History

The United States Army Medical Service Corps

WORLD WAR I

THE SANITARY CORPS

Upon assuming office in January 1914, Surgeon General William C. Gorgas initiated planning for what he believed would be the eventual U.S. participation in the war. His experiences in Cuba and Panama led him to support the establishment of a corps to provide the administrative and scientific specialists necessary for the military medical team. By spring 1916 Gorgas regularly testified before Congress, interspersing his testimony with excerpts from the proceedings of the French Chamber of Deputies on military medical lessons the French had learned. He noted the difficulty created by an insufficient number of military physicians and the burdening of that group with administrative responsibilities `which hamper and delay them in the performance of their regular tasks.`¹ Gorgas described steps the French had taken to remove those responsibilities from military physicians, to the extent that in the first year of the war the French medical department had nearly twenty-five hundred administrative officers and twenty-five hundred apothecaries.²

Establishment of such a corps in the U.S. Army had to wait until entry of the United States into the war. Then General Gorgas` ability to put together an expanded medical support team for the Army was greatly advanced by War Department General Orders No. 80, 30 June 1917, which created an important precursor of the Medical Service Corps. Called the Sanitary Corps `for want of a better name,`³ the organization enrolled newly commissioned officers with `special skills in sanitation, sanitary engineering, in bacteriology, or other sciences related to sanitation and preventive medicine, or who possess other knowledge of special advantage to the Medical Department.`⁴ The officer strength was set at a maximum of 1 per 1,000 total Army active duty strength, and the grades were initially capped at major. The order also provided for 3,905 enlisted personnel in grades from private to hospital sergeant.⁵

Just as the USAAS provided the Medical Department with nonphysician commissioned specialists for the benefit of the French and Italian armies, the Sanitary Corps did the same for the U.S. Army. This corps gave the department the capability to capitalize on new technology in a rich diversity of units with missions ranging from surgical instrument repair to cinematography. Maj. Gen. Merritte W. Ireland, Gorgas` successor as surgeon general, wrote that the corps `assisted notably` in the Medical Department`s wartime performance.⁶ In fact, the principal Medical Department wartime accomplishments cited in an account authorized by Secretary of War Newton D. Baker were those made possible by Sanitary Corps officers.⁷

Sanitary corps officers in Is-sur-Tille, France, February 1919

TABLE 1-SANITARY CORPS OFFICERS BY SPECIALTY AREA AND GRADE ON ACTIVE DUTY 1 NOVEMBER 1918

	COL	LTC	MAJ	CPT	1LT	2LT	Total
Sanitation	1	2	9	79	81	41	213
Food and Nutrition		1	8	35	36	36	116
Laboratory			7	166	174	164	511
Venereal Disease			14	28	28		70
Psychology		1	17	31	31	28	108
Aviation (Psychology)			5	32	38	14	89
Finance and Supply			28	183	202	169	582
Reconstruction		1	14	29	54	52	150
X-Ray			1	1	23	3	28
Overseas			1	244	198	200	643
Hospitals			2	90	93	88	273
Miscellaneous			5	18	17	7	47
Total	1	5	111	936	975	802	2,830*

Based on Inclosures to Letter, The Surgeon General to The Adjutant General, sub.: Estimate of Department`s Needs, 15 November 1918, MSC-USACMH.

*Peak strength of 2,919 was reached on 15 November 1918. Surgeon General Report 1919, II: 1112.

Growth of the corps was rapid. By 30 June 1917, there were 9 officers on active duty-2 majors, 4 captains, and 3 first lieutenants. A year later there were 1,345 officers-a number that included 3 lieutenant colonels and 42 majors- serving in such diverse roles as sanitary engineers, gas defense chemists, bacteriologists, psychologists, and medical supply officers. The corps reached its peak strength of 2,919 officers in November 1918 (see Table 1 for a statistical summary). By then it represented 7 percent of the officers in the AEF, and if the war had continued the department planned for 6,433 officers. Ranks remained relatively low. The corps included only two colonels and five lieutenant colonels, a parsimonious allotment that must have pleased the manpower planners.⁸

William D. Wrightson, the sanitary engineer who had served on Gorgas` staff in Panama, was commissioned as a major and assigned to the Surgeon General`s Office on 31 July 1917. Wrightson was the first officer appointed in the Sanitary Corps, and he served as its de facto chief, signing correspondence as `the officer in charge of the Sanitary Corps.`⁹ Division chiefs in the Surgeon General`s Office were responsible for the placement of officers in their specialty areas throughout the Army, but personnel matters affecting Sanitary Corps officers were coordinated with Wrightson.¹⁰ He was promoted to lieutenant colonel in February 1918 and to colonel that August.¹¹

One issue that came to his attention was General Gorgas` desire to commission qualified Hospital Corps sergeants in the Sanitary Corps. The surgeon general feared that the Medical Department would lose the expertise of its noncom?

missioned officers, who would seek appointments as line officers because they were blocked from serving as officers in the Medical Department.¹² Believing that the lack of opportunity demoralized them, he sought authority to commission them in the Sanitary Corps. The War Department granted his request and, at the same time, removed the grade limitation of major.¹³

In practice, one glitch remained. War Department policy required the transfer of newly commissioned officers to another unit. The effect of that rule was to dissuade hospital commanders from recommending their best soldiers since they knew they would lose them. One wrote the surgeon general that he had a shortage of qualified personnel to fill important administrative positions and was entirely dependent upon enlisted personnel with civilian experience. He was reluctant to recommend sergeants for appointment in the Sanitary Corps for fear of losing them. An example was his records administrator, an attorney in civilian life, who if commissioned would make an ideal registrar or personnel officer. But the transfer policy remained unchanged, despite entreaties by Gorgas.¹⁴

Administrative Specialty Officers

Because the Medical Department needed managers, Sanitary Corps officers were used in administrative roles to a much greater degree than suggested by the name of the corps. A shortage of physicians in combat units often caused the substitution of Sanitary Corps officers or, in some cases, line officers. As one report put it, physicians `had become too scarce to serve in drawing rations and clothing.`¹⁵ As in the scientific specialties, advances in the new science of management were producing demands for officer specialties in the Medical Department for which physicians were not prepared by their medical training. The Surgeon General`s Office was determined to have enough managers at each hospital to free up physicians for the practice of medicine.¹⁶ Consequently, Sanitary Corps officers filled a variety of positions formerly occupied by Medical Corps officers, such as registrar, adjutant, personnel officer, mess officer, medical property officer, and commanders of various medical units and patient detachments.

The process of substituting Sanitary Corps officers in administrative positions was not hasty. Quartermaster Corps officers were initially available for detail to the Medical Department, which lessened the urgency at the beginning. They performed duties in disbursing, medical supply, motor transport, laundry, and facilities management. Furthermore, the department`s ability to draft physicians and its customary use of physicians in administrative roles mitigated against substitution. There was some debate over the proper utilization of Sanitary Corps officers, a reflection of underlying tension. Lt. Col. Alfred P. Upshur, MC, a hospital commander, wrote that Sanitary Corps officers could profitably serve in all the contemplated positions except adjutant. He said that that position, which was important for its broad managerial responsibilities, should be filled by a physician `for the same reasons that the commanding officer of a hospital is a medical officer.`¹⁷

Indeed, as American involvement in the war began, the Medical Department increased the training of medical officers in administration. It began a special

course in 1917 to train physicians for duty as adjutants.¹⁸ However, that course was dropped in the spring of 1918 as the weight of converging events pushed the department into utilizing Sanitary Corps officers as adjutants and in other administrative duties. The situation became increasingly acute as more American forces entered combat and mounting casualty loads challenged the AEF medical treatment capability. The surgeon general`s requests to increase the number of Sanitary Corps officers cited the need to release physicians for clinical duties.¹⁹ In May 1918 the War Department authorized an increase of Sanitary Corps officers, stipulating that they would be used by the department in order to release physicians for `strictly professional work.` The Medical Department accepted applicants for commissioning from all walks of life and also sought to commission sergeants with experience as chief clerk, mess sergeant, or registrar assistant. In short, change came about under the pressure of events and despite the misgivings of many medical officers. The pressure continued until the end of the war, which found a continuing shortage of physicians in both hospitals and divisional medical units, while the number of Sanitary Corps officers continued to expand.²⁰

Among its members were experts in many arts. The success of Sanitary Corps officers in administrative positions was reflected in the Distinguished Service Medal awarded to Lt. Col. Robert A. Dickson, SnC.²¹ Dickson, who entered the Navy in 1898, was a master hospital sergeant when he was commissioned in the Sanitary Corps. He was cited by the AEF for his work as head of the Chief Surgeon`s Administrative Division. An especially irritating problem when the AEF first deployed to France was the absence of an effective postal service. All mail to Medical Department personnel was addressed to the chief surgeon, and Dickson had 10,000 letters on his hands by the time the matter was resolved.²²

The characters in Joseph Heller`s World War II novel Catch 22 include Lt. Milo Minderbender, an engaging huckster who cornered the Egyptian cotton crop and, when the market collapsed, coated the cotton in chocolate and tried to sell it to the troops as cotton candy.²³ The Sanitary Corps had its own Milo Minderbender in Capt. Fred Pumphrey, SnC, who headed the Paris office of the postwar American Polish Typhus Relief Expedition as it set up operations in 1919.

Pumphrey funneled supplies and equipment to the expedition`s Warsaw headquarters in a manner described as `scrambling, scrounging, cadging, wheedling, quarreling, and politicking.` Pumphrey himself wrote that `with all my trickery around here I have spent endless hours in doing little favors for different parties that count in return favors being given.` Pumphrey`s spirited performance greatly pleased the expedition`s commander, Col. Harry L. Gilchrist, MC, who said his `energetic action and hard work succeeded against colossal difficulties` in getting the humanitarian effort under way.²⁴

Medical Logistics

Medical logistics was a major area of responsibility for Sanitary Corps officers. Gorgas had testified to Congress that providing medical logistics support for an army numbering in the millions would be `exceedingly difficult.`²⁵ The AEF surgeon said a principal lesson learned from previous wars had been the necessity

for `a well organized supply division in the Chief Surgeon`s office, with single and absolute control.`²⁶ Strong central supply organizations were established in the Surgeon General`s Office and in the headquarters of the AEF. Sanitary Corps officers played important roles in their development.

