Chapter 12
THE ORGANIZATIONAL REVOLUTION
The organizational revolution that took place in the Army Medical Department after 1898 was inspired by a growing awareness of the implications of the nation's new status as a world power and a long-held concern of reformers about the lack of preparation of the Army as a whole for modern warfare. The experiences of the Spanish-American War had confirmed their belief that significant changes were needed in the organization and management of both the Army and its various components, in the size of the permanent force, and in the training of officers and men. Thus the pattern characteristic of previous postwar periods, when the Army and its Medical Department had tended to revert to their prewar status, was broken after the Spanish-American conflict.1
The initial changes accomplished during the period before the outbreak of World War I came largely because of the efforts of Secretary of War Root, who believed that strong centralized control and close coordination of the work of the various branches of the Army were needed. The most significant of the changes Root inspired was the creation in 1903 of the position of chief of staff, with its supporting General Staff to coordinate the work of the Army's various branches and to be responsible for overall planning. A medical officer was usually detailed to the General Staff, thereby providing the Army's leaders with insight into the Medical Department's concerns. Although not himself a member of the General Staff, the surgeon general could also explain his department's needs and responsibilities to that organization, thus increasing the likelihood that they would be considered when the Army's future course was set. But disagreement about the best way to prepare for modern warfare and opposition from those whose positions were threatened by change made progress tedious and rendered the achievement of still further reform difficult for both the Army and its Medical Department.2
After Root's resignation in January 1904, his drive to improve the Army's efficiency and effectiveness languished until April 1910, when Maj. Gen. Leonard Wood became Army chief of staff. Despite having endured two operations to remove a brain tumor only weeks before taking office, General Wood attacked his new responsibilities with characteristic vigor. He soon discovered that the chief obstacle to his plans for an Army more nearly approaching European standards in size and training was another former medical officer, Maj. Gen. Fred C. Ainsworth, the adjutant general, who strongly and actively opposed the more centralized organization Wood sought. In May 1911, when Henry L. Stimson became secretary of war, the
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chief of staff gained a valuable ally in support of his reform efforts. With the forced retirement of Ainsworth in 1912, Wood's authority was left unchallenged, enabling him to concentrate on creating an army that could hold its own against any foe.3
The means General Wood used to achieve his goal-increasing the size of the Army, making the division rather than the regiment the basic unit of organization, and emphasizing the training of both officers and men-had profound effects on the Army Medical Department. The increased size of the Army dictated an increase in the size of the Medical Department, one that led to additional administrative complexity. The move to make the division the basic unit of organization in the field required collateral changes in the department's approach to medical support. The emphasis on training placed a heavy obligation upon those already in the department, who would be called upon to indoctrinate new members of the department, National Guard physicians, and line officers in the department's increasingly complex responsibilities. Because of the need to accommodate Medical Department organization and procedures to those of the Army as a whole and also because of continuing progress in the world of medicine, the years before the outbreak of World War I were a time of significant change.
The Surgeon Generals
With the focus of attention increasingly upon preparedness, attacks on Surgeon General Sternberg for his role in the Medical Department's failure to make adequate medical care available to the soldiers of 1898 never ceased, in spite of the fact that the Dodge Commission had not placed major blame on the department for the disasters of 1898.4 At least one critic realistically commented that the department had "accomplished all that could have been accomplished under the circumstances." Few could argue, however, that Sternberg's principal contribution to the Medical Department and to the Army lay in his attempts to give medical officers better weapons with which to fight the diseases that had threatened the health and the lives of the troops in war and in peace. By creating boards specifically to study typhoid fever and yellow fever and by assigning the finest scientists in the department to serve on them, Sternberg gained for himself a large degree of the credit for reducing the threat these diseases posed to soldiers and civilians alike. In appointing a board to study the health problems of the Philippines, he set a precedent that was followed by his successors for many years. A law passed on 2 February 1901 as part of the Root reforms limiting the term of a surgeon general to four years did not apply to Sternberg;5 because of age and with charges still ringing in his ears that his "vain regime" had been an "ingrained orgy of incapacity" and that "the one great blot of the war [rested] upon the medical and surgical department of the army," he retired in June 1902.6
Alone of the men who served as surgeon general between the Spanish-American War and World War I, Sternberg's immediate successor, Surgeon General Forwood, failed to leave his mark upon the Medical Department. In office only three months, until September 1902, Forwood was fated to be remembered chiefly for his management of Camp Wikoff in 1898,7 which had brought him under heavy attack. Upon Forwood's retirement, the law passed on 30 June 1902 that forbade the appointment of any officer as head of a de-
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partment whose age would require retirement in less than four years came into effect. As a result, Colonel O'Reilly was appointed as Forwood's successor over several other medical officers who had more time in service.8
Surgeon General O'Reilly's career in the Army began when he interrupted his medical education during the Civil War to serve as a medical cadet, a wartime position created for medical students. He completed medical school after the war and in 1867 was appointed assistant surgeon. By 1868 he was reported to be suffering from "premonitary [sic] symptoms of cerebral disease," including insomnia, nightmares, memory loss, and headaches, requiring him to take several months of leave to head off what was seen as the threat of permanent disability. Although O'Reilly's health thereafter was apparently not robust, he acquired through the years an enviable reputation. Bailey Ashford in his autobiography described him as "an excellent administrator, the very embodiment of a high-ranking military officer, . . . also a great physician," while Walter Reed wrote in 1902 that he was "a distinguished gentleman . . . with sufficient political acumen to make him of material assistance in the Medical Department." Later in his autobiography Brig. Gen. Jefferson R. Kean wrote of the great affection O'Reilly's many friends, and especially those who had served under him, had for him. O'Reilly's image among junior officers as "a father to us all" was undoubtedly furthered by the fact that, breaking with tradition, he chose younger men to serve in the Surgeon General's Office. Having selected these men "wisely and well," as one medical historian put it, he went out of his way to encourage them to use their talents to the fullest.9
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Upon O'Reilly's retirement in January 1909, Torney became head of the Medical Department. Torney's success in managing the medical response to the challenges of the San Francisco earthquake and fire of 1906 led to his promotion over several of the department's most distinguished medical officers who were senior to him in rank, among them Colonel Gorgas, whose work in Panama was bringing him increasing fame in the field of public health. As surgeon general, Torney followed the path laid down by his predecessor, retaining O'Reilly's staff and policies. Although Torney had a reputation for impulsiveness, his work in preparing the department to care for an army at war was so highly regarded that he was reappointed to a second term in January 1913. As that year neared its close, however, Torney was desperately ill as a result of a bacterial infection of the heart. After developing pneumonia on 22 December he survived but five days, dying on 27 December. He left the completion of his work to Gorgas, who succeeded him in January 1914.10
The Surgeon General's Office
Although the Dodge Commission exonerated the Medical Department for any major responsibility for the horrors of the Spanish-American War, it was critical of the organization and management of the Surgeon General's Office. Neither Surgeon Generals Sternberg nor Forwood attempted the reorganization and streamlining suggested by the Dodge Commission. After nine months of study, Surgeon General O'Reilly concluded that the work of his office was unevenly divided among his assistants and that many minor matters that burdened him could be better handled by his subordinates. The delegation and redistribution of authority he initiated would make it possible, he believed, to expand the department to meet wartime needs without encumbering future surgeon generals with details of the kind that had preoccupied Sternberg.11
In attempting to deal with the problems of his growing organization, Surgeon General O'Reilly created a fifth division in his office specifically to manage personnel, a responsibility that had been handled by the chief clerk. He also established a foreign service roster, which made it possible to give medical officers several months' advance warning of impending overseas assignments and also to "equalize foreign service among the officers so far as was practicable. . . . " He was apparently unable to improve the situation of the department's clerks. Since no retirement was available for them, the oldest members of
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the staff, 28 percent of whom were over 60, were given lesser responsibilities as their capacity for work dwindled to avoid discharging them. In a report to Secretary of War Root, the curator of the Army Medical Museum suggested another problem, one that resulted from the fact that women, considered to be less efficient workers because they were sick more often and needed more help than the men, formed a quarter of the clerical staff.12
When Torney became surgeon general in 1909 the Surgeon General's Office itself was still a simple organization, in spite of the increased size of the Medical Department and of the clerical staff.13 As under O'Reilly, the superintendent of nurses reported directly to the surgeon general, and all other personnel in the office were grouped into five divisions. Medical officers headed separate divisions of supply, sanitation, and personnel, while yet another ran the museum and library, where seven specialists, two with permanent civil service appointments, were part of the staff. The fifth division consisted of the clerical staff of ninety-eight employees, both male and female, which handled general administrative matters under the supervision of a chief clerk.14
Like O'Reilly, Surgeon General Torney was concerned about the female clerks in his office. He wanted to restrict hiring to men until the percentage of women had been reduced because he believed that the "largely scientific and professional" work expected of clerks at the higher levels dictated an increase in the number of men at the lower levels available for promotion. "Vacancies in the higher executive positions [should] be filled from among the men clerks," women being "not as universally as men amenable to the calls of discipline." Furthermore, he noted, women "as a rule do not exhibit that larger zeal and interest in wide official horizons which would fit them for higher usefulness. . . ." Torney also urged that he be allowed to offer higher salaries, and, moved by the plight of some of his elderly, longtime employees whose low salaries forced them to continue to work in spite of physical and even mental infirmities, he suggested that a pension plan be created.15
Despite his sensitivity to the needs of his male subordinates, no matter how humble their positions, Surgeon General Torney found himself involved in a controversy over his management of personnel, the seeds of which he inherited from his predecessors. Since the days of the second surgeon general, Brig. Gen. Thomas Lawson, the head of the Medical Department had traditionally retained his most trusted assistants in Washington, where their skills and their advice were constantly available to him. Unlike Lawson, however, whose refusal to grant preferential treatment to world-famous Surgeon William Beaumont led to the latter's resignation from the Army,16 subsequent surgeon generals occasionally also undertook to spare some of the department's foremost scientists and researchers the routine rotations that were the lot of others. As growing numbers of medical officers became involved in research, the question of whether the assignments of all medical officers should be rotated and whether, beyond that, all medical officers should receive foreign assignments took on an increasing importance.17
Surgeon General O'Reilly's exclusion of the medical officers serving in his office from the foreign service roster highlighted the time-honored custom of retaining the surgeon general's assistants in Washington. Surgeon General Torney was not successful in retaining that policy, in spite of his
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1912 protest of a move to extend the four-year rotation rule customary in the rest of the Army to the Medical Department. He maintained that unless a delay were granted, such a move would upset the schedule of the Army Medical School. He also claimed that although it was desirable that most medical officers be generalists, the great strides in preventive medicine made by the Army had resulted from the work of specialists, for whom regular rotation from assignment to assignment would have been counterproductive. Rotation overseas seemed to be at the heart of the discussion, and the now particularly obvious fact that certain medical officers, men who were not necessarily eminent specialists, were rarely, if ever, rotated to foreign assignments triggered charges of favoritism against Torney and eventually involved Chief of Staff Wood. In December 1912 General Wood, who had the reputation of going out of his way to avoid the appearance of favoring the Medical Department, ordered that certain medical officers who seemed to have benefited from favoritism, among them future surgeon general Lt. Col. Merritte W. Ireland, be scheduled for foreign service immediately.18
Medical Officers
