Part 33

The problems handled by the Division of Laboratories and Infectious Diseases were both varied and vitally important in preventing wastage of troops. The view held by the experts of the division that the enteric group of diseases, which wrought such havoc in other wars, could be controlled by typhoid and paratyphoid inoculation and by adequate sanitary measures, was confirmed by the fact that, though typhoid occurred in the devastated and extremely insanitary regions along the Western Front, it never became a serious menace to the American Army. With the practical elimination of the enteric diseases, the respiratory diseases provided the most important problem for the Medical Department. The most vigorous measures were pursued in studying and attempting to control the incidence and mortality of respiratory diseases, and many facts were ascertained which proved of great value during the period of operations and which, when the lessons to be drawn from them have received sufficient study, will eventually place in our hands more adequate means of control. Epidemic cerebrospinal meningitis is another disease which always has to be feared when troops are mobilized. Infection is transmitted by the discharges from the respiratory passages, usually being disseminated by “carriers,” who spread the disease without having it themselves. In order to detect these “carriers,” any one of whom might unintentionally create as much havoc as an enemy agent in a munitions plant, hundreds of thousands of men were examined, our knowledge of the methods by which the disease is transmitted being thereby greatly increased. The problem presented by the venereal diseases has always been of vital interest to all armies and the fight against this class of infections has been vigorously waged in the American Army for many years. With the passage of the Draft Act it became evident that it would be necessary to extend the fight to the civilian population not only because it was a source of infection of the army but in order to diminish the occurrence of these diseases among drafted men. To accomplish this a close alliance was formed between the Section on Combating Venereal Diseases of the Medical Department and the War Department’s Commission on Training Camp Activities. The methods pursued in preventing venereal diseases aimed, first, at diminishing exposure to infection, and, second, at giving medical treatment to soldiers who have been exposed in order to prevent the development of the disease. One of the most immediately effective measures in preventing exposure was the repression of prostitution and its ally, the liquor traffic, in the neighborhood of army camps and to a lesser degree throughout the country. The surgeon-general assigned specially qualified officers of the Sanitary Corps, mostly lawyers, to the Law Enforcement Division of the Commission on Training Camp Activities, with orders to see that the federal and local laws against prostitution and liquor-selling were rigidly enforced. The results exceeded all expectations. In a year and a half about 130 red-light districts were closed at the instigation of these officers working in the name of the Law Enforcement Division. Street-walking and the connivance of lodging-house and hotel-keepers, taxicab drivers, and others was kept down. Trained women social workers, experts in the management of reformatories and detention houses, and civilian investigators co-operated with the military authorities in the work. Seven hundred and fifty cities and towns were investigated and a thorough clean-up was made in 453. As a result of this work, _it is estimated that to-day not more than five openly recognized red-light districts remain in the whole United States_. It has repeatedly been asserted that military life is conducive to immorality and that the army reeks with venereal diseases. This charge is effectually disposed of by the statement that of a total of approximately 225,000 cases of venereal disease found to exist in the army, 200,000 were contracted before enlistment.

The Division of Surgery is subdivided into sections of General Surgery, Orthopedic Surgery, Head Surgery, and Genito-Urinary Surgery. In each of the forty-five army hospitals in the United States a surgical service is maintained, the chief surgeon and his assistants having practically the same freedom of judgment in deciding upon the kind of treatment that is to be pursued that they would exercise in civilian institutions. To some extent, however, the matter of treatment is governed by the rules laid down in the Army Medical Manual and the regulations established by the Surgeon-General’s Office. Thus, each month a duplicate of the record of every operation performed, a list of the patients who have died and the reasons for their deaths, and a list of the supplies used by the surgical service must be sent to Washington. In addition, the hospital must report upon the number of patients received from overseas and the character of their injuries, and the number of cases of peripheral nerve, empyema, fractures, osteomyelitis, etc., which are in the hospital, together with the classification of the stage of the disease, that is, whether it is improving, whether it is stationary, or whether it will require operation. In this way the Division of Surgery is enabled to maintain a supervision over the operation of each hospital without interfering with its actual workings. In other words, the surgical service is permitted to exercise its own judgment untrammelled and without interference, but it must render a faithful report of all its doings. These monthly returns are carefully scrutinized in Washington and the work of the entire surgical personnel is carefully watched and card-catalogued. Monthly reports from the various commanding officers and from consultants, as well as information picked up here and there, are entered on these cards, so that no officer can remain for any length of time in the surgical service without the department knowing exactly what he is doing and having a very accurate estimate of his ability.