Medical logistics quickly expanded in complexity and scope. Congress initially appropriated $1 million for medical supplies and equipment for fiscal year 1918, but by the end of the year it had appropriated nearly $174 million, and almost $300 million was appropriated in fiscal year 1919. A medical supply inventory of $1 million in 1916 increased a hundredfold by 1917.²⁷ This rapid expansion outpaced the department`s staffing capability since it depended upon physicians to fill its key positions. The AEF chief surgeon reported a `great lack of personnel trained in Medical Department supply work,`²⁸ and in 1918 the surgeon general reported difficulty in fielding the necessary number of medical supply officers. The Sanitary Corps provided the department the means to meet the requirement-a challenging undertaking since those officers had to be recruited, commissioned, and posted at the various training camps before the medical supplies and equipment arrived. By the end of the war 331 Sanitary Corps officers were serving with the Medical Department`s Supply Service, a number that included 288 former enlisted personnel. Only sixteen physicians were so employed at that point.²⁹

The newly commissioned Sanitary Corps officers took charge. As might be expected, the medical supply buildup was not flawless. Both supplies and supply officers had to be in place before the troops arrived, but that did not always work out as planned, and frequently supplies were shipped to camps before buildings were ready for their storage. The medical supply officers improvised storage in farm buildings, in the open, or under canvas. Since they were the only Medical Department representatives on site, their responsibility for those precious items often meant they were on 24-hour duty until the camp became better established. They set up medical property accounts for issue and storage, medical supply issue for camps and divisions, and procedures for supply requisitions and accountability, and they undertook the supervision and training of supply personnel. Originally it was thought that one supply officer at a camp could serve as both the hospital property officer and the divisional supply officer, but this proved to be a poor system. The usual pattern became two medical supply officers, one for the base hospital and one for the division.³⁰

At the beginning of the war the department`s principal medical depots were in New York, St. Louis, San Antonio, Washington, D.C., and San Francisco. During the war depots were added at Atlanta, Philadelphia, Chicago, and Louisville. The expansion increased the need for officers competent in depot management. Experienced noncommissioned officers with medical supply experience were prime candidates and were selected for appointment in the Sanitary Corps on the basis of their performance at supply schools in Newport News, Virginia; Camp Meade, Maryland; and Camp Upton, New York. The Newport News school organized thirteen medical depot companies of three Sanitary Corps officers and forty-five enlisted soldiers each. Eight were shipped to France; one went to Liverpool, England; and another went to Vladivostok, Russia.³¹

Captain Pilling

The Medical Department commissioned Sanitary Corps officers for medical logistics specialties from the best applicants it could find in manufacturing, jobbing, and wholesaling. Procurement was an area of particular emphasis, especially since Germany was dominant in the optical and surgical instrument industries. Fifty Sanitary Corps officers served as `expeditors` who assisted contractors in meeting their requirements. The department sought industrial assistance from experts-especially jewelers and toolmakers-in retooling for the manufacture of surgical instruments, and Sanitary Corps officers performed inspections of newly converted factories.³² Hospital Corps sergeants commissioned in the Sanitary Corps as medical logistics officers provided special talents and experience. One was Capt. Oscar Burkard, SnC, who served as the medical supply officer at Camp Upton, New York. A veteran of long service, Burkard wore the last Medal of Honor awarded in the Indian Wars.³³

Medical logistics specialties also included x-ray and medical equipment maintenance. The Surgical Instrument and Repair Service in Neuilly, France, headed by Capt. Henry N. Pilling, SnC, developed a fabrication capability for surgical instruments as well as the ability to fit artificial eyes and to repair typewriters. The shop assembled mobile field x-ray units by equipping Renault trucks with x-ray equipment and electrical generators. The equipment saw service in the Chateau?Thierry defense and the offense at St. Mihiel and in the final Argonne offensive.³⁴

Medical maintenance soldiers played a starring role on the night of 11 November 1918, Armistice Day, when they drove one of the x-ray trucks, festooned with lights and a bevy of French ladies, down the full length of Paris` jam-packed Grand Boulevard des Italiens. (By one account, this was the only vehicle that made it all the way down the boulevard that night.) A threat of court-martial for the miscreants was later dropped, as was another for their subsequent feat of driving a five-ton Packard truck up the steps of the Paris Opera the next day.³⁵

Resources Management

An Act of 26 September 1917 established new requirements for the auditing of military accounts. To meet them, the Surgeon General`s Finance and Supply

Renault truck outfitted with mobile x-ray equipment

Division initiated contacts with the banking industry as well as with insurance, railroad, and retail sales firms. It endeavored to identify executives for commissioning in the Sanitary Corps who had volunteered for military service or who had been drafted and were about to be inducted in the Army. The department had to work quickly because it was unable to transfer already-inducted soldiers from their assigned units.

A Medical Department finance contingent headed by Lt. Col. W. D. Whitcomb, SnC, arrived in France in January 1918 to form the AEF Surgeon`s Accounting Division. Whitcomb`s operation, which numbered 7 Sanitary Corps officers, 135 enlisted soldiers, and 15 French civilians, was responsible for auditing and disbursing funds for the purchase of medical supplies and equipment. By April 1919 the division had disbursed over $37 million since arriving in Europe. It was recognized for its wartime performance by the War Department`s assistant auditor and the comptroller of the treasury.³⁶

Hospital Administration

The expanding use of Sanitary Corps officers was also representative of changes occurring in hospital administration. The twentieth century saw the hospital become the central institution in American health care. There were an estimated 178 American hospitals in 1873; by 1914 there were 5,047. Advances in medical technology propelled a dramatic expansion in the ability of such institutions to treat and cure (rather than merely to house) their patients. At one time charitable institutions for strangers and the poor, hospitals became centers of community health catering to the middle class.³⁷

Medicine-and the modern hospitals it required-was evolving into a prestigious field of endeavor, a transformation that was accompanied by an institutional revolution in American medical schools. Proprietary diploma mills closed all over the country in the early twentieth century, under attack from medical scientists housed in universities and the American Medical Association`s Council on Medical Education. Ten schools closed in 1907 when the council began rating medical schools, and another ten closed in 1910 when the council issued its second report, at which point American medical schools were more advanced than they had ever been. The movement was given popular currency by the 1910 Flexner Report, which made instant headlines by describing the nation`s medical schools, sometimes in scathing detail. By 1915 there were 96 medical schools, down from 160 in 1905, but those that survived were of much higher quality.³⁸

Pressure for progressive medical education contributed to the demand for better hospitals. The American College of Surgeons (ACS) was formed in 1913 to advance the practice of surgery in the United States. The college desired to set standards for surgical training and practice, and it elected to survey American hospitals in order to identify those that could support good quality training programs. The ACS findings were distressing. Many hospitals, including some of the most prestigious American institutions, maintained no patient records and had no laboratory, x-ray, or other necessary diagnostic or treatment facilities. Only 13 percent of the 692 hospitals could meet the most simple requirements in 1918, the year of its first formal survey. The ACS leadership considered its list of approved hospitals so inflammatory that it was burned.³⁹

The evolution of hospitals led to a requirement for their professional management. At that point the background of most American hospital administrators was principally medicine (nearly all male) and nursing and religious orders (predominantly female). The customary pattern in the United States was larger hospitals directed by physicians, middle-size facilities headed by members of the laity, and smaller hospitals headed by nurses. There were no formal training programs, and hospital administrators learned their profession on the job.⁴⁰ As one observer put it, most had been `pitch forked into their position without special training."⁴¹

The increasing complexity of hospitals and the influence of external pressures also affected the management of Army hospitals. During the war the administrative positions in Army hospitals, except that of commander, were filled by Sanitary Corps officers. The Medical Department wrote into its tables of organization a permanent requirement for five administrative officers in 500-bed hospitals-commanding officer, adjutant, registrar, quartermaster, and mess officer-along with a skeletal working organization that was added to as needed for expansion. The increasing sophistication of hospital design also led to the assignment of thirteen Sanitary Corps officers to the Hospital Construction Section of the Surgeon General`s Office. Their responsibilities included design of hospitals, field design of building modifications, review of new requests, and administrative management of the projects.⁴²

Patient Administration

In Army hospitals medical records maintenance and biostatistical reporting were performed by registrars. Emphasis by the American College of Surgeons on accurate medical records as a measure of quality of care catapulted the function to greater significance. In a similar fashion, biostatistics became increasingly important, and the Medical Department developed into a national resource in the compilation of epidemiological data.

Talented Sanitary Corps officers such as Maj. Charles B. Davenport made important contributions to patient administration. Davenport, a Harvard Ph.D. anthropologist and an internationally recognized statistician, had been the director of the Department of Genetics of the Carnegie Institute, Washington, D.C. He was instrumental in preparing the 1918 Report of the Surgeon General, a document of particular significance due to his analysis of disease conditions in the training camps. Another member of the Surgeon General`s Medical Records Section, 2d Lt. Louis R. Sullivan, SnC, compiled the Medical Department`s World War I data into 156 sections based upon twenty-two occupation and ethnic groups drawn from the 1910 census of the U.S. population. In Europe, 1st Lt. Robert H. Delafield, SnC, was assigned to the Office of the AEF Chief Surgeon where he provided medical records expertise for the expeditionary forces.⁴³

Major Davenport also coauthored Defects in Drafted Men, which documented the results of the physical examinations of two million draftees plus another five hundred thousand men who were rejected by the draft boards. This study accounted for 60 percent of all men examined for the draft and was a significant sample of the United States male population between the ages of eighteen and thirty. Glendon H. Armstrong, SnC, a second lieutenant, was recognized for compiling the study data with electric sorting and tabulating machines; his work was part of the department`s pioneering use of mechanical computing equipment. The report provided new if sometimes inexplicable insights into U.S. demographics. For example, the study found that 28 percent of those drafted were rejected because of physical impairment. As another example, epidemiologists were intrigued by its documentation of a low cancer rate in recruits from mountainous regions.⁴⁴

Scientific Specialty Officers

Sanitary Corps scientific specialty officers were essential for the Medical Department`s war against typhus and other communicable diseases. Officers who ran sanitation teams and rat extermination programs provided contributions that in their beneficial effects outpaced those of some of their more illustrious coworkers. The commissioning of these officers was another reflection of General Gorgas` keen interest in the prevention of disease and his understanding of the need for a complete team to achieve that goal.⁴⁵

The deadly potential of communicable disease was clearly evident from the first days of the war. Although beginning in 1909 French and American biologists had identified the body louse as the vector for typhus, that knowledge by itself did not prevent the most intense epidemic of typhus in history from devastating

Serbia in 1915. Fear of the raging epidemic shut down Austria`s opening attack against that country, and the Central Powers lost six months` initiative. Hans Zinsser concluded that `typhus may not have won the war but it certainly helped.`⁴⁶ The American doughboys who later marched into Europe with the AEF were free from the threat of typhus. They went `over there` with the advantage of efforts by Sanitary Corps officers to systematically apply preventive medicine techniques across the range of militarily significant diseases.⁴⁷

The Army`s preventive medicine effort held the number of deaths from disease to 51,417 of the total 106,378 deaths during the war. The improvement was greatly attributable to Medical Department doctrine, which had moved preventive medicine to the forefront of its responsibilities. By 1912 the Army had said the military physician`s first task was to instruct the command `in the elements of personal and camp hygiene.`⁴⁸

The lessons of the previous century, especially the preventive medicine failures of the Spanish-American War, were capitalized upon as the Army established a sanitation capability in training camps prior to the arrival of troops. This time the surgeon general did not `rest on his circular`; rather, the Medical Department was credited with being ubiquitous. General Gorgas set the example by personally inspecting all training camps to see that sanitation and hygiene standards were being enforced. He extended the same vigilance to Army hospitals; for example, he insisted that his medical inspectors eat unannounced at the hospitals they visited so as to sample the food served to patients.

Commanders at all levels were prodded by surgeons and inspectors general into paying attention to conditions that would affect the health of their commands. Preventive measures included establishment of water purification units and sewage treatment plants, construction of proper latrines and bathing facilities, removal of animal manure, regulation of kitchens and food preparation, fielding of rat extermination programs, and inspection of farms and dairies to ensure wholesome and disease-free food sources. There were systematic programs in malarious regions to drain and oil marshy areas near the training camps to prevent malaria, and soldiers returning from frontline duty in the trenches were subjected to delousing to prevent the spread of typhus. Preventive medicine efforts also included dramatic measures for the prevention of venereal disease.

