CHAPTER IX
THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
GENERAL ORGANIZATION
When the United States entered the war, practically no information wasavailable to us relative to the laboratory organization and activitiesof the nations engaged. Therefore, it was not possible for the MedicalDepartment to formulate at that time any definite plan of organizationbased on their experience; however, as a preliminary measure to the provisionof a laboratory service for the American Expeditionary Forces, the officersin charge of the laboratory division, Surgeon General's office, assembledthe personnel for an initial laboratory and dispatched it to France.1This unit which sailed on July 26, 1917, and arrived in France on August5, consisted of five officers and six enlisted men under command of a majorof the Medical Corps. Designated as Army Laboratory No. 1, it was assignedto station at Neufchateau about 35 miles north of Chaumont.1As the officer in charge of the laboratory division, Surgeon General'soffice, had believed that general laboratory supplies would be availablein France, this unit brought with it only a few special items and procuredfrom the Pasteur Institute in Paris an emergency equipment consisting ofone French Army model field laboratory packed in chests.1 Thisequipment provided very limited material for clinical pathology and generalbacteriology, and only with the greatest difficulty was a very incompleteequipment for neurologic and pathologic work procured.1 A smallrequisition had been placed with the supply division of the Surgeon General'soffice before this unit left the United States, but much of this neverreached the laboratory in France.1 A requisition was placedfor the limited number of items of laboratory equipment on the MedicalDepartment supply table, and provision was made for the supply of a standardcantonment laboratory to corps laboratories, and the Army standard fieldlaboratory equipment (plus a poison detection chest) to mobile laboratoryunits, as they were ordered overseas.1 Army Laboratory No. 1was obliged to occupy a building altogether unsuitable for its purposes,where necessary alterations were made under almost insurmountable difficulties.Neither gas nor electricity was available with sufficient constancy topermit their use.1
The commanding officer of this unit, who was also the adviser of thechief surgeon, A. E. F., in all matters pertaining to laboratory service,1formulated a tentative plan for the laboratory organizations of the AmericanExpeditionary Forces, which was submitted to the Surgeon General in thefollowing letter:2
1. This letter * * * is intended to furnish your officewith an approximate idea of the officers, men, and supplies needed in Francefor the laboratory work of an army on the basis of five corps of six divisionseach-a total of approximately 1,000,000 men.
PERSONNEL
(a) It is planned to establish one army laboratorywith a personnel of 8 officers and 16 men, which will be the central laboratory,fully equipped for all kinds of routine special work, including research.The laboratory detachment and supplies brought over by Major Nichols willserve as the nucleus for this laboratory.
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(b) This office has recommended the establishmentof five corps laboratories with a personnel of 4 officers and 8 men each.These laboratories will be stationary and will need to have an equipmentless complete than that of the central army laboratory, but sufficientfor all routine work. They may be specialized under direction of the armylaboratory, if the routine work of the corps permits.
(c) A field laboratory with two officers and fourmen each will be provided and attached to each division. The field laboratorywill be mobile and its principal work will be the bacteriological and chemicalexamination of water, the taking of cultures and specimens for examinationin the corps or army laboratory, the examination of smears, etc. The fieldlaboratories will depend upon and look to the corps and army laboratoriesfor supplies and supervision of technique, etc.
(d) Summary of personnel-
| Number | Officers | Men |
Army laboratory (8 officers, 16 men) | 1 | 8 | 16 |
Corps laboratories (4 officers, 8 men) | 5 | 20 | 40 |
Field laboratories (2 officers, 4 men) | 30 | 60 | 120 |
| Total | --- | 88 | 176 |
(e) Chemist.-It is planned to include inthe work of the organization given above, all chemical work which is ofgreat importance in this war and which in the English and French servicesis done by separate organizations. It is believed that all laboratory workcan be combined to advantage in our service. For this work officers andmen, chemists of the Sanitary Corps, can be used as follows:
| Number | Officers | Men |
Army laboratory | 1 | 2 | 4 |
Corps laboratories | 5 | 5 | 10 |
Field laboratories | 30 | 30 | 30 |
| Total | --- | 37 | 44 |
SUPPLIES
(a) The supplies for the army laboratory have alreadybeen partly arranged for by a requisition prepared by Major Nichols andsubmitted before his departure from the United States. Further requisitionswill be made on Washington for this laboratory later.
(b) At present, as our own laboratory supplieswill not be available for issue for some time, work will be started nearthe established training camp with a laboratory outfit which has been obtainedby purchase from the Pasteur Institute. Emergency items, as they may beneeded, will be obtained here by purchase from the Pasteur Institute orelsewhere.
(c) It is desired that the equipment of the corpslaboratories shall be the same as that already adopted for the cantonmentlaboratories in the United States. It is believed that the simplest methodof requisition is to ask for five of these outfits.
(d) The standard field laboratory equipment canbe used for the field laboratories with the addition of a chest for thedetection of mineral poisons. It might be possible to obtain these here,but it is preferable to have them sent from the United States. It is plannedto purchase here two motor laboratories, similar to those used in the Englishservice, * * * for trial; but it is believed that our field laboratorycan be used without a special car by transporting it on a light truck orambulance.
(e) Laboratory supplies to replace those expendedwill be asked for by the medical supply officer from time to time accordingto strength as authorized by the supply table.
2. To recapitulate: For the whole laboratory organizationthere will be required about 50 medical officers and 130 men capable ofdoing routine laboratory work, and 35 officers and 45 men of the SanitaryCorps capable of doing chemical work. These should
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be sent to France so that the required personnel for eachdivision field laboratory will accompany each division. The army laboratory,Major Nichols in charge, will do the work of the corps laboratories untilthe latter can be established. There is immediate need for two chemiststo start their part of the central army laboratory organization.
(a) Advance notice of all arrivals should be sent,to facilitate the assignment of laboratory personnel.
3. In regard to supplies, there will be needed 30 morefield laboratories each with a small, suitable chemical chest for qualitativeanalysis for mineral poisons, to be provided in the United States.
(a) The question of the transportation of fieldlaboratories will be made the subject of a later communication.
