SECTION IV
TYPES OF HOSPITALS
CHAPTER XIV
BASE HOSPITALS AT CANTONMENTS AND CAMPS
BASE HOSPITAL, CAMP GRANT, ILL.a
PHYSICAL CHARACTERISTICS
Geographic location.-The hospital was located in the northeast corner of the military reservation of Camp Grant, Winnebago County, Ill., on the banks of Rock River, about 3 miles from the center of the city of Rockford.
Terrain.-The country surrounding the site of the hospital is gently rolling along the Rock River, into which it drains.
Soil.-The soil is a sandy loam containing deposits of gravel. Because of the character of the soil there was, in the immediate vicinity of the hospital, very little high-flying dust in dry weather; and what little there was was largely eliminated by means of grass grown on the neighboring unoccupied land. The soil became very muddy after rains, but the subsequent provision of cinder and board walks prevented the carrying of mud into the hospital corridors and wards by the personnel, patients, and visitors.
Roads.-The roads for transportation were three in number: One running northwest and southeast (the Kishwaukee Road); one running north and south; and one encircling the hospital. The Kishwaukee Road, extending to Rockford, was a well-built concrete road (about 20 feet wide); the road running north and south was of macadam; and that encircling the hospital was of cinders.
Climate.-Extremes of heat and cold were experienced. The mean temperature during the summer was 80 F.; in winter, 15. During the summer, however, there was usually a pleasant breeze from the southeast blowing up the river.
Sanitary status.-The sanitary status of the neighborhood of the hospital was good. The Rock River, flowing along the western boundary of the hospital, is a very beautiful, rapidly running stream, shallow and not navigable, varying in breadth and containing wooded islands. Into this stream the entire sewage of the camp emptied.
STAGE OF DEVELOPMENT
Organization.-The organization of the hospital may be divided into two periods, the first being that in which temporary quarters were occupied for hospital purposes; and the second, from the time when the base hospital officially assumed control of the buildings designed for its permanent occupancy. The
aThe statements of fact appearing herein are based on the "History, Base Hospital, Camp Grant, Ill.," by Lieut. Col. H. C. Michie, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General`s Office, Washington, D. C.-Ed.
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organization was gradual and part of its history is intimately associated with the period prior to the time when the hospital was officially designated a base hospital, and before the mobilization of the divisional troops had occurred. The events of that early period will be given to complete the historical description of the hospital and to show the metamorphosis of the camp into the base hospital.
During the earliest construction period information was received at the camp that troops would be assigned to that place commencing about: September 1, 1917. The contractors promised the camp surgeon that the base hospital would be in readiness for occupancy on August 26, 1917; but as the plans for it were not received from the War Department until about the middle of August, and in view of the fact that special building materials were required, none of which was yet on hand, a further delay was necessarily caused.
At this time there was a small number of troops in camp who had been provided as guards during the construction period. These troops required hospital facilities of some sort, and early in August the building contractors were requested by the camp surgeon to build an infirmary (regimental) building as soon as possible. To equip this building a 24-bed camp hospital was requisitioned by the camp surgeon, and on August 12, 1917, a small hospital of 24 beds was opened in Zone I of the camp. Nine patients were admitted at that time and were carried as "sick in quarters." There were no cooks for this newly organized hospital and in order to hurriedly provide this necessary personnel two promising enlisted men of the Medical Department detachment were assigned to one of the guard companies for one week to receive training in cooking.
The personnel of the Medical Department at that time included, in addition to the camp surgeon, two medical officers and five enlisted men.
When it became obvious to the camp surgeon, about the middle of August, that the base hospital would not be in readiness at the time mobilization was scheduled, a complete field hospital, with the exception of transportation, was requisitioned. This equipment was promptly received and, when put into use, augmented the bed capacity of the hospital to 240. An adjacent regimental infirmary, together with six recently finished barrack buildings, were temporarily taken over for use as hospital buildings. One of the two infirmary buildings was used as headquarters of the hospital, and contained, in addition, the medical supply room, dental office, and the genitourinary wards. The other infirmary building was used as a kitchen and contained, in addition, the officers` ward and operating room, surgical wards, and space for the special medical examiners who had been detailed to duty at the camp in connection with physical examination of the registrants of the draft.
Twenty-one additional Medical Department enlisted men were assigned to duty at the camp before the draft registrants had arrived. A course of instruction, which comprised nursing and operating-room technique, was begun in the hospital for them. For the operating room technique, mock operations were conducted.
By the end of August, 1917, there were 19 officers on duty at the camp hospital, in which there were 27 patients. The chief of the medical service, together with nine of his assistants, had reported in compliance with War Department orders.
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No heat had as yet been installed in any of the buildings being used for hospital purposes, and, as at that time the weather was cold and wet, a request was forwarded to the War Department for authority to purchase 40 oil stoves. This was disapproved.
The first troops of the division arrived in camp September 5, and from then on the number of patients in hospital rapidly increased. The necessity for heat was demonstrated to the division commander, who immediately authorized the purchase of the required number of oil stoves.
All officers and enlisted men of the Medical Department, assigned to duty at Camp Grant during this period, were attached to the hospital for rations and quarters. This practice continued until October 14, 1917. It was quite difficult to satisfactorily care for them at first, principally because of the lack of cooks in the hospital detachment. This was gradually remedied, however, by assigning to the kitchen men who were seemingly most suitable and who were coached by qualified men from the camp school for bakers and cooks.
The construction work on the new base hospital was being rapidly pushed, and by October 14, 1917, it was ready for occupancy, with the exception of the section for head surgery in the administration building, the receiving ward, and the officers` quarters.
The camp hospital was discontinued on October 14, 1917. The patients which it contained, still requiring treatment, were moved to the new base hospital. The equipment for a 500-bed base hospital had, in the meantime, been received and had been properly distributed in the new hospital. The equipment which had been used in the camp hospital, being no longer required, was turned in to the camp medical supply depot.
Hospital provision for civilian employees engaged on the construction work of the camp buildings was made by the contractors. At first these contractors claimed that the Army should give care and treatment to all sick and injured civilian employees. The camp surgeon, however, informed them that this was not authorized, but that the injured employees` compensation act of September 7, 1916, required the contractors to provide hospital and medical attention for all personnel employed by them who became injured in their service. After several weeks the contractors accepted this view and completed one of the regimental infirmary buildings in which a hospital for emergency treatment was started. Cases requiring more than emergency treatment were sent to the Rockford City Hospital.
CONSTRUCTION FEATURES
There was considerable delay in commencing the construction of the hospital because of the delayed receipt of the plans for it from the War Department and because of the slow delivery of building materials. The materials used in the construction of the hospital were different in many respects from those required for the buildings in the main part of the cantonment; and, as the constructing quartermaster was not in the possession of information regarding where these materials had been ordered by the Cantonment Division of the War Department, it was impossible to trace them. Actual construction, therefore, was not started until the latter part of August, 1917. Once begun, however, no time was wasted; and, within a period of a little more than a month, it might be said that the hospital, as it had been originally planned, was prac-
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tically complete. The wards, with a capacity of 1,250, were ready for occupancy by the middle of October.
Experience in the use of the various buildings of the hospital demonstrated that the more closely the use of them was restricted to that purpose for which they were provided, the more excellent was their design. There were many features, however, in connection with the different buildings, which this experience showed should have been provided in some instances, and in instances where some features were provided these were used for other purposes.
Administration building.-In the administration building it was found that there was great need for toilet facilities for the various classes of personnel engaged in the performance of duty therein. These included officers, nurses, female employees, and enlisted men. There was, likewise, a constant demand for a utility room. In the sergeant major`s office there was an inadequacy of space; so, one half of the contiguous porch was inclosed and made into a part of the room. The information bureau had a totally inadequate space allotted for the volume of business it carried on. The room intended for the registrar was never used as such, but was converted into an office for the chief nurse.
Receiving building.-The receiving building was not satisfactory; there was a considerable wastage of space; and it was impracticable to admit patients in the manner prescribed by the Surgeon General`s Office; that is, to give each patient a bath, check his clothing, furnish him with hospital clothing and send him to a specified ward. There was but one bathroom in the receiving building; consequently, the contagious patients could not be mixed with other patients; moreover, the distance was too great from the major portion of the wards, and the corridors were too cold during the winter to risk sending patients through them immediately after the patients had been given a hot bath. The use of the observation rooms was found to be impracticable because of their inadequate capacity, and the lack of any provision for diets. As the south wing of the receiving building was used as the receiving office and the office of the detachment of patients, the available room in which to store patients` effects was sufficient for only 940 patients. The original arrangement for storing the effects of patients comprised a series of pigeonholes, 18 inches square. In these small spaces all the clothing had to be practically stuffed. This arrangement was changed by hospital labor so as to provide holes 18 by 18 by 9 inches, six in a vertical row along the upper half of the racks, the lower half being so arranged that the patients` overcoats, raincoats, blouses, and breeches could be suspended on clothes hangers. All underwear was laundered, and the outer clothing was pressed by a steam presser located in the clothing room. The officer of the day occupied the room constructed for him, and an adjacent room was used by the medical and surgical officers of the day. The noncommissioned officer in charge of male nurses occupied one room. A lavatory was divided into two rooms, making a unit lavatory. A small room adjacent to the receiving office was made into the receiving officer`s office, by constructing a door between the two rooms.
Officers` ward.-The officers` ward was well constructed; but the capacity originally provided was found to be too small, and an additional wing was added in the spring of 1918. Officers suffering from contagious diseases were cared for in the isolation ward at this hospital. This would have been obviated had
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the additional wing been separated from the main portion of the officers` ward, and been provided a diet kitchen, which would have permitted it being operated as a contagious ward. The lack of an electric bell system was seriously felt, and one was provided by the personnel of the hospital. Inconvenience was likewise experienced because of the lack of clothes closets in the separate rooms of the ward.
Head house.-In the head house the dental department was very satisfactory. In the eye wing, and ear, nose and throat wing, a considerable amount of space was unused. Experience demonstrated that these activities could have been operated in a considerably more restricted building.
X-ray laboratory.-In the X-ray laboratory there was never sufficient space to carry on the necessary work, and the inadequacy became more apparent as a large number of plates and films accumulated for storage. The need of a toilet was repeatedly demonstrated, not only for the use of personnel, but for use by patients, particularly those who had been given bismuth meals.
The laboratory.-The laboratory as originally constructed was entirely too small, but in the spring of 1918 a satisfactory addition was made to it. No adequate storeroom having been provided, the short corridor running southeast was closed at the east end and this space was made into a very satisfactory storeroom. The animal house was located in the small space surrounded by the laboratory building and three corridors, was provided with a concrete floor, floor drains, and hot and cold water, and was heated by steam heat. The area surrounding the animal house was used as a yard for the animals. Since no chemical work was done at the hospital the hood and chemical laboratory were used as a place for the preparation of media. To facilitate the filtering of the media two small pipes were installed, fitted with funnels, and connected with the high pressure steam line. The arrangement operated most satisfactorily. To provide a water still of adequate capacity, an unserviceable hot water tank from a battery of sterilizers was connected with the high-pressure steam line and the cold water pipe. This improvised still had a capacity of 50 gallons a day. The gas plant, which was a part of the laboratory equipment, could never be made to operate, and proved to be a fiasco.
Surgical pavilion.-Except for an inadequacy of space the operating pavilion was satisfactory. To overcome the deficiency an addition was constructed, by the personnel of the hospital, north of the operating room and east of the corridor. This additional building was divided into three rooms-an office for the chief of the surgical service, an examining room with which it connected, and a room which was provided with a concrete floor and made into a gauze-reclaiming laundry. Immediately east of this division a pit was dug, lined with concrete and covered. An emergency boiler was placed there and connected with the high-pressure steam line. It so happened, however, that it was never necessary to use this emergency boiler.
Post exchange.-Structurally, the exchange met all the requirements of the hospital, and no necessity arose which required any alterations in it. There were some objections connected with it, however, which were principally due to its location. Because it had been centrally placed it was practically impossible to prevent patients from buying any and all forms of foodstuffs, regardless of the diets prescribed for them. It was practically impossible, also, to keep the adjacent corridors clean. These objectionable features would have been
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obviated had the exchange been located in a less accessible portion of the hospital group.
Mess and kitchen.-The capacity of the general mess proved to be always ample. There were some faulty features in the original construction, which, profiting by experience, could be readily eliminated. The original tables were poorly constructed in that their tops were made of 3-inch tongue-and-groove boards, securely nailed down. These boards shrank, leaving fairly wide cracks in which foodstuffs collected, making it practically impossible to keep them clean, and it was necessary to cover them with oilcloth. The ceilings were too low for the size of the building; consequently, the rooms were dark; and because of the absence of sunlight, the floors dried very slowly after being mopped. This difficulty was increased when the two additional wings were constructed. Ventilation of this room was found to be difficult also. The main diet kitchen was very satisfactory, but it was improved by installing in it a large electric range. The equipment of the main kitchen was adequate and well selected. A charcoal oven for pies was purchased and installed, but unfortunately was not a success. A toilet and root cellar were installed in the spring of 1918, and these proved highly satisfactory. The potato parer, meat chopper, and bread cutter were very satisfactory as labor and time saving devices. The ice boxes and refrigerating plant were ample and satisfactory in every respect. The storeroom was insufficient at first, but with the construction of the new wing this shortage was eliminated. There was no original provision for the storage of bread, and a large bread cabinet was built by the personnel of the hospital in the room opposite the ice boxes. The runway northwest of the ice boxes, intended for the passage of food carts, was unused and proved to be waste space. It was found more satisfactory to have the food carts pass down the corridors and be served at the two large kitchen doors. To provide an office for the mess officer so that he could be constantly at the mess, and have sufficient space for his clerks and records, a room about 12 by 15 feet was built in the north corner of the kitchen, for which purpose a portion of the storeroom was taken. The space between the center and southwest wings was covered over and inclosed with wire screening. This was provided with a concrete floor in which there was a floor drain, and the space was used as a central garbage station. Approximately 40 garbage cans were assembled there, according to the class of garbage designated for them. One man was kept on duty to care for this station, at which garbage from all wards of the main part of the hospital, as well as from the general mess, was collected. Men from the wards brought the garbage, after each meal, in closed commodes. Entrance to the garbage station for these men was from the outside.
Guardhouse.-The guardhouse proved to have no value as such to the hospital, as all prisoners were taken care of by other organizations in camp.
Single wards.-The linen closet of the single ward being entirely too small for a place in which the head nurse could have an office, it was never used for that purpose. In the recovery room there was rarely necessity for the use of more than one bed. The diet kitchen was satisfactory except that no shelving was provided; and, as it was not possible to obtain this until after January, 1919, a kitchen cabinet for each ward was provided, in lieu of shelving. These cabinets were built to order in Rockford, Ill., to provide storage facilities for the standard ward kitchen equipment. This equip-
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ment was sent to the factory with instructions to build a cabinet adequate to contain it, and, in addition, 18 loaves of bread. These cabinets proved to be better than shelving and were provided at about an equivalent expense. Their cost was $19 each. In the ward utility room no shelving was originally provided and there was insufficient shelving constructed in the linen closet. As no provision had been made in the ward surgeon`s room for papers, a set of pigeonholes was built by the Lane High School of Chicago for each ward. There were 60 pigeonholes in a set, each hole measuring 4 by 4 by 8 inches, which gave adequate space for each chart separately, and all the necessary blank forms. The toilets of the wards were satisfactory and met all requirements. The wards proper provided ample space for 34 patients, and the verandas, inclosed with movable screens, were large enough to accommodate all of the beds when necessary. When additional fire doors were built in each ward, an elevated runway had to be constructed from the floor of the ward up to the door, and then down to the floor of the veranda, because the return steam line passed along the floor. It was considered cheaper to build this runway than to change the return pipe line. This created a somewhat unsightly appearance in the ward and made it difficult to place the beds uniformly. Lighting, heating, and ventilation of the wards were very satisfactory. The wall electric sockets were used but very little.
Double wards.-The double wards were very satisfactory for all types of diseases, except contagious diseases, and were satisfactory with the latter class of cases when there was a sufficient number of them to fill both wards. These wards had a common toilet in which there was ample opportunity for the intermingling of patients from both wards, and it was necessary to quarantine both wards when a case of contagious disease developed in either. The one corridor connecting the two wards was used as a recreation room. This was very satisfactory as smoking was prohibited in the wards proper. No floor boards were constructed for the shower baths and the patients complained of having to stand on the cold concrete when taking their baths.
Isolation wards.-The isolation wards proved very satisfactory for miscellaneous types of contagion. The greatest drawback was in taking care of patients in the provided rooms when there were different types of infection, as there was but one toilet in that portion of the building. The isolation wards were used for mixed cases when there were but few cases suffering from infectious diseases. The wards of the main part of the hospital were used when groups of the same contagious disease were sufficiently large to warrant it.
Psychopathic ward.-The psychopathic ward was adequate to care for all nervous and mental diseases developing at this camp. This was made possible of accomplishment by causing a very rapid turnover of patients and not allowing persons to remain therein when they were not strictly hospital cases. The building was very satisfactory except that it was felt the windows should have been covered by iron bars on the outside, and heavy wire netting screens on the inside. This was done in only a portion of the building. No heavy wire screening was provided to cover the radiators to prevent insane patients from burning themselves, and steam supply pipes and return lines were within rooms rather than being above and beneath, respectively.
Ward barracks.-The two-story ward barracks did not prove very satisfactory. As constructed, they provided four wards with separate linen closets,
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toilets, ward surgeon`s room, and ward master`s room. They were distant from the main mess, connected by open corridors, and had no diet kitchen. They were not satisfactorily adaptable for bed patients, and to use them for convalescents created a waste of one-third their space.
Wards of 200 beds.-At the signing of the armistice there were under construction five wards of 200-bed capacity each. These were located in the most convenient places, four of them being connected with the main part of the hospital by closed corridors. The wards, upstairs and down, were complete and separate. There were ample quiet rooms, toilet facilities, diet kitchen, and administrative offices. Wards of 100 capacity each would have been of great value to this hospital during the influenza epidemic and when large numbers of overseas patients were received.
Officers` quarters.-There was always a shortage of quarters for officers at this hospital. It was frequently necessary to place two junior officers in a room intended for one, and even this expedient left the quarters inadequate. They were, however, very well built and were quite comfortable. The recreation room of the officers` quarters was satisfactory as such, but general assemblies were held in the chapel, where more space was available. The dining room, kitchen, and storeroom proved to be very satisfactory. The quarters provided for attendants in the west end of the south wing were never used for that purpose.
Nurses` quarters.-The first quarters constructed for the nurses were inadequate both in the number of rooms and in the size of the recreation room. The individual rooms were also too small and all were quite dark. The second set was an improvement on the first and the dining room was of sufficient capacity to care for the nurses from both sets of quarters. Rooms of this newer set were larger, the building was constructed in a better manner and the halls were much lighter. The third set of quarters was a decided improvement over the second type. There were four buildings in this set, and they were used as quarters for the student nurses. They provided 104 rooms, all of which were used for the students. The fourth set of quarters was the best constructed at Camp Grant. The rooms were very large and light, the buildings, two in number, were well ventilated and lighted. They were two story buildings with plaster sidings. In one of them there was provided a large dining room and well-equipped kitchen, which proved ample for all of the nurses. The dining room, formerly used for the nurses, was then made into a very attractive recreation room. The quarters provided for the help, in the latest set, were found to be inadequate. Two cooks and 16 maids were required to carry on the work of the nurses` quarters and mess. Because of the fact that this fourth set of quarters was not connected with the hot water system of the main portion of the hospital, a separate hot water heater was installed in one of the buildings. No shelving was provided in the original set of nurses` quarters. Tables with a drawer were furnished each room in the second set. Nothing was provided for the third set and an open wardrobe and built-in table were provided for the fourth set. None of these was quite satisfactory to the nurses, and a dresser with mirror was purchased for each room. In addition, a wall writing desk was built at the hospital shop for the rooms in the student nurses` quarters.
Colored nurses` quarters.-A separate building was built for the colored nurses who were on duty at this hospital. These quarters had a dining room,
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kitchen, and storeroom combined. They were excellent quarters and met all requirements.
Detachment quarters.-These buildings were constructed for barracks for the detachment, Medical Department. They had a capacity of 62 men for each dormitory, in which, in addition, there were four separate rooms for noncommissioned officers. A solarium was provided in the east end of each. These quarters were very comfortable, well lighted, heated and ventilated. No provision having been made for storing the enlisted men`s clothing within the dormitories, a wall locker for each enlisted man was built by funds obtained from the post exchange. The total cost of these lockers was $1,140. They provided space for hanging the clothing, and there was a locked compartment at the top of each. A hasp and staple were placed on each locker and the soldier to whom it was assigned was provided a separate lock. The quarters of the enlisted men were primarily inadequate, and two additional sets of quarters were constructed in the spring of 1918. The outdoor toilets met all requirements. Additional quarters were authorized and construction was started on them in October, 1918. These buildings were of a more substantial type than those originally constructed and were of the same quality as the fourth set of nurses` quarters previously mentioned. Construction was stopped on these buildings when they were about 60 per cent completed.
The detachment mess.-The detachment mess was sufficient in size at first. In the spring of 1918, to accommodate the increased numbers, a short corridor was built connecting it with an adjacent building and both buildings were converted into a dining room. The kitchen was also enlarged and with these provisions it was possible to feed the entire detachment at one sitting. Prior to that time the surplus men were fed in the main hospital mess. A large detachment kitchen was constructed in September, 1918, and it provided excellent kitchen and storage facilities. The equipment for this kitchen was of the cafeteria type. The ice boxes were very large but proved to be poorly constructed and they required an unusually large amount of ice. The cafeteria plan of feeding the men was very satisfactory and was quite economical in the saving of labor. The completion of this new detachment mess was very much delayed because of the difficulty in procuring the new kind of kitchen equipment and it was not opened until about February, 1919. Following the reduction in the number of enlisted men on duty in the hospital this large detachment mess was closed in May, 1919, and its cafeteria equipment was removed and installed in the general hospital mess. The enlisted men and the ambulatory patients were subsisted by this cafeteria. Large black enamel waiters were purchased, by the post exchange of the hospital, in sufficient numbers to provide one for each person. There was difficulty at first in getting the ambulatory patients to use the cafeteria mess. A table was provided for those who were crippled, but great difficulty was encountered in restricting the use of it to the authorized. It was found that a great many patients secured canes and crutches to take with them to the mess, wholly as an excuse to sit at the table for the crippled and thus obviate the necessity of waiting upon themselves. In order to break up this objectionable custom, it was necessary to provide every table patient with a card from his ward surgeon. The cafeteria system proved excellent, generally, principally because of convenience of service and the saving of time. There was no evidence, however, that there was any great saving of food.