Special efforts were also made to control flies and fly breeding. Indeed, a measure of the changed attitude was in the emphasis on eradication of the common fly, which was no longer viewed as a harmless plaything for children. In previous wars those insects had not been worthy of discussion, but in World War I `there was probably no other subject which received as much comment from sanitary inspectors of the Surgeon General`s office as did the fly situation in our military stations at home.` Sanitary Corps officers were important members of the medical team that prosecuted all of these initiatives that made such a difference in World War I.⁴⁹

Sanitary Engineering

Sanitary engineers were a significant addition to the medical team. They augmented the department`s capability with officers who were specialists in water purification, mosquito control, housing, ventilation, sewage and waste disposal,

and control of flies. Competition for appointment as Sanitary Corps officers was keen because of the opportunity for commissioned status as well as the exercise of one`s professional skills. Those who succeeded were assigned to the training camps to perform preventive medicine functions. The newly commissioned officers attended a one- to two-month course at the Medical Officers Training Camp, Camp Greenleaf, Chickamauga Park, Georgia.⁵⁰ Among them was 1st Lt. Joseph A. Tinsman, a sanitary engineer, who was the only Sanitary Corps officer to die from wounds in the war. Tinsman, a native of Harrisburg, Pennsylvania, had been an assistant engineer with the Pennsylvania Department of Health. Assigned to a water supply company, he was wounded on 4 November 1918 during the Meuse?Argonne offensive. He died six days after the Armistice.⁵¹

Efforts to establish sanitation capability at the training camps were initially hampered by camp design and construction policies that had been established before the Army had sanitary engineers to advise on those plans. Obtaining good waste disposal equipment was a problem raised to the attention of the secretary of war. Sanitary engineer officers found that failures in sewage disposal plants were caused by grease content much higher in camp sewage than in ordinary municipal sewage, and they led efforts to design new incinerators and treatment plants.⁵²

In addition, sanitary engineers developed improved water supply operations. Although the Corps of Engineers was charged with the responsibility for water supply points, the Medical Department was responsible for the quality of water produced and the proper functioning of the purification systems that provided coagulation, sedimentation, and sterilization. This required special expertise for, as the surgeon general put it, `water purification plants and sewage plants were not simple mechanical efforts to be operated by men without professional skill.`⁵³ By the end of the war approximately one hundred fifty AEF water plants were supervised by Sanitary Corps officers. Capt. A. Sidney Behrman, SnC, in July 1918 took a Sterilab mobile water purification unit to the front during the Chateau?Thierry offensive, the first such unit operated with American troops in an American sector.⁵⁴

Sanitary engineering functions evolved to the point that in 1918 the surgeon general published a circular to formalize those duties. Sanitary engineers at large camps were charged with supervision of water purification and waste disposal systems, mosquito and fly control measures, consulting with camp surgeons on all engineering or structural aspects related to health and sanitation, and monthly reporting to the surgeon general. They served in sanitation detachments, division sanitary squads, survey parties, water tank trains, water supply companies, and overseas laboratories; as camp sanitary engineers; and as instructors at Camp Greenleaf, Georgia. The Medical Department was authorized 129 sanitary engineers by May 1918.⁵⁵

The efforts to prevent disease through vigorous sanitation efforts in the stateside training camps were mirrored in the preventive medicine measures taken overseas, where the AEF encountered sanitation difficulties. French towns were afflicted with polluted water, and manure, the highly valued fertilizer of the French peasant, was `piled high in front of nearly every house.` Pershing attached

2 sanitary squads to each division-each consisting of 1 officer, 4 noncommissioned officers, 20 privates, and 2 drivers-plus 1 mobile laboratory consisting of 1 officer and 5 enlisted personnel. Initially the squads were headed by physicians, but when possible they were replaced by Sanitary Corps sanitary engineers. One of those officers was 1st Lt. Ira V. Hisock, SnC. Hisock, an instructor in the Yale University School of Public Health, had enlisted in the Army. His division surgeon, discovering a talented private, got Hisock commissioned and placed in command of the 28th Sanitary Squad, then attached to his division.⁵⁶ The preventive medicine efforts of Lieutenant Hisock and his fellow officers paid off `The manure was removed, the mud disappeared from the streets, water was chlorinated, prophylactic stations established, proper latrines made, kitchens regulated, baths established, in fact the machine was in motion, with errors of course, but moving and functioning well.`⁵⁷

Entomology

There was no provision for commissioning entomologists, and this was a handicap for the World War I medical team. Perez Simmons, an entomologist who enlisted for service with the Engineer Corps, wrote that the absence of this preventive medicine capability resulted in an epidemic of severe dysentery in his area of southwestern France during the summer of 1918. Simmons believed that the presence of commissioned entomologists would have prevented much of the suffering his unit endured.

Simmons was assigned to an engineer company engaged in 24-hour forestry operations to provide the AEF with lumber and railroad ties. The area was plagued by flies caused by the unit`s poor sanitation practices; the soldiers had to eat with one hand while brushing away the flies with the other. Simmons` attempts to get action by the company commander were rejected, and although the regiment`s leaders were periodically visited by inspectors, they `made hurried inspections, gave a little advice and usually praise, and departed.` It was Simmons` conviction that commissioned entomologists would have been able to prod his command into doing something and possibly preventing the tragedy that ensued. In June nearly the entire company came down with dysentery, and the soldiers were still in a weakened condition when an influenza epidemic attacked several weeks later. Nine of Simmons` comrades died.⁵⁸

X-Ray

Lt. Jerome Jeffrey, an x-ray equipment expert, was representative of the new scientific specialties provided by the Sanitary Corps. By the end of the war twenty-eight Sanitary Corps officers were serving in x-ray positions in the Surgeon General`s Office, Medical Department schools and supply depots, and the AEF. Those officers directed technicians in installing, operating, and maintaining x-ray equipment; served with physicians as instructors in the x-ray schools; and provided the AEF`s radiological capability in fixed and field locations.⁵⁹

Maj. J. S. Schearer, SnC, a Cornell University professor of physics and electronics (radiology), established the Army x-ray school at Cornell, which trained physicians and technicians for the Medical Department. Experts in x-ray instal?

Lieutenant Jeffrey, standing at left; below, technical staff and instructors at the Cornell School of Roentgenology in 1917.
Major Shearer is seated; Lieutenant Jeffrey is at left; Lieutenant Noel is second from right.

lation and repair were commissioned in the Sanitary Corps and provided a short course at the school prior to their utilization in the field. Officers at the school, with the advice and assistance of leading roentgenologists, developed an x-ray field apparatus as well as a visual scale for fluoroscopy radiation exposure that protected physicians and patients from severe radiation burns. Major Schearer developed a bedside x-ray unit that was used extensively during the war and for thousands of chest x-rays during the flu epidemic of 1918. One of his students, Lt. Victor A. Noel, SnC, became the medical equipment director for the Ritter Corporation after the war.⁶⁰

Laboratory Specialties

Plans to draft physicians with medical laboratory qualifications proved unrealistic. The Medical Department discovered that even if it were able to identify those who were qualified, their number would be insufficient to its needs. Instead, the Sanitary Corps enabled the department to meet its requirement for laboratory specialties by commissioning scientists who were already trained in laboratory procedures or enlisted technicians who were qualified by experience and training.

Parasitologists, chemists, and bacteriologists from universities and state departments of health were offered direct commissions in the Sanitary Corps, where they performed a large number of laboratory procedures, including tests for meningoccus, diphtheria, pneumonia, meningitis, tuberculosis, and infection by hemolytic streptococcus as well as routine urinalysis, blood counts, malaria tests, blood cultures, and preparation of urethral smears for the diagnosis of venereal disease. Some operated rat extermination programs. The laboratory officers made significant contributions. For example, two parasitologists, Maj. Charles A. Kofoid, SnC, and Maj. Marshall A. Barber, SnC, developed a hookworm test considered more than twice as efficient as previous methods. Kofoid said that while 11 percent of the soldiers tested by the Army for hookworm were shown to be infected, he believed the rate would have been 25-50 percent if a better test had been used.⁶¹

The officers attended laboratory training courses at the Rockefeller Institute in New York City; Yale University, New Haven, Connecticut; the Army Medical School (later renamed the Walter Reed Army Institute of Research), Washington, D.C.; and the Sanitary Field Service School at Fort Leavenworth, Kansas. Sanitary Corps laboratory officers and Medical Corps physicians were paired together for the program at Fort Leavenworth. Some enlisted graduates of the training programs at those schools were also commissioned in the Sanitary Corps. Of the 413 enlisted graduates in 1918, 30 were commissioned under that program.⁶²

Sanitary Corps officers served as instructors in the schools. For example, Capt. Donald D. Van Slyke, SnC, and Capt. C. S. Robinson, SnC, conducted a biochemistry training program at the Rockefeller Institute for chemistry graduate students and young faculty members from the various universities who were themselves candidates for Sanitary Corps commissions. Sanitary Corps officers also taught at the Yale University laboratory school, which trained 237 Sanitary Corps officers from 1 August 1918 to 1 January 1919, and at the Fort Leavenworth school, which trained a smaller number. Col. Michael Blew, SnC,

Bacteriological department in Dijon, France; right, interior view of field laboratory car, with exterior shown below

said his training at Fort Leavenworth included an hour daily for equitation, because horsemanship was considered essential for officers. Blew found it of little value in his wartime service. `I got to France, and the only thing I ever rode was a motorcycle sidecar in the mud, but we had to take equitation.`⁶³

The Fort Leavenworth school organized thirteen mobile laboratories, each headed by a Medical Corps officer whose staff included one Sanitary Corps officer and three to four enlisted soldiers. The mobile laboratories were innovations in medical support. Formed at the request of the AEF surgeon, they represented the first use of a laboratory capability as part of combat forces. They were part of the division-level medical support teams, where they provided an ability for chemical and bacteriological examination of water and urethral smears and the preparation of cultures for examination by fixed laboratories. Thirty-one mobile laboratories were operational by the end of the war and another nineteen were being organized.⁶⁴

Physical Reconstruction

The war produced a distressingly large number of disabled soldiers. A Senate report estimated in January 1918 that there were thirteen million wounded and crippled soldiers among the European belligerents, including three million amputees, and Congress recognized that as United States forces entered combat they would incur a correspondingly high number of veterans who would need rehabilitation. However, no single U.S. government agency was tasked with the overall responsibility for the well-being of disabled veterans. Rather, there was a patchwork of veterans` benefits. As a solution, Congress tasked the Army and the Navy with providing medical care in cooperation with a newly formed Federal Board of Education, the forerunner of the Veterans Administration. The surgeon general organized a Division of Physical Reconstruction to direct vocational rehabilitation programs for disabled soldiers at twenty-seven Army hospitals. In May 1918 the War Department authorized 24 Sanitary Corps `educational officers` for this function, a number that increased to 119 in July. Those officers conducted special workshops, assisted in reconstruction therapy, instructed vocational courses, and assisted the mental and physical reconstruction efforts of the medical team.⁶⁵

Maj. Bird T. Baldwin, SnC, was formerly a Harvard professor of educational psychology and an authority in child development and psychology. In April 1918 Baldwin was appointed as chief psychologist at Walter Reed General Hospital where he became the director of rehabilitation of disabled soldiers. There he developed a pioneering occupational therapy program in coordination with the psychological, medical, x-ray, and surgical services. It involved a variety of `curative shops` that enrolled one to three thousand patients monthly from October 1918 to March 1919. Baldwin published a monograph as a protocol for other hospitals to follow in developing their own programs.⁶⁶

Nutrition

John R. Murlin, Ph.D., an assistant professor of physiology at Cornell University Medical School, unable to obtain an appointment in the Medical

Sanitary Corps food expert in his office in Dijon, France

Department because he was not a physician, went to the Officers Training Camp at Plattsburg, New York, to be commissioned as a Quartermaster Corps officer. There he volunteered to assist the mess officer, an infantry officer inundated with complaints about the poor quality and wastage of food. Murlin`s work convinced him of the need for nutritional surveys of Army camps, an idea which he recommended to Alonzo Taylor, Ph.D., the expert adviser to Herbert Hoover, the head of the U.S. Food Administration. Hoover saw Murlin`s report and contacted General Gorgas, who, impressed with Murlin`s work, offered him a commission as a major in the Sanitary Corps. Major Murlin was made head of the newly established Food and Nutrition Division in the Surgeon General`s Office.

