort, and economical installation, these necessities were authorized and installation began. 5. Table 151 shows briefly the average schedule of buildings for a so-called 1,000-bed hospital. TABLE NO. 153.-Average schedule of hospitals. Title. Use. Number of buildings. Guide to quartermaster of desired arrangement.. Ward, kitchen, and mess for sick officers.. Quarters, kitchen, and mess for medical officers on Quarters, kitchen, and mess for nurses on duty.. Operating rooms and other features for these special- All operating except that done in F-1.. For hospital exchange, amusement, barber shop, etc. .do. For small groups of contagious cases.. Barracks, toilet, and day room for enlisted personnel Kitchen and mess hall for Medical Department men For post-mortem work, preparation and viewing of For religious services and amusements.. For storage and handling of linen and for future For mental and nervous diseases. 6. It was desired to provide hospital space for over 3 per cent of the command for which the hospital was to serve, but this was not authorized. This was, however, offset in a measure by the installation of certain corridors and porches. This was most fortunate, as was proven later in the winter before the general enlargement of these hospitals was authorized. 7. There was a shortage of competent draftsmen and designers throughout the remainder of the calendar year 1917, and it still exists to-day. It was, however, necessary at this period to increase the drafting force. This was rendered difficult because the Civil Service Commission was not able to supply draftsmen and the law does not permit this office hiring draftsmen except at a very low figure. This state of affairs rendered the commissioning of draftsmen about the only means by which this office could secure competent service. The circumstances almost warranted this recourse, which, however, was not resorted to. Architects, however, versed in hospital design and construction or in military procedure were commissioned in the Sanitary Corps for supervising duties. By considerable effort and after extended delays the drafting and designing force was organized and all hospital plans were studied and restudied and revised as occasion demanded. In justice to the draftsmen secured, it should be said that they have worked faithfully and have without hesitation put in many hours and days overtime. When one considers the fact that they are underpaid for this class of work to-day, every credit should be given them. 8. The problem of hospital construction comprehended (a) the enlargement of existing post hospitals to meet the demands of increased garrisons, especially at coast artillery posts and recruit depots; (b) the construction of hospitals at every National Army and National Guard camp and all other training camps; (c) the construction of hospitals for the embarkation camps; (d) construction of hospitals for miscellaneous military activities, such as arsenals, filling plants, proving grounds, depots, etc.; (e) the construction of new general hospitals; (f) debarkation hospitals; (g) and certain special hospitals which for purposes of administration are classed as general hospitals. 9. During the execution of this work considerable expansion took place. At the beginning 5 civilian employees were engaged in the work under the supervision of 1 officer who had other activities as well. There are now 18 officers and civilian employees engaged on the technical and administrative work of this branch. The velume of work done is much greater proportionately than the increase in personnel. In this year it has been possible to bring the construction branch in direct physical contact with the hospital division of the Surgeon General's Office, which has been a great step forward. If the Surgeon General's Office is to continue to prepare working drawings of desired construction, this consolidation should continue. The blueprinting plant is separated, and this should not be, but it is now not possible to consolidate further. 10. For the fiscal year which ended June 30, 1918, the Congress appropriated $750,000 for construction and repair of hospitals at military posts already established and occupied, and gave authority to use, from the above sum, $25,000 to erect a new hospital at Fort Ward, Wash.; $100,000 to build a modern hospital at Schofield Barracks, Hawaii; $90,000 to enlarge the Walter Reed General Hospital; $90,000 to erect a modern hospital at Fort McPherson, Ga.; and $60,000 to build an officers' infirmary for the general hospital, Fort Bayard, N. Mex. The hospitals at military posts have been kept in repair, but, owing to the necessity for funds to use in constructing temporary hospital buildings rendered necessary on account of the war, it was impossible to construct the new buildings authorized by Congress, and the funds were used to construct temporary buildings; therefore it will be necessary for Congress to renew the amounts stated before the above-mentioned hospitals can be constructed. Congress also appropriated $25,000 for the current fiscal year for construction and repair of quarters for hospital stewards at military posts already established and occupied. These funds have been used for the purpose for which they were authorized, and the quarters are in fairly good condition so far as repairs are concerned, but some general hospitals and some military posts are in much need of such quarters. Deficiency appropriations for 1918 have been approved by Congress for construction and repair of hospitals, as follows: Oct. 6, 1917.. July 8, 1918. Total........ $35, 000, 000, 00 19, 654, 300.00 13, 936, 554. 