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Garage.-This building was adequate for three ambulances only. It was well built, but had no floor drains to carry off wash water. There were no lockers for the storage of fatigue clothes of those on duty in the garage building, nor were there shelves for the necessary garage tools.
Utility shop.-This building was provided as a carpenter, plumbing, and steam fitters` shop and was of adequate capacity, but, as other like buildings, contained no shelving. An electrically driven saw with much detachable apparatus was purchased by the post exchange of the hospital, with which to construct lockers for the men of the detachment. This apparatus proved of the greatest value in maintaining the essential repairs in and about the hospital. Work done in this shop was performed almost exclusively by a force of men belonging to the Medical Department detachment of the hospital, thus making it almost independent of the utilities department.
Laundry.-This building was constructed and was provided with a drying room, 22 tubs, collar racks, and a steam disinfector. Other laundry equipment
FIG. 81.-Laundry, Base Hospital, Camp Grant, Ill.
was not provided. The post exchange, however, purchased a complete set of laundry equipment and installed it in this building. It was necessary also to construct floor drains, as these were not originally provided. It happened that there was a laundryman in the Medical Department detachment to whom was given charge of the purchase and installation of the machinery. He afterwards trained the laundry force, which comprised 19 men. This force cared for all of the clothing of the detachment at a flat rate of $1.50 a month, and this included the cleaning and pressing of uniforms and overcoats. The men of the laundry detachment were given extra-duty pay at the rate of one-third of their salaries. The quality of the work they did was excellent and there were practically no complaints from the men. The laundry was able to reimburse the post exchange for the initial cost and declared dividends to the extent of approximately $5,000. The laundry also washed the face masks that were used in the hospital and frequently did emergency laundry work for the hospital, for which no charge was made.
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Mortuary.-This building proved very satisfactory so long as the number of deaths did not exceed four per diem. Because of the proximity of the hospital to Rockford, Ill., no embalming was ever done at the hospital. When autopsies were performed, the lack of running water over the post-mortem table was felt.
Chapel.-Except when deaths occurred in the detachment, the chapel was not used for funeral purposes; but the building proved very satisfactory and was used daily as a meeting place for officers, for courses of instruction. It was also used once a week for general meetings of the medical officers of the hospital and camp.
Power house.-The heating of the hospital was at all times adequate, and those troubles which occurred in the fall of 1917 and during the following winter were due to inefficient management. With the original construction there were a low-pressure system of steam heating, operated at approximately 10 pounds, and a high-pressure steam system for the steam tables, dish washers, and other kitchen equipment, as well as for the operating room and the laundry. The high-pressure system was kept at about 60 pounds. During the summer of 1918, a return system of condensed water was installed, and the pressure of the heating system was then maintained at about 30 pounds, reduction valves being installed at the entrance to every building. The hot water for the main portion of the hospital (as originally constructed) was heated in the power house and pumped to various parts of the hospital. For the first 12 months this was never very satisfactory; the water was never very hot and frequently it was cold. The hot water for the two-story ward barracks, the Red Cross Convalescent House, the three sets of nurses` quarters, and the colored nurses` quarters was heated by steam coils in the separate buildings. Prior to the summer of 1918, when there was no return system, the water of condensation was exhausted into the sewer. The steam coils which were used for heating the water proved to be very satisfactory, as the water was always as hot as could be desired.
Supply warehouse.-These buildings were well built, but proved to be insufficient in number when the hospital was operating at its maximum capacity. During the greater part of the time additional buildings of the hospital group were used for needed storage space. No shelving at all was provided these warehouses when they were constructed. It was therefore necessary to use scrap lumber and prepare temporary shelves upon which to place small articles until the necessary authority could be obtained from the War Department to provide suitable shelving.
The Red Cross Convalescent House.-The Red Cross Convalescent House was built and equipped by the American Red Cross. Heat, light, and water were furnished by the Government. This building proved to be very satisfactory as such, and met all reasonable requirements.
Corridors.-The corridors of the main portion of the hospital were all inclosed. Originally their floors were very rough and were made of short boards. As they were weak and constantly broke through, authority was obtained, in January, 1918, to lay a second flooring. This second flooring was placed on the original one, with its boards in the same longitudinal direction; consequently it did not strengthen it. Thereafter, it was not uncommon to
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see large holes throughout the corridors where the boards had broken through. The corridors connecting the two-story ward barracks and isolation wards were of the umbrella type and afforded no protection from the extreme cold in this section of the country. Large fire doors were constructed in the spring of 1918, to allow the crossing of motor-driven fire apparatus. In order to provide this passage, the level of the corridor floor was lowered to the ground. This necessitated the construction of two inclines, frequently as steep as 15 degrees. Because of this incline it was impossible to use hot water in the food carts of the wards, and in addition it was difficult to transport liquid foods in the carts. Wood strips, 3 feet long and 1 inch wide, were placed on these inclines half way across the corridor, to enable crutch patients to go up and down them. In spite of this provision, however, five patients slipped and fell on the inclines, causing a refracturing of arms or legs. There were several places where the lowering of the corridor floor was made to a level below that of the ground, giving rise during rainy weather to collections of pools of water.
Lighting and ventilation.-The lighting and ventilation of the hospital were very satisfactory. The ventilators for all of the buildings originally constructed consisted of a parallel set of openings, 12 inches wide; passing down the center of each building. These could be closed by drop doors hinged in the attic. A spring was attached to the doors to keep them open, and cast-iron catches were provided to fasten them when pulled down. These ventilators proved very unsatisfactory, as the planks warped and the catches could not work. The later type of ventilator, which was a large door situated at intervals and opened by a rope, was much more satisfactory. The roof ventilators in the original construction were objectionable because they permitted the entrance of rain and snow and became such a serious problem that it was necessary to cover them with burlap, in the winter of 1918. With the ventilators on the buildings subsequently constructed, there was never any trouble.
Fire-alarm system.-An aero fire-alarm system was installed in the spring of 1919, connecting all buildings used by the patients. This system proved to be very delicate and there were many false fire alarms.
PERSONNEL
COMMISSIONED PERSONNEL
Because of the shortage of medical officers of the Regular Army, only one Regular Medical Corps officer was assigned to this hospital during the period of the war, with the exception of four newly appointed first lieutenants in the latter part of the existence of the hospital. Every caliber of officer was represented among the medical officers assigned. With the exception of a very few, none of them had had any prior military experience.
During the fall of 1917 there was quite a large number of medical officers, who were totally unqualified to perform any duty whatsoever, assigned to duty. Some of these could not be absorbed and it was necessary to discharge them from the military service.
The rank held by a medical officer when he reported for service proved to be no guide to his professional attainments. Military rank was therefore not kept in the foreground at the hospital, and officers were assigned to fill
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positions in accordance with their ability and not necessarily because of their seniority in rank.
Drill and setting up exercises for officers were begun in September, 1917, and continued until the spring of 1919. In view of the fact that the age of officers at the hospital ranged from approximately 25 to 65 years, it was necessary to divide them into two or more companies. This was accomplished by placing the majors and officers of over 45 years of age in one company, and all others in one or more other companies, contingent upon the number of officers to be assigned. The older men were given drill and setting up exercises in moderation. The other companies were given one hour`s drill, later including the foot drill of the soldier, tent drills, ambulance drill, and the litter drill. Parades and reviews were given from time to time at which were present the entire personnel, including the band. Great interest was evidenced by all in drills and other functions. The officers were required to turn out for retreat daily when in camp, but any officer could be excused from drill upon his request. There was a roll call at drill and retreat and if any officer absented himself therefrom without excuse he was required to make a formal explanation on a blank form provided for that purpose. This form was filed with the officer`s efficiency report.
Each officer at the hospital had an efficiency record. This was made, by the chief of his service, on a form submitted weekly, and covered attention to duty, discipline and control of men, professional zeal, diagnostic ability, absences from formations, and anything else of a special nature.
The conduct of the officers and their esprit de corps were generally excellent. They took great interest in the organization and cooperated fully in the discharge of their duties, to the best of their ability.
The dental officers assigned to the hospital had their offices and quarters there. They were directly under the camp dental surgeon, however, and no active part in their control was assumed by the commanding officer of the hospital. The number assigned was adequate and their work very satisfactory.
The officers of the Sanitary Corps filled such positions as adjutant, mess officers, registrar, exchange officer, detachment commander, and recreation officer. These officers proved well qualified and of great help to the hospital.
The following procedure was adopted to properly familiarize new officers with their duties in connection with the hospital and the service in general: The adjutant gave each newly arriving officer a blank preference card to complete. This card contained the officer`s name, rank, organization, age, name, and address of nearest relative, military service, professional training, and an expression of his desire for assignment to duty, first, second, and third choice. The officer was then presented to the commanding officer, who designated his assignment, following which the assistant commanding officer, assigned the new officer to quarters, arranged for his baggage, instructed him in the method of saluting, informed him as to meal hours, drill hours, classes, and other standing camp and hospital orders. He was then shown his pigeon holes where his orders and mail could be found and was instructed in the proper use of the officers` register. The preference card was given to the sergeant major, who added the officer`s name to the roster and prepared special orders assigning the officer to duty. The assignment orders were distributed as follows: Officer`s pigeonhole, drill director, chief of laboratory (for vaccina-
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tions), chief of medical service (for physical examination), mess officer, chief of the service to which the officer had been assigned, and a copy for file in the officer`s file envelope.
When officers were relieved from duty at the hospital a special order was issued, copies being distributed as described in the preceding paragraph, and, in addition, to the property officer. The officer to be relieved was given a hospital check sheet, and was required to call at the following offices to receive therefrom clearance signatures before he was permitted to leave the hospital: Mess officer, laundry, exchange, property officer, and chief of service.
ENLISTED MEN
There was a general shortage of enlisted men on duty at the hospital until the spring of 1918. One noncommissioned officer and 4 recruits were assigned to duty in June, 1917, and 25 additional men in August following. The latter group included a sergeant, first class, for whom a special request had been made as he was especially qualified to handle sick and wounded records. Sixty recruits were assigned by orders issued at division headquarters, 86th Division, about September 5, 1917 . These men formed part of a group of 100 who had been transferred from Fort McDowell, Calif. About September 10, 1917, the first men of the draft were assigned. These men were generally of a very poor quality; five were discharged for physical disabilities and of the remainder only two ever rose to the grade of a noncommissioned officer.
In an effort to properly classify the enlisted men assigned, the following plan was adopted at the beginning of the hospital: Every enlisted man assigned was personally interviewed by the commanding officer, special attention being paid to the following points, and the information obtained in relation to them made of record: Education, grade; occupation in civil life; military experience; position desired in the hospital; age; a general estimate of physical condition on the basis of 10 representing perfect; general rating on a basis of 10; and tentative assignment. (This tentative assignment was the first assignment the soldier received in the hospital and was decided upon after obtaining the information called for by the preceding headings.) It required approximately one month to obtain this desired information, but it proved of the greatest value. As an example of the accuracy and value of such an interview, every soldier who was interviewed and given a rating of eight and one-half or more, ultimately became a noncommissioned officer; and there was not an example where the soldier who received seven or less became a noncommissioned officer. This list of ratings was of more value to the hospital than the soldier`s official qualification card, and was frequently referred to when it was desired to select men for special positions.
The general shortage of enlisted men was especially felt in the general hospital mess, as it appeared almost impossible to obtain cooks. This shortage of cooks made it necessary to call upon the school of bakers and cooks for assistance. The school assumed practical charge of the mess until the latter part of January, 1918. Transfers from the organization proved a serious handicap to the hospital. For each officer and enlisted man in the camp there was a qualification card. These cards were classified at camp headquarters. Frequently these headquarters would receive an order to transfer a definite number of men of specific qualifications. The qualification cards would be referred to
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and men possessing the desired qualifications would be taken, regardless of the position they were holding at the time. Frequently men had become efficient in some specialty other than that given on their qualification cards, and would be removed from the detachment for the original qualifications. Thus, on one occasion, orders were received from camp headquarters transferring the mess officer to a grave digging regiment, the mess sergeant and three of the seven cooks to southern camps as automobile experts. The hospital mess was at that time about to become independent and efforts were made to retain the men, but ineffectually.
There were but five enlisted men assigned to the hospital who were a part of the Regular Army. One master hospital sergeant reported for duty in July, 1917, and proved of great value in assisting with the organization. He was commissioned and sent overseas early in 1918. One other enlisted man of the Regular Army happened to have a qualification in photography only and was of no value in any other capacity. One was transferred to the camp surgeon`s office, and the other two remained with this organization but a short while. In other words, the base hospital at Camp Grant was practically organized without enlisted men from the Regular Army and was run for approximately nine tenths of its duration without any enlisted men therefrom. As trained noncommissioned officers were unobtainable, primarily, the most promising material was selected and each department of the hospital given a desk in the office of the commanding officer wherein all work was carried on in its infancy under his supervision. By the time these offices had expanded to that extent requiring more personnel, some one of the men had been instructed, to whom charge of the office work was given, and the offices were established in their proper places.
About 50 per cent of the men assigned to the detachment were personally selected and transferred individually from camp organizations. Every effort was made to make their duty at the hospital as pleasant as possible, perhaps a little more so than with other organizations, with the result that there were a great many individual applications for transfer. Close attention was paid to the mess of the enlisted men, lockers were built in their quarters, a recreation room was provided and equipped for them, and dances, parties, athletics, and many other forms of amusement were provided. This all not only resulted in contentment but made it possible to select some of the best material in camp. Fortunately, both the commanding general of the camp and the division surgeon assumed the view that first-class work in the hospital could not be accomplished without there being well qualified men with which to do it.
Because of delays incident to the required repair work of the hospital, it was decided to acquire, for the detachment, men qualified as plumbers, steam fitters, electricians, and carpenters. It was possible to accomplish this and the hospital performed practically all of the repair work with its own organization. The men so selected were assigned to duty with the quartermaster of the hospital and worked under his supervision.
The standard maintained for the enlisted men of the hospital was that unless they were physically qualified to perform the duties of a soldier of the line they were not physically qualified far duty with the organization of the hospital. This resulted in there being very few substandard men in the detach-
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ment. In the spring of 1918 the Surgeon General requested a report showing the number of men physically qualified for overseas duty. Had the men reported as being qualified been transferred, it would have resulted in seriously handicapping the hospital.
Three hospitals were organized at Camp Grant for overseas duty. Of these, one was a base hospital and two were evacuation hospitals. A nucleus of men was transferred from the detachment of the hospital to each of the overseas hospitals, forming a very substantial foundation on which each of the new hospitals could build. The men were selected according to their classification and when grouped were able to carry on all of the administrative work for a small hospital. All enlisted men transferred to Camp Grant for duty with the overseas hospital were assigned to duty in the base hospital for instruction. Base Hospital 58 and Evacuation Hospitals 20 and 37 were trained in this way. Two hundred raw recruits from the South were all the men that Evacuation Hospital 20 had to start out with, but at the time this organization left camp its personnel gave the appearance of being of the best.
In building up the organization of the hospital the plan followed was to train each man to fill a specific position rather than have him attain a slight degree of familiarity with all branches of the hospital as a basis for promotion. Promotions were made by grade and no men from the hospital were allowed to skip a grade. Promotions were made on the first day of each month. The officer in charge of each department was directed to submit his recommendations for promotion after having consulted with his senior noncommissioned officer to obtain from him information for or against the proposed promotion. These promotion lists were consolidated and forwarded to the detachment commander for his recommendation. If vacancies existed they were filled by such men who had been properly recommended, after they had been given a perfunctory examination by the commanding officer of the hospital.
The following plan was utilized in the assignment of men to duty: The entire detachment was divided into 12 sections, each being in charge of a noncommissioned officer; and as many noncommissioned officers were assigned to assist the noncommissioned officer in charge as were found to be necessary. The detachment commander ultimately had general supervision over all the sections. However, as it was very difficult to get a satisfactory detachment commander during the first 14 months of the hospital`s existence, orders were issued to the effect that no man would be transferred from one section to another without the approval of the commanding officer of the hospital, except in the case of transfers from the casual section which was used as a general replacement section. This provision was found necessary, also, because many of the new noncommissioned officers were not sufficiently trained in their positions and would, at times, make transfers that proved to be not to the best interests of the service of the hospital. The following sections were established in October, 1917, and were continued throughout the existence of the hospital: Clerical and administrative; male nurse; mess; transportation; Quartermaster; police; laboratory; operating; X-ray; exchange; casual; and miscellaneous.a
aIn reality this miscellaneous section was not a section in the true sense of the word, since it had no noncommissioned officer in charge of the men assigned, and the work performed by the men belonging to this section, generally speaking, pertained to some other of the sections. The stenographers and orderlies assigned to the officers of the various chiefs of service belonged to this miscellaneous section.
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The sick officers proved to be hard to satisfy, and it was difficult to retain enlisted men in this part of the mess. Authority was requested to give enlisted men on duty in the officers` ward mess additional pay. This request was approved. The additional pay made it possible to retain enlisted men of this mess section in a satisfactory state of mind.
The nurses` mess was operated under the supervision of the mess officer in the beginning, and there were civilian cooks and waiters. The nurses complained of the poor quality of food, and difficulty was experienced in trying to keep the mess from getting in debt. In an effort to better the conditions, the chief nurse ultimately took over the operation of the nurses` mess and appointed one of the nurses to have active charge. One enlisted man for each 50 nurses was assigned from the detachment of the main mess. This plan worked very satisfactorily and remained in operation thereafter.
A separate mess was started in one of the isolation wards and was operated for the three isolation wards. At first this was thought to be very satisfactory and was so reported upon by several inspectors. As time went on, however, and all phases of the situation received consideration, there seemed to be no particular reason for operating this mess, which required additional personnel and proved very expensive. It was discontinued, therefore, and food was served by means of food carts, as was done to all of the other wards, and this arrangement was found to be very satisfactory. The separate mess had been considered with a view of keeping the patients and personnel of the isolation ward apart from the remainder of the personnel of the hospital. It was impossible, however, to keep the nurses, enlisted men, and officers separate and it was necessary for these persons to retain their quarters with the remaining portion of the personnel. In this connection, it may be of interest to know that there was not a case of exanthematous disease which developed in any officer, nurse, or enlisted man at the hospital who was associated with the care of that particular disease.
There were approximately 10 dietitians who had been assigned to the hospital. Each worked in quite a different manner. The first dietitian did practically all of the special cooking, personally, being assisted by two kitchen police. Later she was relieved by two other dietitians, both of whom assumed a supervisory capacity, performing less actual work personally; and from that time on the major portion of the actual special cooking was done by the enlisted men, under the supervision of a dietitian.
ARMY NURSE CORPS
The first female nurse reported for duty October 10, 1917. Prior to that time nursing had been carried on exclusively by enlisted men. Thereafter, female nurses were rapidly assigned, and during the existence of the base hospital there were in all 815 nurses on duty at one time or another. This number included both graduate and student nurses.
During the first six months of the life of the hospital, the type of graduate female nurse assigned was not of high professional quality, except those graduate nurses who already belonged to the Regular Army. The new nurses came from small hospitals, and small towns, and were advanced in years. As time pro-
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gressed a much superior type of nurse came into the service, and for the first eight months of 1918 the nurses assigned to this hospital proved to be of the highest type obtainable; they were well trained, energetic, enthusiastic, and physically qualified to perform their duties.
The nurses, generally speaking, desired overseas service and several hundred were given their preliminary training and sent abroad. By the fall of 1918 it was evident that the supply of graduate nurses was approaching exhaustion in the United States, and the type of nurses then being assigned was more nearly similar to those who entered the service during the early period of the war.
It was customary, from the beginning, to place the nurses in an officer`s status at Camp Grant, and, because of this, it was difficult at times to prohibit social relationship between the nurses and enlisted men. An order was issued prohibiting this, and every nurse was furnished a copy of the order when she was assigned to duty at the hospital. Any infringement upon this order resulted in disciplinary measures being taken and if the nurse did not respond to an ordinary reprimand, her discharge from the service was recommended.
The question of recreation for the nurses was considered at a very early period. It was a difficult problem at the beginning because of the absence of a satisfactory place in the hospital for suitable entertainments. The city of Rockford could not be depended upon for the recreation for these young women, as any such recreational activities could not have adequate supervision. The medical officers` wives were ineffectually called upon to assist, it being explained to them that this was something they could do toward helping win the war. The nurses themselves gave every evidence of being unable to entertain each other. Teas, card parties, picnics, and other forms of entertainments, where only ladies were present, were tried, but generally speaking such entertainments were not successful. When the Red Cross Convalescent House was built in the spring of 1918, it was possible to have dances, and this form of recreation proved to be practically the only form of amusement that a majority of the nurses cared for.
Student nurses.-Student nurses were assigned to this hospital in groups, commencing in August, 1918, and in all approximately 150 were assigned for training. These girls were younger than the graduate nurses and were full of enthusiasm. The problem of absorbing them in a large hospital in a military camp where there were 50,000 men was considered with grave apprehension. It was concluded that one of the very best things to do was to teach these girls the meaning of military orders, to promote the honor system of regulations among them, and to make them feel that they were an important part of the hospital organization. With all this in view, they were organized into three provisional companies which were made into a battalion. They were given setting up exercises and the foot drill of the soldier. This drill was given by the commanding officer principally, and his close association with the student nurses made it possible for him to learn the individual characteristics of the young ladies and to so outline regulations, governing their military life at the hospital, as to make them meet the best interests of the students as well as the hospital. Student nurses were selected to act as commissioned and noncommissioned officers for each provisional company; and the organization as a whole was given squad, company, and battalion drill. They were given the various
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calisthenic exercises, signal drill; were taken on moderate marches; and were given may other types of instructions of the soldier.