Many demands placed upon the Medical Department after 1898 exacerbated old difficulties even as they created new ones. Perhaps the department's oldest problem, a shortage of trained and experienced physicians, became formidable in the face of the possibility of modern warfare. Experience dating from long before the Spanish-American War had already taught the Army that waiting to deal with this situation until war was imminent and large numbers of civilian physicians had to be called in to meet emergency needs precipitated further complications, for "an untrained, or even a half-trained Medical Officer" was "by the very nature of things an ally of the enemy." Furthermore, although one of the Dodge Commission's specific recommendations had been for increases in the number of medical officers in the department, any significant progress that might be made toward achieving this goal would only add to the problem of familiarizing new medical officers with the ever-increasing complexities of their administrative and medical responsibilities. Nevertheless, Congress continued to ignore the question of medical care for the victims of future wars and to be niggardly in increasing the size of the department to meet already existing needs. Thus, for years after the end of the Spanish-American War, Medical Department efforts to prevent a recurrence of the shortage of trained and experienced personnel were, like those of other agencies in a similar predicament, in vain. In 1904 the proportion of medical officers to the total number of men in the Army was less than half that in either the Civil War or the Spanish-American War.19
That these problems would continue to plague the Medical Department began to become obvious in the months after the end of the war. The volunteers and regulars who had enlisted specifically for the war were mustered out, and in March 1899 Congress authorized an army of 65,000 regulars, an increase from the previous authorized peacetime strength of 27,000. The legislature also created a 35,000-man volunteer force to replace the wartime volunteers in the Philippines and to serve until 30 June 1901. Each of the volunteer regiments was to have three surgeons. Although most of the physicians who accepted positions as regimental and assis-
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tant surgeons with the volunteers at this time were veterans of the Spanish-American War, Surgeon General Sternberg believed that ideally at least one physician with each volunteer regiment should be a regular medical officer. As a result, of the 140 medical officers appointed to the United States Volunteers by June 1899, 45 were regular medical officers.20
Surgeon General Sternberg protested the continued shortage of trained medical officers by pointing out that a department with only 15 more physicians than before the beginning of the Spanish-American War could not provide adequate care for an army spread out from the Caribbean to the Pacific, especially when troops were still conducting active military operations in the Philippines. Congress' initial response to Sternberg's plea was restricted, however, to granting his request that the previous limit of 400 contract physicians be raised to 480. To make the best of this bad situation, the surgeon general urged that National Guard physicians be instructed in hygiene and sanitation to create a pool of doctors trained as military surgeons to be available in the event of war.21
The situation did not improve when, on 2 February 1901, shortly before the volunteers of 1899 were mustered out, Congress voted to increase regular infantry regiments from twenty-five to thirty and regular cavalry regiments from ten to fifteen, but added only 129 more medical officers to the Medical Department staff. A total of 320 medical officers was thus expected to care for the almost 86,000 officers and men that could now serve in the Regular Army and their families as well. Rather than further increasing the department's staff of regulars to meet the needs of the hundreds of isolated posts still existing in the Philippines and to care for 5,000 scouts, the legislature permitted the president to appoint 200 surgeons and assistant surgeons of the U.S. Volunteers to supplement the regular medical officers in the Philippines for two years. With barely more than 500 physicians, the department was thus required to provide medical attendance to a total of 125 posts, to 567 garrisons in the Philippines, to five general hospitals in the United States and the Philippines, and to troop transports. Moreover, additional physicians were needed at the Army Medical Museum and the Surgeon General's Library. Even the new Hygienic Laboratory of the Public Health and Marine Hospital Service used the services of the Army's medical experts; a medical officer was regularly detailed to its eight-member advisory board. Still faced with a shortage of officers, the department was forced to continue its heavy reliance on contract surgeons.22
To obtain the maximum benefit from the new openings for regulars voted in 1901, Surgeon General Sternberg encouraged experienced contract and volunteer surgeons to take the Medical Department's entrance exam, and Congress permitted the time the volunteers had served to be counted toward their rank if they passed. The reopening of the Army Medical School in November 1901 guaranteed that even inexperienced medical officers would soon become familiar with the most basic requirements of military medicine; however, although more than half of the nation's physicians earned as civilians less than what they could earn as first lieutenants, Medical Department salaries were too low to attract the best doctors. Furthermore, the large proportion of medical officers in the lower ranks clogged the pathway to promotion, and thus Sternberg was losing to civilian life some of the most promising young surgeons already in the department. Since the 1901 law did not address the
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problem of how to obtain the large numbers of trained physicians that would be needed in the event of war, the Medical Department was still not prepared to meet the demands of a major emergency.23
When O'Reilly took office as surgeon general, the Medical Department's problems seemed to be multiplying, but he showed no sign of being intimidated. Initially, he was no more successful in obtaining further increases in the number of commissioned officers in the department than Sternberg had been. The poor opportunity for promotion discouraged potential applicants. Fewer medical school graduates were available to apply to the Army Medical Department because, as a result of the movement to reform medical education then rapidly gaining momentum, inferior civilian medical schools were closing. The number who passed the entrance examination, always a small percentage of the total, was also dwindling. The surgeon general chose this time to make the examinations for promotion more demanding. He also continued the custom of having candidates for promotion serve a year as "attending surgeons in the principal medical centers of the United States." To add to the department without lowering its standards, O'Reilly, like Sternberg before him, took advantage of the experience of former volunteer medical officers, hiring some as contract surgeons so that he could send them back to the Philippines. He allowed those who were under 42 years of age to take the department's entrance exam. The five who passed received the rank of captain, to which they would have been entitled had all their service been as regulars.24
In spite of the difficulty in filling vacancies, Surgeon General O'Reilly rejected the idea of appointing even completely qualified black surgeons to serve with black troops. Among the reasons he cited for this decision were his belief that black troops had more respect for white officers, including medical officers, than they had for blacks and that the white officers of black units would find "the attendance of a colored physician . . . repugnant," especially as far as the care of their women was concerned. Furthermore, most hospital corpsmen were white and would object to taking orders from a black.25
In 1904 the surgeon general took advantage of the flexibility of the contract hiring system to add a new control over the Medical Department's would-be medical officers. Rather than commission them immediately upon their passage of the entrance examination, he decided to require them to sign contracts when they entered the Army Medical School and to award them commissions only upon the successful completion of their courses. O'Reilly thus gained a period during which he could observe their conduct as students of military medicine; easily eliminate any who, though unsuitable, might have slipped by the entrance examination; and motivate all to greater efforts in their studies.26
Although Surgeon General O'Reilly was able to maintain the quality of the Medical Department, the problem of size remained. Troops were still needed in the Philippines, but since the number of posts to be garrisoned had dropped drastically, the 200 volunteer surgeons sent to the islands in 1901 were not replaced when their terms of service were up in 1903. When, also in 1903, Congress took a step forward by finally requiring the Medical Department to familiarize the civilian physicians of the National Guard with the demands of military medicine, it simultaneously took a step backward by failing to increase the size of the Medical Department to reflect these added duties.27
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O'Reilly argued the department's need for more medical officers before Secretary of War Root, who endorsed the surgeon general's plea in December 1903. The following January, Root emphasized that to have available in wartime men who were "competent to conduct the administration of the great and complicated medical service," the most difficult challenge the Medical Department was likely to face, the appropriate training must be undertaken in peacetime. O'Reilly then drafted a "bill to increase the efficiency and enlarge the Medical Department," which Secretary of War Taft approved shortly after his appointment in February 1904. In January 1905 President Roosevelt, who even published an article on the subject in Military Surgeon, called upon Congress to pass the bill, stating that "it is not reasonable to expect successful administration in time of war of a department which lacks a third of the number of officers necessary to perform the medical service in time of peace."28
Nevertheless, though Congress was willing to vote increases in the Ordnance Department in 1906, it ignored the needs of the Medical Department. Secretary of War Taft noted in his annual report that because experienced medical officers were taken from their posts to accompany the new army of occupation in Cuba, the care of garrisons at several large posts had to be entrusted to inexperienced contract surgeons. Surgeon General O'Reilly emphasized in his annual report that while the number of line officers in the Army was sufficient for a force of 100,000, the number of medical officers was appropriate for but 42,000. Because war would force the Army to call in large numbers of civilian physicians, the Medical Department would face "a lamentable breakdown" in the event of hostilities, "for the selection and training of medical officers is a gradual process."29
When Congress finally addressed the question of the need for more regular medical officers in April 1908, it created 123 new vacancies. It also made official the designation Medical Corps, already in informal use as an inclusive term for the department's regular physicians, thereby emphasizing their status as career military officers. But unless Congress made the Medical Department more attractive to promising young physicians, the authority to sign on more doctors would be meaningless in view of the fact that the department could not find physicians willing to fill the vacancies it already had. To deal with the discouragement caused by slow promotions, therefore, the legislature placed more than half the new openings at the level of major or above. More openings at the top resulted from initiating examinations for promotion from major to lieutenant colonel; the major who failed both the promotion examination and a reexamination was retired. Although a requirement for promotion examination up to the rank of brigadier general in all corps and bureaus had been on the books since 1 October 1890, it does not appear to have been applied to the Medical Department. Further inducements included increases in the pay of the Army surgeon so that it compared favorably with incomes available to civilian physicians, as well as retirement on three-quarters pay after forty years of service. The post surgeon would still be allowed to supplement his military income by caring for private patients, but now he could do so only if it neither interfered with his Army duties nor involved opening an off-post office. At this point, the outdated system of giving Medical Department officers labels, such as assistant
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surgeon and surgeon, above and beyond their rank was finally abandoned.30
In the 1908 law Congress also created the Army's first reserve corps, the Medical Reserve Corps, a step whose importance Medical Department authorities described after World War I as "impossible to overestimate." Surgeon General O'Reilly believed that this step at last met the Dodge Commission's objective in calling for more medical officers in the department. In theory, in providing a pool of physicians from which the Army could draw, the new corps would eliminate the need to rely on contract surgeons. The Medical Department could now screen civilian doctors willing to help the Army in time of need and verify their credentials and skills before their services were required. Any officer joining the Reserve Corps who refused active duty when called up would forfeit his commission. But since the law did not require military training of Reserve Corps officers, it did not create a pool of physicians with an understanding of military medicine.31
To be eligible for the Medical Reserve Corps, a doctor had to be between twenty-two and forty-five years old, a graduate of a reputable medical school, and entitled to practice medicine in his home state. With the passage of both physical and professional examinations, he was commissioned as a lieutenant. Except for payment for disability received in line of duty, the reserve officer was entitled to none of the benefits received by his counterpart in the regulars, but Surgeon General O'Reilly believed that the patriotism of the nation's leading physicians would lead many of them to join the new corps.32
Although Surgeon Generals O'Reilly and Torney were successful in putting into effect most of the recommendations made by the Dodge Commission, and although O'Reilly suggested that he had met them all, one escaped them despite their best efforts. The early detection of health problems of any type or, better yet, their prevention, made the work of the inspector so important that the commission urged the creation of a corps of sanitary inspectors or of chief surgeons performing that function and blamed some of the troubles of the Spanish-American War on the lack of such an organization. Unable to attain this goal despite his belief in the need for it, Torney was forced to rely on assigning a medical officer to act as sanitary inspector in each geographic department. Thus, even though the trend at the time was toward formalizing common practices and, as a result, other specialized corps were being created, he had to continue the practice of designating individual medical officers to serve in this capacity whenever the gathering of many men at one site posed a particularly great threat to sanitation. In 1912 the War Department ordered that medical officers conduct twice a month "physical inspections" of every enlisted man to ensure that the earliest signs of vermin infestation, venereal disease, and foot problems, among other things, could thus be detected. Even though the function of the inspector was recognized, no specific place for him in the Medical Department was created.33
