Part 32

Beginning, as I have already said, with a peace-time personnel of barely 700 officers, and a peace-time organization, the Medical Department expanded as the army expanded, until, when the Armistice was signed, it was serving 4,000,000 American soldiers at home and overseas and had, in addition, spread its safeguards over millions more of the civil population on both sides of the Atlantic. Several years prior to the war there had been organized a Medical Reserve Corps which included in its membership many prominent physicians and surgeons. The National Guards of the several States also had their respective medical organizations. The Medical Department at the outbreak of the war consisted, therefore, of nine corps: the Medical Corps, the Medical Reserve Corps, the Medical Corps of the National Guard, the Dental Corps, the Dental Reserve Corps, the Dental Corps of the National Guard, the Veterinary Corps, the Veterinary Reserve Corps, and the Veterinary Corps of the National Guard, to which were added before the war had been in progress a month a Medical Corps, National Army, a Veterinary Corps, National Army, a Sanitary Corps, and an Ambulance Corps, making a total of thirteen distinct services in the Medical Department. By the act of August 7, 1917, however, all of the above were merged into the Medical Corps, United States Army, thereby greatly simplifying administration. But it was quickly realized that, even by calling to the colors every medical officer in the Reserve Corps and the National Guard, the personnel would still fall far short of the number required to provide for the proper care and treatment of the enormous armies which were rapidly being placed in the field, for already the Secretary of War had made his celebrated remark: “Why stop with an army of 5,000,000 men?” Some conception of the problem confronting the surgeon-general may be had when I explain that the Medical Department was expected to furnish each infantry division with approximately 111 officers and 1,400 enlisted men. In addition, an enormous number of medical officers was required for the camp, base, and general hospitals which were springing up like mushrooms, almost in a night, throughout the land. In order to obtain these officers it became necessary, therefore, to appeal to the medical profession of the United States and to the various medical societies, the American Medical Association taking a particularly energetic and enthusiastic part in the work of recruiting. The response of the medical men of America was as prompt as it was gratifying. Specialists whose names were as familiar to the public as those of Cabinet officers and who for a single operation received fees equal to the annual salary of an ambassador; obscure country practitioners who made their daily rounds in mud-bespattered buggies and who, as often as not, received their pay—when they received it at all—in produce; prosperous middle-aged physicians with established and lucrative city practices; struggling young internes; lecturers on medicine and surgery at universities and colleges, put aside their private affairs and offered their services to the nation. So universal was the response, indeed, that numerous communities found themselves facing the prospect of being wholly without medical attendance, for all their physicians were in or were trying to get into khaki.

The same patriotic enthusiasm was shown by the dental profession. At the outbreak of the war there were only 86 dental officers in the Regular Army, this number being based upon the ratio of one dentist to each thousand enlisted men. And, though the importance of a clean, healthy mouth was fully recognized as being essential in maintaining the health of the individual soldier, no Dental Reserve Corps existed at this time. It was evident from the very beginning, therefore, that, in order to care for the teeth of millions of fighting-men, it would be necessary to strain to the very limit the resources of the dental profession. Moreover, before the war had been in progress half a year, it was found necessary to raise the authorized quota of one dentist to every thousand men to one dentist to every 500 men. But the dentists lagged not a whit behind their fellows of the medical profession, so that when Germany threw up her hands and cried “Kamerad!” there were 6,284 officers in the Dental Corps.