The student nurses were drilled daily, except on Saturday and Sunday, regardless of weather conditions, until the spring of 1919, when the wards of the hospital became filled with overseas patients, and nursing requirements increased to such an extent that it was necessary to retain some of the students in the wards at all times.
The student nurses were furnished a winter uniform as follows: An olive drab shirt, olive drab breeches, puttee leggings, an olive drab overcoat, a khaki skirt, an overseas cap, a woolen helmet, woolen gloves, marching shoes, and overshoes. The Army uniform was used as far as possible; the gloves and overshoes were furnished by the Red Cross; the marching shoes by the Salvation Army. The student nurses took a great deal of interest in the drill, which considerably improved their carriage and facilitated disciplinary control. Special insignia was devised and furnished to designate the different "officers" of the organization.
The student nurses` battalion was required to turn out as a formation at retreat daily, except Saturday and Sunday.
The recreation for the student nurses was not much of a problem. They possessed a great deal of talent among them, and this was utilized in such a way as to entertain not only the students themselves but others of the hospital. They were, generally speaking, girls of a superior type and made all of the entertainment in which they participated very successful. The Red Cross Convalescent House was turned over to them on the first and third Fridays of each month and in it they gave such entertainments as their recreation committee had planned. Refreshments and music were furnished by the commanding officer, upon their request.
The student nurse, like the graduate nurse, was placed on the status of an officer.
PATIENTS
During the existence of this base hospital 35,899 patients were admitted for treatment and 38,757 out-patients were examined and treated.
Two large epidemics were experienced. The first, commencing on December 26, 1917, followed the arrival of about 500 recruits from Columbus Barracks and Jefferson Barracks. These recruits had every form of contagious disease commonly seen in this section of the country. The epidemic continued until late in the spring of 1918. Measles appeared first, and, fortunately for the hospital, the apex of the occurrence of this disease had passed when the scarlet fever outbreak reached its height. There was but little meningitis. The second epidemic started the latter part of September, 1918, and ended in the following November. This was the influenza epidemic, in which it would seem that the pneumococcus played a more important role than the bacillus of influenza.
The largest number of medical cases was under treatment during the month of October, 1918, being of the so-called influenza type. The largest number of surgical patients was handled in March, 1919, representing practically all overseas wounded. The largest number of genitourinary cases was treated in July, 1918, just prior to the departure of the 86th Division. This number
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of genitourinary cases in camp was greatly augmented by the transfer of this class of patients from other camps, especially Camp Custer, Mich. The number of eye, ear, nose and throat patients was greatly increased upon the arrival of overseas patients in December, 1918, and the greatest number of such cases was handled during that month. This class of patients continued high throughout the spring of 1919. The number of mastoid operations increased following the influenza epidemic. The largest number of contagious cases developed during February, 1918, being incident to the first epidemic mentioned above. The largest number of nervous and mental cases was on record in July, 1918, which was due not only to the hospital cases, but to the fact that many cases were referred for observation from the camp during this month. The largest number of days lost per patient was in June, 1919, due to the high percentage of overseas convalescents in hospital at that time.
A classified report was maintained, showing, numerically, the various classes of patients, and the days lost by them. This classified report was of great value in bringing forcibly to the attention of chiefs of service and ward surgeons the importance of discharging patients from hospital just as soon as possible. Each month this report would be considered at an officers` meeting, when the services of the hospital would be compared one with another and from month to month. Quite a degree of competition between the services was thus brought about.
The establishment of the genitourinary infirmary at Camp Grant was of the greatest value to the hospital; it relieved the hospital of an immense amount of work and prevented the hospitalization of thousands of patients who did not require confinement to hospital. Approximately 2,000 patients passed through the genitourinary infirmary. These patients were on a special-duty status and were kept in quarantine. Such cases were transferred to hospital as needed treatment therein, and the remainder were cared for at the infirmary. The genitourinary services of the hospital and the infirmary were closely associated. This was made possible by assigning the assistant of the genitourinary service of the hospital as officer in charge of the infirmary.
GENERAL ADMINISTRATION
PROPERTY
Generally speaking, requisitions were handled very expeditiously and property received without very great delay. There were, of necessity, various grades of property. This was especially true of such articles as linen sheets and towels, of which there were all sizes and qualities received. The white enamel tables were insufficient in number and were very fragile. These tables were made of cast iron and the attachments for the legs were easily broken and could not be repaired. The wooden bedside tables did not prove satisfactory: they were 6 inches too low and provided but one shelf, they were easily overturned, and the varnish soon came off their tops, making them very unsightly. The lack of a suitable ward cart was very greatly felt, and every conceivable means, such as litters, wheel litters, wheel chairs, food carts, and baggage trucks, was utilized to convey supplies to wards.
In January, 1918, an interior storage battery truck, with trailer complete, was furnished this hospital by the American Red Cross. As the hospital was
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built without steps this truck could reach any building used by patients. Its capacity was a ton and it could carry any load that could be upheld by the corridors. It was used to collect soiled and to distribute clean linen; to bring supplies from the medical supply depot and other places. In fact, it was used almost continuously throughout the day for hauling supplies of all kinds from one part of the hospital to another. In this service it proved to be of the greatest help. It was run by storage batteries, for which a charging apparatus was furnished. This charging apparatus had an automatic cut-off and every other night the truck was attached to the charging dynamo. When the batteries were fully charged the dynamo was automatically cut off. This truck was operated for more than 18 months without necessitating any expenditures for repairs.
The hospital was embarrassed at times because of lack of funds to purchase articles needed immediately, such as rubber stamps, special office equipment, and emergency reports.
QUARTERMASTER DEPARTMENT OF THE HOSPITAL
The first attempt at an organization of the quartermaster department of this hospital was made the latter part of September, 1917, when a portion of the permanent base hospital was taken over. At this time there was no allotment of Quartermaster Corps personnel, nor was there any evidence that such a corps allotment would be made. A rough draft of the requirements of the hospital was made and available personnel, possessing qualifications for that department, were transferred to the Medical Department and the organization of the Quartermaster detachment was then effected with Medical Department personnel. At that time all utilities were handled by the camp quartermaster; and as the personnel was limited and supplies were difficult to secure, a separate and distinct utilities department was organized in the quartermaster department of the base hospital. The medical supplies were being handled by the camp medical supply officer, who also served as property officer for the base hospital, though he was not directly under the supervision of its commanding officer. Considerable difficulty was experienced in determining the line to be drawn between such duties as should be performed by the camp medical supply officer and those by the quartermaster of the hospital. The work of actually equipping the wards was of necessity handled by the quartermaster, as he had the only available personnel, transportation, and organization with which to carry on this work. The question of accounting for Government property, under such a system, caused many delays and difficulties, and in most cases only the finest efforts at cooperation prevented serious delay in the functioning of the supply department.
THE SECURING AND ISSUING OF PROPERTY
For several months after the organization of the hospital, property was issued to the various wards and departments upon memorandum receipt, signed by the ward surgeon or head of the department in question. This system was abandoned at an early date because of the constant change of personnel and because of the inability of the new officers to adequately supervise the care of property and to account for it. After many experiments it was
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found that the following system possessed the greatest degree of merit and the least objections: The hospital was divided into sections, each having a property officer. This officer was, generally speaking, a junior and one whose qualifications and temperament made him valuable for this type of work. On or before Wednesday of each week each ward or department submitted to the property officer of their section a requisition covering a week`s supplies, both expendable and nonexpendable. These requisitions were examined and approved by the property officer of the section and were turned in by him to the office of the supply officer by Wednesday night. In the office of the supply officer the requisitions were examined and after being approved, for issue, one copy was forwarded to the warehouse, where the storekeeper placed the articles requisitioned by each ward or its department in a separate container. The property requisitioned was ready for use on Thursday morning. Meanwhile, the accounts section had placed all nonexpendable articles upon a shipping ticket and this shipping ticket had been turned over to the storekeeper for him to obtain the signature of receipt. When the ward master called for his supplies on Thursday he certified upon the issue ticket that he had received the nonexpendable articles listed thereon, and certified upon one copy of the requisition that he had received the expendable articles listed thereon. On Friday afternoon all issue tickets for the week were signed for by the property officer of each section. One copy of the shipping ticket was then filed in the numerical file of issue tickets; and the other copy, retained in the office of the supply officer, was filed in the folder of the particular ward to which the property was issued. This file was arranged so that a separate portion was reserved for each unit property officer, as well as a separate section for the issue tickets of each ward. Each unit property officer was provided a desk and file and was required to open and properly maintain loan record cards for each ward or building within his section. On Monday of each week these loan record cards were indexed by the loan adjusting clerk, to insure the proper posting of and keeping accounts up to date. Tuesday of each week was set apart for the turning in of unserviceable and surplus property, and receiving reports were properly accomplished on that day. All unserviceable property turned in was accompanied by a statement, made by the unit property officer, that the property was rendered unserviceable by fair wear and tear. In cases where such a certificate could not be furnished, the unit property office was required to submit a statement showing how the property became unserviceable. Once each month unserviceable property was placed upon an inspection and inventory report and turned in to the salvage department.
Medical property officers were required to check the property of their wards prior to the last day of the month and to submit a shortage and excess report upon a form devised by the supply officer. On this form, shortage and excess of property found in each ward or building were noted, and under the column for remarks a statement was made to show how such shortage or excess occurred. The loan-adjusting clerk then made a physical replacement of wards, as far as possible, by giving the excess of one ward or building to other wards or buildings wherein there were shortages. The net surplus remaining in any ward or building was then charged to the net shortage placed upon survey. In this way every effort was made to have each ward, on the
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5th of the month, correct in its property accounts. Each ward was standardized with basic articles and each ward was allowed such additional articles as were necessary for the proper functioning of that ward in accordance with its type. Every effort was made to discourage the transfer of property by wards, and when a patient was transferred from ward to ward the physical replacement of property was required.
Emergency requisitions were allowed and were expedited, since during the major portion of the week there was no issue of general articles or supplies. After the above-described system had been working for a short time few emergency requisitions were necessary.
Property was drawn from the camp supply officer in two ways: Upon monthly requisitions covering the general articles of issue, the need of which could reasonably be anticipated; and upon emergency requisitions requiring either open-market purchases or further requisitions upon the zone supply officer. Considerable difficulty was experienced in securing the expedition of open-market purchases where these purchases were made by the camp supply officer. Trying as was the difficulty of securing prompt purchase by the camp supply officer, equally trying was the difficulty of securing payment of bills incurred, the payment for which was to be made by the Surgeon General`s Office. Considerable difficulty was experienced in the proper accounting for supplies purchased under allotment to the commanding officer of the hospital, due to the fact that the hospital did not maintain stock record cards, but merely loan record cards. This matter was properly adjusted finally by obtaining special authority to open emergency stock record cards for the purpose of dropping expendable articles purchased.
All property issued to the base hospital by the camp supply officer was issued upon loan and, under regulations, was taken up on loan record cards. As the property accounts of a large Army hospital involved approximately 3,000 nonexpendable items and as the account was necessarily a very active one, the record card was found extremely difficult in use for property accounting, and it was also found that within a short time it was necessary to make over great portions of the loan cards to accommodate additional entries. Also, after the account had run a few months it was necessary even to use the adding machine in order to determine accurately the amount of property on hand.
TRANSPORTATION
Prior to the establishment of the Motor Transport Corps but little difficulty was experienced in the proper handling and upkeep of the motor transportation of the base hospital. Upon the establishment of the Motor Transport Corps the quartermaster of the base hospital was given a definite allotment of motor transport personnel, and thereafter no difficulty was experienced in making this department properly function in accordance with the needs of the hospital. Subsequent orders pooling the transportation, except ambulances, under the Motor Transport Corps officer, and the taking over by that officer of all duties relative to repair and upkeep of motor transportation, interfered with the transportation service of the hospital. It was difficult to make the transportation requirements of this large hospital fit in with the arranged transportation scheme of the camp.
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Animal transportation in the base hospital was secured in adequate amounts and little difficulty was experienced in the proper care and use of such transportation.
DISPOSAL OF WASTES
Perhaps no single duty of the Quartermaster Department presented so much difficulty as the proper observance of sanitary regulations and the disposal of wastes. After trying for several months the system of having garbage cans at the end of each ward, the plan was abandoned as an impossibility, and a central garbage receiving station was built in the vicinity of the hospital general mess. The station was screened and its doors, opening upon the loading platform, were provided with springs. Within the station the galvanized-iron cans were placed in rows, each row of a sufficient number to receive definite classes of garbage or waste. A competent noncommissioned officer was in charge of the station to supervise its operation. Each ward or building was provided with the proper number of closed commode pails, suitably labeled, showing the type of waste or garbage to be placed in each pail. Each ward or department was required to convey its pails of garbage to the garbage-disposal station between the hours of 8 and 9 each morning, and 6 and 7 each evening. At the disposal station the garbage was inspected and placed in the proper can. The disposal cans were called for each morning between 9 and 12 and hauled to the camp garbage-disposal plant. This system operated successfully in almost every particular.
GROUNDS AND GARDENS
Through the use of hospital and exchange funds, together with funds received from the Red Cross and other welfare organizations, seeds, plants, and farming machinery were purchased, and the entire hospital grounds seeded in grass and laid out in appropriate flower beds. It was found that, by first seeding the new ground with oats, followed by blue grass and clover, excellent grass could be secured the first year. Well-seeded lawns not only enhanced the beauty of the hospital and added to the contentment and satisfaction of the patients and personnel, but had a decided advantage in that they prevented the raising of dust.
The use of hospital funds permitted the operation of a hospital garden upon a neighboring 10-acre plot. This garden provided a large percentage of the fresh vegetables used in the mess and netted a clear profit in hospital funds through the saving of approximately $4,000.
DISINFECTING PLANT
The operation of this plant had two purposes: The disinfecting of clothing of patients admitted to the hospital, of the bedding used by patients suffering from contagious diseases; and the disinfection of clothing and equippage of the personnel of the camp suspected as contacts in contagious disease. This plant operated for 22 months with practically no shutdown, either day or night, and only two one-thousandths of 1 per cent of the clothing and equipage handled was destroyed or rendered unserviceable.
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LAUNDRY
From the start difficulty was experienced in securing adequate service for handling the linen of the hospital, and this difficulty existed until the establishment of the camp laundry. The service rendered by the camp laundry in handling the linen of the hospital was satisfactory, except for the fact that it required considerable work in maintaining an adequate check of the hospital linen. This difficulty was finally overcome by placing at the camp laundry a noncommissioned officer of the hospital detachment who personally superintended the receiving and disposition of hospital laundry, and by the establishment of a separate section of the camp laundry for handling the hospital linen.
UTILITIES
In 1918 the utilities of the camp were consolidated under the camp utilities department, and it was then clearly demonstrated that the hospital could not properly function by adhering to the general camp scheme for handling the utilities of the hospital. Due to the disinclination of the camp utilities officer to establish the zone system and place men of the utilities department on special duty at the base hospital, the general condition of the hospital buildings, equipment, and steam and plumbing lines became so bad that it was essential to make use of Medical Department men to look after needed repairs. The subsequent assignment of a new utilities officer at the camp enabled the quartermaster of the hospital to so arrange a scheme whereby the noncommissioned officers of his own department were placed in general charge of their respective sections, and the enlisted men or civilian employees from the camp utilities department were assigned to the quartermaster at the base hospital. In this way a subutilities department was organized for the hospital and all calls for repairs of an emergency character were telephoned to the utilities desk in the quartermaster`s office, while the less urgent repairs and construction were requested by letter. Service orders were prepared and frequently reports, together with copies of service orders, showing labor and material expended, were forwarded to the camp utilities officer. With this arrangement the utilities service operated very satisfactorily with a minimum of delay and inconvenience to all concerned.
GAUZE RECLAMATION
During the year 1917 information was received that there was a shortage of absorbent cotton and gauze, indicating the necessity for economy on the part of hospitals in the United States, so that overseas hospitals might be adequately supplied with these articles. A substitute for cotton was furnished, known as "cellu-cotton." This was tested out in every department of the hospital and was found of practical use in all departments except the laboratory and dental, eye, ear, nose, and throat sections. The fiber was so short that the material could not be made into satisfactory swabs or plugs. A gauze substitute was furnished, known as "re-knit" gauze. This was a cotton material made in different widths and lengths with a texture similar to stockinet. Its absorptive quality was about equal to that of gauze, and because of its coarsely woven character, it was possible to wash it many times.
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An addition was constructed adjacent to the operating room where galvanized-iron cans were installed. Hot and cold water and suitable drains were provided. Covered pails were furnished each ward where gauze was used, and instructions were issued that the soiled gauze be immediately collected after removal from patients, placed within the pails, and covered with a solution of 1 per cent cresol. An attendant from the gauze-reclaiming laundry, as the addition to the operating room was called, collected the soiled gauze daily, soaked it 12 hours in one of the galvanized-iron cans, and then sterilized it by boiling. The gauze was then washed in an electric washing machine, with soap, soda, and bleach, rinsed in cold water, run through the wringer, and then dried.
By experience it was found that it was better to place the gauze on white enamel tables or on clotheslines for drying. After drying, it was packed in suitable packages, covered with muslin, and sterilized by fractional sterilization. Bandages were also cleaned in a similar way.
The result of this reclamation process reduced gauze consumption from 700 yards per day to an average of less than 10 yards of new gauze per month. The consumption of absorbent cotton was reduced to 5 pounds per month, and the issue of new bandages to about five dozen per month.
The gauze reclamation required labor and close supervision, but this was offset by the saving of material resulting from its use. The handling of these materials was under the supervision of the chief of surgical service. The building was constructed by soldier labor of the hospital on locally prepared designs, and it contained, in addition to an office, an examining room for the chief of the surgical service, reclaiming laundries, and an emergency sterilizer for the operating room. It was built for approximately $365.
It was possible to keep the gauze white, but great care was needed in bleaching it, otherwise the fiber was destroyed by the use of too strong a bleaching solution. It was very difficult to accurately keep track of individual pieces of re-knit gauze, but such efforts were made and it was possible to reclaim this re-knit gauze as frequently as 100 times. With the continuance of the reclaiming the various fabrics became roughened, with the result that more or less lint appeared on the surface. The gauze also became hardened with use, with consequent reduction of its absorptive qualities.
To offset the possible dangers incident to the re-use of pus-soaked gauze laboratory checks were frequently made and a great deal of attention was paid to it by the chief of the surgical service.
MILITARY SECTION
In the early days of the existence of the hospital, when the only quarters available were barracks in the Infantry area of the camp, no attempt was made to accomplish anything other than the care of the sick. When, however, the permanent hospital buildings were ready for occupancy, and the hospital personnel increased in number, efforts were made to give the newly enlisted and newly commissioned personnel instruction in the Medical Department drill.
The medical officers of the hospital, with the exception of a few whose duties required their presence elsewhere at the specified hours, were required to report for drill one hour daily except Saturdays, Sundays, and holidays,
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and for retreat on the same days. In the beginning this drill consisted of foot drill, as outlined in the Drill Manual for Sanitary Troops, and was conducted by the commanding officer. The routine foot drill was varied from time to time by setting up exercises, litter drill, ambulance drill, visits to the camp trench areas, and short walks. Because of the fact that many of the medical officers were of mature years and unaccustomed to physical exercise a little time was required to accustom themselves to this drill. They soon began to enjoy it, however, and, with the exception of a very few, were of the opinion that the drill was not only beneficial as an exercise but a pleasant experience. As time progressed it was found that some of the older officers and a few with minor physical disabilities were unable to keep up with the drill as outlined, and the increasing number of medical officers also made it necessary to conduct the drill in several detachments. By this time officers had been assigned who had had previous experience in some military organizations, such as the National Guard, and a sufficient number of them were found qualified to conduct the drill, thereby relieving the commanding officer of this duty, except as to supervision. Three detachments were formed and were designated Companies A, B, and C. Each had a commanding officer and a first sergeant. Company A consisted of officers over 45 years of age and who had had sufficient instructions, either locally or elsewhere, to be qualified for more advanced instruction. Company C consisted of officers under 45 years of age but requiring elementary instruction in drill. This company was used as a casual company from which officers were placed in Company A after being instructed. Company B consisted of officers over 45 years of age or those holding the rank of major. This company was given light forms of exercise, consisting largely of early morning walks and light setting up exercises.
The drill of the graduate nurses was conducted under some degree of difficulty, by reason of the fact that no hour could be arranged when all graduate nurses could be spared from their duties, and because there was a necessary, constant changing of personnel.
With the arrival of the first detachment of student nurses drill was started immediately, under the personal direction of the commanding officer. This drill was given the student nurses merely because of its benefit to them for exercise outdoors. They became especially enthusiastic and in a remarkably short time became well qualified. They were organized into three companies, each company representing a group. Keen class rivalry developed, particularly after officers had been selected from them and these officers had become qualified to handle their companies independently. The great problem in connection with their drill was that of uniforms, and the manner in which this was solved has been mentioned in the section on student nurses.
Drill for the detachment Medical Department was conducted under the supervision of the detachment commander, and in the beginning was very unsatisfactory. Men on duty caring for the sick could not be spared, and as a result drill instruction was given only to a limited portion of the personnel. This was remedied by introducing a method whereby the entire personnel was divided into five groups, each of these groups being required to drill for two hours one day a week at 1 p. m., and then being allowed the remainder of the day off duty. In this manner it was possible to give drill instruction to all members of the personnel and at the same time to afford them some leisure hours. The result of this arrangement was very satisfactory.
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From time to time reviews were held on the base hospital parade grounds, and were participated in by all of the above-named groups. The base hospital reviews were unique in the color combinations furnished by the graduate nurses with their white uniforms and blue capes thrown back over their shoulders to expose the red linings, and the blue uniforms with olive drab knitted sweaters worn by the student nurses. Parades were participated in by the detachment at various times, and upon one occasion each of the above-mentioned groups was represented in a public-health parade in the city of Rockford.
