CHAPTER XIII
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)
SECTION OF WATER SUPPLIES; SECTION OF FOOD AND NUTRITION; MUSEUMAND ART SECTION; LABORATORY OF SURGICAL RESEARCH
SECTION OF WATER SUPPLIES
The entire question of water supply and purification in the AmericanExpeditionary Forces is dealt with in Volume VI of this history. Thereinreference is made to the fact that stationary laboratories were establishedin the Services of Supply, A. E. F., for water analysis in certain MedicalDepartment general laboratories. One of these laboratories was the centralMedical Department laboratory at Dijon.1
In addition to water analysis, a subject which is outside the scopeof the present chapter, the necessity existed for supervising water supplyactivities in the zone of the advance, not otherwise cared for by the watersupply service, A. E. F. This supervision centered in the central Medical Departmentlaboratory at Dijon. Until the latter part of September, 1918 (except fora short period that is referred to below), the water supply activitiesof the division of laboratories were supervised by the section of infectiousdiseases.2 It was during May, 1918, that efforts were made toorganize a definite section in the central laboratory for coordinatingwater supply. Such a section was established and charged with the coordinationof Medical Department activities pertaining to water supplies in the zoneof the advance. However, since the officer then assigned to the sectionwas retained therein only a short time, it was not until the followingearly fall that water supply work of the Medical Department in the zoneof the advance was definitely coordinated.2
On September 27, 1918, an officer of the Sanitary Corps, expert as regardswater supply and analysis, was assigned to organize a section of the centrallaboratory having to do with control of such water supplies in the zoneof the advance as come within the province of the Medical Department.2Thereafter, that section was engaged in the supervision of water surveysin all training areas in the Advance Section, the assignment of properMedical Department personnel, the instruction of divisional personnel inwater survey work, including control of chlorination of water supplies,and coordination with the officer in charge of the laboratories in thewater supply service.2 The chief of the water supply sectionin the division of laboratories and infectious diseases was the representativeof the Medical Department, in its liaison with the water supply service,A. E. F. made; plans pertaining to Medical Department activities connectedtherewith, and distributed the laboratory facilities which were made availablefor water analyses.2
214
SECTION OF FOOD AND NUTRITION
In August, 1917, there was organized in the Office of the Surgeon Generala division of food and nutrition, whose officers were authorized by theSecretary of War on October 16, 1917, to inspect food supplies in camps,to endeavor to improve the mess conditions, and to study the suitabilityof the ration and the food requirements of the troops. Officers of thisdivision were sent to camps in the United States where they gave instructionto cooks, mess officers, and unit commanders and also made extensive studiesof ration suitability and requirement.3
On January 18, 1918, the chief surgeon, A. E. F., requested that suitableofficers be sent to France for similar services in the American ExpeditionaryForces,4 and one month later the commander in chief, A. E. F.,made the same request by cable.5 Accordingly, six officers wereselected for this purpose and on March 1, the Surgeon General wrote thechief surgeon, A. E. F., that they would report for service after havingstudied food conditions in England.6
The Surgeon General outlined the nature of the services these officersalready had rendered and suggested that they be authorized to make a thoroughinspection and study of all food supplies and mess conditions and reportto General Pershing, through the chief surgeon, A. E. F., on the followingsubjects:7 The quality of all Army subsistence supplies; theadequacy of the field ration (permissible and desirable modifications ofthe ration from the standpoint of transportation difficulties); balancingof menus (the desirability from the standpoint of economy of simultaneousmenus for entire divisions); improvement in mess conditions with a viewto the greatest conservation of food consistent with adequate feeding;suitability of hospital dietaries; suitability of rations used in prisoncamps with a view to greater economy; correlation of practical experienceof other armies with regard to rations and mess conditions and its applicationto our own forces.
