EARLY in 1918 the Medical Department of the American Expeditionary Force began to add to its equipment a type of hospital, known as ambulance chirurgical automobile (A. C.A.), which had been developed by the Service de Santé of the French Army. The French recognized from the early days of the war that certain types of wounds, such as abdomens, chests and heads, should receive early surgical treatment and be held for a considerable period before transportation. Soon after the lines became stabilized they began to operate these "non-transportable" cases in formations which were pushed up as close to the trenches as was compatible with comparative safety. The early surgical ambulances were more or less permanent in type, but the obvious need for well-equipped units which were mobile brought about the development of the auto-chir. The great success of these hospitals led to a rapidly increased output; and as the supply of active auto-chirs increased it often became possible to operate the less severely or "transportable" wounded within a few hours after injury. The good results of the French military surgeons in the treatment of fractures and wounds of the soft tissues were due to their ability to keep ahead of infection by the practice of early and complete excision of damaged tissues; and in this the well-equipped and easily movable auto-chir was an important factor.
The equipment of Mobile Hospital No. 6 was an A.C.A. of the 1917 type, to which was added a certain amount of U. S. A. Medical Department property. The essential factors about which the auto-chir was built were two Renault camions, the sterilizing and the X-ray cars. A boiler mounted at the rear of the sterilizing car supplied steam for two autoclaves, a water sterilizer and compartments for boiling instruments. This car, located at an entrance to the operating room, furnished an ample supply of sterile dressings and hot water, and constant boiling water for the instruments. The X-ray car contained an excellent equipment for radioscopic and plate work, and when the table, stand and tube were set up in their light-proof cloth booth in a tent or building, the inside of the car became a dark room for developing plates. Power for the X-ray as well as for lighting the tents was supplied by 110-volt generators mounted forward of the engines of the sterilization and X-ray camions, which could be alternated at the work of generating power if the lights and X-ray had to be kept going over long periods. These two cars supplied in compact and mobile form the sterilization and radiographic facilities which are ordinarily so difficult to achieve in an advanced unit, as well as electric light for the entire hospital.
The only building was a collapsible house which was intended to serve, with the camions located at either side of it, as operating and X-ray space. This allowed room for only two tables and therefore could not be used as the only operating room except in quiet times; instead of this a tent might be used for operating and X-ray. The house could be warmed by a hot-water system of four radiators, fed by two charcoal stoves set outside.
The major portion of the tentage was of the excellent Besseneau type, with a capacity of eighteen or twenty beds each. The canvas fitted over a folding wooden framework, inside of which was slung a cotton lining, making the tent double walled with an air space of about eight inches. There were eight window spaces on each side, into which fitted framed isinglass windows. At either end was a vestibule giving double doors if the tent stood alone, or covered access to the corridor. It had many advantages over a British marquee, being less bulky, better lighted, more easily heated, and free from obstructing tent poles. The fire risk, always great under canvas, was increased by the fact that the tentage had been treated with a paraffin mixture to make it waterproof. There were thirteen Besseneau tents and four sections of framed, canvas-covered corridor; so that the tents might be set up about the corridors in any one of many different schemes, depending on the character of the ground. The remainder of the auto-chir tentage consisted of ten tortoise tents, suitable for storage and kitchens, and for living quarters if necessary.
To mention briefly some of the other French equipment: there were two hundred folding iron beds, with mattresses, pillows and sheets; folding iron tables and chairs; a complete and beautifully packed assortment of surgical instruments; dressings, drugs and laboratory supplies; electric light cable and lamps of an ingenious pattern which could be plugged in at any point on the cable. The transportation consisted of a two-ton Renault truck and trailer, two three-quarter-ton Fiat trucks, two rolling soup kitchens and the two special camions. There was also a large and heavy mechanical laundry and drier, mounted on two wooden-wheeled trucks.
The first auto-chir taken out by the American Expeditionary Force was Mobile Hospital No. 39, commanded by Lieutenant Colonel Flint of New Haven, which was in operation in the spring of 1918. Two others Mobile Hospitals Nos. 1 and 2, were in action at the Marne fighting later in the summer. By August the American Expeditionary Force was taking alternate auto-chirs with the Service de Santé. The policy was to request a nucleus of four or five officers, twenty nurses and thirty non-commissioned officers and men from Base Hospitals which had been in service for some time. Of the six Base Hospitals, which were attached to the British Expeditionary Force in the summer of 1917, five acted as sponsors for Mobile Hospitals. The Presbyterian Unit of New York sent out Mobile Hospital No. 1 in June, 1918; the St. Louis and Cleveland units sent out Mobile Hospitals Nos. 4 and 5 in September, and the Philadelphia Unit sent out Mobile Hospital No. 8 in October.