Military funerals were held at the base hospital chapel for some of the patients and those of the personnel who died while on duty.
WARD MANAGEMENT
Every effort was made to have ward service attractive for the men, for it was soon found that good men could not be kept in the wards if their services were not appreciated by giving them promotion and responsibilities. General Orders, No. 5, Base Hospital, Camp Grant, Ill., dated November 12, 1917, specified the duties for the ward surgeon, the head nurse, and the ward master of each ward. This system was very satisfactory. In addition to having a ward master for night and day duty in each ward, a supervising ward master was appointed for each row of eight wards. The ward master was rated as nurse, while the supervising ward master was a noncommissioned officer. This supervising ward master was the property sergeant of his row. All supervising ward masters were under the noncommissioned officer in charge of male nurses, who had a day and night assistant, each of whom assumed general charge under his supervision.
The care of the ward property was most unsatisfactory in the early history of the hospital when the ward surgeon acted as the property officer for his ward. Several plans were tried and the most satisfactory evolved was to assign an officer as property officer for each row of wards and the supervising ward master as his property sergeant.
Patients were not allowed to have their clothing in the wards. There were two exceptions to this rule: Officers were allowed their clothing if they desired to retain it, and patients in convalescent wards dressed in their uniform. Prior to January 1, 1919, there were very few convalescent patients, consequently, there were very few patients who had their uniforms. Upon the arrival of overseas patients who had been allowed to have their uniforms in other hospitals the enforcement of the order became difficult. However, it was done. The number of convalescents increased and they were given separate barracks. There were times when it was necessary to give ward patients passes, on account of exceptional conditions arising at home. It was interpreted that if a patient was in physical condition to leave the hospital and go on pass or furlough, he had sufficiently convalesced to warrant transfer to the convalescence service, at least for a short time. A soldier under these conditions was transferred to a convalescent ward and given a pass. In other words no condition arose that necessitated a patient having his clothing in any wards except convalescent wards. This plan not only greatly improved the neatness of the ward, but it prevented patients being absent without leave. Prior to January 1, 1919, there were but three patients absent without leave from this hospital: One was insane and the other two were colored men who left the hospital during the night to
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escape operation. Upon the arrival of overseas patients and the establishment of a large convalescent service, it was not uncommon to have patients absent without leave when they had their uniforms in their possession. This practice, however, did not grow to alarming proportions and all cases were tried by court-martial and given appropriate sentences.
Patients` outer clothing was steam pressed in the hospital laundry and patients in the convalescent service were allowed to have their clothes pressed as frequently as they desired. This privilege was not abused.
Patients in convalescent wards were given pajamas, sheets, and, at first, hand and bath towels. Because of a great loss of them, the issue of towels to convalescent patients had to be discontinued.
The problem connected with patients smoking in the wards was one of more or less annoyance from the very beginning of the hospital. It was deemed advisable to prohibit smoking in the wards for three different reasons: Fire hazard, ventilation, and police. Smoking was prohibited in the wards during their entire existence. This became much more difficult upon the arrival of the overseas patients, and through the interference on the part of civilians, and others in more or less authority. Smoking was permitted in the bathrooms, on the verandas, and outdoors, as well as in private rooms. When it became necessary for a bed patient to smoke, his bed was taken out on the porch. Smoking was also prohibited in the mess hall, kitchen, corridors, and main assembly room of the Red Cross convalescent house.
DEATH AND SERIOUSLY ILL CARD INDEX
When a telegram was sent informing the nearest relative of a patient of the fact of that patient`s death, a card was made for the latter, giving the name, rank, organization, date of death, and name and address of the nearest relative. A file of these cards made possible a rapid and ready reference for all deaths.
Another index was kept for the "dangerously ill" telegrams, the cards being filed alphabetically, according to the towns in which the designated relatives lived. Each of these cards showed not only the town and State, but the name, rank, and organization of the soldier, name and address of the person to whom the remains were to be shipped, and the date on which shipment was made in the event of the death of the patient. This latter index was not found absolutely essential except when the number of telegrams became too large to be borne in mind for several days. From time to time there would be two patients with the same name, but living in different towns. Also telegrams would be received from relatives referring to patients as "brother," "son," etc., which made it practically impossible to locate the right soldier without a great amount of searching of the files. When such telegrams were received in response to telegrams sent out, the index mentioned was of great value.
FOLDERS FOR CLINICAL RECORDS
One of the minor problems arising, from time to time, and one of the most difficult to solve, was the keeping of clinical records in such condition as to be suitable for permanent records of the Medical Department. The Shannon file, as prescribed, for keeping these charts, proved unsatisfactory, and various methods were tried in an effort to keep the charts in proper condition. The
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successful method finally attained is shown in Figure 82. The folders and metal clips were purchased by the American Red Cross upon request of the commanding officer.
FIG. 82.-Folders for clinical records, Base Hospital, Camp Grant
The greatest advantage of this method of keeping charts in the wards was that the charts remained clean and of good appearance; and the size of the clasps was sufficient to permit secure grasping of a chart of a considerable degree
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of thickness. These charts carried the ward number and the bed number, thus making them easy of identification. They were either hung upon the wall, or filed in pigeonholes. The folders consisted merely of a back and front cover of semistiff bristol board, hinged with cloth, over which was placed a spring steel clasp.
Each ward was supplied a set of folders and clips equal in number to the bed capacity of the ward.
BLANK FORMS
For the purpose of facilitating the transaction of routine business within the hospital, approximately 50 blank forms were locally devised and reproduced by mimeograph. These were of greater or less importance and those only which proved most practical will be included in this history.
All officers on duty at the hospital, except those excused because of duties elsewhere, were required to attend all military formations. Roll was called at these formations and officers absent without proper authority immediately received a memorandum in the form shown below. When returned to the commanding officer by proper indorsement, this form was filed with the officer`s record, and if the explanation was not satisfactory further steps were taken in the matter.
[Form No. 13-BHCG.]
HEADQUARTERS, BASE HOSPITAL, CAMP GRANT,
Rockford, Ill., ................................ 1918.
Memorandum:
To......................................It is requested that you report to those headquarters, by indorsement hereon, your absence from............................this date.
..............................................................
(Signature)
1st Ind.:
..................................................
The work of the mess officer was considerably facilitated by furnishing him daily reports from the main office of the hospital as indicated in Form 12. This form was made daily from the morning report and was sent to the mess officer as early as practicable. It furnished the mess officer a guide for his daily preparation of meals as well as a check against the diet cards submitted by each ward.
[Form No. 12-BHCG.]
(To the mess officers, Base Hospital.)
DAILY REPORT OF RATIONS AT BASE HOSPITAL
Date .............................
Base Hospital enlisted personnel.......................................................
Q. M. C. attached for rations............................................................
Total rations due.....................................................................
Female nurses..................................................................
Enlisted sick in hospital......................................................................
Officers sick in hospital......................................................................
---------------------------------------
Sergeant Major, Base Hospital.
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Form No. 16 was a daily report prepared by the officer of the day presented by him to the commanding officer on completion of a tour of duty. It was made in duplicate, one copy being retained in the administration files and one delivered to the new officer of the day, for any later necessary reference. It will be noted that space is provided for the signature of a "`medical officer of the day" and "surgical officer of the day. " It was found necessary during the busy periods of the hospital`s existence to furnish some assistance to the officer of the day, in order that all parts of the hospital might have adequate attention at all times; accordingly, an officer was assigned from the medical service as medical officer of the day and one from the surgical service for similar duties. These officers were charged with the professional care of patients and with rendering necessary assistance to the officer of the day. Their tour of duty was from 7 p. m., at which time they reported to the officer of the day, until the ward surgeon came on duty at 8.30 a. m. In addition the surgical officer of the day was assigned to duty as emergency officer from 8.30 a. m. to 7 p. m. the day following his tour of duty.
With this report was submitted daily a list of seriously ill patients, in duplicate, one copy for the information bureau and one for the clerk in charge of "danger" telegrams. A list of patients whose status was that of "prisoners awaiting trial" was also furnished, with a report of the officer of the day, for the information of the commanding officer and summary court-martial.
[Form No. 16-GHCG.]
BASE HOSPITAL, CAMP GRANT, ROCKFORD, ILL.
DAILY REPORT OF OFFICER OF THE DAY.
.................................................., 191.....
(Date going off duty)
Inspection of hospital made at (state hour) .................................................
Detention ward (verified by personal count twice during tour):
Prisoners-
General.....................................No.........
Garrison........................................................No.........
Awaiting trial...............................................No.........
Patients..............................................................No.........
Total in detention ward.....................................................................
Duties of female nurses performed satisfactorily...........................................
Duties of male nurses performed satisfactorily.............................................
Patients in hospital-last report.............................................................No.............
Patients admitted...........................................................No.............
Patients discharged.........................................................No.............
Patients remaining in hospital...........................................................No.............
Civilians admitted:
(1) In Government service............................................................No..............
(2) Not in Government service............................................................No...............
Civilians in hospital (give ward and name under "Remarks")............................No.......
Civilians treated (out-patient). Separate special written report in each case..............No......
Seriously ill patients in hospital (give name and ward number under "Remarks").....No............
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Deaths:
(1) ........................ ............................ ................................................
(Name) (Rank) (Organization)
(2) Effects in ward promptly checked and turned over to adjutant .....................................
(3) Remains promptly removed to morgue ...........................................................................
(4) Officer of the day present when death occurred ...........................................................
Emergency work.......................................................................................................................
Remarks ......................................................................................................................................
N. C. O. in charge of quarters ..........................................
N. C. O. in charge receiving office ..................................
Night guard.........................................................................
.............................................................................
(Medical officer of the day)
.............................................................................
(Surgical officer of the day)
............................................... ...................................................
(New officer of the day) (Old officer of the day)
It was the practice at the hospital to permit relatives of patients seriously ill to remain for a limited period as guests in the rooms provided for that purpose in the convalescent house of the American Red Cross. Four days was established as the maximum period for such guests to remain and for the information of the commanding officer the report of guests was submitted daily in the following form:
DAILY REPORT OF THE RED CROSS HOUSE, BASE HOSPITAL, CAMP GRANT, ILL.
Guest Name of relative Date admitted
....................................................................................................................
....................................................................................................................
Remarks......................................................................................................
...................................................
(N.C.O. in charge)
The following form was devised for the use of chiefs of service; and upon it a monthly efficiency report was submitted, covering each officer on duty at the hospital.
Name............................................................
..................................1918.
Attention to duty............................................................................
Discipline and control of men.........................................................
Diagnosis ability.............................................................................
Professional zeal ...........................................................................
Adaptability...................................................................................
Recommendations........................................................................., M. R. C.,
Chief of Service.
FORMS USED FOR WARD REPORTS
In compliance with paragraphs 446 and 456, Manual for the Medical Department, 1916, the diagnosis of all patients admitted to hospital was furnished the registrar on the forms shown below. These were reproduced by printing because of the large quantity required. The ward surgeon submitted these reports in duplicate, one copy being sent to the registrar and the other delivered to the chief of the service concerned, thus affording a double check upon inexperienced medical officers.
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DIAGNOSIS CARD
Submitted to the S. & W. office within 24 hours after admission. Make diagnosis agree with that of ward surgeon on page 55F. State always whether it is your original, a change, or an additional one. Indicate all operations and changes of status with dates. Diagnosis must comply with paragraphs 446, 445, and 456 MMD.
Reg. No...................................................................Date ...........................................................
Name .........................................................................................................................................
Rank ...........................................................................................................................................
Organization
Line of duty (yes or no)................................................................................................................
Ward No.................................................................................................................................... Bed No..............................
................................................................................Ward Surgeon
One of the most important local forms was the "Request for transfer." This form was prepared and signed by the ward surgeon and sent to the chief of his service for approval. It was then sent to the chief of service destined to receive the patient, who designated the ward and gave approval for the transfer. The transfer having been accomplished, the request form was taken to the receiving office where it was recorded and signed, then to the information bureau where it was again recorded and signed. In this manner the wall ward-index in the receiving office was kept accurate and up to date, and the card file in the information bureau was adequately maintained. This procedure was of the greatest value in providing an accurate record at all times of the exact location of the patients within the hospital.
REQUEST TRANSFER OF-
Name ....................................................................................
Rank......................................................................................
Company...............................................................................Regiment........................... Request No.....................................................
From ward ............... bed ............................ to ward ...................... bed ........................................................
Diagnosis:
......................................................................,
Ward Surgeon
Approved:
.....................................................................,
Chief of Service
Approved
.....................................................................,
Chief of Service
........................................................................
nbsp; (Receiving office)
Date ............................. 191...
.........................................................................
(Information bureau)
A request for consultation was made on the form shown, which was reproduced in a size to be readily filed with the chart. This request was initiated by the ward surgeon, approved by the chief of service, and sent to the chief of the service where the consultation was obtained. The consultant recorded his opinion and recommendations and signed the request for the chief of his service. The transfer request shown above was never approved unless consultation had been secured. By this means many unnecessary transfers were avoided and assurance was obtained that transfer when made was being made to the proper ward.
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[Form No. 27a BHCG.]
REQUEST FOR CONSULTATION.
From ward surgeon, ward....................................................
To chief of .............................. service.
Subject: Request for consultation in the case of..........................................................................................................................................
(Rank) (Company) (Organization.)
Bed No................ of this ward
Questions ...........................................................................
.........................................,
Ward Surgeon
........................................ ,
Chief of Service
Date ........................................................, 19..
Opinion of recommendations ........................................................................................................
File with brief 130 Chief of Service
The report on contagious diseases was required daily by the camp surgeon. The form shown is self-explanatory. In practice the ward surgeons were required to submit this form with their diagnosis cards, thus affording the registrar a check both against this report and against the diagnosis.
From wards where contagious diseases occurred only occasionally, this form was sent direct to the registrar. In the contagious-disease subsection of the service of internal medicine there was a noncommissioned officer in charge of records of contagious diseases. Each patient admitted with a contagious disease was identified by a 3 by 5 inch register card, on which appeared his name, rank, organization, initial diagnosis, date of admission, number of ward, white blood-cell count, and date of discharge. These cards were filed alphabetically by name; and were modified as to change of diagnosis, additional diagnosis, transfer, and discharge, thus maintaining an up-to-date record of all current cases as well as a dead file exhibiting all contagious diseases treated at the hospital. The form was prepared by a ward surgeon of contagious-disease wards; and was delivered daily to the officer in charge of contagious diseases, together with diagnosis cards; and in the office of that officer these reports were consolidated, the index file was brought up to date, and the correct report was delivered to the registrar.
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[Form No. 31 BHCG.]
REPORT OF CONTAGIOUS DISEASES
Instructions: This report is to be submitted to the registrar before noon daily for all contagious patients admitted to this ward the last 24 hours. Also for additional diagnosis if of a contagious nature. The case to be reported upon but once for any given disease. Front page of history (55a) furnishes all information except diagnosis. Report upon the following diseases: Pneumonia, influenza, measles, scarlet fever, mumps, meningitis, diphtheria, smallpox, chicken-pox, whooping cough, and typhoid fever.
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Upon the return of large numbers of officers from overseas, it was found that many of them were convalescent and their condition did not warrant handling them as ward patients. Therefore, quarters were provided these convalescent officers, at a considerable distance from the officers` ward and the convalescents quartered therein; and they were placed upon a status equivalent to that of an officer on duty, with nothing to do, however, but to report daily for treatment or examination. For the information of the commanding officer, the name, rank, and organization of each officer was reported daily on the form shown below.
DAILY REPORT OF OFFICERS IN OFFICERS` WARD ANNEX.
..............................191
Instructions: This report will be prepared daily and sent to the adjutant for the information of the commanding officer before noon. Only officers actually occupying rooms in the officers` ward annex will be included. (This will include those absent on leave less than 48 hours, but will not include those absent for a longer period.)
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(Name.) (Rank.) Ward Master.
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The large number of inexperienced medical officers on duty in the hospital soon resulted in a tendency for patients to remain in hospital longer than was necessary. In order to check this, all patients who had been in hospital for 30 days or more were reported to the commanding officer on the last day of each month, on the form shown. This method had a decided influence in preventing patients from becoming fixtures in hospitals.
[Form No. 6 BHCG.]
MONTHLY WARD REPORT.
(To be rendered by each ward on the last day of the month, giving by name, rank, and organization, every patient who has been in hospital 30 days or more. The date of admission to hospital as shown on the front sheet of the history, the diagnosis, degree of improvement and signature of the ward surgeon to be shown.)
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Ward Surgeon.
In the receiving office an envelope was used wherein to place a patient`s money, trinkets, and other valuables. A copy of the receipt furnished the patient was filed in the envelope. This receipt was a copy of the patient`s clothing card. The patient`s name, rank, organization, and serial number were noted on the envelope. The receiving officer, at designated times, took the envelope and clothing cards to the registrar where they were checked. Special drawers were constructed in the registrar`s office for the filing of these envelopes by register number. After the patient had received his valuables, his name, rank, etc., were erased and the envelope returned to the receiving officer, to be used again. This system worked very satisfactorily and required no revision.
DEMOBILIZATION FORMS
With the beginning of demobilization it was found that many of the requirements could be met by the use of forms devised locally, particularly in the classification of applications for discharge and in the making of certain required certificates and affidavits.
At the time of the signing of the armistice, there were on duty at this hospital 947 enlisted men of the Medical Department, of whom all but one were drafted men, members of the enlisted Medical Reserve on active duty, or those who had enlisted for the period of the emergency. In general, the point of view assumed by these enlisted men was that the time of war ceased with the signing of the armistice. At this time the hospital had not fully recovered from the shock of the influenza epidemic, and the enlisted strength of the command was none too great for the necessary work remaining to be done. Demobilization instructions began to be received from the War Department, which, particularly Circular No. 77, War Department, 1918, with its various
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amendments, offered a means of release from the military service to men who submitted claims properly substantiated. These claims immediately began to appear. The requirement was then announced by the commanding officer that two affidavits from responsible parties, uninterested, must accompany each claim. A conscientious effort was made to place the proper recommendations on each application, for the information of the commanding general. Approximately 200 applications being received and forwarded, it became evident that some means of classification would be necessary in order to secure justice to worthy applicants for discharge and at the same time to maintain a sufficient personnel for the effective operation of the hospital. A classification of the entire enlisted detachment was made, determining and recording the relative merits of every claim for discharge. A form was devised entitled "Personal preference card," which was printed on blue stock. This card was filled out by the soldier and sworn to before a summary court officer. It was carefully explained to the men that their services were urgently needed and appeals were made to their patriotism and sense of duty to indicate as late a date for discharge as they possibly could. In a great majority of instances a fine spirit of cooperation was manifested. The blue cards, having been completed, were filed alphabetically by name. For each blue card a 3 by 5 inch index card was prepared, giving the soldier`s name, rank, duty, and date of discharge requested by him. These cards were filed by dates, beginning with the earliest date when discharge was desired. Proceeding through the entire detachment as rapidly as possible, each soldier was interviewed by a board of officers who made an effort to determine the merits of each claim. The following classification was then adopted: Immediate discharge; dates definitely specified; dependency claims, class B; dependency claims, class C; industrial claims, class A; industrial claims, class B; industrial claims, class C; educational claims; and valid claims for discharge.
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[Form No. 10 BHCG.]
NOTIFICATION OF SERIOUSLY ILL PATIENT IN HOSPITAL.
(This form to be filled in and immediately sent to the adjutant as soon as a patient becomes seriously ill; that is, if the patient is more apt to die than to recover. The ward surgeon will be held responsible for this report between the hours of 8 a. m. and 4 p. m. and the officer of the day between the hours of 4 p. m. and 8 a. m. Ward surgeons will notify the O. D. of the seriously ill patients in their wards before going off duty.)
Reg. No. .......... Hour .................... m. Date .............................. 1918.
..............................................................................................................................................................................................
(Surname) (Christian name) (Rank) ( Co. ) (Organization)
Name of nearest relative.............................................................................................................
Exact address...............................................................................................................
Clinical diagnosis.....................................................
Name of messenger.................................................. ..........................................M. R. C.
Received by the adjutant at.................................................................................
Relative notified at............................................... By ....................................
Remarks....................................................................................................................
.............................., Adjutant.
HEADQUARTERS , U. S. ARMY BASE HOSPITAL, CAMP GRANT, ROCKFORD , ILL.
From: The commanding officer, base hospital.
To: The commanding officer.
Subject: Report of death of enlisted man.
1. The death of....................................................................... is reported. Cause of death...................................................................................
2. Death occurred at this hospital at ...........................................................................
His remains are with ................................................................................., undertakers, Rockford , Illinois. Your attention is invited to paragraph 83 A. R., C. A. R. 77, 1918, and the 112th A. W.
3. The designated relative has been notified by wire, requesting disposition of remains.
4. You are requested to have your summary court officer call on the summary court officer, base hospital, to collect and receipt for the effects of this soldier.
5. In compliance with orders of the commanding general, 86th Division, May 6, 1918, the following is offered for your information and guidance: "A presentable uniform will be provided in each case. It is not believed that this calls for a new uniform in each case. If the soldier`s uniform is in pretty good condition, it should be used in lieu of a new uniform, being properly pressed, if necessary. If the man`s uniform is not in good condition, a new one should be secured, but by reason of the present large demand for uniforms, etc., care should be taken to conserve the supply in this manner as much as possible.
6. Instructions from the War Department, June 4, 1918 , provide that-"The articles of uniform to be furnished deceased soldiers under the provision of paragraph 37, A. R., as amended by telegram (722.2 Misc. Div.) Office of The Adjutant General, March 9, 1918, shall consist of the following: One cotton or woolen, O. D.; one pair breeches, cotton or woolen, O. D.; one pair drawers, cotton or woolen; one undershirt, cotton or woolen; one pair stockings, cotton or woolen; one collar, white."
7. It is requested that this matter be expedited so that the remains may be shipped.
----------------------------------------,
Lieut. Colonel, Medical Corps , U. S. A.
(2 copies to camp Q. M.)
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[Form No. 11 BHCG.]
CERTIFICATE OF UNDERTAKER FOR DECEASED SOLDIERS.