This letter was accompanied by documents which described the work alreadyperformed by the food and nutrition service in Army camps in the UnitedStates.7
Among the members of this initial group and the personnel who reinforcedit later were men who in civil life had been State food commissioners,experts in the Bureau of Chemistry, physiologists, biochemists, organicand analytical chemists, State and city food inspectors, and those whohad had practical experience in the large packing houses in the UnitedStates.8 Members of the section throughout were selected becauseof their knowledge of its specialties, with the result that collectivelythey were qualified to solve the scientific and practical questions pertainingto its activities.8 The officers composing the first group sentoverseas had received training from three to six months in the camps inthe United States, and the others who came later received training duringvariable periods.8 Having been trained in the United States,where saving privileges on the garrison ration were permitted, membersof this section were not as familiar as could have been desired with preparationof the garrison ration if it were not supplemented by purchases nor withthe possibilities of the rolling kitchen-i. e., with basic conditions pertainingto the preparation of food in the American Expeditionary Forces.8
215
The officers composing the initial group remained in England from March16, to April 2, 1918, studying the British system of rationing and itsadministration and making a preliminary survey of the service of food inAmerican rest camps.7 One officer who was detached to remainin England and to attempt correction of the nutritional defects there discoveredin the American service remained on this duty until the end of November,1918.7 The other members of the group proceeded to France, wherethey reported to the chief surgeon, A. E. F., April 12. The chief of thisservice was assigned to duty under the director of the division of laboratoriesand infectious diseases, with office at Dijon, and the other members todifferent sections of the Services of Supply, in order that they mightconduct inspections therein concerning food and nutrition, make practicalrecommendation, and improve the subsistence of troops.7 Whenthese assignments were made the chief surgeons of the sections concernedwere notified of the nature of the work the officers would perform, andtheir cooperation was requested.9 After these inspections werecompleted the members of the group held a conference at Dijon, where theydiscussed the defects they had noted in food supply, its preparation andservice.7
In order to promote the correction of these faults and to study nutritionalrequirements that would eventuate if it became necessary to reduce thequantity of the ration, the chief surgeon, A. E. F., directed that a foodand nutrition section be established under the control of the directorof the division of laboratories and infectious diseases.7 Tothis section the following duties were assigned:7 Representationof the chief surgeon, A. E. F., in matters pertaining to the nutritionof troops; investigation of Army food requirements and consumption; advisoryservice in the specification of rations and dietaries; inspection of foodsupplies and mess conditions with troops, hospitals, and prison camps;instruction in food inspection and handling, mess management, and othermeasures for the maintenance of nutrition and for the conservation of food.7The organization of this section was announced in Circular No. 37, chiefsurgeon's office, in June, 1918, and in the following month its dutiesas noted above were published in Circular No. 40, chief surgeon's office,July 20, 1918. It acted on all matters of importance pertaining to thefood supply of the American Expeditionary Forces, maintaining close liaisonwith the chief quartermaster, A. E. F., and with the fifth section of thegeneral staff, A. E. F., which was charged with instruction and training.7
Based upon a survey which four officers of this service made in Mayand June, 1918, of the food conditions in six divisions in the advancesection, finding it advisable that personnel qualified to give instructionbe attached to these organizations for more or less permanent duty, movingwith them in successive changes of station,10 the representativeof the Medical Department with the fifth section of the general staff,on July 8, 1918, submitted the following memorandum to the acting chiefof staff G-5:
Subject: Project for Instruction in Cooking and Food Conservation.
1. Cooking schools.-Instruction in food values,selection and balancing of the ration, mess management, cooking, use ofthe rolling kitchen and improvised cooking devices, arrangement, cleaning,and care of kitchen equipment, storage, preservation, and conservationof foods,
216
and kitchen sanitation is given to selected replacementsin the school for Army cooks in connection with the school for bakers atthe base division, first corps. Similar schools are projected in otherbase divisions.
2. Field parties.-Officers of the food and nutritionsection of the Medical Department have been visiting the various divisionsand base sections in France for purposes of observation and instruction,and three are now on duty with the United States troops in England. Actionhas been taken to secure additional trained officers of the food and nutritionsection from the United States in order to give sufficient personnel forextension of the work. Field parties (consisting of one officer of thefood and nutrition section, one butcher, and two cooks) will be assignedto a certain area corresponding to that covered by the division of anyarmy corps and will be kept moving from division to division within thatarea. They will observe the methods of distribution and handling of theration, mess management, cooking, kitchen economy, serving and food conservation,and will establish temporary centers of instruction for mess sergeantsand the methods and procedures adapted to the conditions found.
3. Source, control, and distribution.-Officersengaged in this work will come from the officers of the Sanitary Corps,food and nutrition section of the Medical Department. The butchers willbe secured from the enlisted men of the Medical Department, QuartermasterCorps, and from replacements trained in the cooking schools. Control offield parties and personnel attached to base sections and various headquarterswill lie in the sanitary section of the office of the chief surgeon incooperation with G-5. Control of the instructors of the various schoolswill lie with the commandants of these schools, or the commanding officersof the base divisions in cooperation with G-5. Distribution will be tentativelyas follows:
At Medical Department laboratory: | Officers |
| Officer in charge food and nutrition section (general supervision) | 1 |
| Officer on duty in the food laboratory | 2 |
| Officers for emergency examination and instruction | 2 |
| On duty at base section in England | 3 |
| On duty at base sections in France | 5 |
| On duty at First Corps schools | 2 |
| On duty with hospitalization section, chief surgeon's office | 1 |
| On duty with chief quartermaster | 1 |
| On duty at cooking schools | 2 |
| 19 |
| Butchers | Cooks | Officers |
Field parties: For 5 army corps | 5 | 10 | 5 |
| Services of Supply troops | 2 | 4 | 2 |
| 7 | 14 | a26 |
aIncluding 19 from above.
Increases in personnel and parties will have to be madeas necessity arises.
With the approval of the assistant chief of staff G-5 and the cooperationof the chief quartermaster, the section now organized field parties, eachof which consisted of one officer from the food and nutrition section,one butcher, and two cooks, with the grade of noncommissioned officer,the last mentioned being drawn from the Medical Department, QuartermasterDepartment, and replacements.7 During the period of its greatestactivity about 40 noncommissioned officers, cooks, and butchers were assignedto the nutrition service, most of them being incorporated into the fieldparties. These units were sent to divisions at the front training areas,military schools, and later to organizations in sections of the Servicesof Supply.7 Before a party reported to the organization
217
to which it was temporarily assigned, the adjutant general, A. E. F.,sent to the commanding officer concerned the following form letter:11
1. In compliance with instructions from these headquartersa field party of the food and nutrition section, Medical Department, hasbeen assigned for temporary duty with the organizations of your command.