When the Secretary of State intimated to the German Ambassador that his immediate departure for the Fatherland would cause no tears, there were barely 400 members of the Army Nurse Corps, 170 of whom were reserve nurses, having been called into active service as a result of the mobilization on the border. Yet when the war ended, the corps carried on its rolls the names of 21,480 nurses, nearly half of whom were serving overseas. As long as a veteran of the Great War lives, the work of these young women will be referred to with something akin to reverence. They displayed a courage, self-sacrifice, and devotion beyond all praise. Among them were capable, experienced executives who wore on the breasts of their trim blue jackets ribbons showing that they had seen previous service in Cuba, in the Philippines, and on the Mexican border. Others, hundreds upon hundreds of them, came from the hospitals of the larger cities. But by far the greater number of them were graduate nurses who left assured and lucrative private employment for the fatigues, the discomforts, and ofttimes the dangers, of army work. Nurses with wide executive experience were brought into the service as chief nurses of the great army hospitals, some of which had from 300 to 600 nurses on their staffs while the influenza epidemic was at its height. Their work in this emergency requires no comment, for they were untiring in their efforts, taking no heed of the number of hours they worked and frequently staying at their posts until they dropped from exhaustion. During the epidemic 127 nurses died in this country and 35 overseas from influenza or pneumonia resulting from it. Though a number of American nurses have been decorated by foreign governments, our own government has seen fit to recognize the heroism of only four: Miss Beatrice McDonald, who received the D. S. C. for staying by her patients when the hospital in which she was on duty was bombed by German airmen, though severely wounded herself, Miss Helen G. McClelland, Miss Isabelle Stambaugh, and Miss Julia Stimson, who received the D. S. M.

Meanwhile the enlisted personnel had increased enormously. At the outbreak of the war there were in the Medical Department approximately 6,900 men. During the nineteen months of hostilities this force steadily expanded, the recruits including medical students, pharmacists, and others of a medical turn of mind. Not every one in the corps had had experience in medicine or kindred subjects, however; the chief orderly at the hospital in which I was in France had been one of the editors of _Vanity Fair_, another had been engaged in the importing business, and one of the enlisted men at Fort McHenry Hospital, Baltimore, was a motion-picture actor whose features are known to “movie” fans all over the United States. The Medical Corps reached its maximum strength in November, 1918, when its records showed a total of 264,181 officers and men. Thus it will be seen that the personnel of the Medical Corps alone at the close of the Great War was much greater than that of the entire Regular Army before the beginning of hostilities.

The Medical Corps naturally divides itself into two main branches: the Division of Surgery and the Division of Internal Medicine. The latter, as its name indicates, deals almost entirely with non-surgical diseases and conditions; in other words, medicine as distinguished from the knife. One of the principal functions of the Division of Internal Medicine consisted in obtaining, training, if necessary, and assigning to duty in the various hospitals and camps expert examiners in diseases of the heart and lungs, these officers being charged with the duty of determining the fitness of recruits for military service and their condition on discharge, with special reference to heart disease and tuberculosis. This latter phase of their work assumed such important proportions, however, that it was eventually taken over by a separate division. Another function of the division was to obtain mature and highly trained internists of long experience to serve as Chiefs of Medical Service in base and general hospitals, these officers, who included many of the ablest physicians in the United States, being responsible for the professional care of all medical patients. For a time a school was maintained to train these medical chiefs, practically all of whom were fresh from civil practice, in the details of army-hospital administration. Younger men, usually with little or no hospital experience and, therefore, less highly qualified, were assigned to serve under the medical chiefs as ward surgeons in direct charge of sick soldiers. A small number of highly experienced men were also brought into the service as medical consultants, their duties being to visit the various hospitals and to maintain helpful and sympathetic relations between the medical staffs and the surgeon-general in Washington. The above is, of course, merely a hasty sketch of the great work done by the medical internists. The vast majority of them were desperately anxious for service in France and moved heaven and earth to obtain overseas assignments, being bitterly disappointed when they found that the needs of the army required that they should remain on duty in the homeland. By comparison with those of their fellows who were serving within sound and often within range of the guns, domestic service seemed quiet and prosaic. But, as a matter of fact, there was nothing commonplace about it at any time. The nearest approach to it was after the Armistice, when the main impulse and motive for military service, the winning of the war, became a thing of the past. But during the continuance of the war the medical officer, whether his duties kept him on the firing-line itself, in the camp and base hospitals in the rear, far from the thunder of the cannon, or at the cantonments on this side of the Atlantic, never had reason to complain of his work being monotonous or uninteresting, for every day, almost every hour, indeed, brought new experiences and new problems. I doubt if there is a single officer who wore the uniform of the Medical Corps who will not willingly admit that his army work better fitted him for civil practice and afforded him a deeper understanding of the needs of suffering humanity.