Date ...............................,......................., 1918.
This is to certify that..........................................................................................................
(Name in full)
formerly a ............................................................................................... of ...................................................................................................................
(Rank) (Organization)
has been properly embalmed at our undertaking establishment in Rockford, Ill., that the vessels of the head WERE or WERE NOT (erase words not needed) properly injected, that the remains were properly clothed (complete suit of underwear, socks, blouse, breeches, O. D. shirt, leggings, shoes, collar ornaments) furnished by the soldier`s commanding officer.
The remains were shipped to ..................................................................................................................................................................
.................................................................... ......................................................................................... ..................................
(Street address) (City) (State)
Did relatives view remains............................ Name of relative ...................................................................
Remarks made by relatives................................................................................................................................
Date and hour of shipment ................................................................................................................... via .................................................Railroad.
.............................................................................. ,
Contract Undertakers for the Government
[Form No. 16 BHCG]
RECORD OF FUNERAL SERVICES
(Chaplain, Base Hospital)
Funeral services were held over the remains of the late
............................................................................................................................... at ................................................................................................................................m.
(Name) (Rank) (Organization) (Time)
.............................................................................................................................................
(Place)
The relations were (not) present. This soldier died of ........................................................................
at .............................................................m., ............................................................................................................................................
(Time)
..................................................................................................,
.........................................................................................................
(Rank)
COLORED PATIENTS
Before any colored troops were assigned to Camp Grant, the commanding general assembled all unit commanders and instructed them to treat all soldiers alike irrespective of color. He stated that the colored men were drafted for the same purpose as the white men and officially no distinction was to be shown. All unit commanders assembled their commands in turn and imparted to them these instructions.
In the hospital, colored patients were placed in the same wards with the whites; there was a common dining room; and they were freely allowed the use of the exchange. Not an instance of racial friction was reported as having occurred between patients in the hospital.
During the spring of 1918, general instructions were received from the Surgeon General to classify the patients in hospitals in accordance with their race and to place the colored patients in separate wards. No friction had arisen and the hospital was comfortably filled with patients. A segregation would have necessitated twice the ward space being used. In view of the fact that no trouble had arisen and that there was inadequate space to properly segregate the patients, the old plan was continued.
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CORRELATION OF OFFICES AND RECORDS
Receiving office, discharge office (office of the registrar), ward, information bureau, clothing room: All patients were admitted through the receiving ward, and each was accompanied by a request from his organization surgeon for admission. This request had a tentative diagnosis, the name, rank, organization, barrack number, and sometimes the serial number of the patient. All patients were brought to the hospital by ambulances, obtained either from the ambulance company or the hospital.
RECEIVING OFFICE
Forms 55a, 55f (the transfer diagnosis) three copies of the patient`s clothing card, the receipt for a patient`s valuables, and one blotter sheet were prepared in this office. The ward to which the patient was to be assigned
FIG. 83.-Receiving office, Base Hospital, Camp Grant
was designated. The patient was then conducted to his ward by the orderly, who took with him Forms 55a and 55f and one copy of the clothing card. This was the authority for the ward master to admit the patient. The clothing card showed all articles of uniform the patient then had in his possession. The patient retained the receipt for his valuables. The clothing cards, 55a, blotter sheet, and receipt for valuables were numbered by means of a duplex numbering machine, and in advance. The blotter sheet provided space for 31 admissions. Thirty-one sets of clothing cards, histories, and receipts were numbered in advance and kept intact, being used consecutively. After midnight the noncommissioned officer in charge of the receiving office made five consolidated copies of the day`s admissions, one for each of the following offices: Registrar, information bureau, chief educational officer, head medico-social aide, and receiving office (retained copy). At 9 a. m. the following morning, the receiving officer took the money, valuables, and trinkets to the discharge officer (registrar), with
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two copies of the clothing card. These cards listed the valuables, etc. The registrar checked the lists, and if they were found correct he receipted for them on one copy of the card. This card was held by the receiving officer as his receipt. The third copy of the clothing card was filed with the patient`s valuables in the registrar`s safe.
WARD
The patient was received and his clothing was checked against the clothing card. The clothing was then returned to the patient`s clothing room with the property tag attached, a duplicate of which was retained by the patient. The clothing was accompanied by the property card, which was again checked by the noncommissioned officer in charge of the clothing room, the card then being returned to the ward by the messenger and attached to the patient`s history.
The other Forms 55 were added to the patient`s history in the ward. No Forms 55a were allowed in the wards, as a safeguard against patients being admitted directly to the ward. If a history was seen without Form 55a there was an immediate investigation. The authority for discharging the patient was with the ward surgeon. When the lower half of Form 55a was completed by the ward surgeon, it was then the duty of the ward master to get the patient out of the hospital. The signed history and property card were taken to the clothing room by the ward master and the clothing of the patient was obtained. The history was taken to the registrar. The ward master assembled his patients for discharge and took them to the registrar at 1 p. m. The patients were checked out by the histories. Their clothing and valuables were checked by the third copy of the clothing card on which the patient receipted for them to the registrar. After all patients were discharged, the registrar made five consolidated lists of discharges, one copy for each of the following offices: Information bureau, chief educational officer, head medico-social aide, receiving office, and the registrar`s office (retained copy). A wall board was kept in the receiving office. On this board there was a row of cards for each ward; and each row was provided a card for each bed in the ward. The list of discharges was used in withdrawing cards from this board, of patients discharged, and the blank spaces, therefore, indicated empty beds.
REGISTRAR
The registrar received the blotter sheet daily from the receiving office at 9 a. m. This sheet gave the necessary data for starting Form 52 for each patient. The list of admissions from the receiving office was used as a check. The valuables and clothing cards were also received at 9 a. m., and filed by register number in a safe, especially built for this purpose. This safe was kept in a strong room. The patient`s register card was prepared from the blotter sheet and filed. All patients were discharged through the registrar`s office on Form 52, completed from the history and diagnosis cards. The consolidated list of discharges was furnished the information bureau.
THE INFORMATION BUREAU
The admission sheets were received from the receiving office; and when possible, the noncommissioned officer in charge of the receiving office at night prepared a card index for each patient admitted, showing the name, rank,
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organization, and ward to which assigned. If these cards were not prepared in the receiving office, they were prepared in the information bureau and filed alphabetically. The discharge office furnished a daily list showing all discharges. The cards were then withdrawn and placed in a dead file where they were held for 10 days and then destroyed. Patients were transferred from ward to ward only upon request of the ward surgeon and after approval of the chiefs of services concerned. When this transfer was completed, the ward master would take the request for transfer to the information bureau and the patient`s ward number was changed accordingly. The request for transfer was then returned to the ward and filed with the history.
Two telephones were installed in the information bureau, one for incoming calls and one for outgoing calls. When calls were received the patient was located, his ward called, the necessary information obtained and given to the person calling, without it being made necessary to ring off.
A great deal of emphasis was placed on each office explicitly carrying out these instructions. However, in spite of this, patients would occasionally get lost in the hospital. The plan was then adopted to re-check all patients in hospital semimonthly, so as to obtain their exact location. All forms of disposition of patients were handled, as described, by discharge to duty. This system was very satisfactory and enabled the receiving office, discharge office, information bureau, and all wards to keep informed as to the movement of patients.
OFFICES OF THE MESS OFFICER, SERGEANT MAJOR, DETACHMENT COMMANDER, CHIEF NURSE, PERSONNEL OFFICER, COMMANDING OFFICER OF DETACHMENT OF PATIENTS, RECEIVING OFFICER, AND REGISTRAR.
This correlation is explained to show how the mess officer was kept informed, at all times, of data essential to checking his daily mess receipts. The detachment office and personnel office would send daily a statement to the sergeant major exhibiting all changes in the enlisted personnel-assignments, transfers, discharges, and sick. The chief nurse rendered a daily morning report to the sergeant major showing similar changes among the nurses or civilian personnel employed for the nurses. The personnel office reported to the sergeant major, likewise, changes for reconstruction aides, after the morning report from the chief educational officer had been received. The detachment of patients rendered a morning report for patients on furlough or on sick leave. The registrar furnished a list of discharges to the receiving office. This list was then classified according to officers, nurses, enlisted men, and civilians, added to the surgeon`s morning report and returned to the sergeant major. The sergeant major then made his report to the mess officer, showing the number of enlisted men, officers, nurses, and civilians employed in the hospital that day. The information also showed what civilian employees were entitled to rations and those civilians sick in hospital who were on either the enlisted or commissioned status. This enabled the mess officer to compute his income for that day. These details were necessarily accomplished by 9 a. m., and were checked by the commanding officer.
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OFFICER, OF THE DAY`S REPORT, SURGEON`S MORNING REPORT, BED REPORT, AND FIELD REPORT OF PATIENTS
(FORM 83, M. D.)
The old officer of the day reported at 9 a. m. daily, presenting in writing his report for the preceding 24 hours. On this report was shown the number of admissions, discharges, the number of civilians, by name, and the total number of patients in hospital. These figures were checked against the surgeon`s morning report, which was prepared under the sergeant major`s supervision, classified by organization. These two reports were checked against the bed report which showed the total number of patients in hospitals, by wards, prepared under the supervision of the receiving officer. The three reports were then checked against the patient`s field report (Form 83, M. D.), prepared by the registrar, and showing the total number of patients in hospital, by diseases. The four reports were checked by the commanding officer. A great deal of information was obtained by reading these reports and any errors in them were readily detected in the number and classification of patients.
DEATH RECORDS
No patient was declared dead except by a medical officer. This officer then completed Form 55a of the clinical history and prepared the death certificate in duplicate (one for file). These records were immediately sent to the adjutant, who caused the death check to be started, giving this particular death the next serial number. The clinical chart was marked conspicuously in red pencil with this number, which was also placed on an adhesive strap fastened, under the supervision of the medical officer, around the deceased`s left forearm, near the elbow joint. The strap showed, in addition to the number, the patient`s name, rank, and organization. The remains were taken to the mortuary where the noncommissioned officer in charge entered in the mortuary book the information shown on the adhesive arm band.
It was the duty of the adjutant to see that a "danger" telegram had previously been sent and that the undertaker was immediately notified. A copy of the "danger" telegram was attached to the death check sheet. The fact of death was immediately reported to the deceased`s organization commander on a blank form used for that purpose. This form also included any necessary data for the organization commander. The following morning five complete and itemized lists of deaths were prepared, one copy each for the camp surgeon, the attending surgeon in Rockford, the hospital chaplain, the chief of the laboratory, and one to be retained. The undertaker called for the remains, and reported to the adjutant, who gave him a copy of the death certificate. This certificate was the authority for the undertaker to receive the remains from the noncommissioned officer in charge of the mortuary. The undertaker receipted in the mortuary book for the remains, and that the remains were properly embalmed was certified to by the undertaker. When the remains were ready for shipment the undertaker notified the chaplain and the attending surgeon in Rockford. The attending surgeon inspected the remains in accordance with regulations and submitted his written report of that fact. The chaplain held services, of which he submitted a written report. The chief
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of the laboratory was informed in order that he might perform an autopsy, if advisable.
All of the above-mentioned reports were returned to the adjutant and attached to the death check sheet, as was also the receipt for the patient`s valuables, in compliance with the one hundred and twelfth article of war.
When shipping instructions were received from relatives, a copy was furnished headquarters, Camp Grant, where the necessary transportation was issued, as well as orders for an attendant when necessary. Copies of these proceedings were also attached to the death check sheet. When shipment had been made and all reports had been turned in, the entire proceedings were brought to the commanding officer for signature, after which they were filed with the patient`s chart. If an autopsy had been performed a report of this was also filed with the chart.
By this means it was possible to double-check every action taken, and out of 1,304 deaths which occurred at this hospital but one serious error was made. This error was due to the fact that, during the influenza epidemic, among those who died were two enlisted men, one named Toney Mack and the other Mack Toney. Both bodies were shipped to the same address. The error was discovered, however, before the remains reached their destination and the shipment was stopped by telegram. The error was detected in the double-check system.
DUTIES OF OFFICERS OF THE DAY AND ASSISTANTS
Memorandum No. 35.
HEADQUARTERS, BASE HOSPITAL, CAMP GRANT,
Rockford, Ill., May 26, 1919.
By direction of the commanding officer the tour of duty of the officer of the day is 24 hours, 9 a. m. to 9 a. m. He will report on duty and off duty to the commanding officer in person with a written report and his recommendations at 9 a. m.
During his tour he will remain in touch with the telephone operator and the receiving office so that he can be located without delay. He will admit all patients to the hospital between the hours of 12 p. m. and 8.30 a. m. He will be responsible that patients are admitted to the proper wards, that their money, valuables, and trinkets are properly collected and receipted for and delivered to the registrar, and that patients receive the proper treatment after the ward surgeons are off duty.
Civilians will not be admitted to this hospital without authority from the commanding officer except civilian employees of the Quartermaster Department who are suffering from injuries or extreme emergencies, and in either case the report of the officer of the day will give the details in full. A separate written report will be made for all civilians treated at this hospital who are not admitted, giving name, date, circumstances, diagnosis, and treatment.
No charges will be entered against any patient, except the hospital charges under Army Regulations, and no one will receive payment from the patients for services of any character.
The officer of the day will inspect the hospital once between 6 p. m. and midnight and once between midnight and 6 a. m. At each inspection he will satisfy himself that the night guards are properly performing their duties, that all unauthorized lights are extinguished at 9 p. m. and that the hospital is quiet and orderly. He will visit all wards and satisfy himself that all patients are receiving the necessary treatment and that the ward attendants are properly performing their duties. At each inspection he will check the patients in the detention ward and verify the presence by observation of every prisoner in the hospital. He will inspect at least two meals a day in all kitchens except nurses` quarters and officers` mess (officers on duty).
Any medicine or property issue urgently required for the cure and treatment of the sick after the ward surgeons are off duty will be signed by the officer of the day, entering the word "emergency" over his signature.
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The adjutant will be notified of all seriously ill patients that have not been previously reported, and all deaths, giving the name of patient, his organization, and name and address of his nearest relative in order that the required telegrams may be sent. The remains will be labeled by placing a strip of adhesive plaster 1 inch wide around the middle of the left forearm, giving the full name, rank, and organization, and promptly removed to the morgue and placed in the morgue refrigerator. The officer of the day or ward surgeon will see all patients before death if possible; otherwise, immediately after death. A report of death will not be accepted from nurses.
Interchange of a part of a tour of duty between officers is prohibited, but officers may change entire tours by notifying the adjutant the day before the tour commences.
At the termination of his tour, the officer of the day will enter on his report any untoward events which have happened, sign this report, along with signature of new officer of the day, and present it in the proper manner to the commanding officer.
In addition to the officer of the day there will be a medical and surgical officer of the day detailed by the chief of their respective services. These officers will report to the officer of the day at 7 p. m. in the receiving ward, and the report of the officer of the day will give the names of these officers. The duties of these professional officers of the day will be to attend the sick in their respective services between the hours of 7 p. m. and 8.30 a. m. They will make at least two rounds during their tour of duty, visiting all wards in their service, give the necessary emergency treatment, and assure themselves that the attendants are awake and on duty, and that the patients are receiving the proper care. Any neglect in the care of patients or other factor worthy of note is to be reported to the officer of the day, who will incorporate it in his report. These officers will remain in touch with the receiving office at all times during their tour so they can be located without delay, and will sleep in the receiving ward. These officers will not remain in their permanent quarters while on duty. Any unnecessary delay in being able to locate any one of these three officers will be taken as a neglect of duty on the part of the officer in not keeping the receiving office properly informed.
In case of fire or fire drill the officer of the day is directed to report at the scene of the fire and take charge of the Government property. He will order the necessary number of soldiers who may be standing around to guard the property. In case of fire drill he is to report to the fire marshal.
All orders issued prior to this date that are contradictory to this order are hereby rescinded.
By order of -- --
-- --.
FIRE PREVENTION AND FIRE DRILL ORDERS
General order No. 6.
HEADQUARTERS, BASE HOSPITAL, CAMP GRANT,
Rockford, Ill., May 26, 1918
For purposes of instruction, fire prevention, and fire fighting at the base hospital units, this unit is divided into eight zones, as follows:
Zone 1.-Including nurses` quarters, A, C, and D; officers` quarters, wards 11, 12, 13, 21, 22, 23, 24; commanding officers` quarters, administration building, laboratory, operating room, and receiving ward.
Zone 2.-Including officers` ward, eye, ear, nose, and throat building, wards 31, 32, 33, 34, 41, 42, 43, 44, and Red Cross building.
Zone 3.-Including wards 15, 16, 17, 18, 25, 26, 27, 28, general mess hall, kitchen, and guardhouse.
Zone 4.-Including wards 35, 36, 37, 38, 45, 46, 47, and 48.
Zone 5.-Those buildings north of the first line of wards, including wards A, B, C, E, F, G, and H, psychopathic ward, morgue, chapel, power house, nurses` annex, nurses` quarters B, E, and F, and base hospital barn.
Zone 6.-That part of the base hospital unit east of Kishwaukee Road, including the detachment mess and kitchen, barracks, and lavatories, medical supply depot warehouses, shops, laundry, and garage.
Zone 7.-Including wards 51, 52, 53, and 54.
Zone 8.-Including wards 55, 56, 57, and 58.
The zones will be designated by sounding fire call, followed by 1, 2, 3, 4, 5, 6, 7, or 8 blasts, indicating the proper zone. This to be repeated as long as necessary.
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The noncommissioned officer in charge of the detachment will take charge of the hose cart located near the power house. The recruiting sergeant will take charge of the hose cart located south of ward 46. The senior noncommissioned officer in the sergeant major`s office will take charge of the hose cart immediately in front of the administration building.
The detachment commander will detail 10 men to report to each of the above noncommissioned officers to handle the above hose carts.
When fire is discovered it will be immediately reported to the telephone operator, who will report it to the central fire station, Camp Grant, 175; he will also notify the fire marshal of the base hospital, the officer of the day, the commanding officer, the adjutant, and the detachment office. One male nurse will remain in each ward, all others reporting to the fire marshal at the scene of the fire, bringing with him a pail of water. The operating room force will immediately repair to the operating room and prepare for an emergency. All available men from the dining room, kitchen police, all men of the outside police section, casual section, and of the quartermaster section, will report to the fire marshal at the scene of the fire. The officer of the day will report at the scene of the fire, obtain a detail from the men available, and guard all Government property. The officer in charge of the laboratory will keep two litters in the laboratory and detail four litter bearers to report to the officer of the day at the scene of the fire to handle such cases as may be necessary. Ward surgeons and the necessary administrative officers will report at their respective places of assignment and maintain order.
Fire extinguishers and fire buckets are in the various buildings of this hospital and everyone is expected to use every possible means to extinguish a fire as soon as it is discovered; the use of fire buckets for any other purpose than fighting fire is prohibited, and the officers in charge of the various buildings where these are located will be held responsible that these buckets are kept filled with water and used only for the fighting of fire.
When fire is discovered and the alarm given, the various details will procure their fire apparatus and report to the fire marshal at the scene of the fire. The various noncommissioned officers will familiarize themselves with the location of all of the fire plugs of the base hospital unit so that there will be no delay in finding these plugs.
G. O. No. 7, headquarters, Base Hospital, Camp grant, Ill., dated December 25, 1917, is rescinded.
By order of -- --
-- --
HOSPITAL DEPARTMENTS
MEDICAL SERVICE
During the first year in the history of the hospital, the great problem was the control and treatment of contagious diseases. Of these infectious diseases, measles was the most difficult to deal with, though streptococcus pneumonia complicated the measles in only a small proportion of cases. Mumps assumed considerable proportions because of the increase in the noneffective rate; but contagious diseases in general did not assume alarming figures in this camp during the first year.
The medical service from the first was well organized, and it was changed in no essential afterwards. It was here that the mask and the cubicle system of curtaining the beds were first used; and it was also on the recommendation of the first chief of the medical service that patients were masked when sent from camp infirmaries to the hospital. This system of masking was extended, by instructions from the Surgeon General`s Office, to all hospitals in this country.
Following in the wake of the outbreaks at Camp Devens, the Great Lakes, and other camps, Camp Grant was visited by the so-called Spanish influenza in an explosive manner Saturday, September 21, 1918. So sudden and appalling was this visitation that it required the greatest energy and cooperation of every officer, every man, and every nurse to meet the emergency. Up to that
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time the 12 ward barracks were occupied as quarters and storehouses, and 12 wards of the main part of the hospital were empty. It was obvious that the epidemic was on hand and that great effort would have to be made to provide sufficient bed space. Therefore, all two-story ward barracks were vacated and every available officer, nurse, and enlisted man was called upon.
On Sunday, September 22, 1918, the admissions to hospital numbered 194. The main portion of the hospital was made ready for occupancy, increasing the available beds to 1,318. The total number of patients in hospital was 836. On the following day the admissions to the hospital were 370, making a total of 1,159.
Telegrams were then sent to all officers on leave to return without delay. Every effort was put forth to open all two-story ward barracks, and by nightfall six of these buildings were completely equipped for 480 patients. Property meetings were held among the various executive departments of the hospital, the camp medical supply officer and his assistants, as well as the local director of the American Red Cross. Immediate steps were taken to obtain more property.
Tuesday, September 24, admissions were 494. Six additional beds were added to every influenza ward and two convalescent barracks were completely equipped. On the following day the admissions were 711. Patients were placed in corridors 2, 3, and 4. A property meeting was held, and, because of the emergency, the camp medical supply officer sent his assistant to Chicago to expedite shipments of supplies. One thousand units of mess equipment were ordered by the mess officer, and the Red Cross placed an order in Chicago for 6,000 sheets and other supplies.
On Thursday, September 26, there were 607 admissions, making a total in hospital of 2,598. Up to this time there had been three deaths from the disease. The detachment, Medical Department, moved out of its barracks into tents, and these barracks, the exchange, and the corridors were made into a 500-bed hospital.