Plans for the Medical Reserve Corps reached full maturity under Surgeon General Torney with little significant opposition. On 30 June 1909, when he had been in office barely more than six months, 364 physicians were on the Medical Reserve Corps roster; of these, 29 were students at the Army Medical School. The number of Reserve Corps members on active duty varied in the early years of the corps' existence from under 100 to a little more than
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180, but because of the availability of these officers, no more than 20 contract surgeons were needed at any one time. In 1910, to encourage service in the Medical Reserve Corps, Congress decided to permit any reserve medical officer with a total of forty years of active service in any capacity-whether enlisted, contract, regular, volunteer, or reserve-to retire at age seventy with the pay of a first lieutenant. By June 1913, although the number of reserve officers on active duty was falling, the total number in the combined active and inactive reserve had reached 1,205, giving the department a large pool from which to draw in time of need.34
The new Medical Reserve Corps offered many advantages. Most of the first physicians on active duty with the Reserve Corps were former contract surgeons, men with at least a minimum of military experience. Since Congress allowed those vouched for by the surgeon general to enter the corps without taking the entrance examination, Surgeon General O'Reilly could give commissions to 160 of these physicians almost immediately after the passage of the 1908 law while annulling the contracts of all others. For former contract surgeons who did join the corps, their new status as commissioned officers would, according to O'Reilly, bring "great benefit . . . from correcting the former unpleasant and anomalous positions of these gentlemen."35
Among the members of the new corps were young doctors passing the examination to enter the Army Medical School, who now routinely became Reserve Corps lieutenants on active duty rather than contract surgeons. If no openings were immediately available in the regulars, they remained in this status for some time after graduation. Surgeon General O'Reilly anticipated having the younger and less eminent doctors on the inactive list devote a short period each year to military training, when through experience and discussion with regular medical officers they could become familiar with Army routines and requirements. Those who had "already proved their qualifications by their good work" would not be asked to take time from their busy civilian lives to train and would be required to take only the most perfunctory of examinations. Although O'Reilly was enthusiastic about the Reserve Corps, he admitted that the occasional hiring of a contract surgeon might be unavoidable.36
Active-duty reservists served in several capacities. The largest single block was the contingent at the Army Medical School, but an individual reservist was occasionally called upon to take the place of a surgeon at a nearby post while that officer joined troops in the field. Reserve physicians were also ordered to join regulars in caring for the sick and injured and dealing with sanitation on such occasions as the reunion of the veterans of the Union and Confederate armies at Gettysburg, when 24 Medical Reserve Corps officers joined 25 Medical Corps physicians to care for more than 800 sick among these elderly men. Surgeon General Torney was not happy, however, with the need to use reservists for such duties. He believed that the regular Medical Corps should be large enough to deal with these situations without calling up physicians from the Medical Reserve Corps. The existence of the new organization did not eliminate the old problem of an inadequate number of regular medical officers to meet more or less routine needs.37
The effects of the shortage of medical officers were exacerbated by Surgeon General O'Reilly's policy of encouraging "in
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every way important scientific work and original investigation" and of helping "other departments of the Government," even when doing so made the men involved unavailable for Army assignments. By the time Torney became surgeon general, the achievements of Medical Department's physicians were well known and requests for assistance from them were many. Medical schools and scientific organizations sought the assistance of the department's bacteriologists and tropical medicine experts. Openings were offered for medical officers in respected civilian laboratories where they could learn "to do more efficient laboratory work at their posts," an offer that Torney could not wholeheartedly accept because he could spare so few officers from their routine assignments. Some of Colonel Gorgas' subordinates in the Canal Zone worked to lure medical officers to Panama. When cases of plague appeared in Puerto Rico, authorities there successfully sought the guidance of Medical Department experts on how to prevent an epidemic. The U.S. Commission to the Republic of Liberia took an Army surgeon with it to study health problems in that country. A medical officer on sick leave in Europe was asked to manage a hospital for sick and wounded soldiers in the Balkans during hostilities until more permanent arrangements could be made. He was then asked to help in caring for the victims of a cholera epidemic in the same region. To all such talented subordinates Torney apparently gave enthusiastic support.38
As the Army grew in size and the emphasis on large-scale maneuvers increased, medical officers were called upon to participate in an effort to give medical and line officers a greater understanding of one another's responsibilities. In 1910 the inspector general commented that medical officers needed more training in "campaign work" but that those at maneuver camps were too busy to acquire "tactical knowledge." Until this point, as Maj. Edward L. Munson, an instructor in the care of troops at the Line and Staff College at Fort Leavenworth, noted, "medical officers did not know, were not expected to know, and it was too commonly presumed should not know, anything about the tactical handling of troops," the range of weapons, trajectory, or similar matters. The 1911 creation of the Field Service and Correspondence School for Medical Officers as one of the new schools of the Fort Leavenworth Army Service Schools was a step in the right direction, the suggestion that basics of the Leavenworth course be taught at the Army Medical School was not approved because apparently no room could be found in the curriculum there.39
The first class for physicians at Leavenworth began in 1912, offering a six-week nonmedical course designed to familiarize the physician with his staff, field, and administrative duties. The field service course was open to both regular and National Guard officers, with six of each attending the first session-one of the first graduates was future surgeon general Maj. Robert U. Patterson. Among the topics covered were the organization of sanitary work and the equipment used, sanitation in wartime and in occupied territory, and the transport of the sick and wounded. The correspondence course, which was regarded as preparation for the field service course, offered to approximately twenty-five students a broad spectrum of basic courses concerning military planning. Because all classes at the Leavenworth schools were suspended in the spring of 1916, only a few medical officers had had the opportunity of educa-
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tion there before the entry of the United States into World War I.40
The education of line officers in the responsibilities of the medical officer and the work of medical units was also vital. Medical officers continued in the footsteps of such colleagues as Colonel Woodhull, writing books for the instruction of line officers. Major Munson, himself one of these authors, noted that "the general failure by tacticians to recognize medical units as tactical elements had resulted in the medical service being regarded as something to be utilized after battles were fought, and not concurrently with the combat units except so far as the medical service directly attached to combat units was concerned." By 1911 he had succeeded in having a requirement made at Leavenworth that "no combatant problem . . . should . . . be considered as solved until the student officer had demonstrated a suitable disposition of the medical detachments, organizations and wounded." Another medical officer, Maj. Paul F. Straub, who, like Munson, published on the subject of medical service in the field, was teaching at the Army War College. In teaching military hygiene at Fort Leavenworth and the Army War College, medical officers placed emphasis on the course as "a conservation measure" to maximize its appeal to the line and staff officers who were its students. To teach U.S. line officers about the importance of disease prevention early in their careers and upon the recommendation of the surgeon general, a Department of Military Hygiene was even established at West Point, with the senior medical officer there serving as its head.41
The increased respect for the opinion of the medical officer that was a side effect of this sort of course could prove valuable. Even at this late date, the surgeon in the U.S. Army might be informed by his commanding officer that when his advice on sanitation "was wanted he would be sent for and told to offer it; until then he could keep it to himself." This situation was not characteristic of all armies. According to a U.S. medical officer who observed the Russo-Japanese conflict of 1904-1905, the first war in which disease caused fewer fatalities than wounds, Japanese line officers held the opinion of their medical officers in high regard. To their respect, he believed, should be credited the impressive sanitation of the Japanese Army and thus the fact that only 26 percent of the deaths resulted from disease.42
The notion of educating line officers about disease prevention was not always greeted with enthusiasm. Because even the best of courses would provide only limited information, the result might serve chiefly to make a complex problem seem simple.
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Instructing line officers in such matters, the authors of an article in the Journal of the Association of Military Surgeons wrote, was "extremely dangerous, unless it is distinctly understood" that its "sole purpose [was] impressing upon the young officer the importance of the matter, and that he will be acting foolishly if he ignores the sanitary recommendations he receives."43
The lack of enthusiasm engendered for the idea of adding further material to the curriculum of the Army Medical School was understandable. Indeed, although skilled instructors, among them physicians who had served with the Tropical Disease Board, taught at the medical school, its facilities and staff were too small even to enable it to enroll many National Guard officers. The growth of the school and of the museum and library that shared its building rendered the facilities increasingly inadequate. In 1901, since Congress had still not voted money for a building on the grounds of the new hospital being built to replace the facility at Washington Barracks, the school was forced to move into rented quarters. This development created difficulties for both students and staff at the school, since they were accustomed to using the museum's specimens and laboratory as well as their own laboratory during their work. As a result, Surgeon General Torney continued to urge that a building for the medical school be erected on the grounds of the new hospital.44
Dentists
The concern for the number and qualifications of the physicians serving the Army was traditional, but even the Dodge Commission had not considered the Army's need for dentists. Dentistry was still regarded as "a mechanical trade" whose practitioners were called upon to resolve problems after they occurred rather than to prevent them. In 1890, however, the publication of a book on the role of bacteria in causing dental decay brought the medical revolution to dentistry and offered hope of successful prevention and treatment. The important role that dentists could play in the U.S. Army began to become apparent not long thereafter, when the teeth of U.S. soldiers serving for long periods in the tropics rapidly deteriorated. This state of affairs might have been related to a general deterioration in their health during any long period of service in these areas or even to the flourishing bacteria of a hot climate. In February 1901, when Congress increased the number of officers in the Medical Department, it also authorized contracts with 1 dentist for every 1,000 men, up to a maximum of 30 dental surgeons, who as civilians were given the relative rank of lieutenant. In addition, the legislature permitted hospital corpsmen who had served satisfactorily as dentists to receive contracts without the examination required of all others. By June 1902 a board of 3 dentists had administered qualifying examinations to all applicants required to take them and had hired 30.45
Time would prove that 30 dentists were not enough. Since using extraction to deal with rampant decay would leave too many soldiers with too few teeth to eat the Army ration, more and more teeth were filled or crowned rather than removed. Abscesses, gum inflammation, and similar problems also received attention. Far more skill and time were required for treating dental disease than for extraction. Even though each dentist was provided with a Hospital Corps private or acting hospital steward to assist
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him, he often found it difficult to stay far enough ahead of decay to preserve teeth.46
When Torney became surgeon general in 1909, the limit of 30 dentists was a severe handicap, since the ratio of 1 per 1,000 men would suggest that 85 should be employed. The dentists who were serving in the Medical Department were so seriously overworked that the best among them were not likely to renew their contracts. Torney's efforts to correct the situation were initially doomed to failure, but the prestige of the dental profession was growing. At last, on 3 March 1911, after the American Medical Association joined the 50,000-member American Dental Association to pressure Congress to give dentists rank, the legislature created the Dental Corps, to consist of no more than 60 dental surgeons. They were to be assisted by as many acting, or contract, dental surgeons as needed to provide a ratio of no more than 1 dentist for every 1,000 enlisted men, but the number of dental surgeons in the new corps grew very slowly because the path to be followed in reaching that position was slow and tedious. Each candidate passing the initial examination had to accept contract status. Only after three years of satisfactory work as an acting dental surgeon and the passage of yet another examination could he receive a commission as first lieutenant. On 30 June commissions were awarded to 29 of the Army's dentists, 28 of whom remained in the Army a year later, when 10 more dentists were caring for Army patients under contract. By 1913, 13 additional acting dental surgeons had qualified for commissions, but the increase in the number of commissioned dental surgeons in the corps of necessity remained slow.47
Nurses
The Dodge Commission had ignored the need for dentists, but it had called for the creation of a reserve corps of trained female nurses. The use of women to care for the Army's patients was by no means new, and with the development of training schools for female nurses, their value became undeniable, making the formalizing of their position as a permanent institution within the Medical Department a logical step.