When war was declared, the army possessed in the United States two hospitals for general cases, one for tuberculosis, one for rheumatism, and 113 post hospitals, with a total capacity of 6,665 beds. In order to meet the anticipated needs of our great new armies a vast programme of hospital construction was started in August, 1917, and, though it was greatly curtailed after the sudden collapse of the German war-machine, by March, 1919, the Medical Department had at its disposal in the United States alone a total of 130,564 beds. In other words, the capacity of our army hospitals was increased 1,850 per cent in twenty months—a record which is, I imagine, without parallel in the history of medicine. The total number of medical officers, nurses, and enlisted men on duty in these hospitals during the period of the war was equal to the population of Albany, New York, and the number of cases which were treated—2,000,000 in all—was equivalent to the total population of Chicago. These gigantic hospitals, with their cool, clean wards, their ridge ventilation, their wide corridors, their elaborate heating, lighting, water, and fire-fighting systems, are not surpassed by any civil hospitals of their size in the world. To realize this, one has only to visit them. Indeed, it is not the slightest exaggeration to say that the American soldier received the most expensive kind of medical treatment, in hospitals of the finest type, at the hands of physicians and surgeons many of whom had given up princely incomes and leisurely lives in order to work eighteen hours out of the twenty-four at a captain’s or major’s pay.

It did not take the Medical Department many months to realize that it not only had on its hands thousands of sick and wounded soldiers but it also had the great American public—and the public required the most careful and tactful handling. Before we had been at war a year every conceivable sort of rumor in regard to the way in which the men in the hospitals were being treated was making the rounds. It was whispered that they did not get enough to eat, that they were not properly clad, that the physicians played poker and the nurses danced while their patients lay dying, that out-of-date methods of treatment were the rule, that the medical officers were incapable or overbearing. No rumor seemed too fantastic to receive credence. One woman alighted from her limousine at the entrance to the Walter Reed Hospital in Washington and asked to be shown the “basket cases.” Upon being asked by the puzzled attendants what she meant, she explained that she wished to see the soldiers who had lost both legs and arms, and who, she understood, were kept in baskets! And she was quite frankly sceptical when assured that neither at Walter Reed nor at any other military hospital in the United States was there a soldier who had lost both of his legs and both of his arms. In order to combat such ridiculous and harmful stories, to keep the public informed of the splendid treatment which the soldiers were receiving, and to cheer up the depressed and lonely soldiers themselves, the Publicity Section of the Surgeon-General’s Office established a series of hospital papers which covered the entire country. _The Come-Back_, edited and published at the Walter Reed Hospital, Washington, D. C., jumped in one issue to the ranks of the big dailies and steadily held its place in everything—news, editorials, cartoons, advertising, and circulation—that makes a successful newspaper. _The Right About_, published by the patients of Debarkation Hospital No. 3, located in the former Greenhut store in New York City, soon ran up a circulation of more than 50,000—at five cents a copy, too. Among the other papers was _The Trouble Buster_, published at Fort McHenry Hospital, Baltimore; _The Ward Healer_, at General Hospital No. 12, Biltmore, North Carolina; _The Pill Box_, at Debarkation Hospital No. 1, Ellis Island; _The Reclaimer_, General Hospital No. 34, East Norfolk, Massachusetts; _The Stimulant_, General Hospital No. 19, Lakewood, New Jersey, and a score or more of others with equally amusing names. The joyous, humorous, American spirit of these papers set a fashion of good cheer and sportsmanship among the patients, their attitude being characterized by the slogan shouted from the top of the first page of one of them: “The Come-Back chirps so loud that nobody has the nerve to growl.”