Murlin, Gorgas, Hoover, and other advisers hammered out a plan for teams of Sanitary Corps officers who would conduct nutritional surveys at Army camps. Murlin canvassed universities, medical schools, and agricultural stations for nutritionists, who were offered commissions in the Sanitary Corps. They conducted a pioneering program of surveys throughout the United States, beginning in October at Camp Crane, Allentown, Pennsylvania.⁶⁷ Murlin`s program was particularly useful for the training his teams provided for cooks, mess sergeants, and mess officers as the Army moved toward a nutritionally sufficient ration for soldiers rather than just `filling the cavity.`⁶⁸ Their efforts advanced the nutritional status of the Army even though some of the basic chemical and physiological processes were not understood.⁶⁹

Maj. Samuel P. Prescott, SnC, a Massachusetts Institute of Technology (MIT) nutritionist, conducted a one-week course for nutrition officers at MIT in which the officers were instructed in the methods of preservation, handling, and

inspection of various foods. The course later relocated to Camp Greenleaf, Georgia. In all, 116 Sanitary Corps officers served as nutrition officers. Their duties included advising commanders, quartermasters, and unit surgeons on the composition and nutritive value of foods, conducting nutritional surveys, inspecting food, assisting at the cooks and bakers schools, and assisting in coordinating mess requirements with subsistence supplies.⁷⁰

One inspection of a nongovernmental source of food was considered newsworthy. The Stars and Stripes reported in 1918 that a raspberry drink sold to the troops as Bill`s Bug Juice `was found to be all that its name implies.`⁷¹

Psychology and Physiology

Sanitary Corps psychologists made important contributions in World War I. Robert M. Yerkes, Ph.D., professor of psychology at Harvard and president of the American Psychological Association, began to organize American psychologists to assist the War Department immediately upon the U.S. declaration of war. Under Yerkes` leadership they conducted demonstration trials in October and November 1917, using tests they developed in coordination with the American Psychological Association and the Psychology Committee of the National Research Council. With General Gorgas` support, Yerkes was commissioned as a major in the Sanitary Corps in August 1918 and was appointed chief of the newly formed Division of Psychology in the Surgeon General`s Office. Yerkes and his assistant, Maj. Harold C. Bingham, SnC, recruited a talented team of officers. Capt. Edwin G. Boring, SnC, was one; he later became the Edgar Pierce Professor of Psychology at Harvard. Another was Maj. Louis M. Terman, SnC, who developed the Stanford version of the Binet-Simon intelligence test. The pioneering psychologists met resistance from the Army line as they introduced the use of psychological services in the Army. There was also resistance from within the Medical Department, even though Gorgas supported the initiatives.⁷²

Yerkes` cause was not made easier by intelligence tests the Sanitary Corps psychologists conducted at four training camps. Those reports showed that physicians, dentists, and veterinarians had the lowest intelligence scores of 5,500 Army officers tested in the early trials. The alarming results reflected the still-evolving condition of U.S. medical training and the imperfect selection methods of the Medical Department. Col. Henry A. Shaw, MC, a medical inspector, at Gorgas` request gave a special report to the surgeon general on the test results. Shaw confirmed the findings as an accurate representation of the state of affairs and recommended immediate action to weed out undesirables from the Medical Corps.⁷³

Using the early trials as their guide, beginning in the fall of 1917 Sanitary Corps psychologists conducted the first large-scale use of psychological testing as a method of screening Army inductees for mental ability. It was a watershed in the development and acceptance of intelligence testing in the United States. The department tested over 1.7 million inductees, including 41,000 officers. Based on those tests, the Army immediately discharged 7,800 soldiers, sent 10,014 to labor battalions, and placed 9,487 in development battalions. This was the first intelligence survey of a major portion of the American population. The Sanitary Corps officers discovered that draft boards had conscripted some soldiers with a mental

Professor Yerkes, later in life

age as low as four years. About 30 percent of the recruits were unable to read a newspaper or write a letter home.⁷⁴

The department initially appointed sixteen psychologists as Sanitary Corps officers and provided temporary appointments in the civil service for another twenty-four; over one hundred officers were commissioned for this purpose during the war. They attended the School for Military Psychology at Camp Greenleaf, Georgia, headed by Capt. William S. Foster, SnC. There they received basic officer instruction in addition to training in psychological testing. The department established a psychology staff of four officers and six civilians at each of four installations: Camp Lee, Virginia; Camp Devens, Massachusetts; Camp Dix, New Jersey; and Camp Taylor, Kentucky.⁷⁵

The Army found the tests were useful in identifying the mentally incompetent, classifying recruits by mental capability, and selecting soldiers for specialties. The testing program refined its capability in order to identify soldiers with intellectual deficiencies for assignment to development battalions, to select soldiers for military and civilian schools, and to group training sections by ability The psychology staffs at the Army training camps increased their proficiency to the point where they could test 2,000 soldiers a day and report the results within twenty-four hours. By July 1918, 79 Sanitary Corps officers were conducting screening tests at 28 camps and 3 general hospitals, a number which had increased by November to 97 officers at 33 camps.⁷⁶

Sanitary Corps psychologists and physiologists also contributed to the development of Army aviation. Airships and airplanes were part of the new technology in World War I. Airplanes had become sufficiently sophisticated to perform aerial reconnaissance, close air support of ground forces, and bombing missions, and there were experiments during the war with `hospital ships,` airplanes, typically JN-4 `Jennies,` modified as air ambulances to carry one litter patient. Sanitary Corps officers and other Medical Department personnel assigned to the Medical Division of the Signal Corps Aviation Section headed de facto a separate medical department supporting Army aviation. There they contributed to the emerging field of aviation medicine.⁷⁷

A desire to establish scientific methods of selecting aviation applicants resulted in the establishment of the Army`s Medical Research Board. The board requested the immediate appointment of thirty-one Sanitary Corps physiologists and psychologists in 1917 to develop aviator classification standards and screen-

Staff of the School of Military Psychology, 1918. Captain Foster is at left.

ing tests. Maj. John B. Watson, SnC, organized the examining boards. The resulting program provided the Army with a means of selecting suitable candidates for flight training as well as for specialized training in pursuit bombers and night bombers and as artillery observers. The War Department used those tests to screen applicants at sixty-seven special examining stations around the country. Sadly, as much as the Army publicized its scientific methods, it never did fully dispel the notion that the examinations were actually a form of refined torture. One popular version had it that applicants were hit over the head with a mallet. Those who regained consciousness within fifteen seconds were considered `the stuff of which aviators are made` and accepted.⁷⁸

The Medical Research Board established the Medical Research Laboratory at Hazlehurst Field, Mineola, Long Island, to investigate conditions affecting aviator performance. Maj. Edward C. Schneider, SnC, and Maj. Knight Dunlap, SnC, headed the physiology and psychology departments, respectively. Their first priority was to develop a test that would measure the ability of aviators to endure partial asphyxiation, an important question in a day of primitive oxygen breathing devices and before the advent of pressurized cabins. The investigators had little to go on initially, and their findings led to further research on general aviator performance and fatigue.⁷⁹

In June 1918 the Medical Research Board asked for another 69 psychology and physiology officers. Colonel Wrightson supported that request and raised the ante to 140 officers, and later raised it to 199. Wrightson argued that the department had found it necessary to follow up initial screening with periodic examinations in order to detect `physical and temperamental deterioration` since 75 per-

cent of aviation accidents were caused by pilots flying `when they are not in the pink of condition.`⁸⁰

Sanitary Corps physiologists and psychologists were members of the AEF Air Medical Research Laboratory, which went to France at the request of General Pershing in September 1918.⁸¹ There, physiologists who had been instrumental in determining selection criteria for aviator training at the Mineola Laboratory were key figures in evaluating aviator performance once on active flying status. Edward Schneider, transferred from Mineola and promoted to lieutenant colonel, served as the physiology representative on the five-member medical research board that oversaw the aviation medicine research effort in the AEF. Schneider wrote the physiology chapter of the board`s final report. Physiologists continued to concentrate on the effects of high altitude upon performance, using a rebreathing apparatus to test the ability of aviators to withstand oxygen deprivation. In addition, they evaluated a number of tests for physical efficiency as well as overall hygiene factors that would help flight surgeons determine aviator fatigue and general fitness. They devoted considerable attention to developing guidelines for the use of oxygen.⁸² The work of the physiologists was complemented by psychologists who conducted psychometric tests to evaluate aviator performance. Capt. Floyd C. Dockeray, SnC, who earned his wings in France and the coveted rating of Reserve Military Aviator (RMA), authored the report`s chapter on psychology. Together those Sanitary Corps officers were valued members of the aviation medical team that reduced the number of accidents and increased the morale of aviators.⁸³

Several issues had emerged by the end of the war that would form the basis for future trends. Both psychology and physiology had been demonstrated as disciplines necessary for the medical team. Yerkes proposed adding psychologists to infantry divisions, which would be the first use of psychologists in the forward combat area. He also proposed a mental health team concept of psychologists and psychiatrists. Both of those ideas would have to wait for their day to come. There was also a dispute brewing as the Medical Department resisted efforts by the line to transfer the psychological testing function (and the psychologists who did it) away from the Medical Department.⁸⁴

Gas Defense

The first use of poison gas in World War I was by the Germans at Ypres in 1915. The Allies followed suit, and gas soon became a widely used weapon. The United States manufactured 10,000 tons of chemical weapons, much of which was sold to the French and British, but defensive measures by the combatants blunted much of the weapons` effectiveness. In the United States, initial disarray in offensive and defensive chemical warfare was resolved in a decision by the secretary of war in May 1917 directing the Medical Department to assume responsibility for the development and production of gas masks and goggles. The surgeon general established the Division of Gas Defense to carry out this mission, with an authorization for 154 Sanitary Corps officers, which was eventually headed by Lt. Col. Dewey Bradley, SnC. Maj. Knight Dunlap, SnC, developed a test for determining the effects of different types of masks on soldier performance as part of the division`s efforts. Those responsibilities included development and

acquisition of chemical sprayers for decontaminating trenches and oxygen apparatuses for resuscitation of gas victims.⁸⁵