2. This field party is charged with the investigationof ration conditions as to transportation, handling, preparation, and conservation,and instruction of mess sergeants and cooks as to field mess management,field cooking, and conservation within these organizations.
3. It is desired that the officer in charge of the fieldparty be given proper authority and support in order that he may carryout the duty to which assigned. The officers in charge of the field partyhave been directed to make reports to the director of the Medical Departmentcentral laboratory, A. E. F., and authorized to make reports to the divisionsurgeon of the organization with which he is on duty, or as you may direct.Attached find a copy of "Duties of field food and nutrition officers,"which will fully explain the duty required of this party.
DUTIES OF FIELDFOOD AND NUTRITIONOFFICERS
PROCEDURE ON REPORTING TO THE ORGANIZATION
1. Report through adjutant to the commanding officer.Present to him your orders, with a statement of your duties, and requestthat local orders or authority be issued. Suggest that the local orderauthorize you to inspect all food materials from their receipt by the organizationto their consumption by the men; to inspect condition of all kitchens andthe efficiency of their administration; to give instruction to mess sergeantsand cooks in mess administration and in the storage and preparation offood, and to make recommendations to organization commanders, mess officers,and to the commanding officer in matters affecting the proper feeding ofthe men and the conservation of food.
2. Report to the division surgeon or senior medical officer,explain your mission, present to him your instructions, request his advice,and follow his suggestions.
3. Consult with the railhead officer, division quartermaster,or subsistence officer and supply officers and examine food supplies toobtain information re the ration issued, the various components, theirpercentages, quality, period of issue, storage facilities, and method ofdistribution.
4. Visit all kitchens in the organization; note and recordin each the points covered in the outline of the reports. Give individualinstruction personally, and through noncommissioned officers of the fieldparty, to mess sergeants and cooks for the improvement of the mess andavoidance of waste. See that they know what the ration is and whether theyget all of it. Consult organization commanding officers and make recommendationsto them where desirable.
5. Choose one or more centrally located kitchens illustratingconditions in the area and develop them as models for the practical instructionin cooking, mess administration, and avoidance of food waste. Build heremodel bread boxes, shelves, meat safes, work tables, grease traps, andany other devices which can be made of the materials at hand or obtainable.Assemble here, with the permission of the proper authorities, the officers,mess sergeants, cooks, and men of different units and demonstrate the advantagesof your devices, the importance of good meals, and the necessity of avoidingwaste. Accept and stimulate suggestion and criticism. Devise a system ofcompetition between messes, involving the recognition and public mentionof excellence.
6. If accompanied by the noncommissioned officers, cooks,mess sergeants, or butchers, distribute them at various points in the areaso as to give the necessary practical distribution over the whole organizationas quickly as possible.
7. Your first duty is to improve the food as served tothe men. Food conservation is merely giving the men more and better foodand putting less in the garbage pail and extracting or saving for messconsumption or commercial use all material of value. In training areasand in positions not exposed to shell fire there should be no food waste;material not used should be deducted from the following issue, with correspondingreduction in transportation, tonnage, and drain upon resources at home.
218
With troops occupying trenches or positions under shellfire there will be frequent and inevitable waste of food as well as ofother material. Your duty under such conditions is to urge that such foodbe allowed and delivered as will make possible the proper feeding of themen in spite of unavoidable waste. Study the food needs of the men andtake steps to insure that the needs are complied with.
Report on any unusual requirements of particular troops.
8. Make reports weekly to the food and nutrition section,A. P. O. 721.
9. Notify the food and nutrition section one week in advanceof the time that your work within a division is to be completed, requestingorders to move to another organization.
REPORTS
1. Officers will make oral or written reports to commandingofficers through division surgeons or other officers under whose directionthey work. These reports should contain a brief statement of conditionsfound and specific recommendations for their improvement. Avoid long reports.Don't criticise unless you are able to have the fault corrected. Be surethat your recommendations are practicable-otherwise don't make them. Correctfaults by informal conference and suggestion or by your own efforts beforewriting reports about them. Always pay due respect to military courtesyand the limitations of your authority, which is only advisory.
2. In addition to reports within the organization, officerswill make regular reports weekly by mail to the director of laboratories,food and nutrition section, A. P. O. 721, and special reports by telegraphwhenever necessary. Officers in the various sections of the Services ofSupply will similarly report to the chief surgeon in that section.
3. The outline below will serve as a guide in inspectionsand in the preparation of weekly reports. Adhere to the numbers as statedand it will permit considerable abbreviation. In reports after the first,from each division it will usually not be necessary to repeat items underA. B., etc., covered in the first report.