Lieutenant Colonel Lee, commanding Base Hospital No. 5, was asked about the middle of August to partially staff Mobile Hospital No. 6. This he agreed to do, despite the fact that the American Expeditionary Force had already taken heavy toll from the unit and that replacements had not been received. Colonel Lee himself was ordered to the American Expeditionary Force at about this time, and most of the staff sent to Mobile Hospital No. 6 was selected by the new commanding officer, Major Lyman. At various times between August 28 and September 15 the following personnel from Base Hospital No. 5 reported to the Assembly and Instruction Park for Mobile Units at Parc de Princes, Paris: Captain E. B. Towne, commanding officer; Lieutenant T. R. Goethals, adjutant; Lieutenant J. E. Foley, supply officer; Captain H. S. Forbes, medical and sanitary officer; Captain J. P. Wall, surgeon; Sergeant, 1st Class, Ginger, top sergeant; Sergeant, 1st Class, Langdon, top sergeant; Sergeants: Donovan, Greeley, Pickett; Corporal Freeley; Privates 1st class and Privates: Barker, Barrett, Barry, Carrier, Chamberlain, Coleman, Danforth, Dowdell, Dunn, Getchell, Harwood, Hersey, Holmes, Houlihan, Hundley, King, Madison, Mahoney, McCaffrey, McGann, Miner, Monroe, Oppenheim, Silva, Wood. Sergeant Ginger went sick on arrival in Paris, joined the unit for about a week in October, and was then permanently detached. Sergeant Langdon and Private Mahoney were detached from the unit in October. Privates Barrett and Silva went sick in September and did not rejoin the hospital. Twenty-six of the original thirty-one were with the unit throughout. During this period the following also reported for duty: Lieutenant P. A. Klebba, laboratory and transport officer, and two men; Lieutenant P. B. Mulligan, X-ray officer, and two technicians; and Lieutenant S. W. Jackson, surgeon. Therefore, up to September 25, when a sergeant, a corporal, and forty-eight men just arrived from the United States were attached as the unit left Paris, the strength was eight officers and thirty-three non-commissioned officers and men.
Through the early part of September equipment from the French and from the United States Medical Department stores came in day by day. The first men to arrive from Boulogne were attached to Mobile Hospitals Nos. 4 and 5 for instruction. As equipment of Mobile Hospital No. 6 arrived, tentage and portable houses were set up and pulled down; the laundry was tried out; the sterilizing and X-ray camions were put into commission, and electric lighting arrangements were installed and tested. As far as possible the men on the ground were given an opportunity to become familiar with all aspects of the equipment, for it was necessary to fill from the available personnel many new, responsible and highly specialized positions. By September 25 most of these duties, such as the operation of the sterilizing and X-ray cars and electrical equipment, the construction of building and tentage, the care and direction of the transportation, carpentering and plumbing, and charge of stores, were in competent hands. The laundry, a rather cranky affair at best, was a doubtful quantity in the absence of an experienced laundryman. The office force, though expert in British paper work, was much handicapped by the absolute lack of United States Army forms, and further, by having only one typewriter. There was a definite lack of competent chauffeurs, and there was only one cook; here it was necessary to depend on reinforcements. On entraining September 25 the really important defects in equipment were, a second typewriter and army forms, and the United States transportation, consisting of a three-ton truck, a touring car and a motorcycle side car. A large amount of Medical Department Supplies had been received, some necessary and important, and some needlessly duplicating French supplies. Among other things was a laboratory equipment in eight large cases, which filled one three-ton truck. Other essentials, which were not available at the moment in Army stores, were provided by the American Red Cross, which always co-operated promptly and generously; among these were stoves and stove pipe, tarpaulins, rubber boots and gas-oxygen anæsthetizing apparatus.