The Army`s director of the Gas Service was charged with coordinating the multiple agencies-including the Medical Department-involved with chemical warfare, but without central authority. It was a confusing setup, which the director of the AEF Gas Service dismissed as `exceedingly embarrassing, cumbersome and inefficient.` In a move contested by the Medical Department, the War Department transferred the Division of Gas Defense and its 294 Sanitary Corps officers to the reorganized Chemical Warfare Service in June 1918 as it placed all authority for chemical warfare under one head. There they performed the gas defense mission as members of the organization that was the forerunner to the Army Chemical Corps.⁸⁶

The expertise of Sanitary Corps officers in decontamination made them natural candidates for another mission as the AEF went to war with the body louse. Some reports at the end of the war estimated that more than 90 percent of the soldiers were `lousy.` The AEF Degassing Service was reorganized into the Bathing and Delousing Division, and its twenty Sanitary Corps officers set up a theater-wide organization. In all, 315 officers and over 3,000 soldiers operated delousing points within the divisions plus delousing plants at each embarkation point, which were capable of delousing 10,000 soldiers in twenty-four hours. The process consisted of bathing and disinfecting. The division used a variety of equipment including 6 large plant sterilizers, 68 stationary steam sterilizers, 283 horse-drawn sterilizers, and 583 improvised steam sterilizers. The division processed 11.3 million soldiers and 25 million articles of clothing.⁸⁷

Venereal Disease Control

Sanitary Corps officers took part in an intensive venereal disease control program. Raymond B. Fosdick, assistant to the secretary of war, headed the Army`s Commission on Training Camp Activities, whose programs included measures to provide recreation services for soldiers. The commission`s Law Enforcement Division enforced provisions of the Military Draft Act that gave the president authority to establish prostitution-free zones around military installations. Forty Sanitary Corps officers, mostly lawyers commissioned as lieutenants, conducted those enforcement activities. Their efforts were complemented by commissioned officers of the U.S. Public Health Service who had targeted the cantonment areas as public health hazards.⁸⁸

By November 1918 seventy Sanitary Corps officers were assigned to the venereal disease program. A magazine article that month proclaimed that the Army had reduced the venereal disease rate by 50 percent. It said American soldiers were `the cleanest set of fighting men in the world.`⁸⁹ Unfortunately, the truth was that at that moment the AEF was experiencing the highest rate since deploying to Europe.⁹⁰

After the Armistice Maj. Bascom Johnson, SnC, formerly counsel for the American Social Hygiene Association, and fifteen other Sanitary Corps officers went to France to serve as advisers to the AEF for its venereal disease control program. General Pershing had requested this assistance since the United States pol?

icy of total prohibition was at variance with the French policy of licensing houses of prostitution. All officers and enlisted soldiers were examined for venereal disease prior to their return to the United States. Those who were infected were restricted to `segregation camps` where detained officers and noncommissioned officers served as cadre. The large number held back required the AEF to organize a provisional regiment of six battalions. This in turn generated support requirements, and the Segregation Camp Hospital opened in June 1919 with a staff that included a Sanitary Corps officer as registrar.⁹¹

Photography

Photography, especially motion pictures, was another good example of new technologies provided to the Medical Department by the Sanitary Corps. In November 1917 Lt. Thomas L. W. Evans, SnC, formerly head of a New York photography firm, organized the Instruction Laboratory at the Army Medical Museum, Washington, D.C. His organization included a Motion Picture Section, initially headed by Lt. Robert Ross, SnC. Ross, as a major, took Museum Unit #1, a still and motion picture team, to France.⁹²

Ross was replaced in Washington by Lt. Charles W. Wallach, SnC, who produced a thirty-minute film on venereal disease, Fit To Fight, which caused quite a stir at the Rotary International Convention in June 1918. The film was later a national source of controversy when local Rotary clubs sponsored showings, `usually for men and boys over 16.`⁹³ (Sixty-five years later the Army Staff exhibited a nicetouch of amnesia when it used the same title for an Army physical fitness program.)

Pharmacy, Chiropody, and Optometry

In 1916 the War Department had authorized the advancement of pharmacists to hospital sergeant and master hospital sergeant. Pharmacists continued to serve in the Army as enlisted soldiers in World War I. The absence of opportunity for commissioned status was galling to pharmacists who believed they should be used in their professional capacity as pharmacy officers as well as in administrative duties such as adjutant and medical supply officer in order to relieve physicians from nonclinical duties. Ironically, while pharmacists, as executives of pharmaceutical and medical supply companies, provided expert advice to the surgeon general through membership in advisory committees, they were ineligible for commissions in their area of expertise. Pharmacists argued that this prevented the Army from having access to officers with ability and talent in a specialized field it needed. They maintained that a corps of commissioned pharmacists would ensure the establishment of well-organized pharmacy operations throughout the Army and would prevent conditions such as those described in the sick call at one training camp. `The drugs were set out on an old pine board and the doctor put his hand into the tin cans and handed out pills or tablets into the grimy hands of the sick men, with verbal instructions as to their use.`⁹⁴

For the first time the department provided for foot care to soldiers. There was growing recognition that doughboys marching off to the transports taking them to France would benefit from `the promotion of foot efficiency,` and the Surgeon General`s Division of Orthopedic Surgery considered the promotion of foot

care-and getting the Army to procure enough shoes in the proper sizes-as its major wartime contribution. The increased sophistication in attention paid to conditions of the foot was evidenced in the pioneering work of an Army surgeon, Col. Edward L. Munson, MC, who published a handbook on foot care and who is remembered by the Munson last, a genuine improvement in shoe design that was a blessing to soldiers who spent so much time on their feet. `The footwear of the soldier,` said Munson, `is the very last article of his apparel upon which to practice economy` Chiropodists, the forerunners of podiatrists, were employed by the Medical Department as civilians under the supervision of orthopedic surgeons to handle foot ailments in the training camps. The department also employed enlisted chiropodists. The surgeon general solicited the assistance of the National Association of Podiatrists in identifying chiropodists as they were drafted so that they could be transferred to duty with the Medical Department.⁹⁵

About 9 percent of soldiers during World War I had a refractive error which required them to wear eyeglasses.⁹⁶ However, the Medical Department`s ability to give soldiers proper eye examinations was a hit-or-miss proposition. Few physicians other than ophthalmologists could perform an accurate refraction, and there was no provision for commissioning optometrists. Optometrists could enlist in the Hospital Corps, and an occasional few could practice their specialty. An example was Edward J. Perkins, O.D., the first optometrist to have official authority to practice in the Army. Perkins enlisted in the 30th Infantry in 1914 after studies at the California College of Optics. In 1915 his unit moved to Plattsburg Barracks, New York, where the post surgeon allowed him to practice optometry at the base hospital. Perkins` efforts were appreciated by line commanders who saw improved marksmanship scores by their soldiers. Another pioneer was Otto R. Englemann, O.D., who served as an enlisted optometrist at the eye, ear, nose, and throat clinic of the base hospital at Camp Grant, Illinois. The clinic chief, a Medical Corps major who knew his limits in refraction, would use prearranged signals to recall himself from the examining room when he had to examine general officers. That was so that Englemann could enter and actually perform the procedure.⁹⁷

The need for proper eyewear led to the development of a program in 1917 to furnish spectacles to officers and recruits for a price 10 percent over the government`s cost for the frame and lenses. The following year the Army authorized the free issue of spectacles to enlisted personnel. Officers, nurses, and civilian employees were authorized to purchase eyeglasses through the post exchange. The Army purchased frames for 45 cents, cases for 15 cents, and lenses for 95 cents up to four dollars. The surgeon general authorized hospital commanders to designate enlisted `oculists` to order and fit spectacles.

The need for a spectacle fabrication capability in the Army resulted in the formation of optical manufacturing units. Optometrists and optical technicians could enlist as privates and seek assignment to those units.⁹⁸ The department organized a base optical unit consisting of eight auxiliary manufacturing sections. Commanded by Capt. F. H. Edmonds, SnC, in civilian life the head of an optical firm and the unit`s only officer, it deployed to France in April 1918. There the auxiliary units were stationed with base hospitals, where they also made dark lens?

es for gas casualties undergoing atropine or belladonna therapy and experimented with aluminum frames.⁹⁹

Summary

The formation of the Sanitary Corps was a major event in the history of the Medical Service Corps. Indeed, today`s MSC is almost a mirror image of its precursor. When the United States entered the war, the Medical Department needed a wide array of specialties in order to fight a European conflict, but it could commission only graduates of medical, dental, or veterinary schools. Medical Corps officers filled a range of administrative positions in the medical force structure and provided what coverage they could for the scientific specialties. However, that practice removed physicians from clinical duties and used them in roles for which they were unprepared. Furthermore, in many cases the department simply did not have access to the specialties it needed.

The diversification of medical specialties in turn reflected the enormous improvement in scientific medicine. The practical benefits of medical progress to the Army were immense. Sanitary Corps officers can be credited with helping the Medical Department give American generals freedom to concentrate on enemy threats and not epidemic threats. The department had learned lessons from its previous conflicts, and there was no need for a sanitary commission to prod it into action in World War I. For the first time, the ratio of battle deaths to deaths from disease was 1:1 overall, and much more than that in the theater of operations. General Gorgas boasted that the Medical Department had prevented a half million cases of disease and saved ten thousand lives in the first six months of mobilization alone.¹⁰⁰

New management technology enabled the department to commission officers in the varied skills it needed for an increasingly sophisticated industrial organization. The administrative specialty officers of the Sanitary Corps and the U.S. Army Ambulance Service gave the Medical Department access to the businesslike skills necessary to support the nation`s huge new army. Those officers brought a depth of skill, talent, and dedication to the Medical Department that presaged the future Medical Service Corps administrative specialty officers in a remarkable way.

The ability to commission officers in a wide variety of administrative and scientific specialties resulted in their substitution for other commissioned Medical Department officers, i.e., physicians. While this process was beneficial for the department`s mission and generally recognized as such, it did produce some underlying tension, as the debate over the adjutant position and the introduction of psychology reflected. That internal tension would surface again in the future.

The question still to be answered in 1918 was what would happen after the war. Both the Sanitary Corps and the U.S. Army Ambulance Service were wartime entities formed for the national emergency. Would there be an opportunity for full and rewarding careers for administrative and scientific specialty officers in a peacetime Army Medical Department? Or would the Medical Department return to its old ways until reawakened by a new emergency?

Notes

¹1. Gorgas: Phalen, Chiefs of the Medical Department, pp. 88-93. Quoted words: U.S. Congress, House, Hearings before the Committee on Military Affairs, 6 Jan-11 Feb 16, p. 694, hereafter cited as House, Hearings, 1916.

²2. Testimony: House, Hearings, 1916, pp. 694-95. Gorgas testified `almost daily.` Gorgas and Hendrick, William Crawford Gorgas, p. 305.

³3. Quoted words: Lynch, The Surgeon General`s Office, p. 152. Lt. Jerome Jeffrey, Sanitary Corps (SnC), an x-ray equipment expert, said he never understood the origin of the name, since he never knew of any of those officers in World War I who had anything to do with sanitation. Jeffrey to THU, 14 May 58, MSC-USACMH.