(b) There will be required five corps laboratoryequipments similar to those now used in the cantonments established inthe United States.
(c) Additional equipment which will be requiredfor the army laboratory will be covered by requisitions from France fromtime to time.
4. Résumé:
(a) Required at once: 2 chemists, Sanitary Corps.
(b) Required with each new division which may cometo France: 2 officers (1 a chemist), 4 men (1 a chemist), 1 field laboratoryequipment, to which there must be added 1 chest, chemical (for the detectionof mineral poisons, etc.).
(c) Required before November 15, 1917: 1 cantonmentlaboratory (4 others to follow before January 15, 1918).
(d) The personnel for corps laboratories shouldbe sent from time to time as indicated by the divisions which are dispatched.
5. For the purpose of supply it is requested that thisletter be taken as a requisition.
This letter indicates, among other things, that the chief surgeon'soffice desired three special types of laboratories not previously authorizedin War Department Tables of Organization. A representative of one of thesetypes, an army laboratory, was already provided, so far as nomenclaturewas concerned, in army laboratory No. 1, but in addition to its other servicesthis unit operated as the headquarters laboratory for the entire AmericanExpeditionary Forces until the central medical department laboratory wasestablished at Dijon, January 1, 1918.1 Thereafter in additionto serving the troops in the combat zone, it also served the advance section.1A second type of unit desired was the corps laboratory, to be organizedand dispatched to France in the proportion of one for each corps.1The plans accepted at this time provided that each of these units shouldbe of a stationary character, and well equipped for the service of corpstroops, but events proved that their employment as contemplated was notpracticable.1 Therefore, on arrival, the corps laboratorieswere diverted from their original purpose and operated as base laboratoriesin the different sections of the Services of Supply. The third type ofspecial laboratory desired was the field or divisional laboratory unit,one of which was to be provided for each division. These units were tobe supplied with the standard field laboratory equipment already authorizedby the Medical Department. As the situation later developed, these divisionalunits were retained in the final plan of organization, but their equipmentwas changed.1
In addition to the special types of laboratories mentioned above, Tablesof Organization already provided for a laboratory as a part of each basehospital and specified its personnel and equipment.3 Thoughnone of the corps or divisional laboratories reached France before November1, 1917, several base hospital laboratories (Nos. 6, 101, 15, 18, 17, 8,9, and 27) arrived and began
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operating.3 These base hospital laboratories had fairly completeequipments and supplies at this time, but much of it was useless, sinceneither sufficient gas nor usable electric current was then obtainable.3
Before November 1, 1917, the personnel of the laboratory service inFrance consisted, in addition to the staff of army laboratory No. 1, oftwo commissioned officers and a varying number of enlisted technicianswith the laboratory of each base hospital then in France.3
A considerable amount of routine clinical pathology was performed duringthis early period and an autopsy service of practical value conducted.The bacteriologic work done at this time consisted mainly of a study ofthe organisms concerned in the prevalent infections of the respiratorytract.3 The service for conducting Wassermann reactions wasbegun in September, 1917. The difficulties to be overcome were many. Littleequipment was available, all reagents had to be prepared and standardized,only with the greatest difficulty could guinea pigs be secured, only alow-speed hand centrifuge was available, and it was necessary to use somevery primitive equipment.3 At that time it was planned thatthe Wassermann work for the entire American Expeditionary Forces wouldbe done at army laboratory No. 1, but this proved impractical because ofdelays in transmitting specimens and reports.3
In the latter part of October, 1917, a division charged with the supervisionof the laboratory service of the American Expeditionary Forces was createdas a part of the office of the chief surgeon, and Circular No. 2, chiefsurgeon's office, dated November 9, 1917 (quoted in the appendix), whichannounced the creation of professional divisions in that office, includedamong others the division of laboratories. Later in the same month a sectionof infectious diseases was added to this division.3
The chief surgeon on November 11, 1917, instructed the director of laboratories,A. E. F., to submit plans to organize a division of laboratories and infectiousdiseases.3 Some information was then available concerning theorganization of the laboratory services in the British and French Armies,but it seemed advisable to plan for a somewhat more comprehensive organizationwith greater centralization and more definite administrative control andcoordination than existed in those forces.3 The general projectsof organization and phases of development for the American ExpeditionaryForces as worked out by the general staff were reviewed, the plans of thehospitalization division of the office of the chief surgeon, includinggeographic location of hospitals present and prospective (i. e., thoseleased, under construction, or projected) were studied, and as much relevantinformation as possible was obtained, concerning the proposed lines ofrailway communication.3 By means of this information, and theemployment as a basis of the preliminary plans for the laboratory servicealready adopted, a highly developed project for the organization of thisdivision was formulated.1 On December 29, 1917, a general outlineof the proposed organization was submitted to the chief surgeon, and onJanuary 11, 1918, a detailed outline with the statement that plans werealready being formulated to effect a number of the features it prescribed.1This latter project, which was approved by the chief surgeon, was as follows:1
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ACTIVITIES-DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
SECTION OF LABORATORIES
1. Representative of chief surgeon in all matters relatingto laboratory service.
2. General supervision of all laboratories and the assignmentof special personnel.
3. Direct supervision of purchase and distribution oflaboratory equipment and supplies.
4. Publication of circulars relating to standardizationof technical methods, collection of specimens and other matters of technicalinterest to the laboratory service.
5. Collection and distribution of literature relatingto practicable and definite advances in laboratory methods.
6. General supervision of research.
7. Supervision and action on manuscripts of laboratorypersonnel to be presented to chief surgeon for publication.
8. Cooperation and coordination with the directors ofall the professional divisions, in order that medical and surgical problemsarising during the war may be most effectively handled from the laboratorypoint of view.
SECTION OF INFECTIOUS DISEASES
1. Representative (advisory) of chief surgeon in mattersrelating to the prevention and control of transmissible diseases.
2. Collection and distribution of literature pertainingto practical advances in methods of prevention and control.
3. Preparation of circulars relating to prevention andcontrol.
4. Detail of specially trained units with personnel andmobile material, on request from the division of sanitation, for the investigationof epidemics or threatened epidemics.
