CARING FOR THE WOUNDED
The story of the development of the Medical Department of the Army,
its care of the human wreckage of the battlefield and of the physical
welfare of the fighting forces both at home and overseas recounts
one of the finest and most wonderful of the achievements of the War
Department. It is the same story of marvelous expansion in quick
time, of high resolve and determined effort to achieve the apparently
impossible, and of results that seem almost magical in their bigness
and importance and the rapidity with which they were brought about that
is true of all the American war activities.
At the beginning of April, 1917, there were in the Medical Department
750 medical officers in regular service and 2,600 in reserve. The army
nurse corps numbered 400 and there was an enlisted personnel of 6,600.
There were seven army hospitals with a bed capacity of 5,000, aside
from a few small and unimportant post hospitals. A year and a half
later it had a larger personnel than that of the entire American army
at the outbreak of the Spanish-American war. It numbered then 40,000
officers, 21,000 nurses and 245,000 men. In the United States there
were over eighty fully equipped hospitals with a capacity of 120,000
patients and operating with the American Expeditionary Force were
219 base and camp hospitals having a capacity of 284,000 patients. It
was estimated that nearly one-third of the entire medical profession
in the Union went into active service with the Army and among their
numbers were many of the most distinguished physicians and surgeons in
the country. Of those who went overseas, nearly half that number, over
1,000, were detailed to serve with the British forces.
As an instance of the speed with which it was necessary to work to
secure the needed expansion for the care of war’s wreckage the story
of the building of one of the New York City debarkation hospitals is
illuminating. Several acres of ground on Staten Island were secured for
it and the entire plant, consisting of eighty-six buildings, including
a theater of seven thousand seating capacity, with heating plant and
electric light, water and sewage connections, was finished and ready
for use within one hundred days from the turning of the first spadeful
of earth in the preparation of the site. Its normal accommodation was
for 1,500 patients, but it was so planned that it could be easily
and quickly expanded to care for three times that number. One of its
buildings, measuring 230 by 30 feet, was begun in the morning, finished
by noon of the same day, and equipped by night. Hospital facilities in
France had also to be created quickly and equipped at once with all
the means of treating the victims of scientific warfare that the needs
of the time had evolved. One such big institution in the Cote d’Or
region, for the building of which railways had to be run to the site
and concrete mixers set up and kept going day and night until it was
finished, had 600 buildings of a permanent type and was, in effect,
a series of ten hospitals in one, each devoted to its own specialty
and having its own staff of thirty physicians and surgeons, a hundred
nurses and twice as many men of the Medical and Sanitary Corps, and
its own operating rooms, laboratories, kitchens, officers’ and nurses’
quarters, administration buildings and buildings for patients. A
laundry capable of doing the work for 30,000 people served the entire
plant. The hospital cared for 25,000 at a time and beside it was a
convalescent camp having facilities for all manner of outdoor games
with a capacity for 5,000 more into which the men were graduated for
recovery. Nearly 800,000 soldiers of the American Army were treated in
our overseas hospitals during our war period.
Of the hospitals in the United States a considerable number were in
cantonments and camps and were chiefly used by the troops in training.
The others, specialized for the use to which they were put, were for
debarkation purposes and for the treatment of the wounded, ill, gassed,
tuberculous or blinded. Debarkation hospitals received them as they
were landed and from these they were transferred to receiving hospitals
in and about the port city. Afterward, as soon as physically able,
they were sent by hospital boat or train to a specialized hospital,
if that were necessary, or if not to the general hospital nearest the
patient’s home. These specializing hospitals were so located as to
secure for each one whatever advantages were possible of situation
and climate. Several hospital trains, each complete in itself, with
kitchen, dining and ward cars, special beds for stretcher cases, and
a car for the medical staff, were provided for transportation of the
wounded by land, while a number of hospital boats properly equipped
and staffed with physicians and nurses afforded transportation by
water. In addition to the hospitals, convalescents were cared for in
numbers of convalescent homes all over the country that were donated
for that purpose by individuals and organizations who offered use of
their homes, estates, clubhouses and other buildings. The Red Cross
erected and staffed convalescent houses at all of the base and general
army hospitals in the United States, which gave welcome, cheer and
recreation to the recovering patients.