This development came only gradually. In June 1899 the War Department added the position of reserve nurse to the Army Nurse Corps, whose members still worked on a contract basis. To be eligible for the reserves, a nurse had to have worked for the Army for at least four months and had to agree to return to an active status whenever her services were requested. The duties of Army nurses remained arduous; by 1 July 1900, 13 had died because of disease contracted while on duty. Until 1901 their organization remained basically an informal one, created by the Executive Branch in response to need rather than by Congress, and medical officers continued to debate the value of the female nurse to the Army.48
In the bill of February 1901 that increased the number of regiments in the Regular Army, Congress finally took action that placed the Nurse Corps "on the same footing with the Hospital Corps, as an integral and permanent part of the Army." The Army Nurse Corps now became a matter of law rather than of departmental regulation, its members to be appointed to the Medical Department rather than hired by contract and its head to be formally known as superintendent. The number serving in the new corps was to be determined by need, and each nurse was to serve three years. As a physician, McGee could no
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longer direct the Army's nurses, since in appointing a superintendent, the secretary of war was allowed to consider only graduates of two-year or longer courses at nurses training schools. Congress also adopted the concept of the reserve nurse, but the number in this category remained small-only 44 of the 167 nurses in the Medical Department in 1902.49
The number of nurses on active duty hovered around 100 in the years after the creation of the corps, with the two largest groups serving at the general hospital at the Presidio in San Francisco and at the First Reserve hospital in Manila. Retaining even this small number of qualified nurses in the Army became very difficult. The Isthmian Canal Commission tempted nurses as well as physicians, offering better salaries and working conditions than the Army. A "large contingent of ex-army nurses" who might otherwise have reenlisted in the Medical Department was soon serving under Colonel Gorgas. Surgeon General O'Reilly's attempts to make Army service more attractive to nurses were in vain. By 1908, when the Canal Commission had been offering nurses a higher salary than the Army for several years and the new Navy Nurse Corps was giving women more fringe benefits than O'Reilly could offer, including more generous leave and travel allowances, he was unable to fill all the vacancies in the Army Nurse Corps.50
In 1910, to encourage qualified women to join the Army, Congress finally authorized an increase in pay from $40 to $50 a month. An additional $10 was allowed for overseas service, and an increase of $5 for every additional three years of service up through nine years was also voted. This measure encouraged enlistment to the point where all vacancies had been filled when the appropriation went into effect. The following year another 25 spaces were voted for the Nurse Corps, with yet another 25 in 1913, for a total of 150.51
The increase in the size of the Nurse Corps made necessary greater attention to the facilities available for housing female members of the Medical Department. The additional nurses recruited in 1911 were assigned to the Army-Navy Hospital in Hot Springs, Arkansas; to the base hospital at Fort Sam Houston in Texas; to the new Walter Reed General Hospital in Washington, D.C.; and to the office of the Army surgeon responsible for the care of government officials in the District of Columbia. Although initially the facilities at Walter Reed, like those at many other hospitals, were not adequate, by June a new building for the nurses was in place. Thereafter whenever possible, nurses unfamiliar with the Army were sent to Washington, D.C., for training in the military aspects of their duties and for observation about their fitness for this type of work, much as prospective medical officers were sent to the Army Medical School.52
The Army Nurse Corps owed its growth to its second superintendent, Jane A. Delano, who was also chairman of the Red Cross Nursing Service.53 Since the Medical Department had never been successful in building up a sizeable group of reserve nurses, Delano's position with the Red Cross and her determination in increasing the number of nurses in both organizations were of particular significance. Army planning already assumed Red Cross support in wartime, and by 1911 more than 2,000 "carefully selected" Red Cross nurses had pledged to serve in the event that hostilities broke out. When Delano resigned in 1912 after three years as superintendent, the pool of registered Red Cross nurses was the officially recognized source from which the Army would draw its reserve nurses.54
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The Hospital Corps
In the Hospital Corps the Medical Department had already realized before the Spanish-American War the enlisted corps that other bureaus were still seeking, but obtaining and retaining enough hospital corpsmen proved to be difficult. Because hostilities with Spain had ended, the department was required to refrain from signing on more hospital stewards so that the original prewar limit of 100 could be reached by attrition. The shortage that resulted forced the use of acting hospital stewards in positions normally filled by stewards. In May 1900 Congress finally voted to create 100 more openings for hospital stewards. The following February, faced with the loss of experienced stewards mustered out with their volunteer regiments, the legislature voted still another 100 slots, to be reserved specifically for stewards who would otherwise leave the service. As a result of these two measures, the 167 hospital stewards of 30 June 1900 became 246 a year later.55
The demand for Hospital Corps privates was also great, particularly in the Philippine Islands, where for several years following the end of the conflict with Spain they served the Filipino scouts as well as U.S. troops. The secretary of war's ability to appoint as many privates as he saw fit did not solve the problem because of a rapid turnover of personnel; the almost simultaneous end of many enlistments in the volunteers saw 1,275 hospital corpsmen leave the Army in one four-month period late in 1901. A year later, after many replacements had been sent to the Pacific and the total number of troops there had begun to dwindle, a surplus developed. Because the proportion of corpsmen to troops was higher than the goal of 5 corpsmen to 100 men with white troops and 3 per 100 with native units, Surgeon General O'Reilly briefly stopped sending privates to the Pacific. In March 1907, however, the Medical Department gained permission to organize a Hospital Corps company in the Philippines. Vacancies in this company were filled as they occurred by transfers from the line, though such men were traditionally not highly regarded because of their "moral and mental inferiority." Hospital Corps noncommissioned officers were retained with the Philippine Souts, but in 1908 a program to train three privates from each scout company to do the work of Hospital Corps privates reduced the number of U.S. corpsmen needed in the Pacific. The exclusive reliance upon native troops in Puerto Rico after 1905 also contributed to a significant reduction in the need for U.S. hospital corpsmen in the tropics.56
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The declining need for Hospital Corps privates was especially welcome because the requirement for exceptional strength of mind and body made replacements hard to find. The problem was further complicated by the fact that the number of new enlistments tended to fluctuate for reasons Surgeon General O'Reilly could not specifically identify. At times, authority had to be granted to recruiting officers and surgeons to hire locally without obtaining the specific approval usually required from the Surgeon General's Office.57
Army regulations issued in 1901 added the grade of lance acting hospital steward to the Hospital Corps so that the Medical Department would have "an opportunity to test the men as to their qualifications for the position of noncommissioned officers"; of the first ninety appointed to the new grade, twelve were later made acting hospital stewards. In the spring of 1903, as part of a reorganization of the corps, the old titles of hospital steward and acting hospital steward were abandoned in favor of reliance upon grade alone. At this time, the grade of corporal was authorized for as many as twenty corpsmen, a promotion regarded as an appropriate reward for those who, though "excellent and experienced soldiers [and] good disciplinarians," could not pass the exams necessary for promotion to sergeant. Army regulations issued in 1904 added the grade of lance corporal to the Hospital Corps.58 The men so named were to be appointed, apparently without the usual examination, by either the surgeon general or one of the chief surgeons of the military departments. No more men were to be given this grade than would, together with the other noncommissioned officers, constitute a fifth of the detachment with which they served.59
To train hundreds of hospital corpsmen in laboratory work, in the care and trans-
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portation of patients, in such tasks as vaccination, and in the management of paperwork, the Medical Department had to maintain permanent training companies (companies of instruction). These units generally handled no more than 100 trainees at a time in a course that took four months. One such company was set up at Angel Island, California, and another was routinely assigned to Washington, where it could also be used in training the students of the Army Medical School in their future duties. During those periods when the number of corpsmen was being reduced and few new men were available for instruction, the program for student medical officers was adversely affected. When the demand for hospital corpsmen was great, men who were not fully trained might be sent out into the field.60
Other companies of instruction were less permanent. The company of instruction in Manila, for example, was disbanded in 1901, although in 1903 medical officers set up a school for Filipino hospital corpsmen on Mindanao. By 1907 the company on Angel Island had been disbanded, but the Medical Department was maintaining four companies of instruction-two in Cuba, one in the Philippines, and one in Washington. Since many who had joined during or after the Spanish-American War had had no opportunity for careful training, the department also set up "detachments of instruction" at various posts, following the pattern initiated before the war. The chief surgeon of each military department, who was responsible for recruiting, training, and disciplining the corpsmen within that department, was required to see that at least five hours each week were devoted to instructing them in their duties. By 1908 an increase in pay had partially alleviated the problems involved in training hospital corpsmen by making it more likely that those already trained would either remain in the Army or reenlist after a period as civilians.61
Like his predecessors, Surgeon General Torney wrestled with problems resulting from the shortage of corpsmen and the difficulties experienced in recruiting and retaining the "better class of men," as he put it. Increasing numbers of experienced corpsmen, 67 in fiscal year 1909 alone, were leaving the Medical Department in favor of the line, where the pay was higher, promotions were more rapid, and duties were more attractive to the average soldier. When Congress created new openings at the top of the Hospital Corps in the spring of 1909, it did so at the expense of openings at the lower levels, leaving the department more in need than ever of Hospital Corps privates, since many were needed by the larger hospitals. Even calling in corpsmen from posts to work with maneuver units could not completely meet the demand in the field, and requests from post surgeons for hospital corpsmen too often had to be denied. When the number of corpsmen dictated by the size of the Army should have been 4,000, the number allotted remained 3,500, with an additional 12 appointed to serve militia units.62
Surgeon General Torney emphasized that the shortage of corpsmen would be disastrous in the event of war. He argued in vain that a proper interpretation of the applicable law would permit the secretary of war to appoint as many privates as were needed without regard to personnel ceilings for the Army as a whole. The easiest way to fill openings-that is, transferring unassigned recruits-"has not resulted," Torney emphasized, "in obtaining the most desirable class of men for service with the sick" and was not likely to produce a
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supply of the highly skilled men he especially sought. He also urged that the rank of sergeant major be added to the Hospital Corps to attract "pharmacists of exceptional ability, X-ray experts, anesthetists," and similar specialists from civilian life, where they were paid more than they would be in the Army. Organizing the Hospital Corps into four permanent field hospitals and ambulance companies in 1911 was a step forward, since it eliminated the need to form these units from the existing companies of instruction each time medical personnel were required for maneuvers, but it did not resolve the problem of the corps' inadequate size.63
Preparing Medical Personnel for War
Obtaining adequate numbers of good men and women for the Medical Department could not alone prevent a repeat of the chaos and confusion of the Spanish-American War. To prepare adequately for the demands of war, doctrine had to be developed to guide the use of medical personnel, who had to be trained in the roles they were expected to play. In the immediate wake of that conflict, plans for using medical personnel effectively were sketchy and based on the approach used in 1898. The responsibility for devising new and detailed plans for meeting the challenges of modern warfare and for training medical personnel fell upon the shoulders of Surgeon General Sternberg's successors.