5. Experimental investigations of suggested prophylacticmethods for the prevention of infectious diseases and recommendations relativeto their general adoption.
6. Collection of statistics and epidemiological data oninfectious diseases.
A. CENTRAL ORGANIZATION
1. Central offices.
Personnel:
Director of division of laboratories and infectious diseases-
(a) Assistant director (section of laboratories).
(b) Assistant director (section of infectious diseases).
(c) Adjutant; 2 secretaries, 2 clerks, chauffeur and orderly.
2. Central medical department laboratory, A. E. F.
Divisions:
(a) Bacteriology.
(b) Serology.
(c) Pathological anatomy.
(d) Chemistry (sanitary-medical).
(e) Medical biology
(f) Supplies (diagnostic and therapeutic sera, vaccines, culture media, stains, standard solutions, portable laboratory units, ect.).
Activities:
(a) Standardization of technical methods.
(b) Manufacture and distribution of culture media, stains, agglutinating sera, amboceptor, antigen, etc.
(c) Distribution of diagnostic and therapeutic sera, vaccines, etc., to base, camp hospital, army, evacuation hospital, and divisional laboratory units and to troops.
(d) Supply of complete transportable and other mobile laboratories for units in the field and for special investigations. (Meningitis, diphtheria, pneumonia, enteric fevers, etc.)
(e) Supply of laboratory animals.
(f) Special highly technical chemical and other laboratory work as required.
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Central medical department laboratory, A. E. F.-Continued.
Divisions-Continued.
Activities-Continued.
(g) Standardization of technique and records of post-mortem examinations and supervision of collection of museum specimens to be forwarded to the Army Medical museum.
(h) Special work on insects (lice, etc.).
(i) Special research work.
(j) Instruction of laboratory personnel in technical methods (wound bacteriology, etc.).
(k) Supply of special personnel and material for the investigation of epidemics.
Personnel:
Commissioned-
Commanding officer.
Adjutant.
Quartermaster.
Chief, division of bacteriology.
Assistant, division of bacteriology.
Chief, division of serology.
Assistant, division of serology.
Chief, division of pathological anatomy.
Chief, division of chemistry.
Chief, division of medical biology.Enlisted and civilians (43)-
2 secretaries.
3 clerks.
10 technicians.
1 electrician.
1 plumber.
1 cabinetmaker.
1 general carpenter.
1 packer.
6 chauffeurs.
1 mechanic, having general knowledge of autos.
1 motor-cycle driver.
5 general utility men.
10 civilian laborers.
NOTE.-Both commissioned and enlisted personnel will be attached temporarily to this laboratory from time to time, for purpose of instruction. Special mobile units for special investigations and reinforcements will be held in reserve at this laboratory.
The central laboratory will supply culture media, stains,therapeutic sera, standard solutions, and other expendable laboratory itemsto laboratory units in the intermediate and advance section, line of communications,and the zone of the advance. It will equip, distribute, and replenish thetransportable laboratory units for camp hospital laboratories. It willstock and replenish all transportable laboratories (in chests) for specialinvestigations (meningitis, pneumonia, diphtheria, typhoid, dysentery,etc.), and all motorized corps and special mobile laboratories functioningin the intermediate and advance sections, line of communications, and thezone of the advance. In the investigation and control of epidemics andthreatened epidemics, it is of the utmost importance that the existenceof suspected disease be recognized promptly, in order that measures forits control and prevention may be instituted without delay. Experiencehas demonstrated already that railway transportation fails absolutely tomeet the necessary requirements. All parts of the area served by the centralMedical Department laboratory can be reached by motor transportation infrom two to eight hours and an adequate motor transportation will be urgentlyrequired. The following transportation will be necessary:
1 1½-ton truck.
1 passenger car (Ford).
2 light Ford trucks.
2 motor cycles with side cars.
2 Ford ambulances.
6 motorized bacteriological laboratories (reserve).
1 passenger car closed (Dodge).
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B. GENERAL ORGANIZATION
(Division of Laboratories)
1. Base laboratories:
(These laboratories will be of two general types: Those functioning directly under the headquarters of the different sections of the Services of Supply and those functioning as base laboratories for single base hospitals or for groups of base hospitals.)
(1) Base laboratories, Services of Supply-
Divisions-
(a) Bacteriology.
(b) Serology.
(c) Pathological anatomy.
(d) Chemistry (sanitary and medical).
(e) Supplies (diagnostic and therapeutic sera, vaccines, culture media, stains, standard solutions, etc.).
Activities-
(a) Manufacture of culture media.
(b) Distribution of culture media, stains, diagnostic and therapeutic sera, etc., to camp hospital laboratories and base laboratories, base hospitals, in their section.
(c) Stocking and replenishing special transportable and motorized mobile units functioning in their section.
(d) Supply of laboratory animals.
(e) Special research.
(f) Investigation of epidemics and threatened epidemics in their section by means of special personnel and material attached. (Transportable units in chests for investigation meningitis, diphtheria, pneumonia, dysentery, etc., and motorized bacteriological laboratory for special investigation.)
(g) Serological and special bacteriological work for camp hospitals, base hospitals, and for troops.Personnel-
Commanding officer.
2 commissioned assistants permanently attached.
2 commissioned assistants to be available for special duty in investigating epidemics.
The necessary enlisted and civilian personnel.Transportation-
1 passenger car and 1 motor cycle with side car.
1 motorized bacteriological laboratory.(2) Base laboratories, base hospitals-
(These laboratories will be organized for single base hospitals (1,000 beds) and base hospital groups (5,000 to 10,000 beds). They will be well equipped as to personnel and material and capable of doing any work ordinarily carried on in a good laboratory.)
Activities-
(a) Bacteriological, serological and gross and histopathological work for base hospitals or for groups of base hospitals.
(b) When necessary, they will be charged with theserological and specialized bacteriological work for camp hospitals intheir vicinity.
(c) Supply of therapeutic sera, vaccines, etc.
NOTE.-The routinepathological work (blood counts, urines, smears, etc.) in base hospitalgroups will be done by a special personnel in small laboratories in closeproximity to the wards. Special base laboratory buildings with adequatespace are being provided for in the plans for the construction of groupsof base hospitals (5,000 to 10,000 beds).
