CHAPTER II
GENERAL FACTORS UNDERLYING THE HOSPITALIZATION SCHEME
HOSPITAL PROVISION AT EXISTING ARMY POSTS AND TRAINING CAMPS
During the first few months after the war had been declared, Regular Army troops were being mobilized and trained at permanent military posts in numbers far in excess of those for which original hospital accommodations had been provided. At many posts, camps had been instituted in which there were being trained men who were afterwards to become officers of the new Army. The provision of additional hospital space for the sick of these troops was effected by the construction of temporary wards, mess halls, barracks, nurses` quarters, or combinations of these or other hospital buildings adjoining the existing post hospitals at the various places. Plans were prepared and the construction of the buildings requested mostly in the month of May, 1917.1
Rigid physical examination of the entrants to these camps excluded practically all possible chronic ailments, and hospital provisions were made for only prospective acute illnesses.
HOSPITAL PROCUREMENT AT CANTONMENTS AND CAMPS
Following the procurement of hospital space at the early training camps, the next necessity in point of time was the provision of hospitals for the sick of the drafted troops and the National Guard at the 32 cantonments and camps. As in the training camps, the character of the sick anticipated was the acute, and it was expected that an abnormal number of beds would be needed for contagious diseases and for cases under observation.
In the completed plans (proposed along lines radically different from the usual Army type) it was supposed that ample provision had been made in these temporarily constructed buildings for laboratories, infectious diseases, wards for the insane, eye, ear, nose and throat patients, general medical and surgical patients, staff and nurses` quarters, and administration. That the plans were faulty in minor respects was due to the necessity for haste and will not seem remarkable when one considers the length of time it requires to develop plans for much smaller hospitals in civil life.
PROVISION OF HOSPITALS AT PORTS OF EMBARKATION
At these ports large camps were established for the temporary quartering of troops awaiting transportation abroad.2 Here, the most rigid physical examinations were given troops and the provision of beds in hospitals had to be not only of sufficient number for the sick, but for communicable disease contacts and for soldiers under observation as well.
As in large mobilization camps, the location of these embarkation camps determined that of the hospital. There was little or no information to serve as a guide to the amount of hospital space required in these camps. Moreover,
34
such information would have been of slight value as the size of the camps was frequently changed-usually increased-and hospital construction was forced to keep apace. As an instance to show the impossibility of foretelling the ultimate requirements of an embarkation hospital, the camp hospital, Newport News, Va., was originally built with a capacity of 250 beds.3 Before the war had closed the capacity of this hospital had been increased to over 2,000 beds and the emergency capacity was even greater.4 It should be stated, however, that a portion of this space was used for debarking sick.
PROVISION OF DEBARKATION HOSPITALS
The general scheme for caring for the sick and wounded of the United States Army abroad provided for the return to the United States of those requiring prolonged hospital treatment. This necessitated the provision, at the ports, of hospitals for their reception.2 The character of sick anticipated was the nonacute.
The location of the hospitals for the reception of these returned sick and wounded was fixed, in general, by the location of the port. Specifically, the actual location was fixed by the larger, local considerations of availability and suitability of space, local transportation, connection with railroad systems of the United States, and connection with the actual point of debarkation. No one site was ideal in all of the above considerations. The good and bad features of available sites or properties had to be considered and the one possessing the best combination selected. The absence of outside recreation space and the presence of extraneous noises and disturbances were disregarded. While these things were undesirable, the contemplated stay of sick in these hospitals obviated the necessity of going to an undue extent in avoiding them. Prompt reception, on short notice, and the possibility of rapid evacuation were features of first and most important consideration.
The requisite space in these hospitals was the subject of considerable thought, being variously estimated. All estimates were subject to adverse criticism as they contained uncertain factors in their very foundations. According to the view of one observer an estimate could be criticized for being too high; from another viewpoint another observer would feel that the estimate was too conservative. The number of expeditionary troops was known and the monthly increments to that number were known. The battle casualties of past wars were considered and applied as far as it was possible to do so to the existing one. The incidence of injury and disease from normal causes could be foretold with a reasonable degree of accuracy. The plan to keep in France all sick and injured, returnable to duty within a period of six months, was known. It was not known until quite late, however, what the rate of return of sick and wounded from France would be.
Based upon known factors estimates were made and revised as necessary, showing the number of sick and wounded that might be expected in the United States. These estimates were used in the Office of the Surgeon General as a basis for planning the capacity of the debarkation hospitals for both ports.5 In applying them it was assumed that the average stay of the sick, returned from overseas, would not be for a longer period than 10 days in the port hospitals.
35
PROVISION OF GENERAL HOSPITALS
Many unusual cases of illness or injury, for which facilities and personnel could not be provided in camp or post hospitals, necessitated the provision of general hospital care. These hospitals had to be made general in the sense in which the term is used in civil communities, equipped for the care and treatment of all varieties of injury and disease.