The great and crowded days of the medical internist in the United States came with the influenza epidemic. Thrilling, trying, and tragic was this period. At first in driblets, then in streams which increased with appalling rapidity, the men poured into the hospitals. In civil life a hospital with 250 beds is considered a very considerable institution and one of which the community it serves has reason to boast, yet the great base hospitals, sometimes with as many as 2,500 beds, were literally swamped with new cases, occasionally as many as 1,000 “flu” patients being brought in during a single day. These men had to be cared for and carried through. But how? Not only were there not enough hospitals in the land to hold them, but the medical profession, already drained of its practitioners by the demands of the army overseas, was unable to find enough, or nearly enough, physicians, nurses, and attendants, for the influenza, remember, showed no discrimination, attacking soldiers and civilians alike. When the epidemic descended upon the cantonments, barracks near the hospitals were taken over by the medical authorities, the well men being evacuated to tents in favor of the sick. In many instances buildings which did not have a stick of furniture in them in the morning were ready to receive patients by mid-afternoon. In the meantime cots, pillows, sheets, and blankets, three or four to each cot, had been moved in. Medicines, glasses, and all the other paraphernalia of modern medicine had been obtained. Fires had been started. Cooks, stoves, cooking utensils, food, and dishes appeared as at the wave of a magician’s wand. Medical officers and nurses had been assigned and had reported for duty. The Red Cross and other war service agencies were on hand. Arrangements had been made to care for the clothing and valuables of the patients and a hundred other details had received attention. And all this, mind you, in a few short hours. Surgical officers volunteered for medical service. Officers from the training-camps of the Medical Corps were sent by tens and twenties to help out. Every city, town, and village between the oceans was combed for nurses. There were not enough ambulances to transport the sick, so private motor-cars, taxicabs, even motor-trucks, were pressed into use. The drivers sat at their steering-wheels day and night until they could no longer keep their eyes open. Medical officers were on duty from daybreak until long after midnight, day after day, week after week. Nurses and orderlies kept at their work until they dropped from sheer exhaustion. This was the home equivalent of battle service. No sterner, no more gallant, resistance to the Hun assaults was ever made by the men on the firing-line in France than the battle which was waged against an equally formidable, equally treacherous, enemy by the men and women who wore on their sleeves the silver chevrons of home service.

The Division of Tuberculosis is one of the four branches of the Division of Internal Medicine, it being the only division that has to do with a single disease. This is due to the fact that tuberculosis is admitted the world over to be the most prevalent disease known, one out of every seven of the earth’s inhabitants dying from some form of it. In order to detect the presence and combat the spread in the army of the Great White Plague, the Medical Corps very early in the war took steps to standardize the chest examinations of soldiers, all recruits being examined upon their arrival at the camps according to the standard thus devised by doctors who were specialists in tubercular troubles. These measures resulted in excluding from the army about 80,000 cases of active tuberculosis. Had the methods pursued in former wars been adhered to, a considerable proportion of these would undoubtedly have escaped detection, and, as tuberculosis is a highly communicable disease, thousands of perfectly healthy men would have become infected. Most of these tubercular cases would have had their disease aggravated by field service, and, moreover, the resources of the Medical Corps would have been heavily taxed had it been called upon to treat so large a number of patients. Soldiers who were suspected of having tuberculosis, or who developed it while in the service, were examined by specialists, who confirmed or rejected the original diagnosis, those who were found to have the disease being immediately sent to special hospitals or sanatoria for treatment. The location of these sanatoria in such recognized and widely scattered health resorts as Asheville, North Carolina, Denver, Colorado, the Catskill Mountains, Arizona, and New Mexico enabled the medical authorities to send the soldier patients to regions which, as experience has taught, promote recovery from the disease, and which were at the same time as close as possible to their homes. Patients sent to these hospitals were not discharged from the service until they were cured or until the maximum improvement had been obtained. Thus soldiers received treatment which few civilians could afford, no multimillionaire being able to purchase better medical attention than that which Uncle Sam gave his boys. As tuberculosis is a chronic disease, and as a certain number of cases will relapse after its progress has apparently been arrested, special efforts were made to teach the patients how to live in order to prevent further retrogression, particular emphasis also being laid on the necessity of observing the sanitary precautions which will prevent the transmission of the tubercular germs from the patient to the members of his family.