Even before the first of the constantly growing streams of wounded began to trickle home from France, it was recognized by the Medical Department that a system must be devised and put into operation whereby these men, instead of being mended and turned loose to shift for themselves as best they could, must be carried along, receiving treatment and pay, until they had attained the maximum degree of physical and functional restoration. For a quarter of a century after the close of the Civil War the streets of American cities were filled with disabled men who eked out their scanty pensions by selling shoe-laces, pencils, novelties, or by begging, because no intelligent measures had been taken to refit them for their former occupations or to fit them for new ones. It was determined that this condition must not occur again. The plan for physical reconstruction of the soldiers, as ultimately adopted, was simple, direct, and effective. It involved primarily the establishment of an administrative organization known as the Division of Physical Reconstruction, divided into departments of physiotherapy and education. Certain subdepartments were also made necessary by the special requirements of those soldiers who had lost their speech, their hearing, or their sight. The sympathy and interest aroused by this work throughout the country quickly drew into it as officers or advisers many men eminent in those walks of life which best fitted them for the exacting duties demanded by this service. The work of physical reconstruction has been eminently successful in its effect upon the disabled soldier, bringing him to a realization that, however great and disheartening his impairment, he might hope for usefulness, happiness, and self-support in the future, and in many cases leading to the adoption of a new and better vocation and a better standing in life. I knew one man who had had both legs blown off by a shell at Château-Thierry. He was a young, fine-looking, exceptionally intelligent fellow, but, with the prospect of spending the rest of his days in a wheel-chair staring him in the face, he had sunk to the depths of misery and discouragement. But one day one of the experts of the reconstruction service sat down beside his bed, offered him a cigarette, and started a conversation.

“What did you do before you went into the army?” the reconstructionist inquired.

“I was a carpenter,” the man answered. “Made good money, too. But I guess the only thing I’ll be good for in the future will be peddling shoe-laces,” he added bitterly. “No one wants a legless man.”

“Ever have any other occupation?”

“No. I always wanted to be an architect, but my people didn’t have the money to send me to college, so I went to work after I finished high school.”

“Would you like to take up architecture now if you could get the training?” the reconstruction expert asked.

“Would I?” the soldier gasped incredulously. “Would I? Say, friend, what’s the use of hitting a fellow when he’s down and out?”

“You’re not down and out,” was the cheery answer. “Not by a damned sight! If you want to be an architect, Uncle Sam is ready to give you a chance. He will give you an education, and pay you while you are getting it, and then he will get you a job. Don’t get the idea into your head that he has forgotten what he owes you boys who have fought for him.”

The last time I saw that soldier he had already commenced his architectural education.

“If he keeps on as well as he has begun,” one of his instructors told me, “he will make several times as much money without any legs as he did with them.”

The educational work starts at the bedside as soon as the patient feels the need of some activity or diversion. Each patient is treated as an individual, an educational activity being selected for him which will have the greatest curative effect and will at the same time present the greatest interest and incentive because of the future usefulness which it holds out to him. Simple crafts, light, desultory, and diverting, gradually give place to more exacting, more purposeful studies and occupations. For one man the series may be bead-work, mechanical drafting, wood-shop, carpentry; for another, knitting, basketry, penmanship, and accounting; for the illiterate it may be some textile project followed by instruction in reading and writing. Since the work began, 75,000 men have been enrolled in some form of educational work in fifty hospitals. Many have regained control of palsied muscles, limbered up stiffened joints, revived dulled mental sensibilities, steadied shaken nerves, or obtained improved physical tone by the application of these methods. To thousands the educational service has brought the discovery that, in spite of the handicap of their disabilities, they possess unsuspected ability in certain lines of useful and profitable endeavor, thus substituting hope for despair and showing them the way to a useful and contented future.

M—— was illiterate; in fact, he could not sign the pay-roll or read the simplest orders; he was bedridden with wounds in his shoulder and arm. He came from a remote mountain community, where the need of even a rudimentary knowledge of the three R’s was not deemed necessary. For thirty minutes a day for six weeks he studied reading, writing, and arithmetic. When he was ready for discharge from hospital he was able to write short letters, though he found spelling puzzling. In reading he made unusual progress, though his oral inflection left something to be desired. His greatest pleasure was to receive a letter from his brother, who had had five years’ schooling but could not write as well as M—— himself, or to write to his mother instead of being compelled to ask the other boys to write his letters for him.