To: Director of laboratories, food and nutrition section
Heading: Organization; date covered by report
Party No.: Number of report
Contents:
A. Information obtained at the railhead or chief supplypoint
1. Storage facilities
2. Amount of reserve food on hand, (1) garrison ration,(2) field ration, (3) reserve ration (4) trench reserve ration, (5) travelration
3. Wastage at railhead or in reserve storage
4. Ration being issued with proportion of each componentand substitute
5. Period of issue; system of issue
6. Quality of food material
7. Desirable ration changes
8. Arrangements for food salvage
9. Faults requiring correction
10. General comments
B. Transportation of food
C. Conditions at regimental food dumps or similar foodsupply points (Nos. 1 to 10, as under A)
D. Report on mess inspections
(1) Name of organizations; (2) commanding officer; (3) mess officer; (4) mess sergeant with his knowledge of ration efficiency; (5) number of men fed; (6) number of cooks and efficiency; (7) general appearance of kitchen (good, fair, poor, excellent); (8) stove facilities roller kitchens, fuel; (9) cooking utensils; (10) storage facilities; (11) sanitation-kitchen surroundings, personnel; (12) waste, garbage, amount, character, disposal, reasons; (13) menus-character; (14) water supply; (15) arrangements for washing mess kits and dishes; (16) character of service-mess hall, tables, line system, billets, dugouts, trenches, marmites; (17) is food good and are men satisfied; (18) shortage or overdraft shown on ration slips; (19) conditions requiring correction and your action; (20) where possible
219
calculate or estimate the gross and net food consumption.Record any significant facts not covered above, such as weather conditions,activity of the men, etc., which affect the food consumption; remarks;(21) estimate the amount of food purchased by individual men from dataobtained from the canteens, from inquiry from the men or from stores inthe vicinity; (22) estimate the amount of food purchased by the organizationto supplement the ration; its source; (23) estimate of wine consumption.
E. Give in detail such methods of instruction and demonstrationas you have used, with comment on their success.
A field party under the immediate direction of the division surgeonand the sanitary inspector of the organization to which it was assigned(or corresponding officers in other commands) inspected the food supplyfrom its receipt at railhead to its consumption; investigated mess managementand mess sanitation; studied the methods of issuing and distributing rations,food preparation, and service, and, by informal conference with those concernedand by practical demonstration, corrected as far as possible any faultsin supply, preparation, or conservation of food.7 The partieswere given a degree of independence which enabled them to develop theirown resourcefulness and to adapt their activities to the conditions whichthe immediate occasion demanded.7 These parties worked in closeconjunction with divisional agencies, especially the first section of itsgeneral staff, the sanitary inspector, the inspector general, the quartermaster,and the several organization commanders.10 They made detailedinspections of kitchens and instructed personnel, either individually orin groups, gave demonstrations and lectures, and distributed circulars.From January to June, 1919, they gave most of their time to schools whichthey conducted for mess sergeants and cooks.10 The program whichthese parties sought to follow was one which they believed would insure,under mutable conditions, that food was regularly provided and handledto the best advantage in so far as storage, preparation of menus, cooking,serving, sanitation, and economy were concerned.10
The field parties did not follow inspections by elaborate reports, forthey were primarily engaged in constructive criticism and instruction ateach mess inspected, but such reports as were necessary and required weremade to organization commanders and to supply officers.7 Weeklyreports were sent by these parties to the food and nutrition section inDijon in order that it might be kept apprised concerning the suitabilityof the ration under changing conditions, the quality of supplies, defectsdetected, progress being made, and other matters.7 These reportsformed the basis for recommendations pertaining to the ration which thissection submitted. It wrote, for example, an order which was adopted withbut few changes by the chief quartermaster, A. E. F., and which was publishedas General Orders, No. 176, General Headquarters, A. E. F., 1918.3
Until September, 1918, when 20 additional officers pertaining to thisservice arrived from the United States, and two others were assigned theretofrom other duties, only the five officers of this section originally servingin France were available there for the service of this section.7One officer of the group first sent, had remained as stated above, in basesection 3 (England); two, at Dijon, were engaged in development of theorganization of the section, solution of problems referred to its headquartersand in special investigations, while the other three served with fieldparties which visited different divisions.7 As but
220
few organizations could be given attention for any considerable perioda readjustment and concentration of effort became necessary in the armies,and a plan was adopted which contemplated that the field parties be sentto headquarters of different corps in order that they might serve theirconstituent divisions, but until troops returned to billeting areas afterthe signing of armistice, the shifting of troops was so frequent that thismethod proved unsatisfactory. Thereafter it was the reverse.7
After the group of 20 officers above mentioned had joined the section,September 1, 1918, others gradually were added, until 43 were on duty withit when the armistice was signed.7 Of this total, four officersbelonged to the Medical Corps and all others to the Sanitary Corps.7Seventy-three enlisted men, most of whom were serving in the field parties,also were serving in this section at that time. By December, 1918, partieshad been attached to 18 divisions for periods varying from a few weeksto several months; and with five of these, two or more parties had beenon duty at different times. After January 1, 1919, field parties assignedto army corps served six other divisions and eventually they had served8 corps and 26 divisions.7