About September 22 twenty nurses arrived in Paris from Boulogne. They were Miss Jefferson, temporary chief nurse, and Misses Birnie, Brooks, Burns, R. A. Cunningham, Dacey, Gregg, Hawkins, Launin, Leibrich, Parker, Pollock, Praetorius, Price, Sedlacek, Thompson, Trueworthy, Wahler, Walsh and Wilday. It had a distinctly cheering effect on the remainder of the unit, almost all of whom were undertaking new and unfamiliar duties, to realize that one part of the work was in hands of nurses of fifteen months' experience in war surgery, fully competent to handle their end of the game. On September 24 the nurses, in charge of Lieutenant Mulligan, left Paris on the Nancy express for French Ambulance No. 225 at Deuxnouds-devant-Beauzée, Meuse. The remainder of the unit, with all equipment on flat and in box cars, left Paris the evening of September 25 assigned to First Army, A. E. F. With the reinforcement of fifty men received that day the strength was eight officers (the establishment was twelve) and eighty-three non-commissioned officers and men. (The establishment was not standardized at this time, but this number was recognized by the authorities as inadequate.) The train arrived on the evening of the 27th at Fleury, a town on the Aire River at the east border of the Argonne Forest, which had that day been made the railhead for the western section of the Argonne-Meuse offensive, begun the previous day. It was an extremely busy place, and transportation was in great demand. By noon of the 28th unloading was well along, and, four trucks having been secured in addition to the unit's transportation, the equipment began to move to Deuxnouds, nine kilometers distant. It rained day and night; this was the first experience with a state of affairs that always held good when moving,---the rain came down hard, and transportation was most difficult to obtain. However, by noon of the 29th, most of the goods were at Deuxnouds and the sterilizing and X-ray cars were ready to function, therefore headquarters was notified that the hospital was ready to take in, and the first convoy arrived at five o'clock that afternoon.
French Ambulance No. 225 was of the permanent type, consisting of wooden barrack wards and operating rooms grouped about a small château. The bed capacity was two hundred, and sufficient material had been left by the French to partially equip about seventy-five beds and one operating room. Deuxnouds was thirty to thirty-five kilometers behind the line on September 29. This ambulance had been made a special hospital for wounds of the head, under the supervision of Colonel Harvey Cushing, consultant in neurological surgery, who had assigned to it six teams headed by surgeons of neurological training, with Captain S. C. Harvey temporarily in charge. On the arrival of Mobile No. 6 these surgical teams and the nurses were already on the ground. Additional officers and men were attached during the next week: a neurologist, a roentgenologist, a dental surgeon, two ophthalmologists, four ward surgeons, a mess sergeant, three cooks and nine privates.
Mobile No. 6 remained at Deuxnouds until October 16. It was understood from the beginning that the location was temporary, and at first an attempt was made to unpack as little as possible, but it was soon necessary to get out most of the supplies and to provide for overflow by pitching tentage. This was due. not only to the rapid intake, but also to slow evacuations. At one time two hundred and ninety beds were occupied, and in addition there were walking wounded in the overflow wards. Captain Harvey was made surgical chief, and ably directed, the clinical work. The officers of the unit, except the X-ray officer and two on duty in the receiving room, were fully occupied with administrative work. Lieutenant Goethals coped successfully with the innumerable daily, problems that beset an adjutant, of which one of the most serious was how to send in reports with no forms and one typewriter. This was done by borrowing specimen blanks and keeping the hard-pushed office force at it day and night. Lieutenant Foley located the scattered sources of supplies, rations, wood, coal, gasoline, and medical stores,---and kept the camp well stocked in spite of inadequate rolling stock. Lieutenant Klebba handled medical supplies and oversaw care of transportation in addition to his laboratory duties. Captain Forbes attended to sanitation and the sick of the unit; while the surgeons, Captain Wall and Lieutenant Jackson, cheerfully did every sort of odd job from receiving-room duty to burying the dead. The nurses fully lived up to expectation by conducting the wards and operating rooms with great ability, though handicapped by inexperienced orderlies.
There were not nearly enough men for the work, and every man was constantly close to the limit of his capacity. In contrast to a British clearing station here there was no alternation with other hospitals, and ambulances came without warning at any hour of the day or night. There was not sufficient strength for separate day and night shifts throughout, so that cooks, kitchen police, electricians and sterilizer operators had to go to work when needed and get sleep as they could. The task of the office and stores force was very heavy. The outside details were hard put to it to keep up with the demands of sanitation, tent pitching, road making and especially grave digging. This last was most difficult, the soil being rocky; help was obtained from pioneer infantry, French troops and finally prisoner-of-war labor. Here, as always, the transportation, sterilization, electrical work, plumbing and carpentering, and the mess arrangements were very successfully managed by the non-commissioned officers and men in these departments. The laundry was put into commission more or less successfully. Aptitude for various kinds of duty was more quickly recognized under working conditions, and soon it was felt that the unit was finding its feet. During this period occurred the only deaths among the company; two men from the reinforcements that joined in Paris succumbed to pneumonia.