Evacuation Hospital No. 37 turned over its entire personnel to the hospital; the depot brigade furnished 250 men as laborers; beds were set up and bedding sacks stuffed with straw; and quartermaster property was used entirely to enlarge the hospital over 1,800 beds. Officers, nurses, and enlisted men were sick in the hospital. Four carloads of medical supplies were received by express, and about 30 motor vehicles were put into use handling the heavy supplies. The receiving office was overtaxed but found to be handling the patients very satisfactorily. The Red Cross took over the handling of the patients` money. The depot brigade cared for patients also. Approximately 300 patients were sick in the infirmaries. Tent floors, Sibley stoves, and electric lights were supplied the tents occupied by the enlisted men of the hospital detachment. The clothing room becoming overtaxed, the patients` clothing was checked, bundled, and placed under the heads of the patients` beds. The mules of the animal-drawn ambulances became exhausted, and Quartermaster trucks and private motor vehicles were called into use. Seventy-five enlisted men from the depot brigade were attached to the base hospital, but many of these men were sick upon arrival. The registrar`s office was moved to the ward room (officers` ward), and the entire receiving ward was turned
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over to the receiving officer. Patients who were discharged were sent with a request to their commanding officer that they be relieved from duty for one week; and, because of the weakened condition of the patients, they were not allowed to walk to their barracks.
The number of nurses was inadequate, and the Red Cross transferred 25 from Chicago and surrounding points.
On Friday, September 27, 1918, the admissions were 671; total patients in hospital 2,936; deaths, 3. Because of the cold nights and threatening weather, it was considered a risk to place patients on the various verandas without inclosures, so the constructing quartermaster was called upon for assistance. He furnished 50 carpenters, and the utilities department furnished a like number. With their cooperation, 39 verandas were inclosed with roofing paper and muslin, and 800 beds were placed on them and made ready for occupancy. The War Relief Committee was called upon to make sputum cups, thus relieving nurses of this work; and the school for bakers and cooks was requested to furnish 14 cooks.
On Sunday, September 29, 1918, the admissions to the hospital numbered 788; the patients then in hospital numbered 3,346; deaths, 6. Nine barrack buildings of the sanitary train were turned over to the hospital for hospital purposes. Barracks 827-N was fully equipped for 126 patients, and all mumps cases were transferred thereto from the main part of the hospital. A kitchen was started in this building, and all mumps patients were subsisted there. The heavy equipment was placed in six other barrack buildings in preparation for further expansion. A check was made of the hospital, and all wards were furnished with additional hospital property, principally linen, as a working surplus. Two hundred and sixty additional enlisted men were attached to the hospital; the others from the depot brigade, as well as officers, nurses, and enlisted men, were showing marked fatigue at that time. There were 4 medical officers, 45 nurses, and 63 enlisted men of the base hospital detachment sick, principally with influenza.
By extreme effort on the part of all concerned, and using all means to obtain property, the hospital was expanded from 610 occupied beds to a capacity of 4,102 beds within a period of six days.
The American Red Cross opened an emergency canteen service in the Red Cross house from which to serve light lunches and hot coffee to officers, nurses, and enlisted men of the base hospital.
On Monday, September 30, 1918, there were 683 admissions to the hospital; 490 patients discharged; and 8 deaths. The total number of patients in hospital was 3,546. During the day 160 beds were added to the various verandas of the influenza wards, thereby increasing the hospital bed capacity to 4,381, and two additional barracks of the sanitary train were fully equipped as wards, making three barracks in that area available for patients.
Patients in hospital, plus personnel on duty (including those attached), brought the total population of the base hospital up to approximately 11 per cent of the entire camp. The main kitchen served the major portion of these and during the day prepared 2,780 liquid diets and between 1,500 and 2,000 regular diets. As the number of persons becoming sick was increasing, all those on duty at the hospital were advised to take advantage of every oppor-
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tunity, when off duty, to take light exercise in the open, or rest or relaxation. On this date there were 5 officers, 51 nurses, and about 100 enlisted men on sick report. In the event ward men were left on duty for more than 12 hours a day, they were instructed to call the detachment commander and inform him accordingly, as occasionally this detail was overlooked during the rapid expansion of the hospital.
The nursing force of the wards was extremely inadequate. However, every nurse and available man was assigned. In order to help the situation, a service corps was organized and divided into eight sections; and a student nurse was placed in charge of each section, with 6 men as her assistants. The hospital was divided into eight areas, a service section being assigned to each area. The principal duties of these sections were to assist the ward personnel by policing the ward and doing the heavy work. Their hours of duty were from 7.30 a. m. to 5.30 p. m.
Tuesday, October 1, 1918, 561 patients were admitted to the hospital; 496 were discharged, making a total in hospital of 3,601. There were 14 deaths. All deaths were due to pneumonia following influenza (clinical). The admissions to the hospital had diminished approximately 100 daily for the preceding three days. To keep relatives of patients ill in hospital informed as to the condition of the patients, "danger" telegrams were sent out at regular intervals.
On Wednesday, October 2, 1918, the admissions were 412, discharges 426, total number in hospital 3,587. There were 30 deaths that day, due to pneumonia, all following clinical influenza. The number of admissions was smaller than during the previous day, but the patients admitted were more seriously ill, and a major number of litter cases was among them. The number of pneumonia complications rapidly increased; nine wards were filled with this type of disease.
Local undertakers were unable to cope with the situation, their capacity being estimated at 13 to 15 bodies a day. Inspection of their establishment revealed 25 untouched bodies at 5 p. m., while 47 remained in the mortuary at the base hospital. Their establishment was in confusion and was not being systematically managed; so two soldiers (embalmers) were sent to their assistance to work under a sergeant of the base hospital detachment, an experienced embalmer. Five more soldiers and a clerk were asked for.
Great confusion in the records of the information bureau resulted from many transfers of patients in and about the hospital without the information bureau being properly notified. A consultation was held and it was decided that, generally speaking, pneumonia patients would be as well cared for in influenza wards as they would be if transferred to pneumonia wards. One ambulance and three wheel litters and a motor truck, together with many men, had been in use an entire day in transferring pneumonia patients to pneumonia wards.
On Thursday, October 3, 525 patients were admitted to the hospital; 482 were discharged; total remaining in hospital, 3,659. There were 42 deaths due to pneumonia, following influenza. There was a slight increase in the number of cases admitted and a large increase in the death rate. Patients admitted to the hospital were more critically ill than before; there were more litter cases admitted; and more patients were developing pneumonia throughout the
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hospital than had been the rule. Approximately 40 nurses arrived for the emergency, and telegraphic notice was received that a like number would arrive in the near future. The ladies of Chicago volunteered their services in large numbers. The services of these ladies were used for filling capsules, work at the information bureau, the preparation of paper cups, clerical work in the ward (transferring temperatures from memoranda to clinical records), and in the supervision of the Red Cross canteen.
The number of visitors, relatives who had been summoned by "danger" or "death" telegrams, greatly increased. The ward personnel was instructed to show these visitors every consideration during their moments of deep distress. Authority was received to employ civilian nurses, and, as they were sadly needed, a great many were employed.
There were 438 telegrams sent out and received by the hospital on this day; and as the telephone lines were swamped a letter was written to the commanding officer, Camp Grant, recommending additional lines. From 400 to 500 telegrams were sent and received daily. The establishment of an emergency telegraph office was recommended.
All the undertakers of Rockford were called into a conference, at which each agreed to take his share of the base hospital work at $50, the contract price. There were at that time 49 bodies in the mortuary and about 30 in Rockford untouched. Each undertaker took his capacity, which was from 3 to 10 bodies, and after all had their establishments filled there were about 30 bodies left in the hospital mortuary. It was obvious that something had to be done in the way of organization and increased capacity. The president of the Western Casket Co., of Chicago, was requested to come to Camp Grant for consultation and assistance.
On Friday, October 4, the admissions to hospital numbered 437; discharges, 520; and deaths, 76-all due to pneumonia. The total number of patients in hospital was now approximately 3,396. There was a decrease of approximately 100 patients admitted to hospital, but the condition of those admitted was of a more serious nature.
The exact hour of death, to the minute, had to be given on the clinical record, and ward surgeons were instructed to see that this information was placed on all clinical histories before they were sent to the office.
The handling of the effects of the deceased grew into an enormous burden. To meet this emergency, an Infantry officer was attached to the base hospital on this date to handle all patients` clothing, valuables, trinkets, etc. His office was established in the clothing room of the receiving ward, and to him company commanders had to report in order to obtain, and receipt for, the effects of the deceased.
The procuring of transportation for remains developed into a large and important problem. A sergeant of the Quartermaster Corps was placed in charge of the transportation for remains as well as the clearing of the same from the hospital mortuary. His office was located in the administration building of the hospital, and all inquiries relative to the shipment or location of a body were referred to him.
The president of the Western Casket Co. arrived, on this date, with a number of embalmers. He consulted with the local undertakers, and by evening a
246
building had been secured which satisfactorily cared for the situation. Arrangements were made whereby local undertakers were to transport the bodies. Three trucks, without tops or sides, were furnished for this purpose, but these were rejected and Army trucks were used, with an officer of the Quartermaster Corps in charge. By midnight the mortuary was empty, although there had been 103 bodies during the day.
On Saturday, October 5, 1918, there were 439 admissions, 328 discharges, and 102 deaths, all of the latter due to pneumonia, and the total number of patients in hospital was 3,579. The admission rate remained practically at this level for several days. The mortality rate having increased steadily from the first week of the epidemic, it was thought probable that the apex had not yet been reached.
There was no known specific treatment for this disease and no known absolute prevention. Therefore, the following memorandum was issued: "The wearing of masks and gowns, frequent washing of the hands, and avoiding putting the hands in mouth or nose are very important. Persons must avoid crowding whether on duty or not, and all officers, nurses, and enlisted men should use every effort to avoid this. Fatigue plays a very important part in rendering one susceptible to sickness and should be avoided as much as possible."
A sufficient number of nurses arrived under orders, together with an adequate number of enlisted men. There being a division of responsibility between the service corps and the ward men, the wards were not sufficiently policed. The service corps was then abandoned. The embalming problem was solved through untiring effort.
On Sunday, October 6, the admissions numbered 370; discharges, 430; deaths, 99-all due to pneumonia. The total number of patients in hospital was 3,420. During the day the head house was equipped and opened as nurses` quarters. The eye department was moved to the former electrotherapeutic room; the ear, nose, and throat department was moved into operating room No. 3; and the recruiting office was moved into the hallway of the dental department. There were now 370 nurses (including student nurses) and these were quartered in the Red Cross house and barracks 1029-N, as well as in the head house and in the regular nurses` quarters.
The death rate reached its highest point October 6, when 116 deaths were recorded. The city mortuary was overtaxed, leaving 20 bodies at the base hospital at 8 p. m.
The number of visitors increased until thousands of persons called upon the information bureau daily for various kinds of information. During a day several thousand telephone calls were answered and sent and 768 telegrams received and sent out. The space was inadequate, and in order to meet the demand a hospital ward tent was erected, floored, and wired with drop lights. Three telephones were installed, desks conveniently arranged, seats provided for visitors, emergency beds placed for persons who might need them, cloak and coat hooks provided, and stoves installed. The new information bureau was conspicuously marked by signs, electric lights, and a Red Cross flag. An arc light was provided and the parking area in the vicinity of the information bureau brilliantly illuminated. The tent communicated with the near-by corridor through which visitors were conducted to the various wards by Red Cross representatives, after
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masks and gowns had been provided them. The index was transferred and only direct information to visitors was given, the clerical side of the information bureau being retained in its original place.
On Monday, October 7, the admissions numbered 235; discharges, 301; deaths, 116; total patients in hospitals, approximately 3,238.
The number of pneumonia cases increased until there were about 1,250 patients in the hospital suffering from this disease. Following a conference held among the medical men of the institution, it was decided to group pneumonia patients so that those acutely ill, coughing, and running high temperatures would be in one group, the convalescents in another group, and the intermediate cases in a third group. Transfers were made accordingly. The idea of the plan was to prevent reinfection of the convalescent patients. It was also decided that cubicle sheets extending to the foot of the bed both interfered with ventilation and prevented the ward attendants from keeping a close watch on the patients; so, thereafter, cubicle sheets were so arranged as to extend from the wall to a point not beyond the patient`s waistline.
There were several instances where mistakes were made in the addresses of the deceased. So far as known such errors were discovered before shipment of the remains. Case numbers were used on all records after death, including a numerical roster, alphabetical card index, death certificate, history, reports to the quartermaster and company commanders, the arm band, the check sheet, and telegrams. This proved of the greatest value. A list of the admissions was made, in triplicate, in the receiving office, one copy being sent to the chief of medical service, one to the camp surgeon, and one to the receiving office. The receiving office handled only the blotter sheet and the valuables of the patients. At the time Form 55a was made, the register of patients` card, No. 77, was made, with a carbon for the index and the discharge of the patient. The receiving office also prepared a discharge sheet in duplicate, one for the information bureau and one to be retained.
On Tuesday, October 8, the admissions dropped to 195; 358 patients were discharged; and the total number in hospital was 2,957. There were 98 deaths, all due to pneumonia following influenza.
The general improvement in the appearance of the hospital during the preceding 48 hours exhibited a better control and a nearer approach to the previous efficiency of the hospital organization. The extra beds were removed from the 30 rows of wards. There was every indication that the epidemic had reached its peak.
On Wednesday, October 9, 133 patients were admitted, 268 were discharged, leaving a total in hospital of 2,782. There were 107 deaths, all due to pneumonia. As there were approximately 1,500 cases of pneumonia in the hospital, this death rate was not considered surprisingly high.
During the early days of the epidemic, the increasing morbidity rate among the personnel was alarming. The civilian nurse personnel showed the highest percentage, and, of those sick, three died. There was great difficulty in getting these nurses to wear masks or gowns, or to carry out many other orders. The graduate nurses came next in number, on the sick list, and three of the Army nurses died. The detachment, Medical Department, had a very high sick rate. About 10 per cent were sick in hospital and the deaths were 12. The nurses,
248
Army School of Nursing, had the lowest sick rate, with but one death. This nurse was not in good health and appeared below normal on admission to the school. As the pupil nurses worked in the wards, on long hours, it was thought that the reasons for their low sick rate were strict adherence to carrying out orders pertaining to masks and gowns, their outdoor training before the epidemic, and their physical condition in general. Eleven medical officers contracted influenza, but among them there were no deaths.
Many of the emergency nurses did not render satisfactory service and caused considerable work and worry by expressing their desire to resign and go home. It was believed that the service would be better off without this class, and they were allowed to return, although some of them rendered less than one day`s service.
The sick rate for the nurses continued high, and on October 8 there were 71 off duty out of 400, while of 1,600 enlisted men on duty there were but 57 excused because of sickness. To this date 4 nurses and 12 enlisted men died; there were no deaths among the medical officers.
On Thursday, October 10, 1918, 118 patients were admitted to the hospital; 214 were discharged; and the total number in hospital was 2,579. There were 77 deaths, all due to pneumonia. There was a noticeable improvement in the general condition of the epidemic during the previous 24 hours-there were fewer deaths, fewer admissions, and the patients as a whole seemed in better condition.
On Friday, October 11, 86 patients were admitted; 175 were discharged. There were 37 deaths, all due to pneumonia. One thousand five hundred pneumonia patients still remained in hospital.
Every effort was made to furnish as much fresh air to patients during the epidemic as possible, as rest in bed and fresh air, with ample water to drink, were believed to be the most important forms of treatment known at that time.
On Saturday, October 12, the admissions numbered 99, discharges 112, and deaths 54, all due to pneumonia. The total number of patients in hospital was 2,391. The small number of patients discharged was due to the fact that convalescents were being held longer in hospital. Up to this time it had been necessary to discharge patients, as soon as possible, to infirmaries, because of the pressing need of beds.
On Sunday, October 13, 85 patients were admitted; 128 were discharged; deaths from pneumonia numbered 36; and the total number of patients in hospital was 2,331. There were 1,504 cases of pneumonia, 24 less than on the preceding day. The general appearance of the patients in hospital was greatly improved and the number of convalescents seen in the wards rapidly increased.
On Monday, October 14, 40 patients were admitted; 124 were discharged; and there were 29 deaths due to pneumonia.
Tuesday, October 15, 65 patients were admitted, 123 were discharged, and 20 died from pneumonia. The patients in hospital numbered 2,139. The two-story ward barracks were now standardized at 80 beds each, and all Quartermaster property was removed and replaced by Medical Department property.
On Wednesday, October 16, 95 patients were admitted and 175 were discharged. There were 22 deaths, one of which was due to scarlet fever, the remainder to pneumonia.
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On Thursday, October 17, there were 67 admissions and 146 discharges; 10 patients died from pneumonia.
The total number of cases of influenza, pneumonia, and deaths reported daily is tabulated below:
TABLE 12.-Influenza and pneumonia statistics, Base Hospital, Camp Grant, Ill.
|
Date |
New cases of influenza |
New cases of pneumonia |
Deaths |
Date |
New cases of influenza |
New cases of pneumonia |
Deaths |
|
1918 |
|
|
|
1918 |
|
|
|
|
Sept. 21 |
70 |
0 |
0 |
Oct. 16 |
19 |
25 |
10 |
|
Sept. 22 |
177 |
0 |
0 |
Oct. 17 |
30 |
17 |
18 |
|
Sept. 23 |
293 |
0 |
0 |
Oct. 18 |
19 |
11 |
9 |
|
Sept. 24 |
488 |
0 |
1 |
Oct. 19 |
6 |
4 |
13 |
|
Sept. 25 |
689 |
0 |
0 |
Oct. 20 |
19 |
8 |
9 |
|
Sept. 26 |
864 |
6 |
0 |
Oct. 21 |
15 |
8 |
5 |
|
Sept. 27 |
984 |
3 |
3 |
Oct. 22 |
5 |
5 |
2 |
|
Sept. 28 |
872 |
19 |
6 |
Oct. 23 |
14 |
3 |
3 |
|
Sept. 29 |
803 |
9 |
8 |
Oct. 24 |
1 |
1 |
2 |
|
Sept. 30 |
616 |
6 |
14 |
Oct. 25 |
3 |
2 |
3 |
|
Oct. 1 |
635 |
133 |
30 |
Oct. 26 |
10 |
0 |
1 |
|
Oct. 2 |
697 |
380 |
42 |
Oct. 27 |
8 |
1 |
1 |
|
Oct. 3 |
408 |
193 |
76 |
Oct. 28 |
6 |
4 |
3 |
|
Oct. 4 |
409 |
247 |
102 |
Oct. 29 |
3 |
0 |
1 |
|
Oct. 5 |
318 |
276 |
99 |
Oct. 30 |
4 |
0 |
0 |
|
Oct. 6 |
218 |
231 |
116 |
Oct. 31 |
3 |
0 |
1 |
|
Oct. 7 |
186 |
201 |
98 |
Nov. 1 |
0 |
2 |
0 |
|
Oct. 8 |
171 |
160 |
107 |
Nov. 2 |
2 |
0 |
2 |
|
Oct. 9 |
100 |
97 |
77 |
Nov. 3 |
1 |
3 |
1 |
|
Oct. 10 |
86 |
87 |
37 |
Total |
9,554 |
2,332 |
1,060 |
|
Oct. 11 |
96 |
75 |
54 |
Not reporteda |
1,185 |
---- |
---- |
|
Oct. 12 |
120 |
33 |
36 |
Total |
10,739 |
2,332 |
1,060 |
|
Oct. 13 |
34 |
25 |
29 |
| |||
|
Oct. 14 |
32 |
32 |
20 | ||||
|
Oct. 15 |
20 |
25 |
21 | ||||
aUpon investigation by the epidemiologist it was found that approximately 1,185 cases were not reported by the medical officers. These were the mild cases which were taken care of in the various infirmaries.
TABLE 13.-Drugs used in dispensary, Base Hospital, Camp Grant, Ill., during the influenza epidemic, 1918.
|
Magnesium sulphate-solution (3,600,000 c.c...........gallons |
900 |
Brown mixture (900,000 c.c.)........gallons |
250 |
|
Liquid green soap (800,000 c.c.)...do.... |
200 |
Liquor ammonium acetate (40,000 c.c)........gallons |
10 |
|
Alcohol (360,000 c.c.)...do.... |
90 |
Tincture digitalis (20,000 c.c.)...do.... |
5 |
|
Whisky (108,000 c.c.)...do.... |
27 |
Calomel tablets |
20,000 |
|
Chloroform cough mixture (800,000 c. c.)...gallons... |
200 |
Aspirin tablets |
92,000 |
|
Liquor antiseptic, alkaline (600,000 c.c.)...gallons... |
150 |
Aspirin powder...pounds... |
40 |
|
Dobell`s solution (400,000 c.c.)...do.... |
100 |
Codeine tablets |
3,000 |
|
Liquor cresolis compound (160,000 c.c.)...gallons... |
40 |
Morphine tablets |
2,400 |
|
Castor oil (80,000 c.c.)...do... |
20 |
Strychnine tablets |
25,000 |
|
Formaldehyde (80,000 c.c.)...do... |
20 |
Adrenalin tablets |
5,000 |
|
Elixir iron, quinine, and strychnine (120,000 c.c.)...gallons... |
30 |
Atropine tablets (hypodermic) |
7,500 |
|
|
Quinine tablets |
2,000 | |
|
Digifoline..................ampules |
250 | ||
|
| |||
TABLE 14.-Figures and statistics from the influenza epidemic compiled by the Quartermaster Department, Base Hospital, Camp Grant, Ill.
|
Carloads |
17 |
Total blankets used |
20,000 |
|
Total weight of supplies handled...pounds... |
750,000 |
Pillowcases |
7,600 |
|
|
|
Supplies transported (truck loads) |
240 |
|
Cubicle wire (about 50 miles)...do... |
260,000 |
Supplies transported (wagonloads) |
520 |
|
Muslin...yards... |
11,000 |
Electric wiring |
Over 1 mile |
|
Tar paper...do... |
30,000 |
Labor days, 1 man for 1 day |
2,675 |
|
Straw...pounds... |
125,000 |
Emergency tents with stoves and floors. |
215 |
|
Sheets |
25,000 |
| |
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There were 81 officers on duty at the hospital when the epidemic commenced. This number being very soon inadequate some medical officers were transferred from the camp, and request was made to the Surgeon General for additional officers. The number was rapidly increased to 130. Medical officers were relieved from all duties, such as detachment commanders, that could be performed by line officers, and line officers were assigned to the hospital by the commanding officer of the camp.