After October 18, 1918, when the director of laboratories and infectiousdiseases was authorized to issue travel orders for the movement of thesegroups their mobility and value in meeting emergencies was greatly increased.7Such orders were issued for specific purposes only; e. g., investigationof epidemics of food poisoning, inspection and prompt recommendation concerningthe preservation of food, and similar purposes.7
After the strength of the food and nutrition service was increased inSeptember, 1918, additional field parties were organized, and soon thereafterit became possible to provide officers for base sections Nos. 1, 2, 5,and 7 (in addition to base section No. 3, provided for at the outset) andfor the intermediate section.7 Officers or parties also werestationed at 10 large camps for considerable periods, and repeated inspectionswere made of supply, preparation, service and conservation of food as wellas other matters pertaining to the mess service at practically all campsin base sections. Many other inspections which sought to be of constructivevalue were made of other organizations including hospitals in the baseand intermediate sections. In base section No. 3 where four officers wereon duty for more than five months, practically all organizations were inspected,many of them repeatedly.7
The most important problems which confronted the section of food andnutrition during the winter of 1918-19 were the following:7(a) Inspection and report upon needs of labor organizations requestingincreases in the ration in accordance with General Orders No. 176; (b)continuation of the inspection and instruction work in base sections withadded emphasis on the messing conditions in the embarkation camps; (c)continuance of instruction to divisional troops in the first, second, andthird Armies and the development of instruction concerning cooking in theircomponent units; (d) the appointment of special inspectors to safeguardthe nutritional interests of our troops on returning commercial liners;and (e) assistance in solving the food problems of the section ofcivil government in the occupied territory in Germany.7 Thefood and nutrition section also provided a representative for investigationand advice
221
concerning matters pertaining to his specialty in the Third Army andanother who supervised messing conditions in the district of Paris, andinvestigated questions of factory sanitation that were of interest to theQuartermaster Corps.7
From November to May the following new features developed in the workof the section:3 The supervision and assistance in the organizationof the large embarkation messes at the base port. This covered base sectionsNos. 1, 2, 5, 6, and the embarkation center at Le Mans. At these same baseports a member of this section in each base served officially on the boardswhich inspected transports to determine the proper food equipment of thesame. At advanced general headquarters one of our officers served as foodand nutrition consultant on the staff of the officer in charge of civilaffairs and there rendered valuable service in determining the food supplyof the occupied territory.
From January to June, 1919, the officers assigned to army corps (wherethey were attached either to the corps surgeon's office, to G-1 or G-3of the corps) exercised general supervision over the nutritional serviceof divisions and devoted much of their time to the development of schoolsfor mess sergeants and cooks.7
Of the numerous investigationsa which this sectionconducted the following were practically noteworthy, viz, food conditionsin the zone of the armies, on the Murman coast, and in the sections ofthe Services of Supply; food service in hospitals; caloric value of theration; laboratory examinations and analyses of food; inspection of factoryconditions pertaining to food supplies; special problems regarding breadand meat issues; rations for later troops and food supply and its serviceon transports, especially on commercial liners hired for transport purposesby the United States.7
The services of the food and nutrition section for the American ExpeditionaryForces as a whole was terminated May 26, 1919, but was continued so longas circumstances required in the administrative sections of the Servicesof Supply and in the remaining army corps, the work being so arranged thatofficers employed therein could automatically be released when their serviceswere no longer necessary.7
MUSEUM AND ART SECTION
For the purpose of collecting suitable medical museum specimens, theSurgeon General, in January, 1918, requested authorization from the commandinggeneral, A. E. F., to send to France a medical museum unit with a designateddirector.12 After receipt of the authorization, and a periodof two months spent in planning for the collection of museum material inthe camps and cantonments of the United States, the director of this unitwas ordered to England in order that he might study both the collectionsmade and methods of collecting employed by the British Army, and was thensent to France for further duty.12 In the meantime CircularNo. 17 had been issued by the chief surgeon, A. E. F., calling attentionto the importance of collecting museum specimens and giving brief directionsfor their preservation.12
aFor details concerning these investigations, consult Chap. VI, Sec. II, Volume VI, of this history.
222
The collection of museum and art material in France was made a responsibilityof the division of laboratories, for it early became apparent that theprocurement of pathologic material would be wholly dependent on the efficiencyand activity of the officers who performed autopsies.12 Thefirst task, therefore, was the improvement of the necropsy service in theAmerican Expeditionary Forces, which at that time, because of lack of personnelfor such service, was very inadequate. During the summer of 1918 it becameevident that there existed a great need for a routine service of this characterwhich would afford a means of professional inspection of the measures whichmedical officers employed in their care of patients.12 Thisinspectorial need was filled in satisfactorily, and, although the numberof pathologists was constantly so limited that they could not give morethan incidental attention to the collection and preservation of pathologicmaterial, their collections were more extensive than could have been hopedfor under the circumstances.12