During the eighteen days at Deuxnouds the hospital admitted eight hundred and nineteen wounded, most of whom came in the first ten days. There were forty-four deaths, before or after operation. The cases comprised anything with a bandage above the neck, and had in most instances been through a field hospital and an evacuation hospital before arrival. Functioning as Mobile No. 6 did at Deuxnouds was plainly not what the unit was intended for; the special camions and tentage were not absolutely needed for such a fixed hospital, and a mobile and self-contained unit could be used to better advantage nearer the front. However, the experience was invaluable to a new and untried organization.
From the beginning of the Argonne-Meuse offensive the great road from Clermont to Grandpré, on the western edge of the forest, had been heavily taxed by the tremendous traffic. Several points liable to congestion and blockade had developed in the town of Varennes, at two mine craters near Boureuilles, and to a lesser degree in the towns of Neuvilly and Clermont-en-Argonne. All these points were between the lines and the nearest mobile or evacuation hospitals. Ambulances were frequently caught and delayed in the traffic jams, and it became necessary to place a surgical hospital north of Varennes, which was the "bottle-neck" nearest the lines. Mobile Hospital No. 6 was therefore temporarily attached to First Corps and ordered to set up north of Varennes near the great highway. On October 14 most of the equipment moved in French trucks to a location near the River Aire, opposite Montblainville and just off the Grandpré road, a point about thirty-two kilometers from Deuxnouds, and about seven kilometers behind the line at that moment. The operating teams stayed at Deuxnouds, to continue with Mobile No. 8, which was to take over the hospital; all the nurses and a party of officers and men also remained behind temporarily. Unfortunately it was not possible to find the chief surgeon, First Corps, on the morning of the move; for next day, with all the equipment on the ground and the tentage partly erected, it developed that the location selected was not satisfactory to the authorities, who wanted the hospital at a point two kilometers south, where Field Hospital No. 162 was already set up. The tents came down and another move began at once. This misunderstanding brought a regrettable increase of heavy work on the men, who were now going through the hardest grind which the unit experienced.
Field Hospital No. 162 was located on a one-way road, half-way between Varennes and Cheppy and just off the highway. This was high ground, fully exposed to wind and weather, and one and one-half kilometers from the Buanthe River at Cheppy. The location had been five kilometers on the German side of the line, directly north of the famous Vauquois Hill (253); this stretch of country was taken by the 35th and 91st divisions on September 26. Mobile No. 6 was directed to combine with the Field Hospital, which was taking care of non-transportable wounded on a small scale, having in addition to its regular equipment two Besseneau tents, and small sterilizing and X-ray plants. It was therefore impossible to construct according to one of the schemes which had been planned, and tentage was pitched so as to expand the existing plant to the best advantage; but it was easy to get under way rapidly, and patients were received beginning the 17th of October. The nurses were not brought up until about the 24th, because during the first days in this location there was considerable shelling and bombing of the adjacent wrecked towns and of the roads. Even after the nurses came up Varennes and Cheppy were bombed, but as there were no anti-aircraft guns in the vicinity the planes could fly low and bomb their objectives fairly accurately. A large cross of sheets was staked out on the ground soon after arrival. At about the time of this move the transportation of the unit was increased by the addition of a three-ton Liberty truck, a Dodge touring car and a motorcycle sidecar. The heavy special camions made the trip overcrowded roads, wet and often steep and rough, in a way that surprised even those who had the most confidence in them. The laundry and drier were successfully trailed up and located on the Buanthe Stream with the help of tanks.