In order that the medical service could function properly with the rest of the hospital it was necessary to create an additional office. The officer in charge of this additional office was designated "chief of clinics." Special orders were issued placing this officer in charge of all hospital services, and empowering him with the authority to issue orders in the name of the commanding officer of the hospital. The chief of clinics continually made rounds over the hospital, visiting every ward daily, examining such cases as he thought necessary, instructing the ward surgeons and taking general charge of the distribution and discharge of patients. His services were of the greatest value, not only in this capacity but as an adviser to the commanding officer.
Much time was spent in preparing required reports. The services of five experienced officers of the medical service were required for from two to five hours each morning in preparing the reports for the camp epidemiologist, and then frequently the reports were only relatively correct. Other reports required by higher authorities demanded much time and necessitated the services of valuable medical officers.
During this epidemic the medical service constituted almost the entire hospital, since only a few surgical and special wards remained beyond the jurisdiction of the service. Yet, in spite of this enormous expansion within the short period of a week, there was system and order in the work of the medical officers. The chief of the medical service established a system of inspection and consultation that kept the service coordinated, and by means of a night force of medical officers on duty from 10 p. m. to 8 a. m. all medical officers had adequate rest and were at all times capable of performing efficient work.
The post-epidemic period until January 1, 1919 , was one of anticlimax, both because of a let down after the epidemic and because the signing of the armistice brought a lessening of enthusiasm in all branches of the service. Logically, there was no reason for the latter effect in the Medical Corps, but it existed nevertheless. It is to the credit of the hospital organization and its personnel that this state of mind did not result in any lowering of professional standards.
The arrival of overseas convalescents brought a great variety of chronic cases, including some of the rarer diseases. During the first year of hospital activity there was a certain monotony in the type of disease cared for. During the second year, and especially after January, 1919, there was a greater number of chronic cases, the nephritic, cardiac, rheumatic, gastrointestinal, essential blood diseases, and diseases of ductless glands. Another circumstance which increased professional interest considerably was diagnostic work done in cooperation with the medical discharge board in the demobilization organization. Many obscure cases reached the hospital from this source.
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SURGICAL SERVICE
When the hospital was opened there were no surgical patients; and under the direction of the commanding officer drills were held daily for the purpose of teaching operating-room technique.
The first operation was a herniotomy. Following it, the number of operative cases gradually increased, until at the end of the year 1917 the total surgical admissions had reached the not inconsiderable number of 631.
The work of the surgical service was very much the same as that of any of the general hospitals of the larger cities of the country. Only 2 deaths in a series of 228 operations occurred, each the result of general peritonitis following acute appendicitis, the peritonitis existing at the time the patient was admitted to the hospital.
Until the middle of December, 1917, the sterilizing of all surgical supplies for the operating room was done in an Arnold sterilizer; in spite of this fact, there was but one case of postoperative sepsis. This complication was very mild and occurred in a double hernia, the interesting feature being that both sides of the patient were done without any change in gloves or gowns, and the side operated upon first became infected, the opposite side healing by first intention. Subsequent to the middle of December, the sterilizing was done in a modern steam sterilizer of the Morris-Scanlan type.
Prior to October 23, 1917, the operating was accomplished in the end room of one of the wards originally intended for either recovery of patients or as an isolation room. On October 23 the operating personnel and equipment were moved into the operating pavilion, which was devoted entirely to operatingroom work. This pavilion had, with the exception of elaborate details of construction, all the advantages of a modern metropolitan hospital. Primarily, all the enlisted personnel on duty in this operating suite had absolutely no knowledge of any of the principles of asepsis or antisepsis, but very soon they reached a high state of efficiency.
The surgical service at the end of its first year of existence had the equipment of a first-class surgical unit. In the operating pavilion there were two large operating rooms which were connected by an anesthesia room and sterilizing room, containing ample sterilizers to easily meet the demand of 50 operations weekly. Adjoining the operating room was the office of the chief of surgical service, which was added in May, 1918, and a small laundry to reclaim soiled gauze and bandages. The latter proved of great economic value by reducing the use of surgical dressing materials to a remarkable minimum.
A third operating room, used only for septic cases, with an adjoining dressing room for emergency cases, was opened in the building for head surgery.
Surgical wards comprised, at the end of the first year of the hospital`s existence, a receiving ward, which was opened in April, 1918. To this receiving ward were sent cases which did not go directly to the operating room. Here their histories were taken, physical examinations of them were made, and diagnoses of their conditions reached after careful consideration. There was installed in this ward a unit clinical laboratory in which the various blood and urine examinations were made in shorter time than by the usual routine. Here also the laboratory work of the other surgical wards was done. By using this ward as a diagnosis and observation ward, better diagnostic conclusions could be reached,
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and the danger of occasional contagious diseases being admitted to other wards was lessened. It was here that instructions to new officers were given in paper work, in the keeping of charts, and in the routine work of the ward.
In addition to the receiving ward, the surgical department had two recovery wards for clean postoperative cases, one ward for pus cases and one for orthopedic patients, including those with fractures.
About 150 officers were instructed in the surgical service and prepared for overseas work, many lectures and lantern slide demonstrations being given for this purpose. Officers of Base Hospital No. 58 and Evacuation Hospital No. 20, both organized at Camp Grant, were afforded opportunities to work in the wards and operating rooms, thus enabling their respective chiefs to observe the staffs concerned and to assign members of them in accordance with their qualifications. In addition to the regular officer class for instruction, special surgical meetings were held three times weekly; and ward "walks" through different wards took place practically daily, to keep up the interest of the surgical staff.
In so far as the surgical work at the base hospital is concerned, three epochs may be distinguished: The period of development from the beginning of the hospital to September, 1918. In September, 1918, the second period was ushered in by the influenza epidemic which demanded all hospital space and brought into the surgical service approximately 100 empyema cases. Fortunately, this period was of short duration and was followed by the period after the armistice, when the entrance of overseas cases into the surgical service of the hospital changed the character of the surgical work entirely. During the first period, the fitting of soldiers for duty, by operating on remediable defects, constituted the main activity of the service. Incidentally, appendicitis, accidents, and rarer surgical conditions, to be expected in a camp population of over 40,000, gave a variety to the work. In the second period, the work consisted principally of operative procedures on the empyemas occurring in the influenza epidemic. The statistics of the hospital show a mortality rate of all the empyema cases with all complications to be but 20 per cent. In the reconstruction period many cases of compound fractures following gunshot wounds, in all stages of repair and nearly all accompanied by osteomyelitis, kept the hospital surgeons and the departments of physiotherapy and reeducation busy. A number of aneurysms, skull defects, injuries to peripheral nerves, were of special interest. During this time, patients in the surgical department numbered as many as 1,400.
SECTION OF ORTHOPEDIC SURGERY
This section was under the direct supervision of the chief of surgical service, and no sharp line of demarcation appeared between the orthopedic and surgical sections. The arrangement worked with complete satisfaction because of the willing cooperation of the various chiefs concerned.
The orthopedic section was one of the innovations in the Medical Department, and by reason of its newness in the military hospital, the limits of its field of activity were not clearly defined; and there was at this hospital, as in many civil hospitals, some concern in the assignment of the cases to the various sections of surgery.
Previous to the receipt of overseas wounded, the major portion of the orthopedic cases in hospital were fractures or joint injuries, the remainder
253
being back cases, arthritic conditions, and deformities admitted for study or corrective work.
Other important work of this section was the examination of men to determine their fitness for various arms of the service or for their retention in, or rejection from, the Army. As a matter of course, a large percentage of such examinations was made on subjects of real, imaginary, or pretended foot disability. The handling of these foot cases for the best interests of the service presented quite a problem. During the earlier days of the orthopedic section, considerable time was given, by the out-patient service, to the correction of such deformities. With the growth of the camp, and increasing activities within the hospital, this work was taken up in the development battalion, and the orthopedic section acted only in an advisory capacity or as a board of review in these cases.
Other important groups examined were those suffering from low-grade arthritis of long standing, traumatic or focal in origin, and subjects of old healed bone and joint injuries which, though not incapacitating them for relatively inactive civilian occupations, produced sufficient disability to necessitate rejection from the military service. Particularly was this the case with internal derangements of the knee, and the fact was strongly impressed upon the officers of this service that this type of injury merited much more consideration than had been given many men already treated by them.
In the wards themselves the grouping of the bone and joint cases had very material advantages in the application of definite lines of treatment and in comparisons of end results obtained. The standard splints were used routinely and did not apparently lessen a man`s initiative. They left much opportunity for ingenuity in their application to individual cases and at the same time offered strong evidence of the fact that simple apparatus, properly applied, gives the desired result. Such standard splints simplified the kind of supplies very much and their use made the officers in training familiar with them before these officers were assigned to units for overseas service.
With the admission of overseas cases in December, 1918, the service began to expand rapidly and take on a very different character. The signing of the armistice, and the demobilization following it, had greatly reduced the work of the orthopedic section; but after December 15, 1918, the wards quickly filled with open and closed injuries of bone, nerves, and soft parts. Dressing cases, hitherto rather rare in the orthopedic section, became the rule and the character of work to be done changed completely. The resources of the department were taxed to the utmost and the officers within it at this time were called on for more activity than at any time in the existence of the hospital, save during the days of the influenza epidemic. Once again the orthopedic section and the general surgery section had no sharp line of demarcation, for the cases were border line in such a large proportion of instances that only by active cooperation could the best results be obtained. At this time the orthopedic section, besides caring for wards where patients, more definitiely orthopedic, were collected, acted in an advisory capacity on splinting and physiotherapy throughout the hospital.
The addition, in January, 1919, of the department of physiotherapy, supplied the orthopedic service with a very necessary help in the way of massage
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and supervised gymnastics. The contribution by this department to the results obtained was a very large one and demonstrated the need of permanent provision of this kind wherever bone and joint injuries were treated.
LABORATORY SERVICE
The degree of development and progress attained by the laboratory section could be equaled only by the best civilian institutions in the larger cities. Many physicians entering the military service at this hospital were astonished to find such a well organized and well equipped laboratory in the possession of facilities anticipating their demands to a marked degree in almost every phase of clinical medicine. In fact many men recently graduating from class A medical schools found the facilities for obtaining clinical laboratory data practically along the same lines and with the same degree of refinement as had been taught them while at school. Those who had been in general practice came to realize the importance of blood, urine, and other examinations in a way not before recognized; and discovered that clinical bacteriology, including pneumococcus-typing, claimed a position not to be disregarded in the intelligent care of medical and surgical patients. This much may be said regarding the relation of the laboratory to the ward surgeon, covering, in general, the examinations usually regarded as routine. The laboratory at this hospital did all this but its organization plans included a field of development almost equally important to the hospital and of paramount significance to its personnel, namely, constructive investigation. Unfortunately, its growth in this direction was cut short by the disorganization incident to demobilization of the Army.
During the most trying period of the existence of the laboratory, when the hospital was suddenly crowded with sick of the influenza epidemic, and when demands for laboratory supplies and equipment exceeded by far any anticipations, special provision was made locally, and so promptly were requests carried out that not once was the laboratory work delayed on account of want of equipment or supplies.
X-RAY DEPARTMENT
The X-ray department was opened on October 31, 1917, when the space allotted to it consisted of but three rooms. The first room was used as an office and viewing room as well as for filing exposed plates. As the volume of work increased, the space allotted for the filing of plates became congested and it was found necessary to remove the old plates from the file. These were carefully placed in boxes and were moved out into the corridor; and the boxes were numbered and so placed that, when it was necessary to look at an old plate, it could be very easily found. The second room was used for radiographic and fluoroscopic purposes, a small room being walled off in which the transformer and unexposed plates were kept. The third room was used for a dark room and as a storeroom for chemicals and accessories.
The transformer installed was the Universal type (Wantz model) manufactured by the Victor Electric Corporation, and the accessories used were manufactured by the various X-ray firms of the country. Due to the unusually heavy demands on the transformer and to minor errors in installation,
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some difficulty was experienced in the early weeks of operation, but after the troubles were located and rectified no further difficulties were experienced and a greater volume of work was handled daily.
Until the end of 1917 there was a chief of service, one officer as an assistant, and three Medical Department enlisted men, acting as technicians. This personnel handled the work satisfactorily during that period. Subsequent to the end of 1917 there was a steady increase in the number and variety of X-ray examinations, as a result of which the work grew to such an extent that it was found necessary to increase the personnel and make some additions to the equipment. The personnel was increased to two officer assistants and six enlisted men. The principal addition to the equipment was one United States Army table and one portable X-ray outfit complete, this being added about the middle of the year 1918.
The apparatus and laboratory space permitted the accomplishment of any ordinary X-ray work, but was grossly insufficient for the volume of work demanded during the year 1919.
The X ray proved to be a very important factor during the last quarter of 1918, when the influenza epidemic was present, the major portion of the work consisting of X-raying pneumonia and empyema cases; also during the first quarter of 1919, when overseas patients in large numbers were X-rayed. The majority of these overseas patients were recovering from the effects of gunshot wounds and were for the most part such surgical cases as those with foreign bodies, fractures, and osteomyelitis; but there were some gassed cases and miscellaneous conditions which were included in the medical service. This great inrush of patients placed a heavy demand on the X-ray department, both for diagnostic purposes and as a means of obtaining a complete record of the man`s physical condition before his discharge from the Army. During this time from 60 to 80 patients were handled daily and a great many instructive and interesting cases were encountered.
After Camp Grant was made a demobilization center, numerous patients were sent to the X-ray department for examination. A great many of these were men who had been overseas and had been seriously gassed. Each case was fluorscoped and if anything suspicious was found a set of stereoscopic plates was made. A report was sent to the medical examining board the same day; and in that way the men, in case their conditions did not warrant observation or treatment, were able to receive their discharges with the other members of their respective organizations. On account of the inconvenience of sending the men from the examining board to the hospital, and because the number of suspicious cases increased, a fluoroscopic machine was installed at the place where the men were examined. This took a great amount of work from the X-ray department, and only cases that needed plating were sent thereafter to the X-ray department.
The addition of the portable apparatus to the X-ray equipment made possible radiographic work in the pneumonia and empyema wards. It proved to be an indispensable aid during the influenza epidemic.
All acute chest conditions were X-rayed as a routine on their entrance to the hospital. The empyema cases had a plate and a film taken on the same exposure. The plate was kept on file in the main laboratory and the film was
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sent to the ward with the roentgenologist`s report, both of which served as a means of reference until the case was dismissed from the hospital. The film was then returned to the main X-ray laboratory and was placed with the plate.
A complete set of localization apparatus was added to the X-ray department; and during the rush of convalescent overseas cases some localization for foreign bodies was required; but the work was not done on an extensive scale.
GENITOURINARY DEPARTMENT
Immediately upon the opening of the genitourinary service of the base hospital, a definite policy was established to minimize to the greatest possible extent the loss of effectives from venereal diseases. To accomplish this it was necessary to organize and train a force of men to properly treat venereal diseases; and each enlisted man of the Medical Department, assigned to this service, was given individual instruction. A small unit laboratory was established and within a month after the opening of the base hospital the genitourinary department was functioning in every way and running smoothly.
The percentage of venereal diseases detected among the inducted men differed in no way from the average percentages detected at other camps; however, only active venereal diseases were admitted to this hospital for treatment. A working plan was established in connection with the organization of the camp, and all ambulatory venereal cases were treated as out-patients at the base hospital. By so doing it was possible to limit the service to two wards of the hospital and at the same time give the best possible treatment to all cases of the camp.
Each venereal case was gone over thoroughly and its pathological condition was located. No routine treatment was followed for cases affected with gonorrhea; each case was individualized and treated according to the pathological condition present. When urethritis existed there was no self-treatment by the soldier. Each venereal ulcer was thoroughly examined for spirochta pallida. Many times this required repeated examinations. Once the spirochta pallida was demonstrated, intensive luetic treatment was started immediately. By following this plan of procedure not many cases of active secondary lues developed. The luetic treatment which was administered was in accordance with instructions issued by the Surgeon General. Venereal ulcers which were not luetic were handled in such a way that the stay in hospital of those having them was comparatively short and among them very few suppurating buboes developed.
Cases of pyuria, hematuria, etc., were carefully studied to locate the true pathological condition. Most of these complications were found to have existed prior to enlistment and men suffering-from them were discharged on surgeon`s certificate of disability. Those that were contracted after entrance into the service were given appropriate treatment. Very little operative work was done. Many soldiers were observed with varicocele. It was borne in mind that operative intervention in this condition was often followed by untoward results, and these cases were given palliative treatment, an effort being made whenever possible to have the men affected assigned to a duty compatible with the condition present.
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During the spring of 1918 the camp received a large number of colored troops and among them there was a high rate of venereal disease. Because of this condition a camp venereal infirmary was established. The conditions which these colored recruits presented were such that they were not fit for military service, still it was felt nothing special could be gained by placing them in hospital. A thorough understanding between the officers at the base hospital and those on duty at the camp venereal infirmary made it possible for these two units to work hand in hand, and the same policy was pursued relative to minimizing the number of noneffectives by sending only those cases to hospital in which there was a definite indication for hospital treatment. No soldier was denied hospital treatment whenever such treatment was necessary.
DEPARTMENT OF OPHTHALMOLOGY
The work done in the department of ophthalmology consisted of the following four distinct classes of activity: That in the out-patient department, where most of the work was done; the care of patients in the eye ward; consultations in other wards of the hospital; and the fitting and dispensing of eye glasses. The work of the outpatient department consisted of the treatment of the various eye diseases, refraction, numerous examinations for commissions, promotions, discharges on Surgeon`s Certificate of Disability and special examinations for the air service. The total number of new cases treated in the department was 4,083; return patients 6,583. The total number of refractions was 2,529. Only serious cases, accidents, etc., were sent to the eye ward.
In a great many instances men were accepted for military service when they had surprisingly low vision. Correction of the error in these cases was most necessary for their usefulness in the Army and after their return to civil life. A gratuitous issue of glasses was made to these men. They were inclined to take two pairs of glasses, that furnished by the Army, and another, of better appearance, at their own expense. When the glasses, gratuitously issued, were sent to the soldiers it was very difficult to secure a receipt for them, accordingly, the practice was adopted of obtaining their receipt at the time the glasses were fitted. Many pairs, having been receipted for, were never called for, and it was necessary to use the frames and lenses for other soldiers.
Among the negro soldiers there were many absurd complaints, but in general their eyes were very good. Some cases of trachoma were seen, however, as well as some cases of true night-blindness.
The influenza epidemic left but one medical officer in the eye department, the two others being called upon to assist in the handling of the epidemic. A great deal of work was done in the eye department during the epidemic period, the influenza patients being affected usually with conjunctivitis.
During the period in which overseas patients were being handled in large numbers at this hospital there were many cases of wound of the eye and brain. In addition, many cases were referred to the department from the demobilization center of the camp for examination.
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OTOLARYNGOLOGY SECTION
The arrangement by which the work in the several specialties was taken care of in departments devoted to these specialties proved to be one of the greatest features in the organization of the base hospital. This provision made it possible to utilize the services of men whose years of work in each field prepared them for this task.
The department of otolaryngology was an important part of the base hospital at Camp Grant, as has been evidenced by the number of cases cared for in the department. The work naturally fell into three divisions: That in the otolaryngological ward; consultation on cases confined to other wards in the hospital; and the out-patient department. All the cases which required surgical treatments were included in the otolaryngological ward. The cases on which operations had been done under local anesthesia, such as the various intranasal operations, were placed in the ward for at least the first night, in order to guard against risk from a possible bleeding. Consultation work on patients in other wards of the hospital included the examination and treatment of a great many patients, especially in the wards assigned to the care of acute infectious fevers. These cases included, for the most part, those suffering from otitis media, acute tonsillitis, particularly where the condition was complicated by peritonsillar abscess, of which there were a great many, and cases of acute infection of the nasal accessory sinuses. The work carried on in the outpatient department was especially important. As in most out-patient departments where otolaryngology has been represented, the number of patients applying for treatment was very great, the major portion of them requiring advice rather than special treatment. Every effort was made to discourage unnecessary revisits to this department. This was done by directing the patient himself how to take care of such local treatment as could be readily done by the patient. Such cases were chiefly those who applied for treatment of nose and throat conditions, where surgical measures were not called for. Cases suffering from chronic defects in hearing were carefully diagnosed; and all those, where local treatment could offer no hope for improvement, were advised to return for a course of treatments. This latter group included cases of otosclerosis, many cases of chronic middle ear catarrh, and those with nerve defects. By this policy, not only was unnecessary congestion in the outpatient department avoided, but soldiers were not kept unnecessarily from duty.
An important part of the work which fell to this department was the examining of cases found to have defective hearing after they had been sent to Camp Grant for discharge. It was important to differentiate the cases of deafness due to shell concussion from those of chronic deafness, the result especially of otosclerosis or nerve deafness. This differentiation required a careful analysis such as could be carried out only by making a functional examination of the hearing with tuning forks.
Due to the large number of cases treated, efficiency in the work of the outpatient department was possible only through the intelligent assistance of the enlisted personnel, and that obtained from the nursing department. Where so many cases were passed upon, as was found to be necessary in this department each day, it meant that much of the work, particularly that dealing with the administrative part, the selection and preparation of instruments, etc., had to be entrusted largely to assistants other than medical officers.
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NEUROPSYCHIATRIC SECTION
The function of the neuropsychiatric service in the hospital was chiefly the examination of recruits referred by the division psychiatrist, during the early days of the emergency, and the care of the psychoneurotic, and of the frankly psychotic, soldiers during the entire period.
From the beginning, of course, it was understood that all the insane would be discharged from the Army as quickly as possible. In consequence, the psychopathic ward was based on retention rather than treatment. Quite frequently, however, it was found that patients had to be retained in the ward for a considerable length of time, due to various unforseen circumstances. The construction of the ward was found to be quite adequate and well arranged, but it hardly met the requirements for the insane, the psychoneurotic and the neurological cases and a guardhouse for the prisoners. It was very obvious that the insane, especially the disturbed type, should be isolated, preferably in single rooms with windows well secured and barred. It was rare that three or four patients of this class were in the ward at the same time, when four or five single rooms constructed in this manner would have been sufficient.