Many of the soldiers are country boys and will go back to farming when they leave the hospital. For them there are courses in farm accounting and work in the gas-engine shop and with the hospital’s tractor. Clerks who were unable to obtain promotion because they did not understand stenography and typewriting are learning those branches, and some are taking courses in the newest systems of cataloguing and bookkeeping. A boy who had lost both legs above the knee became proficient in Spanish in order that he might assist his brother in the management of a ranch near the Mexican border. Others are taught woodworking, gardening, the operation and repair of gas-engines, shoe repairing, oxyacetylene welding, printing, electrical mechanics, lettering, and drawing. One day there was brought into the reconstruction hospital at Colonia, New Jersey, a boy whose hands had been taken off at the wrists. For five weeks he had been fed and cared for by any one who happened to be near. He was helpless and despondent. The able and energetic woman in charge of the educational work in his ward suggested that if a spoon was fastened to the stump of his right arm he would be able to feed himself. At first he said that he couldn’t, but she insisted on his making the attempt. The very next day he called to the sergeant who had told him that dinner was ready: “I can wait on myself now.” Then he devised a way to light his own cigarettes. Before long they had rigged up a device by which brushes could be fastened to his arms and he was set to work painting toys and boxes. And he did it remarkably well, everything considered. And, what was much more important, he whistled as he worked.

I doubt if any branch of the army did more efficient work in its respective line, and received less credit from the public, than the Veterinary Corps. This lack of appreciation was due, in the first place, to public ignorance of the duties of the corps and of the character of its personnel. Most people associate a veterinarian with the old-time country horse-doctor, of rough manners and still rougher speech, who was known to every man and boy in the countryside as “Doc.” The army veterinarian is a different genus altogether. He is usually as smart in appearance and as well-set-up as any officer of the line; he is more often than not a university graduate, and his methods of treatment are as modern and scientific as those of a surgeon or a medical specialist. The impression also seems to prevail that, as a result of the wholesale motorization of artillery and transport and the enormous use of aircraft, animals played but a small part in the Great War, and that consequently the army veterinarian enjoyed something akin to a sinecure. As a matter of fact, nothing could be further from the truth. Probably you were not aware that when the war ended, the United States Army possessed close to half a million horses and mules—the exact figure was, I believe, about 470,000—and was purchasing hundreds of more daily. Not only was the task of inspecting and supervising the care of this great body of animals an enormous one, but, as a result of the extreme scarcity of horse-flesh—for buyers for the European armies had almost drained the markets of the world before we entered the war—and because of the lack of tonnage, the animals of the A. E. F. were, as a divisional commander expressed it in a general order, “worth their weight in gold.”

Prior to 1916 there were only about 75 veterinarians in the entire army, but with the passage during that year of the National Defense Act the number of veterinarians at the call of the government was materially increased by the creation of the Veterinary Reserve Corps. The Veterinary Corps, like other branches of the service, kept pace with the expansion of the army, and when the Armistice was signed it had on duty 2,200 officers and an enlisted force of more than 21,000 men.

When an animal is first led before a purchasing commission its relation to the Veterinary Corps begins. Every horse and mule must be examined by a veterinary officer for soundness and freedom from physical defects before it can be purchased. As soon as the purchased animals have arrived at the various remount depots they become the objects of unceasing attention by the Veterinary Corps, whose duty it is to keep them free from disease and in the highest state of efficiency. This work includes the sanitary inspection of stables, picket-lines, forage and bedding, methods of feeding, watering, grooming, and shoeing, the detection and segregation of communicable diseases and the establishment of proper quarantine regulations, the care and treatment of all sick animals, the operation of veterinary hospitals, the investigation of the cause and cure of equine diseases, and the keeping of records. Another important duty of the corps in France was the prompt evacuation of all wounded animals in order that they might not hinder the mobility of the troops or engage the attention of the men. In order to facilitate the evacuation of sick and wounded animals from the Zone of the Advance, 21 veterinary hospital organizations—each consisting of 7 officers and 300 men, and each having a capacity of 1,000 sick animals—were trained, organized, and sent overseas. There were also sent to France 2 base veterinary hospitals with a capacity of 500 animals each. Besides this, every cantonment in the United States had its own veterinary hospital, varying in capacity from 200 to 600 animals each. As a result of the scientific methods of sanitation and treatment introduced by the Veterinary Corps, the mortality among animals was enormously reduced (in the early days of the war the British estimated that the average life of a horse in France was only sixteen days), thousands of disabled horses which in former wars would have been shot were evacuated, mended, and sent back to the front for further service, and millions of dollars were saved to the American taxpayer.