Through the port of New York flowed the main stream of the American
Army on its way overseas and there its individual factors had to
undergo final physical examination. The work of the Surgeon of the Port
expanded from week to week, as his duties in connection with the army
and the army transports grew, keeping pace with the increasing numbers
that were sent month by month to Europe. In one mid-summer month in
1918, and subsequent months saw even greater numbers, he put his
final approval of physical fitness on 272,000 soldiers bound for the
battlefields of France. On the first of July, 1917, the staff of the
Surgeon of the Port of Embarkation, New York, consisted of two officers
and one private. A year later there were under him 530 commissioned
officers, 110 contract surgeons, 340 nurses and 2,640 men, while
directly under his control, exclusive of other hospitals in the same
region, were thirteen hospitals having 12,500 bed capacity of which
11,000 were ready for use.
A more than fifty-fold expansion in the number of army nurses, from
400 to 21,000, was necessary to meet the need for their services.
Graduating nurses entered the nurses’ corps and an army School of
Nursing was established, with headquarters in Washington and branches
in a score of military camps throughout the country. Many hundreds of
young women enrolled, took the course of training which, intensive and
somewhat specialized for army work, prepared them quickly for duty.
The developments of scientific warfare, with its new and fearful
weapons of death and its new modes of attack, laid new duties upon the
medical profession and new demands upon its knowledge and its methods
of healing. It restores one’s faith in human nature, after realizing
the devilish ingenuity of the death and wound dealing instruments of
the world war, to find how incessantly the ministers of healing worked
in hospital and laboratory behind the lines to evolve new agents and
new methods for the mending of the wreckage from the front. Whatever
else may or may not have been won out of the vast destruction of the
world war, the medical profession can be assured that its devotion and
its heroic labors have been rewarded by a wonderful advance in the
frontiers of its knowledge.
The army medical officer found new problems facing him at every
fresh development of the conflict, and to fit him for grappling
with these new phases of human needs the Medical Department of the
Army established numberless schools and courses of study at medical
institutions, at hospitals and wherever could be brought together
the factors necessary for this specialized and intensive training.
Physicians and surgeons in overseas hospitals had evolved a number of
new and effective methods for the treatment of casualties of various
kinds and medical officers newly inducted into the service had to have
instruction in these developments, while for those who had to undertake
recently specialized work it was necessary to have whatever training in
that specialty had become possible.
Intensive training and clinical opportunities were provided for
instruction in new methods in war surgery and fractures and in the
treatment of infected wounds; there were schools for the training of
medical officers in the use of X-rays; of laboratory specialists; for
special work with diseases of the heart; for treatment of pneumonia
and of those infectious diseases that are of frequent occurrence when
large bodies of men are brought together. A particularly determined
effort was made along preventive lines to lessen in the American Army
both at home and in France the menace of venereal disease, always
feared for its power to lower the efficiency of armies. Instruction
by various means, an incessant campaign of vigilance by specially
trained physicians, treatment of infected men, military punishment of
offenders, endeavors to control the surroundings of camps, all were
among the methods with which this scourge of all armies was combated,
with remarkable success. The percentage of such diseases in the Army
was below what it is in civilian life and very much below that of its
prevalence in the Allied Armies.
One of the schools made necessary by the new methods of training
instituted in the American Army was that for the instruction of
military psychologists who were needed for the work of examining the
men, as they came from their local boards and were inducted into
the training camps, in order to eliminate those mentally unfit for
army service and grade those accepted according to their mental
qualifications, for the information of their officers, as already
described in the chapter on “The Making of the Army.” Under the
supervision of the Medical Corps, this school trained many officers for
psychological work at the cantonments, the course lasting two months.
This development, an American idea, was something new in the making and
training of armies, but it proved its value in the higher efficiency
gained by enabling officers to select for special duties the men best
fitted for them and so increasing the efficiency of the fighting units.
A new development of wartime medical science was made necessary by
air warfare which soon brought into being the flight surgeon who
kept under his observation the men in training at flying fields. So
important did this division of the Medical Corps quickly become that
special facilities were provided for the training of flight surgeons
and laboratories were established for the investigation of the medical
problems connected with the air service.
Until the influenza epidemic swept the country in the autumn of 1918,
after devastating the populations of Europe, the disease figures of the
American Army had set a new low record both at home and overseas. For
the year ending with the first of September, 1918, which covered the
time from the first gathering of men in the cantonments, the death rate
for all troops in the United States was 6.37, which is a lower rate
than that in civilian life for similar ages. But when the plague of
influenza, which on its way around the world took a toll of 6,000,000
lives, descended upon the camps and cantonments in the United States
the death rate rose to 32.15 per thousand. For the entire term of the
war the disease death rate was 17 per thousand in the expeditionary
forces and 16 per thousand in the army at home. The comparison of these
figures with the rate maintained before the passage of the epidemic
shows how deadly it was. During the summer months of 1918 the death
rate for the troops both at home and overseas fell to 2.8 per thousand.