Perhaps the most crucial and exacting responsibility medical personnel would have to handle in time of war was evacuating the wounded. As many men as possible, including physicians, had to be kept at the front, but the fighting forces must not be encumbered by those no longer able to fight. Medical officers had to be prepared to divide the sick and wounded according to their condition so that those who would not be able to return to the front within a short period could be swiftly evacuated far from the battlefield. In briefly outlining how these goals should be achieved, early versions of the Army's Field Service Regulations and Medical Department manuals followed an approach based on that used in the spring of 1864 in the Civil War. The manual issued in 1906, drawn up, like succeeding manuals, by a board of medical officers who utilized suggestions solicited from members of the department, offered a detailed refinement of earlier plans for the organization of medical service in the field. It was designed, according to Surgeon General O'Reilly, "not only to meet the needs of to-day, but also the exigencies of war and the requirements of field service, making all the details of administration plain to the untrained volunteer surgeon." The medical units-field hospitals and ambulance companies-that took part in the maneuvers of 1908, however, were still "wholly provisional, since permanent units did not exist."64
Although even more detailed instructions were available by 1909 to guide every step of Medical Department activity in the field, the first attempt to gather a force as large as a division together at one time would not be made for another two years, and the Hospital Corps was yet to be permanently organized into field hospitals and ambulance companies. The 1909 regulations stated that in the event of war the chief surgeon of an army, who was the equivalent of the modern theater surgeon,65 would give general instructions to the chief surgeons of component field armies who, together with the division surgeons, would be responsible for devising specific and
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comprehensive plans to be followed at the front. Of the facilities to care for the wounded, dressing stations, each established by an ambulance company, would be nearest the front, but their number was to be as small as possible to avoid breaking up division medical personnel. Dressing stations and field hospitals were to be in the collecting zone, evacuation and base hospitals in the evacuation zone, and general hospitals in the distributing zone. In addition to four field hospitals and four ambulance companies and any dressing stations that were set up, the divisional medical organization in the field was to include a transport column, two evacuation hospitals, a base hospital, and a supply depot.66
When in 1910 the division replaced the regiment as "the basis for army organization," thereby becoming the Army's "great administrative and tactical unit," the Medical Department tailored its approach to caring for the sick and wounded in the field to suit the new 20,000-man division, which was composed of three brigades, each of which had three regiments. Plans that covered the entire line of evacuation from battalion aid station to base hospital were formalized. The manual issued in 1911 offered still greater detail than previous versions and represented a further refinement and formalization of earlier approaches rather than a significant alteration in them.67
As called for by the 1911 manual, a director of ambulance companies and a director of field hospitals would serve under the chief surgeon of each division. A reserve medical supply would also accompany each division. According to this plan, wounded who could walk were expected to follow one of the roads to the rear to the division's clearing station, a new concept for the U.S. Army designed to prevent the overcrowding of field hospitals by those least in need of aid. For those who were seriously injured, an aid station established by a regimental surgeon would be the first stop. They would then be taken by litter to the ambulance or dressing station. An ambulance would complete the move back to the nearest of the four 108-bed field hospitals that were allowed each division. Except in regiments operating independently, the regimental hospital had already been reduced to a 6-bed infirmary that played no role in the handling of the wounded in battle. Litter-bearers were organized into four ambulance companies per division, all of which worked under instructions from either the division's director of ambulances or its chief surgeon. Patients in need of prolonged care would be moved to one of the division's two 324-bed evacuation hospitals and from there to the division's 500-bed base facility. A 200-bed hospital train or ship-the former with three physicians, the latter with five-could evacuate patients still farther. When the battle was over, all severely wounded who could not be evacuated would be placed in one of the field hospitals. This facility would become a fixed unit, while the three remaining field hospitals would move on with the division.68
Surgeon General Torney benefited from the existence of the General Staff and the Army War College. Though established "to train officers for General Staff duties on the principle of learning by doing," in practice the college "instead of becoming exclusively an academic institution . . . became a part of the General Staff." The surgeon general was thus able to discuss his reservations about how well the Medical Department could carry out its role as outlined in the most recent regulations directly with those responsible for creating war plans. In 1911 Torney, Chief of Staff
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Wood, and the planners of the Army War College became involved in a heated discussion when the surgeon general realized that they did not appreciate the implications of the shortage of hospital corpsmen. When the possibility of creating a second division to join the maneuver division already in the field along the Mexican border was discussed, Torney pointed out in very positive terms that he would not be able to provide it with adequate medical coverage without a much larger complement of hospital corpsmen. He could draw on the Medical Reserve Corps for as many more physicians as he needed, but "by no kind of legerdemain can an efficient medical service be provided for another division of regular troops without the enlistment of additional Hospital Corps men."69
Surgeon General Torney's efforts to obtain an adequate number of worthwhile men for the Hospital Corps so that the Medical Department could play the role outlined for it in the event of a major war were never successful. The Army's Field Service Regulations called for every division to be assigned four field hospitals and four ambulance companies. Even as late as 1913, when the Army was organized into four divisions, the surgeon general did not have the manpower to staff the requisite sixteen field hospitals and sixteen ambulance companies.70
The increasingly complex doctrine being developed to guide the medical service in the field emphasized the critical need to familiarize the civilian physicians upon whom the Army would have to rely in wartime with their duties before hostilities began. The task that would face the Medical Department in the event of hostilities would be enormous. The largest group of physicians and corpsmen that the department would have to train was found in the National Guard. For each division of the Guard, whose members were presumably totally unfamiliar with the most recent plans, as many as 100 or more civilian physicians, 132 noncommissioned officers, and 745 privates and privates first class would have to be trained. Of these, 5 doctors and 33-57 enlisted men would be needed in each field hospital and 4 medical officers and 24 enlisted would be required to accompany each infantry regiment.71
Eager to increase the size of the nation's pool of physicians with military training and wishing to foster a close relationship between National Guard medical officers and their counterparts in the regulars, Surgeon General O'Reilly urged Guard personnel to look to the Medical Department for advice, assistance, and supplies. Guard and regular units began training together when permanent camps of instruction were authorized in 1901, and in 1903 Congress increased the Regular Army's role in training and equipping the Guard. Regular medical officers noted a lack of discipline on the part of Guard medical officers, who reported to camp only when it suited their fancy. National Guard physicians were eligible to take many courses open to members of the Medical Department, but few took advantage of the opportunity.72
General Wood believed that brief periods of intensive military training in summer camps were the only realistic way to prepare both support and line troops for any future wartime expansion of the nation's armed forces, yet the time available for training militia physicians in this way proved to be inadequate. Surgeon General Torney urged making additional training available through summer camps run specifically for medical officers. In the summer of 1909 such camps were established on both coasts and a third was
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opened in the Midwest. At each, a field hospital and an ambulance company were called in to demonstrate the work of the Medical Department in the field. During the month these institutions were in operation, National Guard doctors rotated through them for two-week training periods. The reaction to these camps was mixed, and the enrollment was sometimes poor, but Guard officers who attended them were generally enthusiastic.73
Although the medical camp concept was apparently abandoned after one summer because of lack of funding, in 1910 a regular medical officer, Capt. Henry D. Thomason, was assigned to the Army's Division of Militia Affairs to guide the medical and sanitary service of the National Guard and to prepare its medical personnel to work in the field with their regular counterparts. During joint maneuvers involving both Guard and regular units that year, regular medical officers were "liberally supplied as inspector-instructors to the National Guard and the sanitary units of the Army were sent out as object lessons." The effect of this training by example as well as by discussion was "a general awakening and improvement in the sanitary service" of Guard units. With the National Guard growing rapidly in size, Captain Thomason succeeded in having the institution of the instructor-inspector made permanent with regular medical officers assigned to function in this capacity. He was also successful in his attempt to have a few of the top noncommissioned officers of the Hospital Corps sent to help train the corpsmen of Guard units. In spite of some improvement, the success of this approach was limited because supplies of both trained personnel and equipment continued to be inadequate; in 1911 Thomason noted that the National Guard had but twenty ambulance companies and twenty field hospitals when it should have sixty-one of each. Since the regulars themselves lacked twenty-seven of their goal in each category at this time, they were in no position to supplement Guard units. As a result, Thomason remained pessimistic about the Guard's ability to handle wartime casualties.74
Concluding that many National Guard problems went beyond inadequate numbers, Surgeon General Torney blamed some difficulties experienced in training Guard medical personnel on the lack of federal control over state Guard units. Commanding officers of National Guard regiments in some states could appoint their medical officers without benefit of an examination to test their competence as physicians. Other difficulties stemmed from the fact that few outside the Army appreciated that there was more to being a medical officer than patient care. Local officials were often not aware that even the most competent physicians required training in such areas of military medicine as map reading, weapons, tactics, and the art of predicting approximately how many men might be wounded in a particular battle. The problem of the malingerer was also difficult for civilian doctors to appreciate since they almost instinctively placed the good of the individual above the good of the military unit. Because so many of the Army physician's duties were administrative, Torney agreed with Captain Thomason that inspector-instructors should serve with Guard units. He also urged that more medical officers in the Guard take advantage of the Leavenworth courses.75
By the time of Surgeon General Torney's death in 1913, conditions in the National Guard were improving. Some states had organized their medical services following the Medical Department example. But the need
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HARRY L. GILCHRIST in his office
for doctors to be familiar with "tactical principles, the methods for the employment of sanitary troops, the transportation of their materiel and supplies, the organization of the different units of different arms, and many other things too numerous to mention" was still too often unrecognized. Although more states were requiring physical examinations and immunizations for their recruits, the requirement placed a greater and unwelcome burden on Guard physicians. Captain Thomason's successor, Maj. Harry L. Gilchrist, pointed out that "the majority of men" in the National Guard joined "not only from a patriotic standpoint but also for the purpose of diversion," one of the diversions apparently being practice with weapons. The assignment to spend evenings examining and immunizing soldiers, work similar to that which occupied their days as civilians, left Guard physicians less than enthusiastic about their patriotic duty. This trend, many believed, undermined the enthusiasm of doctors already in the Guard, led to an increase in resignations, and discouraged prospective new members.76
General Hospitals
Many of those so seriously wounded in a major war that their recovery period might be prolonged would have to be cared for in facilities in the United States, for the most part in general hospitals. Although plans were developed for the use of these facilities, few adjustments were being made in the network of permanent general facilities in the United States and its territories to prepare them to care for any large number of the patients that a major conflict might produce. Those changes that did take place in these hospitals came, with one partial exception, in response either to
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CHIEF SURGEON GIRARD (center left) operating
peacetime requirements or to the continuing need to care for the sick and wounded from the Philippines.77
By 1900 some general hospitals established to meet the needs of the Spanish-American War had been closed, among them the modern 1,020-bed hospital at Fort Monroe, Virginia. Others remained in operation after the end of hostilities and were even expanded, funding apparently being more easily obtained for them than for post facilities. To these institutions, which were under the direct control of the surgeon general rather than that of the local commander, came the sick and injured brought back from foreign lands and soldiers and members of military families with more serious illnesses or injuries.78
A large general hospital was maintained on each coast. In the West, where the sick from units going to and from the Pacific were left for care, the need for general hospital space increased for several years after the end of hostilities with Spain. X-ray specialists were in such great demand that during the period of the Philippine Insurrection the services of at least one civilian technician were required. The work of Elizabeth Fleischmann-Aschheim was apparently very highly valued by civilian and military physicians alike in San Francisco, but her own extensive exposure to the new device led to her early death in 1905 while still in her thirties. By 1902, according to the chief surgeon, Lt. Col. Alfred C. Girard,79 the general hospital in San Francisco (named Letterman General in 1911), which received patients evacuated from the Philippines, had recovered from the fire that had destroyed "the entire culinary department" in 1901. Of its average monthly case load of 480 patients, more than half came from the Philippines. It housed the post facility for the Presidio and