Transportation-1 motor cycle with side car.
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Base laboratories-Continued.
(3) Camp hospital laboratories-
Activities-
(a) Routine clinical pathological work for camp hospitals (300 beds) and regimental infirmaries (urines, sputum, blood counts, dark field, diphtheria cultures, etc.)
(b) Collection of specimens from regimental infirmaries(blood for Wassermann, etc.) to be forwarded to base and army laboratories.
(c) Distribution of reports to regimental infirmaries.
Personnel-
1 bacteriologist.
3 enlisted technicians.
1 motor-cycle driver.Transportation-1 motor cycle with side car.
Equipment-Transportable expandable units in chests.
(4) Evacuation hospital laboratories-
(These units will be assigned to evacuation hospitals and will have the necessary equipment to do the routine clinical ward work and special work in wound bacteriology for evacuation hospitals).
(5) Army laboratories-
(Stationary units. Located in permanent buildings in the zone of the advance or in the advance section, line of communications, immobilized well equipped. Directly under the chief surgeon, A. E. F., for administrative purposes. Designated as army laboratories but will not be mobile in the sense of being attached to any particular army and following it as it moves. These laboratories will be organized as necessity for them arises and will be numbered serially.)
Activities-Similar to the activities of base laboratories.
Personnel-
4 commissioned.
10 enlisted.Transportation-
1 passenger car (closed).
1 Ford truck or ambulance.
1 motor cycle.(6) Corps laboratories-
These laboratories will be motorized, mobile units, completely equipped for general bacteriological and epidemiological investigations. They will be numbered serially. They will not be assigned definitely to corps but will be attached to armies, corps, or other units when their services are required. For administrative purposes and purposes of mobility, they will be controlled directly by the chief surgeon.
Activities-Investigation of special problems, epidemics, reinforcement of laboratory units in the zone of the advance, etc.
Personnel-
1 commissioned.
2 enlisted.Transportation-1 motorized bacteriological laboratory.
(7) Division laboratories-
(These units will be assigned definitely to divisions and will be under the order of the division surgeon.)
Activities-General routine pathological work for the division, including bacteriological and chemical examinations of water supplies. When the division is in training, the laboratory unit should be attached to the camp hospital in its particular area. When serving at the front, one bacteriologist and technical assistant will be detached for service in wound bacteriology at evacuation hospitals or special surgical units near the front.
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Base laboratories-Continued.
(7) Division laboratories-Continued.
Personnel-
1 medical officer.
1 officer, Sanitary Corps (water).
4 enlisted.Transportation-
The portable laboratory is to be transported on the sanitary train of the division. 1 motor cycle with side car.
Equipment-In chests, each chest containing a complete unit for a definite purpose. Number of units assigned dependent on character of work anticipated. Ordinarily the equipment furnished will meet the requirements for routine clinical examinations (chemical and bacteriological), examinations of water supplies, and wound bacteriology.
(8) Special units-
Motorized mobile units.
(a) Bacteriological cars.
(b) Meningitis cars.Transportable mobile units (in chests)-
(a) Meningitis units.
(b) Diphtheria units.
(c) Pneumonia units.
(d) Typhoid group, dysentery units.
(e) Wound bacteriology units.
(f) Water supply units.
(g) General bacteriological units.
(h) Camp hospital laboratory units.
(i) Division laboratory units.NOTE.-These special units will be assembled at the central Medical Department laboratory and sent where required. Their expendable supplies (culture media, stains, etc.) will be replenished at the central and base laboratories.
In addition to the functions outlined in this plan, the division of laboratories assumed certain others also; e. g., the collection of statistics on routine and special work done in laboratories, cooperation and coordination with the Chemical Warfare Service, supervision of the collection of museum and photographic records of the Medical Department, and research in a number of medical problems. Furthermore, additional sections later were added to the division, viz., that of food and nutrition, and that charged with supervision of purification of water supplies.1
Some other modifications of this original plan also proved necessary,the more important being the following:1 Army laboratories ofa stationary type were not organized, and mobile units were assigned tothe headquarters of field armies for use in investigations of epidemicdisease in the field; corps laboratories were not organized, for only exceptionallycould highly specialized, technical, bacteriological work, such as woundbacteriology, be done in evacuation and mobile hospitals during activemilitary operations; the divisional laboratory units usually were unableto function, from the purely laboratory point of view, during combat, andfurthermore they required additional equipment when in rest or trainingareas.1
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However, after the chief surgeon's approval of the plan detailed above,efforts were immediately begun by the director of laboratories to carryit into effect, the organization of the laboratory section and more particularlythe establishment of a central (headquarters) laboratory being given firstconsideration.1 After a thorough study of the projected lineof communications it was decided that the central laboratory should belocated at Dijon, which situation presented many natural advantages. Thechief reason for selection of this locality was its proximity to the Americanfront and training areas and to the main line of communications.1Ona visit of inspection to that city by the director of laboratories on December15, 1917, a modern laboratory building was found which constituted a partof the plant belonging to the University of Dijon. Late in the same montharrangements were completed for taking over this structure and here thecentral Medical Department laboratory was established on January 1, 1918.1On the same date the director of laboratories moved his office to the samepoint from Neufchateau, where it had been located first in the office ofthe commanding officer of Army laboratory No. 1, and then in a hut erectedbeside the laboratory.1
At Dijon the director's office was first established in the centralMedical Department laboratory, but in April, 1918, a temporary wooden officebuilding 100 feet long and 20 feet wide, located on the grounds of thelaboratory, was completed and occupied by the director.1
The preliminary plans for the office provided that only two-thirds ofthe building would be used for office purposes, the remainder being reservedfor storage and expansion if necessary, but even before this plan couldbe applied the volume of work had so greatly increased that the entirebuilding was arranged for office purposes. One large room served as a combinedoffice and library, partitions dividing the remainder into small officeswith connecting doors.1 The structure was well lighted by electricityand was heated by stoves during the winter months; telephone connectionsthrough a local switchboard provided communication both with local anddistant offices. Eventually satisfactory telephone connections could bemade with places as far distant as Bordeaux, St. Nazaire, and Brest.1The director's office remained in this building until it was transferredto the office of the chief surgeon at Tours in June, 1919.1
The general arrangement of the offices and the relationship of the officebuildings to the central Medical Department laboratory are shown in Figure5.