⁴Quoted words: WDGO 80, 30 Jun 17, PL.

⁵Numbers: See also William A. Hardenbergh and James A. Tobey, `The Sanitary Corps of the Army; Its Scope and Functions,` Military Surgeon 65 (July 1929): 46-52.

⁶Ireland`s assessment: Ireland, transmittal ltr in Lynch, The Surgeon General`s Office, p. 6.

⁷Contributions: E. Alexander Powell, The Army Behind the Army (New York: Charles Scribner`s Sons, 1919), pp. 437-38. New specialties:SG Report, 1918, pp. 245-46, 251, 273. Movie makers: The Adjutant General (TAG) to TSG, 16 May 18, sub: Personnel for the Sanitary Corps, Medical Department, MSC-USACMH.

⁸Numbers: SG Report, 1918, p. 393; Table J, Sanitary Corps, Dec 17, MSC-USACMH; SG Report, 1919, 2: 1117; Lynch, The Surgeon General`s Office, p. 152; Col. William A. Hardenbergh et al., draft chapter, sub: The Sanitary Corps, undated, folder 83, box 6/18, MSC-USACMH. Positions: Memo, SGO no. 333.054-1, 8 Dec 17, MSC-USACMH. Projected strength: TSG to TAG, 12 Nov 18, MSC-USACMH.

⁹Signature: Lt Col William D. Wrightson, SnC, to Col C. L. Furbush, 10 Jun 18, MSC?USACMH.

¹⁰Change: SGO Office Orders no. 55, 11 Jun 18, MSC-USACMH. An organizational change in June 1918 transferred personnel functions performed by Wrightson to the chief of the Personnel Division. However, Gorgas directed that Wrightson continue as head of the Sanitary Corps to resolve issues related to corps policy and organization. Wrightson to Furbush, 20 Jun 14, MSC-USACMH.

¹¹11. Wrightson: Biographical sketch, THU, OTSG; 1st Lt R.W. Bamberg, MSC, citing Memo, TSG for Wrightson, in draft rpt, sub: History of the Medical Service Corps, 20 Sep 54, THU, OTSG, folder 260, box 16/18, all in MSC-USACMH; Lynch, The Surgeon General`s Office, p. 4; Gorgas and Hendrick, William Crawford Gorgas, pp. 297-301. Wrightson was released from active duty in January 1919.

¹²TSG wishes: TSG to TAG, 11 Aug 17; Memo, Henry N. Fuller, SGO, sub: Notes Related to the Medical Administrative Corps, 4 May 37, MSC-USACMH.

¹³Authority: WDGO 113, 22 Aug 17, PL; Wrightson to Heads of Divisions, SGO, 8 Jun 18, MSC-USACMH.

¹⁴Reassignment: Lt Col S.P. Upshur, Commander (Cdr), U.S. General Hospital #3, Colonia, N.J., to TSG, 7 Jun 18, sub: Sanitary Corps Personnel at Hospitals, MSC-USACMH. Gorgas complaints: Gorgas to TAG, sub: Commissions in the Sanitary Corps, 14 Aug 17, MSC-USACMH.

¹⁵Shortages: Regimental history, 42d Division (Div), sub: Iodine and Gasoline: A History of the 117th Sanitation Team, Lt. Col. Wilbur S. Conklin, MC, commander, 1919, copy in Library of Congress. The 117th`s performance was noted by Brig. Gen. Douglas MacArthur, Div Chief of Staff (COS).

¹⁶Substitution: Memo, Col Winfred A. Smith for Col Miller, SGO, 8 Aug 18, folder 109, box 8/18, MSC-USACMH.

¹⁷Quartermaster Corps: Lynch, Field Operations, p. 172. Upshur: Lt Col A. P. Upshur, MC, to TSG, 7 Jun 18, sub: Sanitary Corps Personnel at Hospitals, MSC-USACMH.

¹⁸Course: Lynch, Field Operations, p. 172. Physicians who completed the course reported to the Fort Riley hospital for on-the-job training. There they received a special report on their aptitude for administration and, if acceptable, were assigned to a hospital as an adjutant.

¹⁹Increase: TAG to TSG, 16 May 18, sub: Personnel for the Sanitary Corps, Medical

Department, MSC-USACMH.

²⁰Shortages: Ibid., pp. 18-20; SG Report, 1919, 2: 1290-91. AEF, 1919: Joseph H. Ford, Administration, American Expeditionary Forces, vol. 2 of The Medical Department of the United States Army in the World War (Washington, D.C.: War Department, 1927), pp. 100-101, hereafter cited as Ford, Administration, AEF.

²¹Dickson: Biographical sketch, THU, OTSG, MSC-USACMH; Hume, The Medical Book of Merit, p. 26.

²²Mail: Ford, Administration, AEF, p. 85.The same problem arose in 1990 in Operation DESERT SHIELD.

²³Minderbender: Joseph Heller, Catch 22 (New York: Dell, 1963), pp. 270-71.

²⁴Quoted words: Alfred E. Cornebise, Typhus and Doughboys;The American Polish Typhus Relief Expedition, 1919-1921 (Newark: University of Delaware Press, 1982), pp. 27-28, 33. Herbert Hoover headed the effort as the director general of relief and rehabilitation for the Supreme Economic Council of the Allies.

²⁵Quoted words: House, Hearings, 1916, p. 580.

²⁶Quoted words: SG Report, 1919, 2: 1505. Also see Ltr, Brig Gen John S. Winn, IG, Services of Supply (SOS), to IG, AEF, sub: Conditions in SOS, 26 Jul 16, RG 120, Entry 588, Box 122, NARA-NA. The chief of the Surgeon General`s Finance and Supply Division said it was `absolutely necessary that the supplies for the care of the sick and wounded be on hand at all times wherever required.` Col Carl R. Darnall to Col Miller, 8 Aug 18, sub: Officers of the Sanitary Corps Required by the Finance and Supply Division, MSC-USACMH; also see SG Report, 1919, 2: 1501.

²⁷Expansion: SG Report, 1919, 2: 227; SG Report, 1918, pp. 20, 320; Lynch, The Surgeon General`s Office, p. 218.

²⁸Quoted words: SG Report, 1919, 2: 1505.

²⁹Number: SG Report, 1918, p. 20.

³⁰Problems: Ibid., p. 320. Functions: Edwin P. Wolfe, Finance and Supply, vol. 3 of The Medical Department of the United States Army in the World War (Washington, D.C.: Government Printing Office, 1928), p. 414, hereafter cited as Wolfe, Finance and Supply.

³¹Supply depots: SG Report, 1918, pp. 320-21. Training: Lynch, The Surgeon General`s Office, p. 234. Russia and England: TAG to TSG, 16 May 18, sub: Personnel for the Sanitary Corps, Medical Department, MSC-USACMH; Lynch, The Surgeon General`s Office, p. 234.

³²Procurement: SG Report, 1918, pp. 320-24. Standardization: Lynch, The Surgeon General`s Office, p. 221.

³³Burkard: A native of Germany, Burkard enlisted in 1898 and advanced to the rank of master hospital sergeant. As a Hospital Corps private he was decorated for bravery in action against Chippewa Indians at Leech Lake in northern Minnesota on 5 October 1898. Burkard was `the hero of the day,` who dragged fellow soldiers to safety `without paying any attention to the bullets which were sprinkling him with sand and cutting the grass all around him. As soon as this was done he would return to the firing line and fire as coolly as he dressed wounds.` Biographical sketch, THU, OTSG, undated, MSC-USACMH; Elbridge Colby, `Our Last Indian War,` Infantry Journal 43 (March-April 1936): 109; Quoted words from Richard K. Kolb, `Last Stand at Leech Lake,` Army 37 (June 1987): 74.

³⁴Mobile units: Jeffrey to THU, 14 May 58, MSC-USACMH. One of the Renault trucks was located in 1937 in a private collection near Morristown, N. J. G. Burling Jarrett, `Notes,` Military Affairs 1 (Fall 1937): 133-34.

³⁵Celebration: Jeffrey to THU, 14 May 58, MSC-USACMH.

³⁶Resources management: SG Report, 1918, pp. 270-72; Wolfe, Finance and Supply, pp. 767, 817-18.

³⁷Hospitals: Duncan Neuhauser, Coming of Age: A Fifty-Year History of the American College of Hospital Administrators and the Profession It Serves (Chicago: Pluribus Press, 1983), pp. 38-39.

³⁸Medical schools: House, Hearings, 1916, p. 636; U.S. Department of Labor, Bulletin no. 863, Postwar Outlook for Physicians (Washington, D.C.: U.S. Bureau of Labor Statistics, 12 February 1946), p. 3; Kenneth M. Ludmerer, Learning To Heal: The Development of American Medical Education (New York: Basic Books, 1985), pp. 72-74, 87-88, 166-90; Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement

of Teaching (1910; reprint, New York: Arno Press and the New York Times, 1972); Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 119-20. See Ludmerer for development of medical schools; 1885 is his date.

³⁹American College of Surgeons (ACS): Shryock, The Development of Modern Medicine, p. 348; American College of Surgeons, Manual of Hospital Standardization (Chicago: American College of Surgeons, 1937), p. 5; Neuhauser, Coming of Age, p. 39; George W. Stephenson, `The College`s Role in Hospital Standardization,` Bulletin of the American College of Surgeons (February 1981): 21; Loyal Davis, Fellowship of Surgeons(Springfield, Ill.: Charles C. Thomas, 1960), pp. 221-22.

⁴⁰Administration: Neuhauser, Coming of Age, pp. 41-65, 105.

⁴¹Quoted words: Charles E. Rosenberg, The Care of Strangers (New York: Basic Books, 1987), p. 279.

⁴²Army staff: Lynch, The Surgeon General`s Office, p. 1053. Hospital planning: Memo, Winford Smith for Col Miller, SGO, 24 Oct 18, MSC-USACMH.

⁴³Registrar: Albert G. Love, Eugene L. Hamilton, and Ida L. Hellman, Tabulating Equipment and Army Medical Statistics (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1958), pp. 70-75, hereafter cited as Love, Tabulating Equipment.

⁴⁴Draftee exams: Albert G. Love and Charles B. Davenport, Defects Found in Drafted Men (Washington, D.C.: Senate Committee on Military Affairs, 1919), pp. 27, 259; this is an abbreviated version of Love and Davenport, Defects Found in Drafted Men (Washington, D.C.: War Department, 1920). Equipment: Use of mechanical equipment dated from 1880 when Maj. John Shaw Billings, head of the Surgeon General`s Medical Library and consultant to the Census Office, persuaded a statistician, Herman Hollerith, Ph.D., to develop machines for tabulating census data. Hollerith incorporated his firm in 1896 as the Tabulating Machine Company located in Georgetown, Washington, D.C. Through various mergers this evolved into IBM. Love, Tabulating Equipment, pp. 36-51; Mark Walston, `Fast Calculating in Georgetown,` Washingtonian 22 (September 1987): 19.

⁴⁵Gorgas: He `had always been more interested in disease prevention than in office administration.` Phalen, Chiefs of the Medical Department, p. 92.

