CHAPTER III
The Medical Records Section, World War I
The formation of a Medical Records Section for Army personnel was necessitated during the Civil War by the volume of records to be handled in connection with pension requests and medical discharges. At the time of the outbreak of World War I, the work in this section consisted, in brief, of the receipt of all records of the sick and wounded of any character that occurred among the United States soldiers, the examination and preservation of these records, the furnishing of information from them to the authorized authorities requesting it, the compiling of statistical material from them for use in the annual reports of the Surgeon General and the Medical and Surgical History of the war, the preparation of the statistical section of the Surgeon General`s report, and the editing of the whole. With the increase in the volume of work connected with the war, steps were immediately taken to reorganize the section.
In October 1917, Maj. Albert G. Love1 was assigned to duty as officer in charge of the Medical Records Section, at that time a part of the Sanitation Division in the Surgeon General`s Office. Lt. (later Maj.) Robert H. Delafield, MC, was assigned to duty as assistant to the officer in charge. Col. James W. Van Dusen, MC, affectionately known to his friends as the "Iron Duke,` was nominally in charge of the Medical Records Section. Unfortunately, Colonel Van Dusen`s other duties were so extensive that he was unable to exercise any supervision over the work.
Both the administration of the Surgeon General`s Office and
1Major Love, later promoted to lieutenant colonel, colonel, and brigadier general, will be referred to, hereafter, by his surname only. He quotes freely and without quotation marks from publications of which he was coauthor either with the late Charles B. Davenport or with Dr. Lowell J. Reed.
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the methods of assembling the vital statistics of the United States Army were familiar to Love at the time of this assignment, since he had had a tour of duty in that office from 1910-14.
This earlier tour of duty had given Love an unusual opportunity to become indoctrinated with the spirit that animated the office with the desire to improve the organization and administration of the medical service so that it could better preserve the health of the Army and render service to the sick and wounded both in peace and in war. As junior captain, at that time, he was privileged to serve with such men as Jefferson R. Kean, Merritte W. Ireland, and Francis A. Winter, then majors but each one later a distinguished general officer who rendered highly efficient service during World War I and thereafter. Gen. George H. Torney was the Surgeon General. He was a quiet-mannered, soft-spoken gentleman but one who could and did become quite emphatic when the occasion seemed to require it.
Other outstanding officers in the Medical Department of the Army at that time with whom Love was fortunate to be associated included Walter D. McCaw, Librarian, Army Medical Library; Paul F. Straub, at the Army War College; Carl R. Darnall, who tripled as adjutant and professor of chemistry at the Army Medical School and as commanding officer of the Field Medical Supply Depot; and Frederick F. Russell, who was professor of bacteriology at the School. Each of these distinguished officers later became a general officer either on the active or retired lists, with the exception of Major Straub who had the misfortune to have been born in Berlin.2 Maj. Merritte W. Ireland, later Surgeon General from 1918 to 1931, was the executive sparkplug of the office. In addition to being a human dynamo with an apparently inexhaustible store of energy, he was a very personable man who attracted attention and respect in any gathering.
Captain Love served as an assistant to Maj. (later Brig. Gen.) Jefferson R. Kean. From him, he acquired a high regard for
2It will undoubtedly be remembered by those living at the time that during World War I even the German name was taboo. The statue of Frederick the Great, after being removed from its pedestal in front of the War College, reposed in the basement. Even German measles was a forbidden name. The German hospital unit from New York City, although an excellent one, could not be sent overseas.
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the Medical Department history and for the traditions of the service. General Kean numbered among his friends some of the more prominent men in the War Department. Capt. (later Gen.) Frank McCoy3 and Maj. Gen. Alvin Crowder, Judge Advocate General, later Provost Marshal General, World War I, and still later Ambassador to Cuba, were among the frequent visitors who came to the office to discuss matters with him. In addition, General Kean was a close friend of Maj. Gen. Leonard Wood, with whom he had served in Cuba soon after the cessation of the Spanish-American War. When he was relieved from the office about 1913, Maj. William L. Lyster replaced him. It was Major Lyster who perfected the Lyster waterbag.
The clerical personnel, many of whom had been in the Surgeon General`s Office for a number of years, were a most devoted and capable group of men and women. Mr. John Wilson was an efficient and capable chief clerk. He had been with Meade at Gettysburg, and when later during the war he was wounded and disabled he was assigned to duty in the Office of Surgeon General Barnes.
