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.
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.
[Illustration: FIELD-HOSPITAL.]
[Illustration: AN INFECTIOUS WARD.]
[Illustration: CLEAR, FILTERED, DISINFECTED WATER.
Complete water-purification plant and laboratory on truck, known as the
“steri-lab.”]
[Illustration: WATER STATION ON THE WESTERN FRONT.
The hose of a “steri-lab” can be seen in the foreground.]
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.”