It is always difficult to attempt to run two units in combination, and it was to the great satisfaction of every one concerned when Field Hospital No. 162 moved across the road, about the 24th of October, to act as a relay station for walking wounded. It did not seem feasible, in view of the fact that the hospital was in operation, and that the men had been hard pushed, to attempt a complete reconstruction of the tentage about corridors. So the rather hodge-podge location of the tents after the Field Hospital moved was adapted and modified by new construction into an arrangement which, though by no means geometrical, proved perfectly workable and satisfactory. A short semicircle of crushed rock was built off the road, and on this opened one end of a double Besseneau (two tents end to end without vestibules). The one next the road was the reception tent, equipped with tables on which to place stretchers for examination, and two stoves. At the junction between this and the next tent was slung the hood of the X-ray, with equipment inside. Beyond this, the second of the twin tents, was the preoperative and shock ward, containing two stoves and a series of horses on which to place stretchers above lighted candles. Here also was apparatus for infusion and blood transfusion. Two officers and four men, forming a "shock team" attached October 17, were in charge. The rear end of the shock tent opened on a radiating and roughly circular arrangement of Besseneaus, connected by duck-boards. Next to the shock tent lay the operating tent, containing six tables and heated by three stoves. At the rear of the operating tent was attached a small section of corridor, really the entrance to the portable house, which opened into the sterilizing car. The X-ray car was alongside the sterilizing car, the two occupying the space between the end of the operating tent and the midpoint of the double reception-shock tent, where the X-ray apparatus was located. By this arrangement the heavy camions were only a short distance off the road, an important point when board road has to be layed; they lay side by side, as necessary, in order to alternate generators; and they lay alongside operating room and X-ray room. This was not the orthodox scheme, but it proved most satisfactory. The eighteen-bed wards were located as conveniently as possible, taking advantage of stretches of fairly level ground and avoiding shell holes when feasible. The bed capacity grew gradually to two hundred at the end of October. The portable house, not being required for an operating room, was set up on the ambulance road opposite the reception tent and used as the hospital office. The nurses occupied a Besseneau tent and a marquee. Nurses and officers messed in a marquee, back of which a kitchen was set up in a tortoise tent. The officers lived in a Besseneau and an American hospital tent. The hospital and company kitchen was in a tortoise tent enlarged by a construction of galvanized iron and tarpaulins. Other tortoises acted as mechanic's shop, quarters for kitchen and transportation details, dispensary, storeroom and morgue. The company, with a few exceptions, lived in "pup tents" at this time. This was done because the demand for two hundred beds did not leave other tentage available, but aside from that the experience with pneumonia at Deuxnouds warned against crowded barracks. Many of the men, in their rare free hours, constructed fairly comfortable quarters with timber and galvanized iron from near-by German trenches and dugouts; and in spite of the cold wet weather and heavy work the company health was good.
During the latter part of October numerous reinforcements were received. Two surgical teams were taken over from Field Hospital No. 162. Two shock teams and two splint teams were attached. A small but welcome squad of enlisted men was received. In November two more surgical teams arrived. By early November the strength had risen to twenty-six officers, twenty-two nurses and about one hundred and thirty-five non-commissioned officers and men. The disproportionate number of officers was due to the fact that four attached surgical teams had three officers each and that there were superfluous X-ray officers; the actual working strength of the unit, aside from attached teams, never rose above eleven officers. Certain reassignments of duty were made to meet changed conditions; thus Captain Wall and Lieutenant Jackson headed two operating teams made up from the personnel of the unit.
The stay at Varennes may be roughly divided into three parts. During the first period, from October 16 to November 1, the hospital was gradually developing and constantly receiving wounded in moderate numbers. The First Army at this time was bringing strong and constant pressure to bear on the Kriemhilde line of defenses, on which the Germans were fighting stubbornly and giving ground very slowly. The First Corps, for which Mobile No. 6 was the nontransportable-wounded hospital, advanced only a few kilometers in this time, and on November 1 lay on a line between Grandpré and Landres-et-St. Georges, not over fifteen kilometers from Varennes. The average interval between receipt of wound and admission to Mobile No. 6 was seven hours. The second period, comprising the first ten days of November, was prepared for with expectation of heavy casualties. This was realized for a few days, but after his line was broken on November 1 the enemy retired rapidly, and by November 6 the front was over forty-five kilometers distant from Varennes. The time interval between receipt of wound and admission steadily increased, and by November 5 it was rarely under twenty-four hours and getting greater. The hospital was losing its usefulness and was prepared to move forward to a point forty kilometers north selected by the commanding officer; but when Sedan was taken on November 8 it became evident that the enemy was not going to stand again, and the move was abandoned. During the third period, from the Armistice until the first week in January, when it entrained at Varennes, the unit was parked awaiting disposition and transportation.