Since General Orders, No. 15, H., A. E. F., January 24, 1918, limitedthe practice of photography in the American Expeditionary Forces, in sofar as obtaining a pictorial history of the war was concerned, to the SignalCorps, the chief surgeon, A. E. F., in March, 1918, approved an elaborateschedule for the taking of photographs by that corps for the purpose ofillustrating the medical history of the war.12 In order thatother technical photographs might be procured, a request was made earlyin May for the privilege of cabling for photographers and artists who werethen in readiness to proceed from the Army Medical Museum in Washington,but this was disapproved by the general staff, A. E. F., in view of theexisting tonnage situation, and in the belief that the requirements ofthe Medical Corps could be met successfully in this particular by the personneland facilities already available, in both the Signal and Engineer Corps.12
On May 3, 1918, the director of laboratories notified the chief surgeonthat provision was contemplated for photographic work on anatomical materialin the advance section and in the central Medical Department and base laboratories.13It was believed that a sufficient number of men for this purpose couldbe found in the American Expeditionary Forces, and it was planned to trainthem, at the central laboratory, in the simple laboratory procedures sothat they could serve both as laboratory assistants and as photographers.13Another acquisition desired by the museum and art service of the divisionof laboratories was a number of artists who could make sketches of anatomicalspecimens and of medical and surgical procedures.13
In July, the division of laboratories reported to the chief surgeon,A. E. F., the lack of men in the Signal and Engineer Corps who had specialtraining in preparing medical illustrations and urged the necessity forspecial training along such lines in order that good results might be procured.12As a result, a cabled request was made to the War Department that a museumunit, consisting of a cinematographer, a photographer, and four artists,with complete equipment and supplies for six months, be sent to France.One officer and seven enlisted men, equipped for making moving pictures,arrived in France September 14, 1918, pursuant to this cablegram.12
General Orders, No. 78, G. H. Q., A. E. F., May 25, 1918, amended previousorders on the use of cameras in the American Expeditionary Forces, and
223
charged the Medical Department with making technical photographs ofsurgical and pathological interest. To carry out this responsibility, theofficer in charge of the museum and art section made a survey of the MedicalDepartment personnel and pertinent equipment in the American ExpeditionaryForces. Several men were found who had been trained in photographing medicalsubjects, but because of the order previously issued concerning the takingof photographs, almost no hospitals were found equipped with photographicapparatus.12 Those that were so equipped were authorized toplace their equipment in use.12 A few cameras were procuredfrom French sources, 3 were borrowed from the Signal Corps, and 24 fromthe Roentgenologic department of the professional services.12A limited amount of photographic supplies was obtained from French sources.12
An examination of the feasible sources of supply-American, French, andBritish-revealed the fact that nothing but formalin was obtainable forthe fixation of pathologic specimens, except in a few base hospitals whichhad first arrived in France and which had brought with them a small supplyof alcohol.12 The only materials available for color preservationwere sodium or potassium acetate and nitrate, one or the other of whichwas obtained after long delay from the French. These materials, photographicand pathologic, were placed in the central medical supply depot, but thefacilities there for distribution either of these or of the other MedicalDepartment supplies used in the museum and art service were inadequate.12
After a careful survey of the situation, Circular No. 42 was issuedby the chief surgeon's office.12 This circular, which gave technicalinstruction concerning the collection and preservation of specimens, isreproduced in the appendix to this volume.
As a result of these efforts, the increase in the total number of pathologists,their assignment at advantageous points, and personal appeals while inspectinglaboratories, much interest in the collection of museum material was developed.12Butthe battle activities in June and July so overwhelmed the laboratory divisionthat very few pathologic specimens were collected at that time.12
On September 15, 1918, the director of laboratories wrote, through thechief surgeon, to the chief quartermaster under whom the officer in chargeof salvage was operating, stating that it was important that certain articlesof interest to it, which were employed in allied armies or in that of theenemy, be collected and transferred to the Medical Department.14These articles included drugs, sera, chemicals, apparatus, instruments,etc., and ordnance. He stated that the Army Medical Museum was chargedwith the collection of such material and the provision of arrangementswhereby it would be made available for future studies and requested thatsuch articles of the character mentioned as had been selected by a medicalofficer be transferred to the division of laboratories for shipment tothe Army Medical Museum in Washington.14
In October and November the epidemic of influenza, coinciding as itdid with the Meuse-Argonne operation, the period of greatest battle activityin the American Expeditionary Forces, again overwhelmed the pathologists,though by this time their number had materially increased.12By this time,
224
also, an excellent necropsy service had been developed, but only relativelyslight attention could be given to the collection of specimens.12Nevertheless, despite the limited personnel and the lack of equipment,of supplies, of containers, of transportation, of time, and in fact ofeverything except a multitude of specimens, upward of 6,000 pathologicspecimens were collected, preserved, and shipped to the Army Medical Museum.12Most of these related chiefly to war wounds and to gas poisoning.12
Early lesions of war gas poisoning were especially difficult to obtain,owing to lack of transportation facilities and of pathologists, and tothe necessity for the collection of specimens for immediate study at thepathologic laboratory in the Chemical Warfare Service, with which the MedicalDepartment attempted to cooperate in every possible manner.12However, a small but a fairly representative collection of these lesionswas assembled. By December 26, 1918, most of the pathologic specimens fromgas-poisoning cases had been forwarded to the laboratory of the ChemicalWarfare Service for study, and the others, which had been held at the centrallaboratory, had been shipped to the Army Medical Museum.15 Anumber of good specimens illustrating the more striking types of lung lesionsoccurring during the epidemic of influenza in the fall of 1918 were preserved.12Lesions illustrating the often unique course of typhoid and paratyphoidfever in men who had received specific prophylaxis also were collectedin considerable numbers during the fall and winter of 1918-19. Fairly goodcollections were made of specimens illustrating lesions of the brain, andof peripheral nerves and certain other conditions.12