Until February the director's office force was still limited to onestenographer, but efficient office and other personnel was then procured,adequate to requirements.1
On February 6, 1918, the director of laboratories was directed to makesuch journeys as were necessary in matters pertaining to the service ofthat specialty.1 Prior to January the urgent necessity for completionof plans for the organization of this division had been such that but littletime could be devoted to inspections.1
During the period from August to December, 1917, inclusive, the plansof organization of the division were elaborated, definitely formulatedand adopted; from January to June, 1918, inclusive, the laboratory serviceunderwent active
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development; from July to November, 1918, inclusive, it worked understress; and from December, 1918 to July, 1919, inclusive it underwent demobilization.1
In the spring and early summer of 1918, a considerable number of additionalactivities were assigned to the division and new sections were establishedas mentioned above.1
On May 22, 1918, the director of laboratories forwarded to the chiefsurgeon the following letter,4 which gave a general summaryof organization then effected and projected, and especially stressed thetransportation needs of the laboratory service.4Such needs became of very urgent importance later.1
FIG. 5.-Groundplan, headquarters, division of laboratories, A. E. F., and central MedicalDepartment laboratory, Dijon
1. I am inclosing herewith a table of organization forlaboratory units that this office considers necessary for the AmericanExpeditionary Forces; as will be noted the laboratories are divided intotwo basic types: Stationary and transportable.
STATIONARY LABORATORIES
2. Central Medical Department laboratory.-Thislaboratory is situated in the advance section and is thoroughly equippedto do any work that may come up. It is estimated that it will eventuallyrequire 25 officers and 50 enlisted men. So far as is possible we are cuttingdown the enlisted personnel by the employment of civilian technicians andlaboratory assistants, thus releasing male personnel for more urgent fieldduties. The civilian personnel is quite satisfactory and is in realitycheaper than enlisted personnel.
This laboratory, in addition to its permanent personnel,has established laboratories equipped for special investigations. At thepresent time surgical shock and chest surgery are the subjects of specialinvestigation in special laboratories. The water-supply service, A. E.F., is provided with special laboratories here. We have arranged with theintelligence section, general staff, to organize a special chemical sectionhere for the investigation of
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correspondence and the development of invisible inks.Special problems will come up from time to time and this laboratory willbe prepared to handle them.
Referring to transportation required for this particularlaboratory, it will be necessary to send laboratory personnel out fromthis center to various parts of the Advance Section and Zone of Advancefor investigation of epidemic diseases. The motor cars, light, are requiredfor this particular purpose. It will also be necessary to deliver standardizedlaboratory units and replenishment supplies to mobile units in the zoneof advance, and three motor trucks, medium, and three motor trucks, light,will be required to meet these needs. We have adopted a standard expandablelaboratory unit system in chests with the idea that when a special investigationof epidemic diseases is to be undertaken, one of these transportable laboratoryoutfits can be placed on a motor truck, medium, size 1½ tons capacity,proceed to the area to be investigated, unpack the chests and organizethe laboratory in a vacant room. On completion of work of this characterthe laboratory can be repacked within an hour's time and returned to itsstation with its own transportation.
Laboratory supplies and sera of various kinds will berequired in the front areas, and these can be taken care of (when railroadfacilities are not direct or possible) by the light motor trucks and bymotor cycle with side car. The two bicycles can be used for messenger workin the city. This laboratory has at the present time three bacteriologicalcars, motor, and these cars will be used for investigation of special epidemics.
3. Base laboratories, sections Services of Supply.-Baselaboratories are being organized in each of the sections on the lines ofcommunication. Already one has been established for base section No. 1,base section No. 2, and intermediate section, Services of Supply, and stationarylaboratories are now en route from the United States for base section No.3 and base section No. 5. These laboratories will handle the general laboratorywork and laboratory work concerned with the prevention of infectious diseasesin their respective sections. To carry out this work efficiently and effectively,transportation will be necessary. One light motor car, passenger, is askedfor; one motor cycle with side car; one bicycle; and one motor truck, medium.To each of these laboratories one transportable laboratory outfit willbe supplied and one 1½-ton motor truck will be required to transportthis laboratory from place to place for the investigation of epidemics.
FIG. 6.-Floorplan of the office of the director, division of laboratories, A. E. F.
4. Base hospital laboratories at base hospital centers.-Wehave organized at each base hospital center one laboratory well providedas to personnel and equipment. This laboratory will serve as a centrallaboratory for the entire group of hospitals, and in this laboratory itis proposed that all highly technical bacteriological and serological workwill be done. In addition to this it is the intention to establish a certainnumber of small clinical ward laboratories in connection with a certainnumber of wards. By carrying out this arrangement we will conserve buildingspace, equipment and personnel. The only transportation necessary for sucha unit is a motor cycle with side car and one bicycle.
5. Base hospital laboratories at base hospitals.-Theselaboratories will be provided for base hospitals of from 1,000 to 1,500beds. No transportation will be required for such units.
6. Army laboratories.-We are organizing in theadvance section, or zone of the advance, laboratory units that will beof a fixed character and will be known as Army laboratories. These laboratorieswill be so located that they will be closely in touch with troops in theline, and it is proposed that all highly technical bacteriological andserological work for divisions in the field be done by these units. Theywill also be provided with a transportable labora-
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tory unit for the investigation of epidemics and willcare for epidemics in their particular section. In order to carry out workon epidemics effectively, it will be necessary to supply them with a 1½-tonmotor truck for the transportation of the transportable laboratory.
TRANSPORTABLE OR MOBILE UNITS
7. Camp hospital laboratories.-We have arrangedto supply camp hospitals with transportable units in chests, but as theseunits are permanent or semipermanent, no transportation for carrying theirtransportable units will be necessary. They should be provided, however,with a motor cycle with side car, in order that they may be in close touchwith infirmaries and other units for which special work will be done.