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other posts in the San Francisco area and served as the general hospital for the western half of the United States. It was also the base hospital for the Philippines and Hawaii. The largest general hospital in the United States, Letterman handled more than 3,000 cases in 1913 and continued to grow in the years before World War I.80
In the East, in the nation's capital, both the needs of the Army Medical School and an increasing number of patients led to the construction of a new general hospital to replace the makeshift wartime facility at the Washington Barracks. Since in the East the demand for large hospitals slowly diminished after the end of hostilities with the Spanish, Congress was initially reluctant to fund a new general hospital. As time went by, more patients were admitted than the buildings at the Washington Barracks could hold, making it necessary to erect tents and then, as the weather turned cold, temporary structures. When the Army Medical School reopened in November 1901, its clinics in surgery were housed in the hospital, where students were also trained to use X-ray equipment. Enlarging the old hospital at the Washington Barracks would not suffice. Surgeon General Sternberg maintained that a twenty-five-to thirty-acre site was needed for a general hospital not only to house facilities where hospital corpsmen and medical students could be trained but also to serve as a base hospital in wartime.81
As the months went by without congressional action, the old buildings of the Washington Barracks hospital continued to deteriorate. Finally, in 1904, after a vigorous campaign waged by Major Reed's friend and colleague, Maj. William C. Borden, the legislature voted $100,000 for the land and another $200,000 for the plant to house a new hospital, to be named after
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Reed, and such lesser structures as barracks for hospital corpsmen and a new building for the Army Medical Museum and the Surgeon General's Library. At the time the Walter Reed General Hospital opened in 1909, its capacity was eighty beds, a few of which were made available to the women of Army families. For several years thereafter, work to make it comfortable and safe for its patients and to create facilities to house the hospital staff continued.82
The other general hospitals operated by the Medical Department included facilities that differed widely in location and function. The First Reserve Hospital in Manila, while regarded as a general hospital, was a division hospital because it was the responsibility of the area commander. If the Army should be involved in a war in the Pacific, this facility could become very important. Sustained guerrilla activity during the Philippine Insurrection placed considerable demands on it, and the Army's sick and wounded continued to be so numerous that additional facilities had to be established to house contagious cases. Unhappy about the condition of the old Spanish building that housed this fixed hospital, which cared for as many as 2,000 or more patients every year, the division's commanding officer recommended the construction of a new and more modern facility, preferably one with "an intercommunicating telephone system . . . and an automobile ambulance."83
The Army's two remaining general hospitals were specialized-care institutions for those suffering from specific illnesses. The patients of the Army-Navy facility in Hot Springs, the Army's oldest permanent general hospital, for the most part treated those for whom the waters of the springs were deemed useful, although some of its occupants were the victims of venereal disease or other problems. It was opened to veterans in 1901. Several years passed before any significant number of them took advantage of the privilege, but its patient load increased in the years immediately preceding World War I. Modernized through the efforts of Torney when he was its commander immediately after the Spanish-American War, this 130-bed facility was described by Surgeon General O'Reilly in 1903 "as complete in every respect as the most elaborate institutions of like nature anywhere."84
The hospital at Fort Bayard in New Mexico was opened in the summer of 1899 for the victims of tuberculosis. For many years soldiers with newly diagnosed cases of tuberculosis had been assigned to posts in the Southwest, an area often recommended to victims of this disease. The new facility, not far from the Marine Hospital Service's tuberculosis hospital at Fort Stanton, provided a place where all soldiers, dependents of the Soldiers' Home and, until 1908, Navy patients with the disease could be isolated and cared for according to their needs. Given the condition of many patients when they arrived, often from the Philippines, the high death rate at Fort Bayard was predictable.85
Supply
Although reformers had demonstrated little concern about the Army's permanent hospital system, the Dodge Commission's report directed considerable attention to the need to prepare to meet wartime's suddenly increased demands for medical supplies, equipment, and transportation. The Medical Department's 1902 manual eliminated possible confusion concerning precisely what equipment was needed for each field hospital and ambulance unit and who would supply each item, but in the early
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years of the new century efforts to accumulate the four-year reserve of nonperishable items suggested by the commission met with frustration. Congress expected the Medical Department to supply other government organizations, among them the National Guard, the Department of Commerce and Labor, and the Isthmian Canal Commission. The discovery that obsolete surgical instruments at many posts would have to be replaced added to the department's burdens. Congress was relatively generous for fiscal years 1901 and 1902, but obtaining the funds necessary to replenish supplies was thereafter difficult at best. A fire that badly damaged the medical depot in New York City in 1909 increased the difficulties experienced during the drive to accumulate and maintain the recommended reserve. Thus, although the department was not ready to meet the demands of a possible future war, a great deal of the energy of those responsible for managing its supplies was consumed by current needs.86
Since prices were generally lowest in New York, a considerable amount of buying was still done there. As a result, the medical depot's capacity had to be increased to provide space for the new reserves. Because much of the current demand resulted from continuing hostilities in the Philippines, Surgeon General Sternberg also initiated the enlargement of the facility in San Francisco. Plans called for each of these two depots to hold supplies sufficient for 100,000 men for six months. To leave the major storage points on the coasts free to supply units outside the continental United States, warehouses to store supplies for 20,000 men for six months were built at the St. Louis depot, which assumed responsibility for fifty-two posts within the United States. Depots were also now maintained at Manila, Havana, and San Juan. Shipping medicines to and from these sites was simplified by a system developed by Munson, a physician of considerable practical genius, who devised a packing system based on the liter. Containers for fractions of a liter were designed so that two, four, eight, or thirty-two of them would fit into the space occupied by a liter container and could be stored with no packing material beyond the carton itself.87
Surgeon General Sternberg wished to accumulate sufficient supplies and equipment to provide each of the fifteen military departments (nine within the United States and six abroad) with two regimental field hospitals, a challenge made somewhat simpler by the reduction in the number of hospitals and concentration of supplies in the Philippines.88 By 1903 Medical Department goals called for having two base hospitals, thirty-eight field hospitals, ten stationary hospitals, seventy-eight regimental hospitals, and seven supply depots, stored in Washington, D.C., San Francisco, St. Louis, and Manila and ready for shipment within twenty-four hours. The Medical Department's reserve of the type of field equipment needed in wartime was large enough to supply five Army corps, except for the items provided by the Quartermaster's Department. When Army units reoccupied Cuba in 1906,89 their medical supplies and equipment were ready for immediate shipment. By January 1909, when Surgeon General O'Reilly retired, all the hospitals and depots originally called for in 1903 had either been accumulated or were in the process of being acquired.90
The Dodge Commission had recommended that the Medical Department manage the transportation of its needs to the extent necessary to guarantee prompt delivery. Although convinced that the principal cause of the supply problems of
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the Spanish-American War was inadequate transportation, Surgeon General O'Reilly concluded that the movement of goods from depots was an administrative problem that "would probably be no nearer solution if the medical department should be given its own transportation department." A separate quartermaster service for each branch of the Army being totally impractical, he dealt with the problem by appointing acting quartermasters from within the Medical Department and assigning men from the department, including Hospital Corps detachments, to accompany supply shipments.91
Although Surgeon General O'Reilly was on the whole determined to carry out the recommendations of the Dodge Commission, he was also not convinced of the necessity for building up significant reserves of all items, since some items could be readily bought in great quantity in the open market. Believing that confusion was in part to blame for the difficulties of 1898, he undertook to have routine needs stored separately from items required only in wartime. He also initiated a system to assemble all supplies needed for a field hospital-regardless of whether they were obtained by the Medical Department, the Quartermaster's Department, or the Ordnance Department-ready for shipment within twenty-four hours. This unit supply system was extended to include equipment for an emergency recruiting setup to handle the first round of physical examinations, for a camp hospital to provide emergency treatment, for a base hospital, for handling regimental needs in combat, for a camp infirmary and reserves for the camp infirmary, for an ambulance company, and for an evacuation hospital. Surgeon General Torney continued the work begun by his predecessors, assembling needed items in Washington, D.C., and shipping them out where needed for use or for storage at a field medical depot created specifically for the purpose. Supplies for one division were sent to San Francisco and for a second division to Honolulu, while some field equipment was stored in Manila.92
The changes that had been made in the organization of the Medical Department by December 1913, when Surgeon General Torney died, would make possible a more efficient administration of the department than could have been achieved under its monolithic structure in the nineteenth century. Detailed plans for the operation of the department in the field had also been developed as part of Army-wide preparations for the possibility of large-scale modern warfare. Greater attention had been devoted to the problems involved in acquiring and distributing supplies, and thought had been given to the use of general hospitals in time of major conflict. Still to be solved was the fundamental and perennial problem of how to prepare the hordes of civilians who would have to supplement the work of regular medical personnel in the event of such a conflict to perform their roles effectively. By 1913, except for the problem of training adequate numbers of civilian physicians, the Medical Department may well have been prepared to meet the demands of a conflict like the one in which it had most recently been involved. It was not ready for a conflict on a scale never before encountered in the course of human history
NOTES
1. James L. Abrahamson, America Arms for a New Century, pp. 29-44, 67, 96-97, 100, 153.
2. Paul F. Straub, Medical Service in the Campaign, p. 3; Rpt 1036 (Request of the Surgeon General for an Increase in the Enlisted Personnel of the Hospital Corps) and Rpt 1752 (Proposed Amendments of Paragraphs 514, 613, 618, and 636, Army Regulations), Entry 5, Record Group (RG) 165, National Archives and Records Administration (NARA), Washington, D.C,; Otto L. Nelson, Jr., National Security and the General Staff, pp. 56-57; United States, Congress, Senate, Report of the (Dodge) Commission To Investigate the Conduct of the War Department in the War With Spain, 1:115-16, 188-89 (hereafter cited as Dodge Commission Report); Jerry M. Cooper, Civil Disorder, p. 34; War Department, [Annual] Report of the Surgeon General, U.S. Army, to the Secretary of War, 1903, p. 18, and 1908, pp. 121-28 (hereafter cited as WD, ARofSG, date); John N. Goltra, "The Executive Element in the Training and Skill of the Army Surgeon," p. 206; Walter Millis, Arms and Men, pp. 173-76; War Department, Surgeon General's Office, The Surgeon General's Office, pp. 56-57 (hereafter cited as WD, SGO, SGO). Unless otherwise indicated, material on the General Staff and the chief of staff is based on James E. Hewes, From Root to McNamara.
3. Hermann Hagedorn, Leonard Wood, 2:89.
4. See Chapter 7 for the Dodge Commission's findings.
5. The law limited the terms of the heads of all the Army's bureaus to four years.
6. "The Surgeon General of the Army and His Critics," p. 822 (first quotation); Charles J. Post, The Little War of Private Post, p. 317 (second and third quotations); "The One Great Blot of the War," p. 279 (fourth quotation); Jefferson R. Kean, "Influence of the Association of Military Surgeons on the Status of Medical Officers," p. 599; Graham A. Cosmas, An Army for Empire, pp. 282-83, 295; Dodge Commission Report, 1:107, 113, 116, 188-89; James M. Phalen, Chiefs of the Medical Department, United States Army, 1775-1940, p. 70; The Military Laws of the United States, 1915, 5th ed. (Washington, D.C.: Government Printing Office, 1917), p. 154, para. 373.
7. See Chapter 7 for the details of Forwood's management of Camp Wikoff.
8. Phalen, Chiefs, pp. 75, 81; Military Laws, 1915, p. 155, para. 380.
9. Ltr, P. Middleton to SG, 8 Dec 1868 (first quotation), vol. 12, Entry 10, RG 112, NARA; Bailey K. Ashford, A Soldier in Science, pp. 105-06 (second and fourth quotations); Ltr (copy), Walter Reed to William C. Gorgas, 21 Jul 1902 (third quotation), Ms C48, Walter Reed and William C. Gorgas Papers, National Library of Medicine (NLM), Bethesda, Md.; Percy M. Ashburn, A History of the Medical Department of the United States Army, p. 283 (hereafter cited as History of MD); Phalen, Chiefs, pp. 75, 79-81; Autobiography, Jefferson R. Kean, p. 157, Ms C14, Jefferson R. Kean Papers, NLM. Kean was promoted to brigadier general in the National Army on 26 June 1918.
10. Phalen, Chiefs, p. 86; Ltr, Albert G. Love to Jefferson R. Kean, 29 Dec 1913, folder Correspondence, 1913-1915, and Kean Autobiography, pp. 139, 165, Ms C14, NLM.
11. Dodge Commission Report, 1:189; WD, ARofSG, 1908, pp. 125-26.
12. Memo, SG to SW, 3 Sep 1909 (quotation), Entry 231, and Rpt, Curator, Army Med Museum, to SW, 9 Oct 1909, Entry 245, RG 112, NARA; Kean Autobiography, pp. 78-79, Ms C14, NLM.
13. By the time of Torney's death in December 1913, the Surgeon General's Office was managing the work of about 4,300 men and women.
14. Jefferson R. Kean, "Medical Department of the Army," March 1913, Entry 231, RG 112, NARA; WD, SGO, SGO, p. 126.
15. WD, ARofSG, 1910, pp. 161-62 (quotations), 163; Kean, "Medical Department," Entry 231, RG 112, NARA.
16. Beaumont's studies of human digestion, made possible when a wound through the stomach wall of one of his patients failed to heal over, brought him wide acclaim.
17. See Mary C. Gillett, The Army Medical Department, 1818-1865, for details on Lawson's policies and his relationship with William Beaumont.
18. Memos, J. F. Bell to SW, 20 Apr 1910, Leonard Wood to AG, 27 Dec 1910, and SG to SW, 3 Sep 1909 and 15 Jan 1912, Entry 231, RG 112, NARA; Louis M. Maus, "The Ethics, Scope and Prerogative of the
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Army Medical Officer," p. 304; Kean Autobiography, pp. 126, 148, Ms C14, NLM.