Though for a number of years prior to the war there had been a steadily increasing appreciation of the importance of neurology and psychiatry in the organization of a fighting-machine, the theories which had been evolved along these lines were never put into practice, at least on a large scale, until America’s entry into the great conflict, when there was organized the Neuropsychiatric Section of the Division of Internal Medicine. When the section was created, about fifty neuropsychiatric officers were commissioned; when the Armistice was signed, this number had risen to nearly 700. The chief function of the section was the exclusion from the army, by means of special tests, of men who, because of mental and nervous diseases, were considered unfit for military service. At first this section was treated with open derision or contemptuous tolerance by certain of the narrow-minded or the prejudiced—for the Medical Corps, like all other branches of the army, is not without its fogies who regard with suspicion anything that is new. The best proof of the success of its work, however, is the fact that it discovered the presence in the army, at home and overseas, of more than 72,000 men suffering from nervous and mental disorders, every one of whom was a potential menace to our success as long as he remained in active service. Thanks to the simple but highly effective tests which the psychiatrists devised, certain men were discovered to be moral perverts; the tests showed that others, if exposed to the strain of battle, probably would have suffered mental collapse, and that still others did not possess a sufficiently developed mentality to understand or to carry out orders. Imagine how grave a menace a single pervert might have proved to the morals of the men with whom he was associated in the intimacy of army life. Picture the danger to the success of a military operation of a single soldier who did not possess sufficient intelligence to understand the orders which were given him or the courage to carry them out. Such men were of far greater potential danger to the welfare of the army than were those suffering from tuberculosis. By means of the psychiatric tests given at the camps and cantonments, more than 1 per cent of all the men brought into the army by the draft were discovered to be mentally unfit and were at once rejected. On the other hand, many drafted men were found to possess exceptional mental qualifications and were thus marked out for assignments where their special aptitudes would prove of the greatest value, in many cases being recommended for the officers’ training-camps. This was the first war in which mental tests have been employed. Men with undeveloped minds, unstable nervous systems, or inadequate self-control are very bad risks for armies. They are unknown quantities and their behavior in moments of stress cannot be relied upon. Such men may cause disaster in action, they are liable to shell-shock, and they are likely to swell the lists of pension claimants. But the psychological tests, though they did not entirely eliminate these dangers, certainly reduced them to a minimum, enabling line-officers to equalize the mental strength of their commands by the reassignment or transfer of men to less exacting duties, or, in the case of those who were actually feeble-minded, securing their discharge from the army and returning them to their homes.

To the Division of Laboratories and Infectious Diseases were assigned the duties of ascertaining the causes of communicable diseases and of establishing methods for their control. The immensely important work of this division was handled by five sections, as follows: (1) The Section of Laboratories, whose duty it was to furnish and train personnel, supervise the work of the laboratories, and standardize the equipment. (2) The Section of Epidemiology, which followed the progress of disease and recommended measures of control. (3) The Section of Urology and Dermatology, which was specially charged with the treatment of venereal disease. (4) The Section on Combating Venereal Diseases, which elaborated and executed measures for educating the soldier on this subject, for the enforcement of legal measures against immoral conditions, and for venereal prophylaxis or early treatment. (5) The Army Medical Museum, which collected pathological material and other specimens of interest to medical men, the scope of its activities being greatly enlarged by the formation of an organization for collecting material in the field.