66 68, 590, 854.66 The last deficiency estimate presented to Congress for $13,000,000, while not gaining approval till after the close of the fiscal year, will nevertheless be used for projects conceived and in some cases completed prior to the close of the fiscal year. This money will be available until December 31, 1918. 11. Many hospitals as they now stand have been added to several times since they were originally hastily planned. It seems quite likely that this unsatisfactory practice must continue, and may even be extended to the majority of the camp and cantonment hospitals, as many camps will probably be increased in size. It was necessary last winter to increase the size of all the camp and cantonment hospitals, but this increase was not due to an increase in the size of the camps. It was rendered necessary because the hospitals as authorized were not quite large enough to care for the percentage of men which it was found advisable to treat and segregate away from their organizations. 12. In addition to hospital construction proper a regimental infirmary was erected for each regiment or separate unit of similar size. Also one and sometimes two large dental infirmaries were built in each camp and cantonment. It has also been necessary to construct in the camps at the ports of embarkation hospital space in excess of that usually necessary at other camps. Eight per cent of troops passing through New York pass through the embarkation hospitals there. These are not to be considered with general hospitals. 13. Aside from the construction of hospitals, regimental infirmaries, dental infirmaries, quarantine camps, etc., all associated with troops in post or in camp, it has been necessary to construct from this fund other hospitals for the care of the sick who may not properly be cared for at existing post hospitals of the United States or at the camp base hospitals. These cases may be called "general" cases, and require what may be called general-hospital beds. Therefore, for the care of the cases that should no longer be retained in camp base hospitals and for the care of those returning from overseas, additional general hospitals were constructed. This work is still going on, and it has been so planned that each month enough general-hospital beds will be added to keep abreast with the incidence of that class of sick. It is planned to establish in each draft district one or more of these hospitals as occasion demands. In such as may be located appropriately reconstruction facilities are being provided. IV. MEDICAL AND HOSPITAL SUPPLIES. 1. GENERAL. At the declaration of war the department was confronted with the task of furnishing supplies and equipment vastly in excess of the requirements in time of peace. The stock of supplies on hand was sufficient to meet the needs of an Army of approximately 300,000. Estimates had to be prepared, purchases authorized, a distribution system devised, additional warehouses secured, depots established, and a force of sufficient magnitude to handle the situation secured. In the Army appropriation act for the fiscal year 1918, approved May 12, 1917, $1,000,000 were appropriated for the Medical Department. The act of June 15, 1917, appropriated $29,780,000 additional. These sums proving inadequate, an appropriation of $100,000,000 was made October 6, 1917, and a further deficiency appropriation of $33,000,000 was made July 8, 1918. On July 21, 1917, the sections of the office handling disbursements, administrative audit of vouchers, and property returns were consolidated into the finance and supply division. This division is charged with all matters pertaining to the procurement and issue of Medical Department supplies and the administrative audit of all vouchers in payment therefor, as well as for services rendered the department. On July 1, 1917, the department had in operation in the United States medical-supply depots at New York City, Washington, St.Louis, San Antonio, and San Francisco. Four new depots at Atlanta, Chicago, Louisville, and Philadelphia were being stocked. It was early seen that with the establishment of the various camps would come the need for the development at each of a local depot equipped to meet all the needs of the camp, regimental organizations, sanitary trains, and the base hospital. It became necessary to find trained personnel to purchase, inspect, supervise transportation, issue, and account for the varied supplies so necessary for the proper care and treatment of the sick. Additional officers and personnel were required for the distributing depots. Officers for the various camp medical-supply depots had to be found, commissioned, and transported to the scene of their future activities before the arrival of the supplies, which in turn had to reach the camp before the arrival of troops. In many instances supplies arrived at the camps before buildings were ready to receive them. They were stored wherever space could be secured in farm buildings, in the open, or under canvas. Every medical-supply officer of the e camps had to adapt himself to existing conditions and remain on duty not infrequently the whole 24 hours if need be, for he was the only representative of the Medical Department present to care for the supplies. With the arrival of troops, enlisted personnel were detailed to duty in the improvised depots, and conditions improved. As time passed, the needed storehouses were completed and the camp medical-supply depots were stocked and in full operation. The Sanitary Corps was authorized June 30, 1917, to provide technical and nonmedical personnel for the various activities of the Medical Department. This corps made it possible to obtain officers for duty as supply officers, purchasing agents, X-ray technicians, automobile and accounting experts, and provided for the development of |