It is evident that during the latter part of October and the first few days of November the hospital was well situated to perform the function for which it was intended. The wounded were received after a short interval and were X-rayed and operated at once or after treatment of shock and hemorrhage. The worst operative risks were anæsthetized with gas and oxygen. After operation they were put to bed, skilfully nursed, and held until fit to evacuate. In short, the type of wounded which must be operated early were treated under almost ideal conditions. The large majority of the cases were abdomens, chests, heads and shocked fractures, knee joints and multiple wounds. The principal difficulty that had to be met at this time was the danger of filling the hospital and, lacking evacuation facilities, automatically putting it out of commission. This was taken up late in October with Colonel Grissinger, the Corps Surgeon, who promptly attached Evacuation Ambulance Company No. 5 for the use of Mobile No. 6 and Mobile No. 4, which had moved up on October 28 to a location two kilometers distant to take the nontransportable wounded of the 5th Corps. This made it possible not only to evacuate post-operative cases, but also, when the rush came, to promptly send on to the Evacuation Hospitals at Les Islettes and Froidos such preoperative cases as were judged to be transportable. This was important, because the "triages" of the divisional field hospitals, which during the quiet times sent in ambulance loads of strictly nontransportable cases, were not able to sort the cases so well under rush conditions, and sent mixed loads including slightly wounded. To facilitate rapid transport of unoperated cases one ward abutting on the road was designated as evacuation ward, to which unoperated cases from the reception tent and post-operative cases from the other ward were taken immediately on being marked evacuable. As soon as four cases were in this ward an ambulance was loaded and despatched. The officer in the reception tent had many difficult questions to decide. He must not fill the hospital with cases that were transportable, but on the other hand it was hard to say what was really transportable under existing conditions. With open road an ambulance might go back to the evacuation hospitals in an hour or an hour and a half, but traffic was heavy and it would probably take much longer. During October the policy was to hold and operate all cases; with the rush on November 1 questionable cases were sent on because the operating capacity of the teams was being severely tried by the truly nontransportables; and as soon as it was clear that the line was moving rapidly north and that very serious cases were not getting back, everything received was operated. The lack of a chief of surgical service was somewhat of a handicap. To keep things running smoothly it was essential that some one of considerable experience should constantly make rounds, advising the reception-room officer, helping the shock-room officer on questions of operability and treatment, keeping the rotation of cases to the operating room in proper order, and overseeing the selections for evacuation. This work was at first handled by the commanding officer, and later by Captain Walter Boothby, who was temporarily attached early in November.
The admissions during less than four weeks of receiving at Varennes totaled four hundred and ninety-three, of which about half came in the six days from October 30 to November 5. The total deaths were one hundred and twelve, of which thirty were dead on admission or died shortly without operation. This high rate of mortality emphasizes the fact that the hospital was dealing with very seriously wounded men, and that a large number of the wounded who recovered would have had little chance had operation been delayed many hours. During the period of activity the unit functioned more smoothly every day. The office force had the paper work well in hand. The transportation, in spite of many difficulties in obtaining spare parts and in doing repairs, was kept up to a high mark of efficiency. Rations were usually plentiful and of good quality; supplies were well ahead of the demand, medical supplies especially being always adequate. The stoves, two to a tent, consumed a truck load of wood a day. Two carts of water were hauled daily from a chlorinating plant at Cheppy, but in spite of treatment it was not very good and some diarrhoea resulted from using it unboiled. When it looked as though linen for the operating room and wards might run short, the laundry went to work, and was beginning to turn out a satisfactory amount of clean material. Lacking an incinerator, sanitary arrangements depended on pit latrines and pits for ward and kitchen waste; the plentiful supply of shell holes was of considerable value here. A cemetery was located on the outskirts of the camp, and the burials were supervised and registered by a sergeant of the Graves Registration Service. The X-ray plant did prompt and good work, and the sterilizing car performed its functions most satisfactorily. The electric lights were often run day and night and never suffered any breakdown. In the operating room a system of standard sets of instruments was tried out and proved to be efficient; these sets were kept sterile and handed to any team when required, thus obviating the delay and confusion of the old method by which each team cleaned and resterilized its own instruments between operations. Donors for blood transfusion were not easily obtained, for the hospital received no walking wounded, but an adequate supply of volunteers was picked up from the patients of Field Hospital No. 162 and other sources.