19. Goltra, "Executive Element," p. 210 (quotations); Dodge Commission Report, 1:188-89; Memo, Acting SG to President, 19 Oct 1904, folder Memoranda, 1904, 1911, Ms C14, NLM.
20. R. G. Ebert, "The Medical Department of the U.S. Army," pp. 93, 96; "Army Contract Surgeons," p. 417; WD, ARofSG, 1899, p. 19, and 1900, pp. 19-20; Azel Ames, "A Medical Reserve Corps for the Army of the United States," pp. 70, 89; C. B. G. de Nancrede, "Personal Experience During the Spanish-American War. . . ," p. 611; Joseph M. Heller, "Experiences of the Spanish-American War From a Different Viewpoint Than Major Nancrede," p. 71; Cosmas, Army, pp. 296-97; Memoranda on Med Corps, 31 Dec 1899, Entry 245, RG 112, NARA; C. Joseph Bernardo and Eugene H. Bacon, American Military Policy, p. 288.
21. WD, ARofSG, 1899, pp. 328-29, and 1900, pp. 17, 20, 96; Martha L. Sternberg, George Miller Sternberg, p. 201.
22. Erna Risch, Quartermaster Support of the Army, pp. 563-64; James A. Huston, The Sinews of War, p. 302; AGO GO 36, 4 Mar 1899, and GO 14, 12 Feb 1901; Edgar Erskine Hume, Victories of Army Medicine, p. 30; Ebert, "Medical Department," p, 92; WD, ARofSG, 1901, p. 35, 1902, p. 16, 1903, pp. 42, 44-45, and 1907, p. 119; William O. Owen, "The Ideal Relation for the Medical Department of an Army," p. 365; War Department, Surgeon General's Office, Manual for the Medical Department, 1906, pp. 9-10; Victoria A. Harden, Inventing the NIH, p. 18; Robert S. Henry, The Armed Forces Institute of Pathology, pp. 93, 139 (hereafter cited as AFIP); Frederick C. Huidekoper, The Military Unpreparedness of the United States, p. 324.
23. WD, SGO, SGO, pp. 58-59; Huidekoper, Military Unpreparedness, p. 324; Ebert, "Medical Department," pp. 92-93, 97-99; WD, ARofSG, 1903, p. 15, and 1904, p. 11; Edward L. Munson, "An Outline of the Organization and Work of the Medical Department of the United States Army," pp. 254-55; James G. Burrow, Organized Medicine in the Progressive Era, p. 15.
24. Munson, "Outline," p. 256 (quotation); WD, ARofSG, 1902, p. 14, 1903, pp. 18-19, 42, 1904, pp. 10-11, 14, and 1907, pp. 119, 122; George Rosen, The Structure of American Medical Practice, 1875-1941, pp. 61, 67; John S. Haller, Jr., American Medicine in Transition, 1840-1910, pp. 221-33; W. Bruce Fye, "The Origin of the Full-time Faculty System," p. 1555.
25. Memo, SG to President, 24 Dec 1904, Entry 242, RG 112, NARA.
26. Ltr, Jefferson R. Kean to William C. Gorgas, 23 Aug 1905, 2:93, Ms C5, SGO Correspondence, 1903-1907, NLM; "The Discussion in the Senate on the Army Medical Reorganization Bill," pp. 305-06; WD, ARofSG, 1903, p. 18, 1904, pp. 13-14, 1905, pp. 131, 134, and 1908, p. 127; "Change in the Examination for the Army Medical Service," p. 61; Robert Smart, "Military Hygiene," p. 38; R. M. Culler, "Some Facts About the Army Medical Corps," pp. 1092-93.
27. War Department, Five Years of the War Department Following the War With Spain . . . , p. 361; idem, ARofSG, 1903, p. 18.
28. First quotation from Hearings Before Committees on Military Affairs of United States Senate and House of Representatives, 64th Cong., 1st Sess., p. 629, RG 287, NARA; remaining quotations from WD, ARofSG, 1906, p. 112. See also Theodore Roosevelt, "President Roosevelt on Army Medical Reorganization," pp. 133-34.
29. Walter D. McCaw, "The Medical Service of an Army in Modern War," p. 348; War Department, [Annual] Report of the Secretary of War, 1906, p. 33; idem, ARofSG, 1903, pp. 18-19, 1905, p. 131, 1906, p. 112 (quotations), and 1908, p. 123; Huidekoper, Military Unpreparedness, p. 324.
30. WD, ARofSG, 1899, p. 329, 1908, pp. 101, 123, 126, and 1909, p. 126; WD, SGO, Manual, 1906, pp. 11, 123; Culler, "Some Facts," p. 1092; Charles F. Craig, "The Army Medical Service," pp. 417, 419-20; Percy M. Ashburn, "Service in the Army Medical Corps," p. 667; Huidekoper, Military Unpreparedness, p. 344; Louis L. Seaman, "Some of the Triumphs of Scientific Medicine in Peace and War . . . ," p. 340; Rosen, Structure, pp. 19, 35-36; Edward L. Munson, "The Army Medical Service," pp. 677-78; idem, "Outline," pp. 254-55; Burrow, Organized Medicine, p. 15; Paul Starr, The Social Transformation of American Medicine, pp. 84-85; "The Army Medical Corps," p. 58; James A. Tobey, The Medical Department of the Army, p. 31.
31. WD, SGO, SGO, p. 60 (quotation); Huidekoper, Military Unpreparedness, p. 345; WD, ARofSG, 1908, p. 123.
32. Huidekoper, Military Unpreparedness, pp. 344-46; "Medical Reserve Corps," p. 68; WD, ARofSG, 1899, p. 329, 1908, pp. 123, 126, and 1909, p. 127; Richard B. Crossland and James T. Currie, Twice the Citizen (Washington, D.C.: Office of the Chief, Army Reserve, 1984), p. 14; Seaman, "Some of the Triumphs," p. 341; Dodge Commission Report, 1:188-89.
33. WD, ARofSG, 1912, pp. 90 (quotation), 91, 1913, pp. 86-91, 93, and 1914, pp. 82, 85; Dodge Commission Report, 1:188-89; WD, SGO, SGO, p. 120.
34. WD, ARofSG, 1909, p. 127, 1910, p. 126, 1911, pp. 170, 1912, p. 177, 1913, p. 163, and 1914,
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pp. 154-55; Huidekoper, Military Unpreparedness, pp.371, 388.
35. WD, ARofSG, 1908, pp. 103 (quotation), 104.
36. Ltr, SG to Jesse Overstreet, 19 Feb 1909 (quotation), Entry 27, RG 112, NARA; WD, ARofSG, 1908, pp. 103, 127; Huidekoper, Military Unpreparedness, pp. 344-45.
37. WD, ARofSG, 1913, pp. 162-63, and 1914, pp. 13, 155; Richard Slee, "The Veterans' Reunion at Gettysburg," pp. 723, 725-26.
38. WD, ARofSG, 1908, p. 127 (first two quotations), 1910, pp. 157-59, and 1913, pp. 177-79; in RG 112, NARA: Ltrs, SG to Arthur F. Chase, 20 Jan 1909, to Simon Flexner, 18 and 26 Jan 1909, and to William C. Gorgas, 6 and 30 Mar 1909 (final quotation), Entry 27, and Jefferson R. Kean to SW, 16 Jul 1912, Entry 231; Percy M. Ashburn, "Report on Medical Conditions in Liberia," pp. 402-09; Clyde S. Ford, "Some Medicomilitary Observations in the Late Balkan Wars," pp. 53-56, 58; Craig, "Army Medical Service," pp. 421-22; Ira L. Reeves, Military Education in the United States, p. 289.
39. First quotation from Paul F. Straub, "The Training of Sanitary Troops," p. 359 (see also p. 360); second quotation from "Better Instruction for Army Medical Officers," p. 1737; third quotation cited in Ashburn, History of MD, p. 253.
40. Phalen, Chiefs, p. 102; Marvin A. Kriedberg and Merton G. Henry, History of Military Mobilization in the United States Army, 1775-1945, pp. 204-05; WD, ARofSG, 1912, p. 187; Reeves, Military Education, pp. 229-30; W. G. Schauffler, "Report of Medical Service School, New Jersey" p. 531; A Military History of the U.S. Army Command and General Staff College, Fort Leavenworth, Kansas, 1881-1963, p. 20; Straub, Medical Service, pp. 7-8, 35-37.
41. Quotations cited in Ashburn, History of MD, pp. 253-54. See also WD, ARofSG, 1905, p. 157, and 1906, p. 130; Winslow Anderson, "The U.S. Army Camp of Instruction for the Officers of the Medical Corps of the Organized Militia," p. 527; Ltr, Jefferson R. Kean to Charles Woodbury, 26 Jan 1910, Entry 231, RG 112, NARA; Henry I. Raymond, "What Is the Most Effective Organization of the American National Red Cross for War . . . ," p. 156; Sternberg, Sternberg, pp. 203-04; Timothy K. Nenninger, The Leavenworth Schools and the Old Army, p. 102; John F. Morrison and Edward L. Munson, A Study in Troop Leading and Management of the Sanitary Service in War; Edward L. Munson, The Principles of Sanitary Tactics; Francis A. Winter, "Preparedness of the Medical Department of the Army in the Matter of Field Medical Supplies," (Paper delivered at the Army War College, Washington, D.C., [Fall 1912]), Military History Research Collection, U.S. Army Military History Institute, Carlisle Barracks, Pa.
42. Owen, "The Ideal Relation," pp. 362-63 (quotation), 364; John M. Banister, "Army Sanitary Administration in the United States and in the Tropics," p. 562; Louis L. Seaman, "Lessons for America in the Japanese Army Medical Service," pp. 585-86; WD, ARofSG, 1905, p. 160; War Department, Reports of Military Observers Attached to the Armies in Manchuria During the Russo-Japanese War, pt. 4, p. 13. Even in the Russian Army during the Russo-Japanese War, wounds killed more than disease.
43. Charles E. Woodruff and Frank T. Woodbury, "The Prevention of Disease in the Army and the Best Method of Accomplishing That Result," pp. 22-24 (quotations); WD, ARofSG, 1908, pp. 39-40, and 1909, pp. 10, 76.
44. Wyndham D. Miles, A History of the National Library of Medicine, pp. 206-07; Henry, AFIP, pp. 147-49; WD, ARofSG, 1909, p. 140, 1910, p. 133, 1911, pp. 176, 183, and 1912, p. 185.
45. WD, ARofSG, 1902, pp. 17, 25, and 1903, pp. 19, 23; Ashburn, History of MD, p. 211; WD, SGO, Manual, 1906, p. 10; V. O. Hurme, "Notes on the Physical and Dental Condition of U.S. Army Men in 1901-1903," pp. 255, 258-64; John D. Millikin, "The Original U.S. Army Dental Corps," p. 387; Gardner P. H. Foley, "The Peaks of Dental History," p. 14.
46. WD, ARofSG, 1902, pp. 18-19, 1903, pp. 21-23, 26, 1905, p. 135, 1906, p. 114, and 1907, p. 120.
47. Ibid., 1909, p.128, 1910, pp. 126-27, 1911, p. 171, 1912, p. 178, and 1913, p. 164; Huidekoper, Military Unpreparedness, p. 386; Memo, Jefferson R. Kean to SG, 23 Mar 1909, Entry 231, RG 112, NARA; Millikin, "Original," p. 387.
48. Dodge Commission Report, 1:188-89; WD, ARofSG, 1899, pp. 25, 29-30, 52, 54, 74, and 1900, p. 24; Hoff's comment on Anita Newcomb McGee paper, f. idem, "Nurse Corps of the Army," p. 273; Dallas Bache, "The Place of the Female Nurse in the Army," pp. 309, 328; Thomas C. Clark, "Some Observations Upon the Medical Service of the Late War With Spain From the Standpoint of a Volunteer Surgeon," p. 365; in RG 112, NARA: SGO Cir 14, 7 Nov 1898, and Cir, 20 Jun 1899, Entry 66, and Ltr, William C. Gorgas to Anita N. McGee, 27 Feb 1900, Entry 147.