Love`s duty in the Surgeon General`s Office in 1910-14 was largely with the Medical Records Section that handled all sick and wounded and sanitary reports and compiled statistical tables for the annual reports. The system of compiling the statistical tables had been used with some modifications for many years at the time of his first assignment to the Medical Records Section. With the adoption of the sick and wounded card in 1904 to replace the list of sick and wounded on sheet forms, the assembling of the statistical tables was expedited. However, the list of diagnoses as reported from the various stations and hospitals was entirely too long for publication and grouping of less important diagnoses was instituted. About 1912, after a number of conferences with a medical officer in the Bureau of Medicine and Surgery of the Navy Department, the International List of Causes of Death was adopted, with required expansions. Obviously, patients do not die from all conditions requiring treatment, but it seemed desirable to use this list so that when a death did occur it could be properly assigned to the cause of sickness or admission. The International
3Captain McCoy was aide to General Wood. He later served as special ambassador to several Central and South American countries.
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List had the great advantage of being the one used by the Census Bureau, all large health departments, and similar agencies abroad.
The method of handling the material prior to World War I was as follows: The cards, after examination for correctness, were filed by station by month. The first step in the assembling of the statistical material was the placing of the International number on the cards. After they were so placed on the cards by station and by month, the total of each group was entered in the appropriate space on sheets about 4 feet long, in sets of four each. The annual sum of the monthly entries was entered below. Then, by skillful folding of the sheets delineating the month and grand total for each station, they were added and transferred to department or division sheets. These, in turn, were consolidated for the United States and then similarly consolidated with the overseas total for an Army total.
In 1917, Maj. Gen. William C. Gorgas, the Surgeon General, and his chief advisors, recognizing that this method was no longer adequate for handling the records in the Medical Statistics Section, decided that the use of machine tabulating equipment was essential. Two types of accounting machines were in existence at the time, the Hollerith equipment and the Powers equipment. One small installation of Hollerith equipment was already in the Reserve Section of the Personnel Division of the Surgeon General`s Office and was being used to locate Reserve officers with specialist training. An experimental use had been made of the Hollerith equipment in the Medical Records Section in 1889.
The U.S. Census Office had used the Hollerith equipment (p. 39) for tabulating the censuses of 1890 and 1900. Apparently, some misunderstanding developed between the Census Office and Dr. Hollerith, and the Census Office decided to develop another machine for the 1910 census. They called Mr. James Powers,4 an engineer, to Washington in 1907, and he invented a sliding punch and a two-deck sorting machine. He obtained authority from the Government to secure a patent, and in 1911 his company was incorporated in Maine as the Powers Accounting Machine Corporation. This machine equipment was installed by the Bureau of Medicine and Surgery,
4The Punched Card, 1952-53, vol. I. Detroit: Punched Card Publishing Co.
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U.S. Navy, in 1917.5 In 1913, Powers developed a printing tabulator. His machine was different from the Hollerith machines in that the former used a system of gravity pins and not an electrical contact. It is understood that the Powers Accounting Machine Corporation was eventually merged with the Remington Rand Company. After Love assumed charge of the Medical Records Section, he and Lieutenant Delafield investigated carefully the advantages of the two systems. They visited the personnel in the Bureau of the Census and in the Post Office Department who had experience in the use of one or both systems. The Hollerith equipment was selected.
When Love reported for duty with the Medical Records Section, in 1917, he was welcomed by the clerical personnel, a number of whom he had known quite well and favorably during his previous tour of duty. They had heard rumors of a change but felt that any reorganization made by him would probably be less radical than that made by someone who did not know and appreciate the system in use.
Those of the clerical personnel who had been in the office in 1889, when the Hollerith equipment had been used, shook their heads and predicted dire disaster. One of them, probably the most efficient one in the office, was on leave when the decision was made. He made a special trip to the office to warn Love against its use. With great earnestness, he said, `We tried those machines in `87 and `88, and after wasting much time we had to tear up the cards,` illustrating with his hands, "throw them away, and go back to our old system." But he was a loyal as well as an efficient employee, and after the system was installed no one worked harder to insure its success than he did.
It must be said in defense of the clerical force on duty in the Surgeon General`s Office at the time when Dr. Hollerith`s machine was first used, that the equipment did not seem to have been especially adapted for the needs of the office at that time. Most of the tables as published in the Annual Report of the Surgeon General of that period were a combination of statistics from the various stations throughout the Army. There were relatively few large statistical tables including all the posts in
5Report of the Surgeon General of the Navy, Bureau of Medicine and Surgery. In Annual Report of Secretary of the Navy, fiscal year 1918. Washington: Government Printing Office, 1918, pp, 1341-1594.
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the United States, and in those tables there were included an enumeration of the time lost by the various types of diseases or injuries which received treatment. It is possible that Dr. Hollerith`s equipment was not sufficiently flexible to provide for them a satisfactory integration of the amount of time lost.