8. Evacuation hospital laboratories.-These unitsare made up of the standard transportable outfits and consists of eightchests. They should be provided with a 1½-ton motor truck to carrytheir equipment. This truck will be used constantly by the pathologicaland museum units attached to the laboratory of evacuation hospitals whennot in use.
9. Mobile hospital laboratories.-A transportablelaboratory unit consisting of eight chests is required for each mobilehospital, and in order that it may be transported one truck, motor, medium,will be required.
10. Divisional laboratories.-This laboratory unitis attached to each division, and its equipment consists of three of thechests of the standardized transportable outfits. To make this unit mobileit will be necessary to supply one light motor truck capable of carryingthese three chests. This unit will also require one motor cycle with sidecar.
11. In connection with the transportation provided forin this T. of O., this office is convinced that the laboratory servicewill not and can not perform its functions properly unless provided withtransportation. In working out the organization of supplies for mobileand semimobile units, we have endeavored to standardize equipments, andthis has been accomplished by providing an expandable unit laboratory systemin chests. These chests are so arranged that a given number of chests willcare for the work of camp hospitals and divisions, while the evacuationhospitals and mobile hospitals will require the full number-eight. TheBritish system has been somewhat different. They have organized a unitsystem consisting of a bacteriological motor car, with the idea that thenecessary work would be done in this car. As a matter of practice it hasbeen found that usually the equipment would be taken out of the car andplaced in a vacant room provided the unit remained at one place for anygreat length of time. These cars cost approximately $7,000. We feel thatthe system adopted by us will be more satisfactory and will be much cheaper,provided the necessary transportation is furnished. A standardized laboratoryunit of chests costs, complete, about $1,200, and a motor truck of 1½-toncapacity will probably cost in the neighborhood of $2,000. This makes about$3,500, while the British units cost from $6,000 to $7,000.
12. It will be necessary that the truck transportationallowed for these mobile units be assigned very definitely to these particularlaboratory units; otherwise they lose their mobility. Laboratory suppliesare difficult to secure. We have heard that during a recent German offensiveon the Western Front the laboratory service for the British Army in Francewere able to save their entire equipment. This was possible by reason ofthe fact that they had transportation definitely assigned to them.
J. F. SILER,
Lieutenant Colonel, Medical Corps, United States Army.
As mentioned above, the division of laboratories had been included amongthe professional services prescribed in Circular No. 2, chief surgeon'soffice, A. E. F., November 9, 1917.3 But that division, beinga part of the division of sanitation in the chief surgeon's office, andtherefore in a somewhat different administrative position from the otherprofessional services which were under control of the hospitalization division,was not grouped with these when they were reorganized by Circular No. 25,chief surgeon's office, A. E. F., May 5, 1918, and by General Orders, No.88, G. H. Q., A. E. F., June 6, 1918.
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The director of the division of laboratories enjoyed entire freedomin the organization and development of his department except that all mattersof policy and those affecting the service in general were submitted tothe chief of the division of sanitation for final decision.1The director was authorized to issue circulars, memoranda, and specialletters of instructions concerning matters of interest in the laboratoryservice. Memoranda which were of interest to the Medical Department atlarge were submitted to the chief surgeon and issued as circulars fromhis office.1
At the time the office of the director of the division was establishedat Dijon, that of the chief surgeon was located at Chaumont, and becauseof their proximity there were then no great difficulties of coordination.But after the chief surgeon's office was transferred to Tours, in March,1918, the unavoidable congestion of telegraph and telephone lines, necessarycensorship regulations, and irregular mail facilities often caused considerabledelay in receipt of orders affecting transfer of personnel.1This situation was remedied by granting to the director of the divisionin August, 1918, authority to issue suitable orders to personnel underhis control whereby he could meet emergencies and fill existing vacanciesfrom the reserve staff on duty at the central medical department laboratory.1Thereafter the efficiency of the laboratory service was greatly increased,particularly by promoting both the early investigation of epidemic diseasesand quick response to emergencies that developed during combat. Bettercoordination would have been secured if the director's office had beenlocated in the office of the chief surgeon, for delays which occurred attime in communication would have been obviated.1 But many andgreater office advantages accrued from maintenance of close contact betweenthe director's and the central Medical Department laboratory at Dijon.1The laboratory was so located that it was less than six hours distant from1,500,000 troops and from hospitals with a total capacity of more than100,000 beds. Request was made of the hospitalization division of the chiefsurgeon's office that the director be promptly apprised of the arrivaland location of all hospital units arriving overseas.1
GENERAL CORRELATION AND ACTIVITIES
In order to correlate the work of the division with the activities ofthe Medical Department in general, the following methods were employed:1
Letters covering the progress of the work and plans for the future werewritten at frequent intervals to the chief of the division of laboratoriesin the office of the Surgeon General at Washington, and in July, 1918,an officer was sent to Washington in order to give more definite informationconcerning the various problems confronting the laboratory service of theAmerican Expeditionary Forces.1
The director had frequent conferences with the head of the divisionof sanitation in the chief surgeon's office, the progress of the work beingreviewed and special matters brought up for final action.1
Weekly reports, covering the general activities of the division weresubmitted to the chief surgeon and copies forwarded to the Surgeon General.1
Copies of all reports on investigations of epidemics as well as reportsthat were considered of sufficient interest were transmitted to the chiefsurgeon for his information.1
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When general or technical circulars involving action by some other divisionor service were contemplated, that division or service was consulted, andapproval and cooperation secured before the circular was published.