About 2,000 microscopic slides of tissue were collected and shippedto the United States.12
A small collection of missiles which had caused injuries and which hadbeen removed at surgical operations was preserved, but most of these werereturned to wounded soldiers, pursuant to Circular No. 42, Chief Surgeon'soffice. A fairly complete collection of unused small-arms missiles andfixed ammunition of the several belligerent nations, a few specimens ofheavy ordnance missiles and of their fragments, and a representative collectionof rifles, pistols, bayonets, trench knives, and other weapons were forwardedto the Army Medical Museum.12
On January 13, 1919, the commander in chief instructed army commandersand the chiefs of all technical and supply divisions concerning the collectionof material for historical and exhibition purposes.16
A large collection of helmets, which showed evidence that they had eitherwarded off missiles or been penetrated by them, a small number of piecesof body armor, and other metal objects such as canteens, mess kits, trenchmirrors etc., which also showed they had been struck by missiles, werecollected and shipped to the museum.2 A number of surgical instrumentsand other items in Medical Department armamentarium, which had been developedor materially modified in our service, or in those of our allies, or inthat of the enemy during the progress of the war were collected and shipped.12
In September, 1918, several artists (medical illustrators, wax modelers,and others) had arrived in France attached to Base Hospital No. 115, whichwas stationed at Vichy.12 An art and photographic section wastherefore established in Vichy in the center laboratory of the hospitalcenter, using this personnel
225
and its equipment.12 Other artists were assigned from totime to time to this art section and were ordered out therefrom to varioushospitals in the American Expeditionary Forces where opportunities affordedmaking illustrations of medical or surgical subjects. This group produced35 casts of surgical cases, about 200 drawings and paintings, and morethan 1,000 photographs of technical subjects.12 In additionto these illustrations and photographs, which were centered at Vichy, anumber of other drawings, paintings, and photographs of technical subjectswere made in other hospital centers, particularly at Allerey, Beaune, Chateauroux,and Paris.12
The cinematographer, photographers, and artists cabled for in August,1918, reported for duty to the director of laboratories in the followingmonth.12 This personnel was distributed as advantageously aspossible, principally to cover the activities of combat divisions. Herethey remained on duty until the signing of the armistice.12Late in September, 1918, the museum section of the division of laboratorieshad been charged with the duty of cooperating with the Signal Corps inmaking photographs for the medical and surgical history of the war.12The Signal Corps, though it had been authorized in March, 1918, to preparesuch photographs, had been able to cover but little of the medical activitiesof the American Expeditionary Forces except the more popular subjects whichwere needed for propaganda purposes.12 After the signing ofthe armistice and as soon as the general photographers of the Medical Departmentcould be released from their duties with combat divisions, a photographicbureau of the Medical Department was established in Paris for making andcollecting photographs and moving pictures illustrative of the medicalactivities in the war.12 Personnel of both the Medical Departmentand of the Signal Corps were assigned to this duty.12
The negatives of the medical pictures taken by the Signal Corps photographerswere developed by them and two prints of each made for the Medical Departmentbureau, the negatives being retained by the Signal Corps.12The negatives made by medical personnel were developed, printed, and filedin the Medical Department bureau. This bureau filed more than 10,000 stillpictures, titled and cross indexed, supplied about 5,000 proof copies tohospital organizations for use in their several histories, and furnished1,500 prints for medical officers of the general staff of general headquarters.12The bureau also photographed about 350 dental specimens. It made about40,000 feet of moving-picture film of surgical and medical subjects, suchas activities in and around hospitals, rehabilitation of convalescent patients,care of psychiatric cases, etc., and filed about 20,000 feet of other motionpictures made by Signal Corps photographers. Nineteen copies of the motionpicture, "Fit to fight," were made for circulation in the American ExpeditionaryForces.12 Two other propaganda pictures-"Fit for America" and"How to avoid typhoid fever"-and six copies of a two-reel anatomic pictureconcerning venereal diseases were also made.12
The Roentgenologic division of the professional services, on requestfrom the division of laboratories, packed and shipped about 2,000 selectedX-ray plates from their point of origin directly to the Army Medical Museum.12These were selected for their technical quality as well as for their scientificinterest and
226
covered in a number of instances special series of cases or series whichshowed different stages in the treatment and healing of the same case.12
Immediately on the signing of the armistice it became obvious that transportationfacilities for specimens, not only within the American Expeditionary Forcesbut also from base ports to the United States, would be exceedingly limited.12A supplemental museum circular (No. 58) was therefore issued from the chiefsurgeon's office December 2, giving directions for expediting transportationand calling attention to the desirability of obtaining material showingstages of healing, etc.12 As a result of this circular the transportationof pathologic specimens directly to base ports from their points of origininstead of through collection centers was materially expedited, as thisprocedure required that dependence be placed on a large number of shippersfor report of details concerning the individual specimens they forwarded,there eventuated in some instances a lack of the detailed information desired.12The shipment of museum material to the United States was greatly hamperedby the inevitable confusion incident to general shipping conditions inFrance and to the lack of tonnage at the close of the war. All the specimens,however, were carefully packed, and it was believed they would not materiallydeteriorate even if delayed one or two years in transit.12