During the Mexican war the disease death rate was 110 per thousand,
during the Civil War in the Northern Armies it was 65 per thousand and
during the Spanish-American war 26 per thousand. During the last named
war the most important cause of death was typhoid fever, before which
medical science was then as helpless as it was during this war under
the influenza scourge. It had conquered that menace and typhoid, by
its precautions, was almost eliminated from our army both at home and
abroad. But notwithstanding the devastations of influenza the disease
death rate in the American Army was cut to a lower figure than had been
reached by any army in previous wars. The lowest previously recorded
was that of the Japanese during the Russo-Japanese war, which was 20
per thousand.
The battle death rate of the American Expeditionary Forces was 57 per
thousand, considerably higher than it had been in any of our previous
wars. In the Mexican war it was 15, in the Civil war in the Northern
Armies 33, and in the Spanish-American war 5 per thousand.
Overseas, during the eight months ending with mid-October, 1918, only
four per cent of the admissions to hospital because of disease resulted
in death. Of the wounded and injury cases treated during the same
period a little less than nine per cent died and over 85 per cent
were returned to duty. Of the American Expeditionary Forces 4,000 were
permanently crippled and 125 were totally blinded.
The medical officers of all the armies won remarkable results in
the quick healing of wounds and the reduction of death from battle
casualties by establishing hospital stations immediately behind the
fighting lines, regardless of danger. This brave course, together
with the efforts of the enemy to annihilate them and their hospitals,
caused much loss of life among them. The Medical Corps of the American
Expeditionary Forces had 46 killed and 212 wounded in action, and a
total of 442 casualties of all kinds.
It was a comprehensive system of caring for the physical welfare of
the American troops that was devised and carried out by the Medical
Department. It had the fighting man constantly under its eye from the
moment of his physical examination for induction into the army until
he was examined for his final discharge. It analyzed his water supply,
it examined his food and inspected his kitchens, it waged war against
flies and mosquitoes in his camps, it made his environment sanitary and
it devoted itself to his welfare if he was ill or wounded.
One of the finest of all its multifold and varied works was the scheme
for the reconstruction of disabled men and their preparation for a
life as useful and successful as they would have enjoyed if unhurt.
The principles of occupational therapy were applied to the treatment
of ill or wounded soldiers in hospitals, beginning with manual work
for the redevelopment of strength and dexterity and continuing with
occupational aids for the restoring of the nervous system and the
bringing about of a cheerful outlook. Nurse-teachers were prepared
for this work by courses of intensive training, lasting from two to
four months. By the time the tide of injured men returning to this
country was at its height this reconstruction work was in progress
in nearly fifty hospitals, some 700 officers and men of the army had
been detailed to serve as instructors and assisting them were 1,200
nurse-teacher aids trained in occupational therapy.
After he had been restored to physical and mental health in the
hospital any soldier who was permanently disabled was given the
opportunity of reëducating himself, if necessary, in order that he
might continue to take a self-supporting part in the work of the world.
The nation had pledged itself thus to care for its disabled defenders.
With the exception of Canada, the United States was the only country
to make this duty, from the first, the affair of the whole people,
functioning through the Government. By act of Congress, the work of
re-training war cripples was placed in the charge of the already
existing Board of Vocational Education, whose agents would get into
touch with the disabled men as soon as they arrived from France, tell
them that the nation would engage to make them economically efficient
again and show them that their rehabilitation depended only upon their
own desire and energy. The crippled soldier could choose any line of
work, agriculture, industry, commerce, any of the professions, and
either add to the training he had previously acquired, or, if it was
necessary, undertake a new kind of occupation. There lay before him
the possibility of a variety of education that ranged from six months
of shop work to a complete college course of four years. Whatever
artificial limbs or appliances he needed were supplied and if he were
short of cash a civilian outfit was furnished. Until this training was
completed his pay continued at the same rate as during his last month
of active service, or it equaled, if this were greater, the monthly sum
to which he was entitled under the War Risk Insurance law. Injured men
in all branches of the nation’s defense who needed this reëducation
were made to feel that in no sense were they receiving charity but that
the country was only, and gladly, discharging a sacred obligation.
Educational institutions all over the land offered their coöperation
and the use of all their facilities in the carrying out of this scheme
of re-training and so also did shops and factories and industrial and
commercial bodies of all sorts. A few months after the wounded began
to return about 13,000 men had registered with the Federal Board for
Vocational Education and it was estimated that there would probably be
about 10,000 more who would need to share in the benefits of the plan.