After the Armistice the hospital soon stopped admitting and took down superfluous tentage preparatory to a possible move into Germany. With little work to do, all hands went sightseeing about the sadly devastated neighboring country, fought over since 1914. The trenches and tunnels of Vanquois Hill, almost cut in two by the mine craters of years of trench fighting when the French and Germans contended for possession of its summit, were thoroughly explored. The battered Argonne Forest was close at hand. Some went as far as Le Mort Homme, Hill 304, Avocourt and Malancourt, all famous names in the 1916 battle for Verdun; and many saw Verdun, Dun and Grandpré. Late in November the nurses were detached for service with Evacuation Hospital No. 18 at Briey, which was taking care of wounded Americans and French who had been in German hands. They did not rejoin, but returned later to Base Hospital No. 5 at Boulogne. All temporarily attached officers and men were gradually withdrawn, lieutenants Goethals and Jackson of the regular staff were detached, and the depleted unit settled down to make the best of life in a deserted and devastated country. The men were drilled and taken on practice marches to partially use up the spare time. The Red Cross and Knights of Columbus were generous with tobacco, chocolate and other luxuries which had previously been difficult to obtain. Early in December it became evident that there was to be no move into Germany, and the camp was repitched to make the wait as comfortable as possible. The pup tents were abandoned, 'and six Besseneaus were pitched and equipped with tarpaulin flooring, beds, mattresses and stoves, to quarter the noncommissioned officers and men. The company kitchen was placed next to the company mess tent, which had been located in one of the former wards after the Armistice. Quarters and kitchen for the officers, now only six in number, were pitched near the road. A portable shower bath with eight spouts had been obtained and set up early in November and taken down after the Armistice; it was now erected again in a well-heated section of corridor, and hot baths and laundry facilities were available all day. Leave was opened, and all officers and nearly all of other rank, who were due, went on permission before January. A considerable amount of stores and equipment was turned over to medical dump, salvage dump, a field hospital and various engineer and labor units in the neighborhood. Finally on January 4 enough rolling stock had accumulated at the Varennes railhead to carry the unit. Camp was broken, equipment and personnel were entrained in a scratch assortment of box cars, gondolas and flat cars, and the train pulled out that evening. At Joinville, Haute Marne, the personnel detrained excepting a detail under Sergeant Donovan that went on to Paris with the equipment. After a few days at Chatonrupt near Joinville the unit was disbanded and the personnel returned to their original units. The former members of Base Hospital No. 5 and some casuals returned to Boulogne. The detail in Paris reached Boulogne later, after Lieutenant Foley had turned in the property.
Throughout the hospital's period of activity the nurses worked with the utmost devotion. They did the long and trying day's routine, and put up with the many discomforts and annoyances of life under such conditions with the greatest good humor. The original men from Boulogne were necessarily the mainstay of the unit, for aside from them there were none of any war experience. It is pleasant to record that of the eighteen noncommissioned positions allowed Mobile No. 6, thirteen were filled by personnel from Base Hospital No. 5 as follows: Sergeant T. F. Barry, carpenter and mechanic; Sergeant F. L. Carrier, outside details; Sergeant J. L. Danforth, laundry and outside details; Sergeant J. A. Donovan, transportation; Sergeant E. F. Dunn, stores except medical; Sergeant P. J. Freeley, medical stores and dispensary; Sergeant R. M. Greeley, office; Sergeant J. H. Hundley, sterilizing camion and operating room; Sergeant F. Madison, mess; Sergeant E. J. McCaffrey, electrician; Sergeant J. J. McGann, wardmaster and receptions room; Sergeant A. W. Miner, tentage and construction; Sergeant E. R. Pickett, office. Nor should it be overlooked that many others from Boulogne, who did not attain noncommissioned rank, did conscientious and efficient work in various positions according to their qualification and training.
Such is the story of the offspring of Base Hospital No. 5 with the American Expeditionary Force. The unit was in action with the First Army for six weeks; during that time it admitted and treated one thousand three hundred and twelve casualties with one hundred and fifty-six deaths, a mortality of 11.9%. Cancellation of the projected jump from Varennes to Brieulle about November 9 was a distinct disappointment to many who felt confident that it would have been accomplished with a speed and efficiency far above the previous move. Time and experience are needed to make any organization run smoothly, and it was not to be expected that the high standard of a similar French or British unit would be attained in this short period; but the hospital compared favorably with the American units with which it came in contact. The officers, nurses and men who worked so hard for the success of Mobile Hospital No. 6 have reason to be proud of its record and achievements.