LABORATORY OF SURGICAL RESEARCH
In order that use might be made of the unusual opportunities which theWorld War afforded for the study of certain conditions, such as shock andhemorrhage, which occur both in military and civil practice, and in orderto obtain information wherewith to meet new experiences in war surgery,as these arose, a laboratory for surgical research was established at Dijon.17This organization was established on the initiative of the chief surgicalconsultant and connected with the central Medical Department laboratory.Plans for carrying on the research work were perfected in January, 1918,but it was not until May 1 of that year that active work was begun.17Two divisions of the unit were established, physiological and surgical,the former being staffed by 4 officers and 3 enlisted men and the latterby 6 officers, 2 nurses, and 2 enlisted men. Investigations of problemsconnected with shock and hemorrhage and the development of a satisfactorytechnique in the treatment of chest wounds were the first studies undertaken.17Studies concerning shock and hemorrhage progressed in such a favorablemanner that late in May instruction was begun of classes in resuscitation,and thereafter teaching and investigation were closely associated in thisservice. With a few interruptions, classes of from 6 to 21 officers wereinstructed each week until November 1, 1918, the successive courses oflectures and demonstrations being gradually amplified and improved.17Members of the classes drawn from the surgical staffs of base hospitals,were organized in resuscitation teams, and when needed they were to beordered to hospitals at or near the front. This plan was not altogethersatisfactory. In many cases the personnel in question could not be releasedfrom their units for this purpose and as a result some of the resuscitationteams in forward hospitals had not received the instruction referred to.17The teaching staff of the surgical research laboratory also gave instructionmonthly to the classes in the sanitary school at Langres.17
227
Meanwhile surgical research was prosecuted, some studies of this characterbeing conducted in British hospitals. Research in the treatment of chestwounds was conducted by a team of 6 officers, 2 nurses, and 2 enlistedmen.17 These studies were not completed but certain principlesapparently were established and surgical operations simplified accordingly.17A project to establish an advance surgical research laboratory where observationscould be made on recently wounded men was contemplated but never materialized.17
REFERENCES
(1) Report of the activities of the water analysis laboratories,to January, 1919, by Lieut. Col. Edward Bartow, S. C. On file, HistoricalDivision, S. G. O.
(2) Report of water analysis work at the central MedicalDepartment laboratory, Dijon, France, January 25, 1919, by Captain H. B.Hommon, S. C. On file, Historical Division, S. G. O.
(3) Report from the chief surgeon, A. E. F., to the SurgeonGeneral, U. S. Army, May 1, 1919. Subject: Activities of the chief surgeon'soffice to May 1, 1919. On file, Historical Division, S. G. O.
(4) Letter from the chief surgeon, A. E. F., to the SurgeonGeneral, January 18, 1918. Subject: Recommendation for food division. Onfile, A. G. O., World War Division, chief surgeon's files (720.1).
(5) Cablegram No. 614, par. A, from General Pershing toThe Adjutant General, February 18, 1918.
(6) Memorandum from the Surgeon General to the chief surgeon,A. E. F., March 1, 1918. Subject: Officers reporting for duty. On file,A. G. O., World War Division, chief surgeon's files (720.1).
(7) Letter from Maj. P. A. Shaffer, San. Corps, December6, 1918, to the director of laboratories, A. E. F. Subject: General reportfrom the food and nutrition section, from its establishment to December1, 1918. On file, Historical Division, S. G. O.
(8) Report on the section of food and nutrition, personnel,August 8, 1919, by Maj. Walter H. Eddy, S. C. On file, Historical Division,S. G. O.
(9) Letter from the chief surgeon, A. E. F., to chiefsurgeons of sections concerned, April 12, 1918. Subject: Duties and cooperationof food and nutritional officers. On file, A. G. O., World War Division,chief surgeon's files (720.1).
(10) Report on the section of food and nutrition, foodproblems with combat troops in France, August 8, 1919, by Capt. C. C. Mason,S. C., and Lieut. A. T. Shohl, M. C. On file, Historical Division, S. G.O.
(11) Letter from the adjutant general, A. E. F., to commandingofficer of the organization concerned, September 20, 1918. Subject: Assignmentof field party, food and nutrition section. Copy on file, Historical Division,S. G. O.
(12) Report on the museum and art service of the AmericanExpeditionary Forces (undated), by Col. Louis B. Wilson, M. C. On file,Historical Division, S. G. O.
(13) Letter from Lieut. Col. J. F. Siler, M. C., directorof laboratories, A. E. F., to the chief surgeon, A. E. F., May 3, 1918.Subject: Photographic work in laboratory service. On file, A. G. O., WorldWar Division, chief surgeon's files (321.630).
(14) Letter from Lieut. Col. J. F. Siler, M. C., directorof laboratories, A. E. F., to the chief quartermaster, A. E. F., September15, 1918. Subject: Transfer of certain material to the Medical Department.On file, A. G. O., World War Division, chief surgeon's files (700.6).
(15) Fourth indorsement from director of laboratories,A. E. F., to the Surgeon General, U. S. Army, December 26, 1918, on letterfrom Major M. C. Winternitz, M. C., to director of Chemical Warfare Service, November7, 1918. Subject: Study of human pathology of poison war gases. On file,World War Division, chief surgeon's files (321.630).
228
(16) Letter from commander in chief, A. E. F., to armycommanders and all technical and supply divisions, January 13, 1919. Subject:Collections of materials of historic value. Copy on file, Historical Division,S. G. O.
(17) Report on the services of the laboratory of surgicalresearch, American Expeditionary Forces, at Dijon, December 7, 1918, byLieut. Col. W. B. Cannon, M. C., and Lieut. Col. J. L. Yates, M. C. Onfile, Historical Division, S. G. O.