A special mailing list was prepared, including divisions of the chiefsurgeon's office, the professional divisions, the sanitary school, thePasteur Institute, the adviser in pathology to the British ExpeditionaryForce, the secretary of the British research committee, the secretary ofthe research committee of the American Red Cross, and individual officerson duty with the American Army, the French Army, the British Army, andthe Italian Army, to all of whom special memoranda, etc., were forwarded.1
Officers of the division represented it at the meetings of the Inter-AlliedSurgical Congress.1 The director of the division attended sessionsof the research committee organized by the American Red Cross, of whichcommittee he was a member.1
Matters affecting the medical and surgical services were taken up throughliaison officers appointed for this purpose by the chiefs of those services.These matters, in so far as the medical service was concerned, included,among others, control of epidemic diseases.1
All matters relating to water supplies were taken up with the seniorrepresentative of the Medical Department with the water supply service,A. E. F.1
In the summer of 1918, it was planned to initiate conferences of specialgroups of officers at stated intervals for the purpose of discussing specialfeatures of their work and the local problems with which they had to contend.1These meetings were to be held every month or six weeks, at the centralMedical Department laboratory, and were to be limited to groups of officersengaged in identical lines of work.1 One meeting was to includethe commanding officers of base laboratories operating in the differentsections of the Services of Supply, and the officers engaged in diseasecontrol; one was to include the commanding officers of base laboratoriesin hospital centers; another the laboratory officers of evacuation andmobile hospitals; another the officers in charge of division laboratories,etc.1 But because of combat activities it was not possible tocall the first conference until November 1 and 2, 1918.1 Thiswas attended by the chief of the division of sanitation, chief surgeon'soffice and his assistant, by the commanding officers of the base laboratoriesfunctioning in the sections of the Services of Supply, by sanitary inspectorsof the sections of the Services of Supply, and others.1
After the signing of the armistice, conditions became so unsettled thatit was not practicable to continue these conferences.1
DIRECTOR'S OFFICE
ADMINISTRATIVE DETAILS
For administrative purposes the office of the director, division oflaboratories and infectious diseases, was divided into six general sectionswith one or more officers on duty in each as assistants to the director.These sections were: (1) Executive office and records, (2) central MedicalDepartment laboratory, (3) section of laboratories, (4) section of infectiousdiseases, (5) food and nutrition section, and (6) water supply section.1
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The offices of the director and those of the chiefs of all the sectionswere located in the same building except that the commanding officer ofthe central Medical Department laboratory had his office in an adjoiningstructure.1
While the ensuing text attempts, for the purpose of clarity, to discussseparately the several sections of the division of laboratories and infectiousdiseases, there was such close coordination and overlapping of severalof these that note should be made of that fact.1 Certain officerson duty at headquarters of this division at Dijon were also on the staffof the central laboratory or on that of the laboratory section.1The central laboratory while a part of the general laboratory system, washighly individualized, and from an administrative point of view was differentiatedfrom the section of laboratories in this division, but the activities ofthe latter were often supplemented by those of the former, as in the solutionof special problems and in other matters noted below.1
The records pertaining to all sections of the office of the director,except autopsy protocols and statistical reports, were centralized in asingle file, controlled by the same decimal filing system which was inuse throughout the Army.1 Incoming mail was classified by theadjutant and distributed directly to the officers concerned. Reports anddocuments of general interest went first to the desk of the director andwere then circulated in the office before going to file.1 Correspondenceand other matters requiring routine action were acted on by the officerdirectly concerned and only such matters were brought to the attentionof the director as were considered to be of interest to him, or concerningwhich his decision was required.1
Matters of general policy were taken up by the director with the officeror officers directly concerned and if considered desirable, with all membersof the staff who might have special knowledge of the subject or from whomadvice would be of value.1
Special memoranda, circulars and forms were prepared ordinarily by thesection most directly concerned, but those of special importance were reviewedby several members of the staff. These memoranda and circulars were oftwo general types: Those covering subjects of general interest to the entireMedical Department, and those covering technical matters pertaining tothe laboratory service.1 The former were forwarded to the chiefsurgeon for incorporation in official circulars issued by his office, whilethe latter were issued and distributed directly from the office of thedirector as "office letters," "memoranda," or "forms," those in each classbeing given serial numbers.1 A general idea of the materialforming the subject matter of circulars and memoranda may be gained fromthe lists given in the appendix.
The commissioned personnel of the division of laboratories was distributedand assigned mainly by the officer at the head of the laboratory section,with suggestions, in some instances, from the director.1 Thedistribution of the special personnel on duty in the sections of food andnutrition, of water supply, and of infectious diseases were assigned onthe recommendation of the officer in charge of those sections, respectively.1
The personnel of this division consisted of officers of the MedicalCorps with special training in laboratory procedures, sanitation, and epidemiology,or
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other special qualifications; officers of the Sanitary Corps who weresanitary engineers, had special knowledge of food and nutritional problems,were competent to make field surveys and laboratory examinations of watersupplies, had general or special qualifications in laboratory procedure,were artists, photographers, executives, or possessed other special qualifications;and enlisted men, many of whom had a special technical training.3
Not more than 12 officers of the Regular Medical Corps and of the SanitaryCorps, who served with the division of laboratories, had any service inthe Army prior to the war.3 Two of these medical officers andone officer of the Sanitary Corps were on duty in the office of the director,the others being assigned to laboratory administrative positions elsewherein the American Expeditionary Forces.3 The remaining personnel,consisting of approximately 670 officers, was drawn chiefly from civillaboratories.3 Many of the enlisted personnel were college graduates,undergraduate students, or men with special technical training in laboratorywork of various kinds. As with the Medical Department generally, therewas always a shortage both of total personnel and of those competentlytrained.3