49. McGee, "Nurse Corps," pp. 267-68 (quotation); WD, ARofSG, 1901, p. 61, 1903, p. 39, 1908, p. 124, and 1909, p. 133; Hume, Victories, p. 205.
50. WD, ARofSG, 1904, p. 24, 1906, p. 119 (quotation), 1907, p. 126, and 1908, pp. 109-10.
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51. Ibid., 1910, p. 130, 1913, p. 164, and 1914, p. 159.
52. Ibid., 1911, p. 172.
53. Jane Delano's name implies some relationship to Franklin Delano Roosevelt's mother; however, when Delano died in France during World War I and plans were being made to exhume her body, initially buried in France, and to reinter it in the United States, it became apparent that she had no near kin and thus that her success was presumably not based on family influence. See Ltr, Clara D. Noyes to Julia C. Stimson, 11 Feb 1920, Entry 103, RG 112, NARA.
54. Kean, "Medical Department" (quotation), Entry 231, RG 112, NARA; Gustavus Blech, "Organization of Red Cross Personnel for War," pp. 228-36; Raymond, "National Red Cross," pp. 177, 180; WD, ARofSG, 1910, p. 130; AGO GO 16, 23 May 1912; War Department, Surgeon General's Office, Manual for the Medical Department, United States Army, 1911, change to Sec. 96; idem, SGO, p. 60.
55. WD, ARofSG, 1898, p. 14, 1899, pp. 20-21, 183, 232-35, 1900, pp. 22-23, 1901, p. 36, 1902, p. 25, and 1908, pp. 123-24; Hume, Victories, p. 28; Risch, Quartermaster Support, pp. 561-62.
56. WD, ARofSG, 1902, p. 27, 1903, p. 32, 1904, p. 20, 1905, pp. 87, 96, and 1906, p. 118; E. L. Ruffner, "The Private Sanitary Filipino Scout," p. 410; WD, SGO, Manual, 1906, p. 65; Rpt 1036, Entry 5, RG 165, NARA.
57. Goltra, "Executive Element," p. 211; Elbert E. Persons, "Medical Service With Philippine Scouts," pp. 708-09; WD, ARofSG, 1901, pp. 37, 39, 1902, p. 28, 1903, p. 32, 1904, p. 20, 1906, pp. 116, 118, 1907, pp. 124-25, and 1908, p. 108; WD, SGO, Manual, 1906, p. 66.
58. The lance corporal was a private serving temporarily as a corporal.
59. WD, ARofSG, 1902, p. 27 (first quotation), 1903, pp. 31-32, 1904, p. 19, and 1908, p. 108 (second quotation); WD, SGO, Manual, 1906, p. 63.
60. WD, SGO, Manual, 1906, pp. 69, 72; WD, ARofSG, 1900, p. 23, 1901, p. 48, 1902, p. 39, 1903, pp. 32, 35, 38, 1904, p. 36, and 1905, p. 138.
61. WD, ARofSG, 1899, p. 182, 1901, pp. 39 (quotation), 40, 1902, p. 39, 1906, p. 116, 1907, p. 124, and 1908, p. 108.
62. Ibid., 1909, p. 131, 1911, p. 174, 1912, pp. 180-81, and 1913, p. 168 (quotation).
63. Ibid., 1911, p. 175, 1913, pp. 14-15, 166 (first quotation), 167-68 (second quotation), and 1914, pp. 12-13.
64. Ibid., 1908, p. 127 (first quotation); WD, SGO, SGO, pp. 63, 70 (second quotation); Frank R. Keefer, "The Functions of the Medical Department of the Army, Especially in the Field," p. 358; Field Service Regulations, 1905, pp. 184-87, and 1910, pp. 12, 183-92; War Department, Surgeon General's Office, Manual for the Medical Department, 1900, pp. 13-17, 23-26; ibid., 1906, pp. 178-244; ibid., 1911, pp. 169-310; Tobey, Medical Department, p. 32; Straub, Medical Service, p. 4; Papers of Med Dept Manual Board, 1906 (see also 1914), Entry 245, RG 112, NARA. Using maneuvers to train all elements of the Army under conditions resembling as closely as possible those encountered in war was one of Secretary of War Elihu Root's goals (see discussion in Charles D. McKenna, "The Forgotten Reform," Army History, Winter 1991/92, pp. 17-23).
65. When a number of field armies conduct operations in the same theater, they might be organized into an army. The field army was a group of divisions, the equivalent of the corps of the Spanish-American War.
66. Straub, Medical Service, pp. 68-69, 75, 77, 89, 156.
67. Field Service Regulations, 1910, p. 12; WD, SGO, SGO, p. 65.
68. Field Service Regulations, 1905, pp. 11-12; WD, SGO, Manual, 1911, pp. 184-206; Manus McCloskey, "The Importance of the Service of the Evacuation of the Sick and Wounded by the Medical Department in Time of War," p. 414; Paul F. Straub, "Medical Service in the Campaign," pp. 691-92, 695, 698-700, 702-03; idem, Medical Service, pp. 95, 129, 139, 149; Henry D. Thomason, "Sanitary Troops in the Organized Militia of the United States," pp. 518-19; Herbert A. Arnold, "Report on Maneuver Camps at San Antonio and Leon Springs, and on Juarez, Mexico," p. 21; William B. Banister, "The Medical Reserve Corps," pp. 27-29, 31-32, 36, 38-41; Elbert E. Persons, "Special Article," p. 403; Reeves, Military Education, p. 293.
69. Hewes, From Root to McNamara, p. 12 (first two quotations) and 12n; in Entry 245, RG 112, NARA: Memos for CofS, 16 Mar, 24 Apr (final quotation), and 8 May 1911, plus Memo by Sec, GS Corps, 27 Apr 1911, Memo for Sec, GS, 18 Jan 1911, and Ltr, AG to SG, 31 Mar 1911.
70. Mahlon Ashford, "The Mission of the Ambulance Company," p. 165; WD, ARofSG, 1911, pp. 175-76, 1912, p. 182, and 1913, pp. 168-69; WD, SGO, SGO, pp. 66-67. Field hospitals had also been informally organized on a division basis in the Civil War (see Gillett, Medical Department, 1818-1865, p. 289).
71. Joseph H. Ford, "Notes on Organization and Equipment for Evacuation of Wounded," p. 669;
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Thomason, "Sanitary Troops," pp. 511, 518-19; Persons, "Special Article," p. 403; Field Service Regulations, 1910, p. 181; WD, SGO, Manual, 1911, pp. 176-233; Straub, Medical Service, pp. 6-7.
72. WD, ARofSG, 1903, p. 39, 1904, p. 25, and 1908, p. 128; John K. Mahon, History of the Militia and the National Guard, p. 143.
73. WD, ARofSG, 1910, pp. 80-83, and 1911, p. 91; Robert H. Pierson, "Conditions of Military Surgery," p. 71; "Better Instruction," p. 1737; George S. Crampton, "Camps of Instruction for Militia Medical Officers in 1909," p. 362; Henry H. Doan, "A Plea for More Camps of Instruction Under Government Supervision, for Officers of the Organized Militia," pp. 75, 77; Edward L. Munson, "The Conduction of Field Maneuvers of Military Sanitary Troops," p. 17; J. F. Edwards, "The Adaptation of the Medical Service of the National Guard to That of the Army," pp. 48-49.
74. WD, ARofSG, 1910, p. 125, 1912, pp. 185-86 (quotations), 187, and 1913, pp. 184-85; Charles D. Center, "Lessons Learned at a Maneuver Camp," p. 34; Thomason, "Sanitary Troops," pp. 515, 517; WD, SGO, SGO, pp. 66, 68-69.
75. WD, ARofSG, 1913, p. 185, and 1914, p. 172; Straub, "Training," pp. 363-69; Ashford, "Mission," pp. 163, 168; Edward L. Munson, "Military Absenteeism in War. . . ," pp. 489-90, 624, 626-28, and p. 25.
76. WD, ARofSG, 1913, p. 89, and 1914, pp. 170-71 (quotations).
77. War Department, Surgeon General's Office, Regulations for the Government of United States Army General Hospitals, 1914 (Washington, D.C.: Government Printing Office, 1914); idem, Manual, 1911, pp. 173-75.
78. WD, ARofSG, 1898, p. 130, and 1899, pp. 61-62.
79. Girard received his permanent rank of lieutenant colonel on 8 October 1900.
80. WD, ARofSG, 1899, pp. 240-41, 1900, pp. 28-29, 33, 1901, pp. 79, 84 (quotation), 1902, p. 138, and 1912, p. 152; WD, SGO, Manual, 1906, p. 57; Peter E. Palmquist, comp., "Elizabeth Fleischmann-Aschheim, Pioneer X-ray Photographer," pp. 35-45.
81. WD, ARofSG, 1902, pp. 136-38, 1903, p. 125, 1904, p. 127, and 1912, p. 156; William C. Borden, "The Walter Reed General Hospital of the United States Army," pp. 20, 22-25.
82. WD, ARofSG, 1905, p. 146, 1908, p. 113, and 1909, p. 140; Borden, "Walter Reed," p. 32. See also Mary W. Standlee, "Borden's Dream," 1:75-78, in Manuscript and Correspondence on History of Walter Reed Army Medical Center ("Borden's Dream) Series, RG 112, NARA.
83. WD, ARofSG, 1911, p. 157, 1912, p. 165, 1913, pp. 148-49 (quotation), 152, 188, and 1914, pp. 142, 145.
84. Ibid., 1903, pp. 123 (quotation), 129, 132, 1909, pp. 141-42, 1912, p. 159, 1913, p. 143, and 1914, pp. 137, 140; WD, SGO, Manual, 1906, pp. 58-59.
85. SGO Cir 1, 6 Apr 1903, Entry 66, RG 112, NARA; Daniel M. Appel, "The General Hospital and Sanatorium for Treatment of Pulmonary Tuberculosis at Fort Bayard, New Mexico," p. 203; Paul M. Carrington, "Further Observations on the Treatment of Tuberculosis at Fort Stanton, New Mexico," p. 207; WD, ARofSG, 1902, pp. 68-69, 1903, pp. 19, 65, 124, 1904, pp. 122, 125-26, and 1908, p. 112; Sternberg, Sternberg, p. 139; "An Army Sanitarium for Tuberculosis," p. 248.
86. WD, ARofSG, 1899, p. 205, 1901, pp. 59-60, 1903, p. 126, 1908, pp. 124, 126-27, and 1909, pp. 78, 148-50; Fielding H. Garrison, Notes on the History of Military Medicine, p. 186; Dodge Commission Report, 1:188-89; WD, SGO, SGO, 1:70; Memo, Acting SG to President, 19 Oct 1904, folder Memoranda, 1904, 1911, Ms C14, NLM.
87. WD, ARofSG, 1900, p. 25, 1903, p. 39, and 1904, p. 29.
88. For the situation in the Philippines, see Chapter 8.
89. For information on the second occupation of Cuba, see Chapter 9.
90. WD, ARofSG, 1901, pp. 59-60, 1903, p. 39, 1904, pp. 28-29, 1907, pp. 130-31, and 1908, pp. 124-25; Woodruff and Woodbury, "Prevention of Disease," p. 12; Persons, "Special Article," p. 402; Field Service Regulations, 1905, pp. 21-24; WD, Five Years, p. 177; WD, SGO, SGO, pp. 61, 70.
91. WD, ARofSG, 1908, p. 125 (quotation); Dodge Commission Report, 1:189.
92. WD, ARofSG, 1908, pp.122, 124, 126, 1911, p. 184, and 1912, p. 193; Abrahamson, America Arms, pp. 83, 92-110; WD, SGO, SGO, pp. 61-62, 220; Clark, "Some Observations," p. 361.