⁴⁶Quoted words: Hans Zinsser, Rats, Lice and History(Boston: Little, Brown and Company, 1935), p. 298. Typhus vector: Shryock, The Development of Modern Medicine, p. 290. Epidemic: Zinsser, Rats, Lice and History, pp. 296-98; Richard P. Strong, `Typhus Fever with Particular Reference to the Serbian Epidemic,` in Typhus Fever with Particular Reference to the Serbian Epidemic, Part I (Cambridge: Harvard University Press, 1920), pp. 7-10; William Hunter, `The Serbian Epidemics of Typhus and Relapsing Fever in 1915,` in Proceedings of the Royal Society of Medicine, Section of Epidemiology and State Medicine 13 (December 1919): 41, 75.

⁴⁷Advances: Unfortunately, that capability did not include success with the respiratory infections, principally pneumonia secondary to the measles and influenza that were common in training camps and on troop transports. For example, an influenza outbreak on a ship in 1918 killed 60 of 1,400 soldiers during a six-day crossing of the Atlantic. Rpt, Maj Edward E. Brinton, IG, to Base Area 3, SOS, sub: Observations Concerning Embarkation and Transport of Troops During Epidemic of Influenza, 19 Oct. 18, RG 159, Entry 26, Box 301, File 333.7, NARA-NA. They were also helped by German preventive medicine practices that stopped epidemics in the east from traveling to the west.

⁴⁸Numbers: Stanhope Bayne-Jones, The Evolution of Preventive Medicine in the United States Army, 1707-1939 (Washington, D.C.: Office of the Surgeon General, 1968), p. 151, hereafter cited as Bayne-Jones, Preventive Medicine; Armed Forces Information Service, Almanac: Defense 83 (Arlington, Va.: Government Printing Office, 1983), p. 46. Pershing reported 81,141 deaths in the AEF, of which 24,786 were from disease. Pershing, Final Report, p. 77. Quoted words: Elbert E. Persons, `The Organization, Management, Duties, Training, etc., of the Sanitary Service with a Newly Raised Regiment,` in Sanitary Field Service School for Medical Officers, Sanitary Field Service (Fort Leavenworth, Kans.: Field Service School for Medical Officers, 1912), pp. 6-7.

⁴⁹Gorgas: James S. Simmons, `The Division of Preventive Medicine, Office of the Surgeon General,` Medical Bulletin (July 1941): 63; Weston P. Chamberlain and Frank W. Weed, Sanitation, vol. 6 of The Medical Department of the United States Army in the World War (Washington, D.C.: Government Printing Office, 1926), pp. 65-68, hereafter cited as

Chamberlain and Weed, Sanitation; Gorgas and Hendrick, William Crawford Gorgas, p. 312. Inspectors general (IG) inspected hospitals as a matter of routine. The Army Inspector General, Maj. Gen. John L. Chamberlin, inspected American Expeditionary Forces (AEF) hospitals in France, where he found at least one hospital `positively dirty.` Rpt, Lt Col Charles H. Patterson, sub: Diary of Events Connected with the Visit of the Inspector General of the Army to France, July 9, 1918, to September 18, 1918, RG 159, Entry 26B, Box 8, File 333, AEF IG, NARA-NA. The hospital referred to was Clermont Base Hospital No. 30, organized at the University of California. Quoted words: Chamberlain and Weed, Sanitation, p. 303. Venereal disease (VD): As an example, organizations with a VD rate of 2 percent or higher were restricted and their commanders received an unfavorable comment in their officers` record books, the forerunner of officer efficiency reports. Chamberlain and Weed, Sanitation, p. 951.

⁵⁰Sanitary engineers: SG Report, 1918, pp. 224, 265. Competition: In one group of 2,000 applicants for enlisted and commissioned status only 250 were selected. Lynch, The Surgeon General`s Office, p. 266. Course: TSG to TAG, 12 Jun 18, sub: Personnel, Sanitary Corps-Sanitary Engineering Division, MSC-USACMH. The course for sanitary engineers was initially conducted in the School of Applied Hygiene and Sanitation. A School of Sanitary Engineering was formed in March 1918. It became autonomous in May 1918. Payoff: Simmons, `The Division of Preventive Medicine,` p. 62.

⁵¹Tinsman: Medical Bulletin (July 1932): 23; SG Report, 1919, 2: 1436; Biographical summary, THU, OTSG, undated, MSC-USACMH.

⁵²Equipment: Frederick Palmer, Newton D. Baker; America at War, 2 vols. (New York: Dodd, Mead, 1931), 1: 313. `The manufacturer of an incinerator might assure us that it would work; but, alas, in practice it often did not work any better than some of the boasted sewage-disposal systems did.` Design problems: SG Report, 1918, p. 268.

⁵³Quoted words: TSG to TAG, 12 Jun 18, MSC-USACMH.

⁵⁴Plants:SG Report, 1919, 2: 1334; Rpt, Behrman, sub: Experience of Colonel A. S. Behrman in the Sanitary Corps, World War I, undated (1959), folder 81, box 6/18, MSC-USACMH.

⁵⁵Responsibilities: WD Cir 67, 15 Nov 18, PL; William B. Hermes, `Malaria Drainage Operations at the Port of Embarkation, New Port News, Virginia,` Military Surgeon 47 (July 1920): 21-23. Number in May 1918: TSG to TAG, 12 Jun 68, MSC-USACMH. The surgeon general argued that the number authorized was inadequate.

⁵⁶Pershing`s request: TSG to TAG, 3 Dec 17, MSC-USACMH. Hisock: Summary of 201 file in Joseph Israeloff, draft chapter, sub: Gearing for Global Conflict, undated (1968), MSC History Project, box 1/18, MSC-USACMH. The unit was the 30th Division.

⁵⁷Quoted words: SG Report, 1919, 2: 1578.

⁵⁸Entomology: Perez Simmons, `A House Fly Plague in the American Expeditionary Forces,` Journal of Economic Entomology 16 (August 1923): 359-61, 363; quoted words, ibid., p. 361. Dysentery attacked 188 of 207 soldiers. What Simmons referred to as the `Spanish Flu` was actually the first wave of the 1918 influenza pandemic, which killed about thirty million people worldwide. It was the worst infectious disease outbreak of the twentieth century. See K. David Patterson and Gerald F. Pyle, `The Geography and Mortality of the 1918 Influenza Pandemic,` Bulletin of the History of Medicine 65 (Spring 1991): 4-7, 21.

⁵⁹ X-ray: Chief, Div of Roentgenology, OTSG, to TSG, 8 Oct 18, MSC-USACMH; Lynch, The Surgeon General`s Office, pp. 468-69. Jeffrey: Jeffrey to THU, 14 May 58, MSC-USACMH.

⁶⁰Schearer: Jeffrey to THU, 14 May 58, MSC-USACMH. Bedside x-ray: Wolfe, Finance and Supply, pp. 582-83.

⁶¹Laboratory officer duties:SG Report, 1918, p. 328; SG Report, 1919, 2: 1324-35; Lynch, The Surgeon General`s Office, pp. 290-91; Col Frederick F. Russell, MC, SGO, inclosure (Incl) to TSG to TAG, 12 Nov 18, MSC-USACMH. Hookworm: Charles A. Kofoid, `Intestinal Parasites,` in Joseph F. Silers, ed., Communicable and Other Diseases, vol. 9 of The Medical Department of the United States Army in the World War (Washington, D.C.: Government Printing Office, 1918), p. 532-33, 541; Kofoid, `Rapid Method for Detection of Ova of Intestinal Parasites in Human Stools,` Journal of the American Medical Association 71 (1918): 1557.

⁶²Training:SG Report, 1918, p. 328.

⁶³Quoted words: Rpt, THU, OTSG, sub: Advisory Editorial Board for MSC History, 13 Nov 58,

pp. R-I, 21-22, MSC-USACMH. Training: SG Report, 1918, p. 439. Rockefeller program: Donald Van Slyke to Thomas Jeffries, 29 Jul 65, MSC-USACMH. Yale and Fort Leavenworth: William N. Bispham, Training, vol. 7 of The Medical Department of the United States Army in the World War (Washington, D.C.: War Department, 1927), p. 460, hereafter cited as Bispham, Training.

⁶⁴Mobile laboratories: Lynch, Field Operations, pp. 213-17; Gorgas, Inspection of AEF Medical Services, p. 39.

⁶⁵Statistics: U.S. Congress, Senate, `Vocational Rehabilitation of Disabled Soldiers and Sailors,` 65th Cong., 2d sess., 30 Jan 1918, S. Doc. 166, p. 11. Congressional direction: U.S. Congress, Senate, `A Bill to Provide for Vocational Rehabilitation and Return to Civil Employment of Disabled Persons Discharged from the Military or Naval Forces of the United States,` 65th Cong., 2d sess., 20 May 1918, S. 4557. The Vocational Rehabilitation Act, also known as the Smith-Sears Act, was signed into law 27 June 1918. Division established: Lynch, The Surgeon General`s Office, pp. 474-75, 479. Veterans benefits: Pershing, Final Report, pp. 835-36, and Encyclopedia Britannica (1912), s.v. `Veterans Administration.` Veterans Administration: Eli Ginzberg, `Federal Hospitalization,` Modern Hospital 72 (April 1949): 63. Responsibility: TSG to Chief of Staff, Army (CSA), 25 Jun 18, and 1st Indorsement (Ind), AGO to TSG, 31 Jul 18, sub: Reconstruction, Physical, MSC-USACMH. Sanitary Corps numbers: SG Report, 1918, p. 403; 1st Ind, AGO to TSG, 31 Jul 18, MSC-USACMH.

⁶⁶Baldwin: See Bird T. Baldwin, Physical Growth and School Progress, A Study in Experimental Education, U.S. Bureau of Education Bulletin no. 10 (Washington, D.C.: Government Printing Office, 1914); Baldwin, Occupational Therapy Applied to Restoration of Movement (Washington, D.C.: Walter Reed General Hospital, 1919), pp. 5-7, 64.

⁶⁷Establishment:SG Report, 1918, p. 377; John R. Murlin to McConnell, 26 Oct 43, MSC?USACMH; Lt Col Robert Ryer, MSC, draft chapter, sub: Nutrition, in draft MSC History, undated (1961), folder 256, box 16/18, MSC-USACMH; Murlin and Caspar W. Miller, `Preliminary Results of Nutritional Surveys in U.S. Army Camps,` American Journal of Public Health 9 (June 1919): 407. After the war Murlin would serve as chairman of the National Research Council`s Committee on Food and Nutrition, as editor of the Journal of Nutrition, and, in 1930, as a member of the White House Conference on Child Health and Protection.

⁶⁸Quoted words: Ryer, draft chapter, p. 26.

⁶⁹Improvements: Paul E. Howe, `The Effect of Recent Developments in Nutrition on the Rationing of the Army,` Connecticut State Medical Journal 6 (March 1942): 157.

⁷⁰Prescott`s course: Ruckman, Technology`s War Record, pp. 28-29. Duties: Memo, Chief, Food and Nutrition Div, for Pers Div, SGO, 22 Oct 18, MSC-USACMH.

⁷¹Bug Juice: Stars and Stripes (27 September 1918): 6.