The personnel to carry on the activities of the division of laboratorieswas acquired from various sources, mainly the following:3 (1)Base hospitals and a considerable number of evacuation hospitals, for theprescribed organization of both those types of units included laboratorypersonnel; (2) stationary laboratory units, of which 5 were sent to France,each consisting of 6 officers and 12 enlisted men; (3) special units sentto France for special, highly technical activities; (4) divisional laboratoryunits automatically dispatched to France for service with divisions; (5)detachments of casuals sent to France on cable requests from general headquarters.(6) The general medical service of the American Expeditionary Forces whencea considerable number of specially trained officers were drawn and assignedto duty with this division.3
All casual personnel and special units arriving in France for servicein this division were automatically ordered to the central medical departmentlaboratory, where their special qualifications were investigated and anynecessary special instruction given.1
The individual qualification cards of officers of the Medical Departmenton file in the headquarters office of the division permitted a broad generalclassification of qualifications, but for the highly technical activitiesin which the division of laboratories was engaged it was necessary to havea much fuller knowledge of the special qualifications of each officer.3A questionnaire, covering in detail the information desired, was thereforefilled in by each officer on duty in the division of laboratories and filedin the office of the director.3 A still better conception ofthe special qualifications of the individuals was gained by direct observationof from 300 to 400 of these officers who served on temporary duty at thecentral Medical Department laboratory either as casuals or as students,taking courses of instruction.3 These officers were interviewedby the personnel officer on duty in the office of the director of the division,and ratings of those undergoing instruction were submitted to him. Fromthese sources of information and from inspections of the work being donein the different laboratories an effort was made so to classify and dis-
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tribute the personnel that the necessary activities might be more efficientlyperformed and elimination of the incompetent effected.3 Thelaboratory personnel sent to France with the earlier base hospitals wasmade up, as a rule, of highly trained and competent men. This statementalso applies to many of the special units.3 The special laboratorytraining of a considerable percentage of the officers, however, consistedonly of the training ordinarily acquired in medical schools plus a shortcourse of training at the Army Medical School, at the Yale Army MedicalSchool, at the Rockefeller Institute, or at more than one of these institutions.3Therefore,special courses of instruction in the bacteriology of epidemic diseasesand in the bacteriology of war wounds were given at the central MedicalDepartment laboratory, approximately 250 officers taking one or the otherof these courses.3 Because of the scarcity of trained administrativepersonnel it was not practicable to form two detachments, one consistingof casuals under the administrative control of the director's office, andthe other of permanent personnel assigned to the central Medical Departmentlaboratory.1 Therefore, both permanent personnel and casualswere carried on the records of the detachment at the central Medical Departmentlaboratory as of a duty status, for rations, quarters, personal equipmentand for statistical and other matters pertaining to the interior administrationof a detachment.1 A list of the permanent personnel on dutyat the central Medical Department laboratory was kept by the adjutant inthe director's office. It was understood that all other personnel was tobe considered as casual and subject to assignment by the director withoutprevious consultation with the commanding officer, central Medical Departmentlaboratory.1 After investigation of their qualifications andany necessary special instruction, officers of this division were assignedto appropriate stations.1
The division of laboratories was charged with the organization of newlaboratory units and the distribution of personnel under its supervision.All requests for laboratory personnel were referred to it, and assignmentsand changes in station made on recommendation of the director.3
While in May, 1918, less than 140 commissioned officers were engagedin activities under the supervision of this division, by November, 1918,this number had increased to 683.3 Their distribution, by corps,grade, and general duties, is shown in the following table:3
Personnel on duty in division of laboratories and infectiousdiseases in November, 1918?
| Colonels | Lieutenant Colonels | Majors | Captains | First lieutenants | Second lieutenants | Totals |
Section of laboratories and infectious diseases: |
|
|
|
|
|
|
|
| Medical Corps | 1 | 10 | 20 | 124 | 317 | --- | 472 |
| Sanitary Corps | --- | --- | 2 | 6 | 64 | 76 | 148 |
Section of food and nutrition: Sanitary Corps | --- | --- | 4 | 11 | 15 | 2 | 32 |
Section of water supplies: Sanitary Corps | --- | 1 | --- | 5 | 15 | 10 | 31 |
| 1 | 11 | 26 | 146 | 411 | 88 | 683 |
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PERSONNELa
Col. Joseph F. Siler, M. C., chief.
SECTION OF LABORATORIES
Col. George B. Foster,Jr., M. C., chief.
Lieut. Col. William J. Elser,M. C.
Maj. Ward J. McNeal, M.C.
SECTION OF INFECTIOUS DISEASES
Col. Richard P. Strong, M. C., chief.
Col. Hans. Zinsser, M. C.,chief.
Maj. Ward J. McNeal, M.C., chief.
Maj. Richard M. Taylor,M. C., chief.
SECTION OF WOUND BACTERIOLOGY
Lieut. Col. William J. Elser, M. C., chief.
Maj. Benjamin Jablons, M.C.
SECTION OF WATER SUPPLIES
Maj. Harry B. Hommon, San. Corps, chief.
Capt. Machael J. Blew, San.Corps.
Capt. Alvin R. Harnes, San.Corps.
Capt. Walter C. Russell,San. Corps.
Capt. Emery J. Theriault,San. Corps.
First Lieut. Henri E. St.Pierre, San. Corps.
SECTION OF FOOD AND NUTRITION
Maj. Walter H. Eddy, San Corps, chief.
Maj. Phillip A. Shaffer,San. Corps, chief.
Maj. David Klein, San. Corps.
Capt. Fred F. Flanders,San. Corps.
First Lieut. S. C. Dinsmore,San. Corps.
MUSEUM AND ART SECTION
Col. Louis B. Wilson, M. C., chief.
Maj. Henry W. Cattell, M.C.
LABORATORY OF SURGICAL RESEARCH
Lieut. Col. Walter. Cannon, M. C., chief.
Lieut. Col. J. L. Yates,M. C.
aIn this list have been included the names of those who at one time or another were assigned to the division during the period July 28, 1917, to July 15, 1919.
There are two primary groups-the heads of the division or the section and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
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REFERENCES
(1) Report from Col. J. F. Siler, M. C., director of laboratoriesand infectious diseases, A. E. F., to the chief surgeon, A. E. F., undated.Subject: Activities of division of laboratories and infectious diseases,from August, 1917, to July, 1919. On file, Historical Division, S. G. O.
(2) Letter from the chief surgeon, A. E. F., to the SurgeonGeneral, U. S. Army, August 12, 1917. Subject: Outline of laboratory organization,
A. E. F. On file, Record Room, S. G. O., 322.15-16 (A.E. F.) (Y).
(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,
A. E. F., to May 1, 1919. On file, Historical Division,S. G. O.
(4) Letter from Lieut. Col. J. F. Siler, M. C., directorof laboratories, A. E. F., to the chief surgeon, A. E. F., May 22, 1918.Subject: Table of organization for laboratory units. On file, A. G. O.,World War Division, chief surgeon's files, 451.