The lack of trained attendants and nurses was one of the handicaps in the neuropsychiatric service. A large percentage of the enlisted personnel on duty therein had little or no training in the care of the insane.
DENTAL DEPARTMENT
When the first dental officers arrived in camp, four of them were assigned to the base hospital. One of these happened to have with him a student case of dental instruments and a foot engine. There being at that time no Government dental equipment in camp, these four dental officers alternated in the use of this secondary outfit. For a dental chair they used a plain wooden kitchen chair with an improvised headrest made of a piece of board, and the cuspidor was a galvanized-iron bucket. With this equipment they took care of such emergency cases as presented themselves.
On the arrival of the portable dental outfit, the hospital dental infirmary was moved into the bacteriological laboratory. When the hospital took over its permanent building the dental infirmary was temporarily established in two rooms of the administrative building. One of these two rooms was used as the office of the camp dental surgeon, the other was used as a dental operating room. The personnel consisted of four dental officers and one assistant.
The arrival of the base hospital dental equipment marked the next and final move of the dental infirmary. This was on December 29, 1917. The equipment, which consisted of three complete base outfits, each of which contained a Columbia dental chair, Ritter wall bracket, electric all-cord engine, and pressed steel aseptic dental cabinets, was finished in white enamel. Other articles of equipment, such as bedside tables, electric grills for the sterilization of small instruments, and electric fans, were issued from the supply room of the base hospital, by direction of the commanding officer. These three base equipments were installed in offices especially planned as to wiring, plumbing, and lighting; and gave the hospital a three-chair dental office, comparable to
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the better-equipped offices found in civil life. In addition, and in connection with these offices, there was a well-equipped dental laboratory with electric air compressors, electric lathes, vulcanizers, etc. Later there was added an X-ray equipment in a separate room, with an adjoining dark room. This was found to be necessary because the main X-ray laboratory was so busy as to make it impracticable to do the necessary dental work.
The surgical work included corrections of jaw fractures, partial jaw resections, draining of antra, removal of oral growths of various kinds, apiectomies, and extractions. This work was done under conduction anesthesia, except in rare instances where a general anesthetic was indicated, when either nitrous oxide and oxygen, or ether was used. This particular branch of the dental service of the hospital handled also between 400 and 500 cases of so-called trench mouth, or Vincent`s angina (oral).
PHYSICAL RECONSTRUCTION
Prior to January 1, 1919, there was no need of physical reconstruction at this hospital because the class of patients treated was principally of an acute type. Patients requiring prolonged convalescence were transferred to general hospitals. With the arrival of large numbers of overseas patients, however, it became essential to revise some of the policies of the hospital. Among the more important changes were those permitting patients more liberties, and the institution of means of procuring contentment, largely of a recreational nature.
The first 1,000 overseas patients admitted to this hospital proved to be extremely difficult to handle. They were disorderly, undisciplined, defiant, and were not willing to abide by military law as had been the case with other patients. Many of them had not been paid for months. They were improperly uniformed and were self-ornamented by many types of improvised so-called war insignia. They had a very exalted opinion of themselves and openly stated that persons who had not gone overseas were not in their class. From a professional standpoint the overseas patients varied a great deal in grades of physical condition, representing those cured and ready for immediate discharge, and all grades up to and including bed-ridden patients of months` duration. Among them were all classes of general medical and general surgical cases.
It was obviously necessary to use military discipline cautiously. It was also necessary to expand the hospital and its facilities to care for the entirely new type of patients. This expansion was provided along two general lines: First, to care for the professional needs of the patient; and second, to provide for his contentment in so far as that was practicable. It was to meet this latter requirement that physical reconstruction was destined to exercise its most important function, and it was about January 1, 1919, that instructions were received to organize this new service.
There were no persons at Camp Grant in the possession of any experience in physical reconstruction. There were no funds available nor was there existent space. Every effort was made to obtain officers and enlisted men at Camp Grant, but this was exceedingly difficult since nearly all persons then in the service were highly interested in being discharged therefrom. However,
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personnel was secured wherever possible, and officers and reconstruction aides were subsequently assigned by the War Department. Funds were allotted the latter part of January, 1919, but it was found difficult to utilize these funds because of either the complicated procedure in obtaining them, or misunderstanding on the part of local authorities. The entire hospital being occupied for purposes other than physical reconstruction, it was difficult to secure adequate space for this activity. This was overcome, however, by assigning one of the two-story ward barracks and securing the entire sanitary train area (which was adjacent to the base hospital) as a part of the hospital. It was not until the latter part of February that it was found possible to organize the reconstruction department, but thereafter its growth was reasonably rapid. The occupational and educational work was originally outlined in two sections: The academic and the manual training; and ward work. The first or academic and manual training work was prescribed for those patients who were convalescent and who wore their uniforms. This was necessary because the buildings used for this purpose were outside the base hospital area, necessitating patients going a considerable distance in order to reach them. The ward work was carried on exclusively in the wards among those confined either to bed or to ward clothing. There was little difficulty in organizing the academic and manual training department excepting the procurement of supplies. Considerable difficulty arose, however, following the development of ward reconstruction activities in the same place and at the same time that a great deal of surgery was being accomplished. The wards were filled with surgical patients, many of whom were more or less seriously ill. The confusion, necessary noise, and dirt incident to carrying on this work interfered with the care of the patients. Ward surgeons became apprehensive over infections, and the worry on the part of some of the patients. The nurses and ward men complained bitterly of the dirt and their inability to keep their wards in a presentable condition. Consequently, it became necessary to make a change as follows: The two-story ward barracks, nearest to the surgical ward, was set aside for electrotherapy and massage on its first floor. One half of the second floor was converted into a collective gymnasium, the other half being equipped for making such articles as basketry, bead work, and rugs, which hitherto had been carried on in the wards. This plan became so popular as to necessitate having more space, and in consequence one veranda was closed in, where clay modeling, poster painting, and other activities were carried on. This building was used principally by ambulatory ward patients of the bath-robe type, every effort being made to make their ward attractive. The patient was taken out of the hospital environment in going to this ward and was given every opportunity for work and amusement at one and the same time. Smoking materials were furnished by the hospital exchange and welfare organizations, a victrola and piano player were provided, and the recreational committee furnished refreshments and entertainment from time to time. The corridor leading to this building was inclosed to protect the patients from undue exposure. The use of this two story ward for reconstruction work for ambulatory patients eliminated a great deal of confusion and many objectionable features from the sick wards. However, it was necessary to carry on some ward work for those patients who were not able to walk or propel themselves in invalid chairs. This necessitated con-
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tinuing reconstruction work among the bed patients, but on a much smaller scale, and included not only those in general wards but in the psychopathic and tuberculosis wards as well.
The occupational therapy for patients who were permitted to leave their wards consisted of the following activities: Woodworking, toy making, basketry, metal working, block printing, sketching, poster making, bookbinding, leather work, weaving, and plastic art. The work was continuous and the teaching staff comprised a group of efficient instructors in the arts mentioned.
Occupational therapy for patients in the wards consisted of the following activities: Bead work, weaving, leather work, and macram.
The educational work was instituted to provide every possible course for which there was a need. Several members of the teaching staff gave their
FIG. 84.-Ward class in physical reconstruction, Base Hospital, Camp Grant
entire time to helping the men to decide correctly as to what work was most worth while for them after reentering civil life. The classes met at 8.30, 9.30, 10.30 a.m., 1, 2, and 3 p. m., each day except Sunday. The usual period was 40 minutes with 15 minutes at the end for individual help. Some of the shop and study classes extended over a longer time. Ward classes were independent of the general schedule. The course given covered commercial art, academic subjects, shop work (including electricity, elementary electrical engineering, automotive features, farm machinery), commercial subjects (including bookkeeping, accounting, auditing, commercial geography, shorthand, and typewriting), and agriculture.
No man was retained for courses after he had become physically ready for discharge from the hospital, except after arrangements had been made on his own request. On discharge each student was given a certificate stating the number and kinds of credits that he had earned. A credit represented two
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weeks of satisfactory work in a course, and was of value in planning further educational work under the Federal Vocational Guidance Board.
RECREATION
The policy of the commanding officer of the hospital was to further properly conducted recreation in moderation. With this in view, practically every entertainment was outlined and approved by him before any steps were taken to put it into effect, and practically every entertainment was attended by him with a view to studying it for future use and for the purpose of seeing that all persons conducted themselves with decorum.
From the very beginning no social relationship was permitted between the nurses and enlisted men, and entertainments were given for officers and nurses, the enlisted men and patients. The entertainments for ambulatory patients were of two kinds-those for patients able to dance; and those, including such games as cards and checkers, for patients with injured legs. Ward entertainments, such as victrola concerts, moving pictures, singing, musicales, and games, were given, but victrolas were not kept constantly in wards because of the noise and disturbance that continuous playing would create. The duration and type of ward entertainments were made to conform with the sickest patients in the ward. Dancing was the favorite form of entertainment for the nurses, and the first and third Tuesday evenings were set aside for graduate nurses, the second and fourth Friday evenings for student nurses. The first and third Thursday evenings were for the detachment, Medical Department, while on every Monday evening parties were given for convalescent patients. These entertainments were held in the Red Cross Convalescent House; the hospital band furnished the music: and the refreshments were provided from the general mess. The nurses were permitted to invite officers from the entire camp personnel. Young lady guests to the entertainments for the Medical Department detachment were obtained through the Patriotic League of Rockford or through the Young Women`s Christian Association.
Besides the regular entertainments, special entertainments were given on all appropriate occasions such as Halloween, Thanksgiving, Christmas, and New Year`s Day.
The entertainments for the Medical Department detachment were alternately dances and smokers. It was found that about one-third of the enlisted men attended the dances and practically all of them the smokers. The smokers were divided into two parts. The first part was a vaudeville performance in the Red Cross Convalescent House; the second part was a supper, with music and monologues, in the general mess. It was noted that, though many arrangements were made and a certain amount of money expended, unless there was some person who was especially trained to conduct the parties they were frequently unsuccessful.
In the spring of 1919, a country cottage was secured at the junction of Rock and Kishwaukee Rivers, about three and one-half miles from the hospital, in a grove on a bluff overlooking the river. It was electric lighted and had a capacity of about 15 people. This capacity was augmented by means of tents,
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which were floored and electric lighted, to accommodate 50 people. The cottage was used alternately by the officers and their families, the nurses, or by the enlisted men, one week being given to each. Large tables were built outdoors and a detail of enlisted men was assigned to do the major portion of the work. All persons, however, were required to assist in keeping the grounds clean and taking care of the quarters and tables. During the week one or more special entertainments were given and the entire personnel, or officers, nurses, or enlisted men, were invited to spend the evening. Such entertainments as corn roasts, barbecues, and cotillions were given. Hammocks, swings, boats, bathing suits, fishing apparatus, and many forms of games were provided for the amusement of the cottage occupants. Each nurse was given three days off duty, and each enlisted man was given 24 hours
FIG. 85.-Cottage used by the hospital personnel for outing, Base Hospital, Camp Grant
off duty, to spend at the cottage. An officer was kept at the cottage at all times and when there were ladies present a chaperon was provided.
THE HOSPITAL BAND
Although there were several military bands in the camp, it was difficult to obtain them for use at the hospital, and it was thought advisable to drill and train a band solely for the hospital. Authorization was requested to organize a 28-piece band on the basis of bands of this size for Infantry regiments. This was approved, and in the spring of 1918 all the enlisted men who possessed any knowledge of music were requested to meet at the chapel with a view to organizing a military band. A complete set of instruments was purchased and the band leader of one of the Infantry regiments offered his services in training the new band. Daily rehearsals were held; and with the acquisition of several experienced musicians a creditable band was soon obtained, so that in about
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three weeks after its organization it was playing at retreat and in six weeks accompanied the hospital nurses to Chicago and paraded them in a large Red Cross drive. The organization rapidly improved in efficiency and was frequently called upon to furnish music in the surrounding towns. An orchestra was organized from the band and furnished music for practically all of the entertainments given for the personnel and patients of the hospital. The band participated in every Liberty Loan drive and all other large patriotic drives that were made by the hospital organization.
During the summer of 1918, drill of the personnel was held daily, the music for which was furnished by the hospital band. It proved a great stimulus to enthusiasm and made it possible to conduct drills daily without apparent fatigue to the enlisted men.
Improvement in efficiency was continuous until the band came to be looked upon as one of the best at Camp Grant. It was not possible to have a commissioned officer as director, but the leader was promoted through consecutive grades until he reached that of hospital sergeant. Noncommissioned officers were appointed in the band in conformity, as nearly as practicable, with Infantry organizations. This was necessary to hold the musicians, as the various musical organizations of the camp were continually trying to get the better musicians transferred away from the hospital band. The organization remained intact until the 7th of July, 1919 , when it was discharged as a group.
WELFARE ORGANIZATIONS
During the early period of the hospital`s existence everyone was too busy to give thought to any form of recreation, and it was not until about the time of the signing of the armistice that recreational problems could be considered. The welfare organizations, namely, the Red Cross, Young Men`s Christian Association, Knights of Columbus, and the Jewish Welfare Board, were represented at this hospital from about the beginning. The War Camp Community Service entered into the activities during the fall of 1918, and the Salvation Army frequently offered its services, but there was no place that this organization could take without overlapping the activities of some other organization.
In so far as the hospital was concerned, the Red Cross was by far the most active. They had no representative at the hospital until about February, 1918, but the field secretaries frequently visited the hospital and distributed such articles as sweaters, caps, chest protectors, and socks. They offered to do anything that the commanding officer would suggest for the improvement of the hospital, within their limitations. The Young Men`s Christian Association confined its activities during the years of 1917 and 1918, almost exclusively to visiting the wards and distributing stamps and stationery, while the Knights of Columbus activities were restricted to religious lines.
About February, 1918, the Red Cross placed a representative at the hospital to work under the jurisdiction of the commanding officer, to provide means of writing letters for patients who were too sick or whose disabilities were such as to prevent writing. The hospital furnished this home service section of the Red Cross with a daily list of seriously sick patients in the hospital. A Red Cross representative visited each ward and wrote any letters that the patients desired to have written for them. These letters were all stamped with the Red Cross and censored by one of the officers of the hospital personnel.
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After the signing of the armistice, and after the arrival of overseas patients in December, 1918, there was a real need for recreational work. The personnel became restless with the desire to return to their homes, and the patients from overseas were disorderly, undisciplined, and frequently defiant of military law. It was quite evident that a crisis was at hand unless the root of the evil could be detected and corrected.
Under date of December 6, 1918, the Surgeon General promulgated a bulletin outlining the various recreational activities for hospitals. In this bulletin there was a statement to the effect that the Red Cross would furnish a recreational officer to take charge of its activities; that the recreational officer would work under the chief educational officer; and all welfare organizations would work under the Red Cross recreational officer. Because of the increase in the size of the Red Cross organization at this hospital it was necessary to move their office from the administration building to the Red Cross Convalescent House. This was done at the time the first recreational officer reported for duty. Instead of placing this Red Cross recreational officer in entire control, a recreational committee was organized with the chaplain as chairman, the Red Cross representative as first assistant, and the social director for nurses and the band director as other assistants. This committee was given a tentative outline to follow. The committee did not work harmoniously, as the conduct of the chaplain in general was such that it was necessary to recommend his discharge from the Army. The Red Cross recreational officer was then placed in charge. Entertainments were given for the patients, officers, nurses, and enlisted men, but the hospital bore the expenses and planned practically all the details.
The number of patients and personnel had considerably increased and the problem of their entertainment was growing more extensive and complex. The various welfare organizations were working in the hospital without very definite outline and their work was constantly overlapping. As it was obvious that a civilian could not carry on the recreational activities harmoniously with the requirements of the commanding officer and in such a way as not to interfere with the running of the hospital, the entire recreational activities were reorganized, an officer of the hospital was placed in charge, and each welfare organization supplied a member to represent it on the recreational committee. Meetings were held once a week at which various recreational problems were discussed. Certain phases of the work were assigned to definite organizations upon their approval, each organization being required to make a written weekly report covering its activities. These reports were consolidated and sent to the commanding officer of the hospital for his approval. Any new line of work required the commanding officer`s approval before it was placed in effect.
It was never possible to make the welfare organizations correctly visualize the military view of recreational work. They assumed that the larger the number of post cards, sheets of paper, and other supplies they gave away, the more important their work. They took the view that every man should have exactly what he wanted whenever he wanted it; that a visitor should be allowed in wards at all times; that all military discipline was wrong if it interfered with the patients` wishes; and that the treatment of patients should be secondary to the recreational work. They wished to place talking machines and other musical instruments in all wards of the hospital, and it was difficult to make them under-
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stand that the conduct of the wards must necessarily be based upon the sickest patients therein. To meet the needs of the patients, victrolas were obtained on movable stands and a victrola concert was given every evening for about 20 minutes, under the supervision of the head nurse of the ward. These concerts were especially planned and the victrolas were removed if any patient showed signs of being disturbed by the noise. Moving pictures were given in the ward in a similar way. The welfare organizations conducted the concerts and moving pictures.
The Young Men`s Christian Association had two secretaries on duty at the hospital for practically the whole of its existence. These men caused no trouble whatever in the hospital and their efforts seemed to be directed largely to distributing stationery and selling stamps. Although they assumed certain obligations on athletics for the detachment, little or nothing was ever accomplished by them and practically all athletic work was carried on at the expense of the hospital exchange and under the supervision of the hospital athletic officer. The Young Men`s Christian Association representatives were always willing, but seemed to be greatly handicapped by the need of funds. The association had a hut located near the hospital but it was not made use of by the hospital personnel to any extent.
The Knights of Columbus had a hut adjacent to the hospital, and its local organization accomplished much in the provision of entertainments for the patients during the year of 1919. Regularly they had moving pictures and parties, and their building was maintained as the soldiers` club room.
The Red Cross Convalescent House was at all times under the immediate jurisdiction of the commanding officer of the hospital. A noncommissioned officer was detailed in charge of it and the policing of it was done by the members of the hospital detachment. An information bureau was located within it and rooms were maintained for relatives of seriously sick, summoned by telegram or letter. A matron was maintained and within the building the Red Cross associate field director had his office. It was constantly required that this Red Cross building be kept clean and orderly and its conduct such that ladies could enter at all times. It was open to patients from 11 a. m. to 9 p. m. (for bathrobe patients) and to 10.30 p. m. for convalescent patients. All patients were required to remove their hats on entering the building and to refrain from smoking in its main room, a smoking room being provided in one of the wings. This Red Cross building was the only building that was maintained for visitors, and it was felt perfectly safe at all times to send ladies to it.
The American Library Association opened a library at the hospital in February, 1919. Subsequent to the arrival of the large number of overseas patients, their library was an attractive reading room and their representative visited the wards, furnishing books and other reading material to all persons desiring them. This association also assisted in the nurses` training school and in the reconstruction work.
THE HOSPITAL NEWSPAPER
Under special authority granted by the Surgeon General in 1918, a semimonthly newspaper was started at this hospital, the first issue appearing April 1, 1919. The issues that were published from time to time were as follows:
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April 1, 1919 (introductory number); April 15, 1919; May 1, 1919 (athletic number); May 15, 1919 (reconstruction number); June 1, 1919; June 15, 1919 (pictorial number); July 5, 1919 (band number); July 20, 1919; and August 1, 1919 (combined number-roster of personnel).
The publication was christened The Silver Chev`, this title being selected from a number of suggestions as being most typical of this hospital in view of the fact that at the time publication was begun there were no persons on duty at the hospital who had actually seen service overseas. At the time of the first appearance of the publication, overseas patients were beginning to arrive in large numbers and demobilization was constantly progressing. Due to these circumstances the most able enlisted men were fully employed on other duties and it was difficult to secure personnel to bring out the paper. This difficulty was accentuated by the fact that enlisted men anxious to be discharged feared that assignment to the paper would delay their discharge. Nevertheless, there was a creditable, progressive improvement in the hospital paper.
A degree of difficulty was experienced locally in securing adequate attention to the actual printing of the publication, and it was necessary to go to Chicago or Milwaukee to secure satisfactory service at reasonable cost. A firm in Milwaukee was ultimately secured to publish the paper and from then on no difficulty was experienced.
Late in March, when plans for the publication were being formulated, certain of the enlisted men instituted an advertising campaign in Rockford, Ill., with very gratifying results. Advertising matter was secured to the amount of approximately $300 per calendar month (for two issues), the advertising to continue during the contemplated existence of the paper, six months from April 1, 1919 . This figure, with the sale of the paper at 10 cents per copy to the members of the personnel of the hospital and to the patients, as well as to subscribers in Rockford, constituted a profit-paying income. In securing the advertising matter, however, an error was committed on the part of the enlisted force assigned to that work, in unwittingly making the statement that the probable circulation of The Silver Chev` would be 4,000 per issue. Furthermore, the advertising was obtained through verbal contract only. When, therefore, it became evident to the advertisers that the circulation was approximately 1,000 instead of the estimated 4,000, and that, owing to demobilization and the constantly decreasing number of patients, this circulation would decrease still further, it became impossible to retain the advertisers and some of the contracts were repudiated by the merchants who made the statement that they authorized the appearance of their advertisements for but one month.
Publication of the hospital paper was discontinued with a double number, representing the issues of July 20 and August 5, 1919 , there being at that time a deficit of approximately $350.
The Silver Chev` never emerged from the experimental stage, but during its brief existence it was of distinct value to the personnel. Its financial failure, attributable to demobilization and lack of adequate supervision in its earlier stages, was more than offset by its influence in enhancing the morale of the hospital during that critical period when every organization in the camp, except the base hospital, was deriving all the benefits of demobilization.
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FIG. 86.-Cover design for one of the issues of The Silver Chev`, Base Hospital, Camp Grant, Ill.
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FIG. 87.-Specimen page of The Silver Chev`
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