⁷²Organizing: Robert M. Yerkes, `Psychology in Relation to the War,` in NAS, Memoirs of the National Academy of Sciences, vol. 25 (Washington, D.C.: Government Printing Office, March 1918), p. 85; Yerkes, `Report of the Psychology Committee of the National Research Council,` Psychology Review 26 (March 1919): 87; Maj Yerkes to TSG, sub: Estimated Number of Psychologists Appointed in the Sanitary Corps for Military Service, 25 Oct 17, MSC-USACMH. Yerkes held an organizing meeting 6 April 1917 at Harvard. Yerkes, Psychological Examining in the United States Army, vol. 15 of Memoirs of the National Academy of Sciences (Washington, D.C.: Government Printing Office, 1921), p. 7. Tests: Yerkes, `Psychology in Relation to the War,` pp. 94-105; TSG to TAG, 7 Dec 17, MSC-USACMH; Lynch, The Surgeon General`s Office, pp. 397-98; SG Report, 1918, p. 373; Louis M. Termon, `The Use of Intelligence Tests in the Army,` Psychological Bulletin 15 (June 1918), pp. 177-87. Staff: SG Report, 1918, p. 372, and Edwin G. Boring to Lt Col Joseph Israeloff, 3 Mar 67, MSC-USACMH. Pioneers: Philip I. Sperling, `A New Direction for Military Psychology: Political Psychology,` American Psychologist 23 (February 1968): 97-98. Stanford test: Morton A. Seidenfield, `Clinical Psychology,` in Albert J. Glass and Robert J. Bernucci, eds., Neuropsychiatry in World War II, vol. 1 of The Medical Department of the United States Army in World War II (Washington, D.C.: Office of the Surgeon General of the Army, 1966), p. 568.

⁷³Low scores: Yerkes, Psychological Examining in the United States Army, pp. 518-19. The branches in `order of excellence` were Engineers, Artillery, Infantry, Quartermaster, Medical, Dental, and Veterinary, based on tests of 5,563 officers at four training camps. Special report: Col Henry A. Shaw, MC, to TSG, sub: Psychological Tests, Camp Lee, Virginia, 16 Nov 17, and Shaw to TSG,

sub: Psychological Ratings of Medical Officers, Camp Lee, Virginia, 19 Nov 17, both in ibid., pp. 18-19, 22-23. `I believe that the time has come when we must insist on a higher standard of professional ability and must exercise greater care in the selection of candidates.`

⁷⁴Intelligence testing: Medical Bulletin (January 1935): 40-42; SG Report, 1919, 2: 1074; and Lynch, The Surgeon General`s Office, pp. 400-401. Army impetus: Kevin McKean, `Intelligence: New Ways to Discover the Wisdom of Man,` Discover (October 1985): 25-41.

⁷⁵School: Lynch, The Surgeon General`s Office, p. 398; Yerkes, `Report of the Psychology Committee,` p. 88.

⁷⁶Tests: Medical Bulletin (January 1935): pp. 40-42;SG Report, 1919, 2: 1074. Numbers: SG Report, 1918, pp. 373-74; SG Report, 1919, 2: 1075; Yerkes to Wrightson, sub: Estimated Personnel for Psychological Service, 6 Apr 18, MSC-USACMH; Yerkes to Div of Commissioned Personnel, OTSG, 24 Oct 18, MSC-USACMH; Lynch, The Surgeon General`s Office, p. 399.

⁷⁷Aviation: U.S. War Department (WD), Division of Military Aeronautics, Air Service Medical (Washington, D.C.: Government Printing Office, 1919), pp. 24-25, 382-85 (interleaved photos), hereafter cited as WD, Air Service Medical; David M. Lam, `From Balloon to Black Hawk: The Origins,` pt. 1, U.S. Army Aviation Digest 27 (June 1981): 44-45. In July 1918 all airfields were required to convert one airplane to an ambulance. SnC officers: Gapen to Col Miller, Pers Div, OTSG, 30 Oct 18, MSC-USACMH. Aviation medicine: WD, Air Service Medical, pp. 99-100; Lynch, The Surgeon General`s Office, p. 486, 488-89; Ayers, The War with Germany, p. 85; Yerkes, `Report of the Psychology Committee,` p. 97.

⁷⁸Quoted words: WD, Air Service Medical, p. 22.

⁷⁹Research: Knight Dunlap, `Psychological Research in Aviation,` Science 49 (24 January 1919): 94; Edward C. Schneider, `Physiologic Observations and Methods,` pt. 1 of `Medical Studies in Aviation,` Journal of the American Medical Association 71 (26 October 1918): 1388, and Dunlap, `Psychological Observations and Methods,` pt. 2 of ibid.: 1392-93.

⁸⁰Board request: Seibert to Air Service Div, OTSG, 17Jun 18; TSG to TAG, 4 Jun 18 and Ind, AGO, 1 Jul 18; TSG to Col G. H. Crabtree, 6 Jul 18; TSG to TAG, 12 Nov 18, all in MSC?USACMH. Quoted words: TSG (Lt Col W. D. Wrightson, SnC) to TAG, sub: Sanitary Corps Personnel for Air Service Division, 4 Jun 18.

⁸¹Laboratory: The unit, consisting of thirty-three officers and fifteen enlisted, arrived at Issoudon, France, 2 September 1918. William H. Wilmer, Aviation Medicine in the A.E.F. (Washington, D.C.: Government Printing Office, 1920), pp. 16-17, hereafter cited as Wilmer, Aviation Medicine.

⁸²Physiology: Edward C. Schneider, `Physiology,` in Wilmer, Aviation Medicine, pp. 59-112. Also see WD, Air Service Medical, pp. 137-227.

⁸³Psychology: Floyd C. Dockeray, `Psychology,` in Aviation Medicine, pp. 113-32.

⁸⁴Ideas and issues: Yerkes to Div of Commissioned Personnel, 24 Oct 18, MSC-USACMH.

⁸⁵Poison gas: Ayers, The War with Germany, pp. 78, 84. Gas defense: Amos A. Fries and Clarence J. West, Chemical Warfare (New York: McGraw-Hill, 1921), pp. 34-35, 77, 103; Lynch, The Surgeon General`s Office, pp. 504-07. Dunlap: Yerkes, `Report of the Psychology Committee,` p. 97.

⁸⁶Quoted words: Fries and West, Chemical Warfare, p. 77. Transfer: WDGO 62, 26 Jun 18, PL, and 1st Ind, AGO to TSG, sub: Chemical Warfare Service (CWS), 13 Jul 18, MSC-USACMH. Maj. Gen. William L. Sibert was appointed the first director of the CWS on 11 May 1918.

⁸⁷Delousing: H.L. Gilchrist, `Delousing the American Army in France," Military Surgeon 47 (August 1920): 131, 146.

⁸⁸Venereal disease: Raymond B. Fosdick, Chronicle of a Generation (New York: Harper and Brothers, 1958), pp. 144-45. Public Health Service: Fitzhaugh Mullan, Plagues and Politics: The Story of the United States Public Health Service (New York: Basic Books, 1989), pp. 73-74.

⁸⁹Quoted words: Edward Frank Allen, `Keeping Our Men Fit Physically and Morally,` in vol. 7 (October-November 1918) of The New York Times Current History, The European War (New York: New York Times, 1918), p. 127.

⁹⁰Rates: Chamberlain and Weed, Sanitation, p. 983.

⁹¹AEF VD control: TSG to TAG, 12 Nov 18, MSC-USACMH; and Chamberlain and Weed, Sanitation, pp. 973-79.

⁹²Photography: Robert S. Henry, The Armed Forces Institute of Pathology, Its First Century

1862-1962 (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1964), pp. 171-74, hereafter cited as Henry, AFIP; Stars and Stripes (9 May 1919): 3. The unit operated out of the Elysee Palace in Paris.

⁹³Henry, AFIP, p. 174.

⁹⁴Pharmacy: Edward Kremers and George Urdang, History of Pharmacy, 3d ed., revised by Glenn Sonnedecker (Philadelphia: J.B. Lippincott, 1963), p. 302; Caswell Mayo, `Why the Pharmaceutical Corps Should Be Established,` American Druggist 66 (April 1918): 25-27, hereafter cited as Mayo, `Pharmaceutical Corps.` Quoted words: Mayo, `Pharmaceutical Corps,` p. 26.

⁹⁵Quoted words: SG Report, 1918, p. 361. Chiropody: Division of Orthopedic Surgery, OTSG, `Foot Care in Military Service,` Marine Corps Gazette 3 (March 1918): 3; Lynch, The Surgeon General`s Office, pp. 432-34;SG Report, 1918, pp. 361-62. Munson last: Edward L. Munson, The Soldier`s Foot and the Military Shoe: A Handbook for Officers and Noncommissioned Officers of the Line (Menasha, Wisc.: George B. Banta Publishing Co., 1917), pp. 55-65, quoted words, p. 39. Munson served as president of the Army Shoe Board, which pioneered innovations in shoe design and foot care based on a study of 2,000 soldiers conducted over four years. Enlisted chiropodists: Frank W. Weed and Loy McAfee, Surgery, vol. 11 of The Medical Department of the United States Army in the World War (Washington, D.C.: Government Printing Office, 1927), p. 593. `Those secured by transfer early in the war soon demonstrated their usefulness to such an extent that the desirability of having all qualified chiropodists who might be accepted in the draft made available for this work became evident.`

⁹⁶Optometry: SGO Cir Ltr, 27 Nov 17, in Lynch, The Surgeon General`s Office, p. 1143; TSG to TAG, sub: Spectacles for Military Personnel, 11 Jul and 9 Sep 18; WDGO 35, 15 Apr 18, all in RG 112, Accession No. 69A-127, Box 10/32, NARA, Washington National Records Center, Suitland, Md., hereafter cited as NARA-WNRC.

⁹⁷No optometrists: `No provision is made in the Medical Department for Optometrists` (SGO to W.F. Hellberg, O.D., Marshalltown, Iowa, 10 Nov 17, folder 58, box 5/18, MSC-USACMH). First optometrist: Edward J. Perkins, O. D., Portland, Ore., to Capt Albert L. Paul, MSC, 3 Jan 60, folder 55, box 5/18, MSC-USACMH. Englemann: Otto R. Englemann, O.D., Chicago, Ill., to Capt Paul, 27 Jan 60, folder 55, box 5/18, MSC-USACMH.

⁹⁸No commissions: The Surgeon General`s Office received hundreds of inquiries from optometrists. Their only option was to enlist as medical soldiers and hope to have their professional expertise capitalized upon by a hospital commanding officer. Lt CT. Cunningham, SnC, to Editor, Optical Journal, New York, 18 Dec 17, folder 51, box 5/18, MSC-USACMH.

⁹⁹Optical units: Lt Col Francis Fitts, MC, SGO, to Mr. Samuel A. Bocolter, Philadelphia, 26 Sep 39, folder 51, box 5/18, MSC-USACMH; Stars and Stripes (23 August 1918): 1-2. Edmonds had been president of an optical company. The first three units were outfitted by Bausch & Lomb Optical Co. Howard Trimby, Sales Mgr, Ophthalmic Instruments, Bausch & Lomb, to Capt Albert L. Paul, MSC, OTSG, 13 Jan 60, folder 55, box 5/18, MSC-USACMH.

¹⁰⁰Ratio: 51,417 deaths from disease: 50,510 battle deaths (Bayne-Jones, Preventive Medicine, p. 151). Claim: SG Report, 1918, p. 236.