The larger purpose of the general hospitals was, however, for the care and treatment of patients from abroad.2 The number of patients from the expeditionary forces precluded the possibility of retaining them at debarkation ports longer than a reasonably sufficient time for their clearance from the debarkation hospitals, and accommodations for them had to be provided elsewhere throughout the country.
The question of the number of returned patients to provide for was problematical. Some of the general hospitals were solely for the tuberculous, others for mental cases, yet both these kinds of hospitals were potentially general hospitals, in the accepted sense, and were operated and controlled as such. Any necessary surgical or medical requirement could be met at any of the general hospitals with one exception-General Hospital No. 7, Baltimore.
To secure this general hospital space by the use of military posts seemed appropriate, and, to a certain extent, this was so directed by the War Department.6 The lease of civilian properties, hospitals, hotels, colleges, loft buildings, and the like was contemplated. This means was used to a great extent.6
The provision of general hospitals by new construction was the most expensive, but could not be entirely avoided, particularly where general hospitals for the tuberculous were concerned. It was always difficult to lease desirable property for use in the treatment of tuberculous patients. The medical profession recognized certain areas as being more efficacious than others in the treatment of tuberculosis and to find suitable properties in these recognized localities for leasing purposes was extremely difficult. In accordance with prevalent opinion, the most popular sections for the treatment of the tuberculous were the mountains of New York and of North Carolina and the high and dry sections of central Colorado, New Mexico, and Arizona. It was in these localities that practically all of our general hospitals for the treatment of tuberculosis were placed.7
Population centers were chosen for the location of general hospitals, other than those especially planned for the tuberculous and neuropsychiatric, the majority of them being naturally located in the East, a few scattered throughout the West in military posts. Large civilian properties, convertible into 1,000?bed hospitals, did not exist in the West.
THE INFLUENCE OF THE PERCENTAGE OF AMBULATORY SICK ON HOSPITAL PLANS
The expected percentage of ambulatory sick had a large influence in the planning of hospitals. Mess halls of the hospitals of the camps, as originally constructed, provided a seating capacity of 60 per cent. Later, it was found that this estimate had been too conservative and that the number habitually able to go to the mess halls varied from 60 to 75 per cent.
36
FIG. 9.-General hospitals superimposed upon Bureau of Census population map of 1910.
37
The use of the two-storied ward barrack-a compromise between a ward and a barrack-early in 1918, was an example of how both exterior and interior arrangements were influenced by the quantity of ambulatory sick.
In preparing the hospitals designed for the overseas sick and wounded, after their return to the United States, arrangements were made for 80 per cent ambulatory patients. Acute diseases were not anticipated, but a high percentage of ambulatory injured was expected.8 The number of patients able to walk proved to be larger than originally estimated, varying from 90 to 95 per cent.9 This discrepancy was attributed to the fact that, after the armistice, there was no military necessity for the retention abroad of the moderately sick and slightly wounded until cured, and these were returned to the United States from hospitals in France as patients whose convalescence, in many instances, had been completed.10
HOSPITAL PROVISIONS FOR THE NEUROPSYCHIATRIC AND THE COMMUNICABLE DISEASES
During peace times, the incidence of mental diseases among troops had been about three per thousand per annum.11 This figure was used, in a measure, as a basis for the provision of beds for mental cases in all of the hospitals. For each 1,000-bed hospital in the camps, two special wards, of 20 beds capacity each, were provided for the observation and treatment of mental cases. In the 500-bed hospitals only one ward, of 20 beds, was constructed.12
In the groups of general hospitals, special hospitals were provided for the neuropsychiatric. Three were established for the insane and one for the psychoneurotic.13
As a rule, 15 per cent of the space in hospitals, for the treatment of mental diseases, was especially prepared for the adequate care of the violently insane.14
Approximately 8 per cent of the total hospital space in camps was designed for the isolation of cases of communicable diseases.15 This space was readily augmented by the use of cubicles in the ordinary wards.
REFERENCES
(1) Annual Report of the Surgeon General, U. S. Army, 1917, 320.
(2) Annual Report of the Surgeon General, U. S. Army, 1918, 305.
(3) Letter from the surgeon, Port of Embarkation, Newport News, Va., to commanding general, Port of Embarkation, Newport News, Va., dated Dec. 10, 1917. Subject: Embarkation hospital. On file, Record Room, Adjutant General`s Office, Correspondence File, 632-1 (Newport News, Va.) N.
(4) Letter from commanding general, Port of Embarkation, Newport News, Va., to chief, Embarkation Service, Washington, D. C.; dated July 8, 1918. Subject: Provision for housing enlisted personnel, Medical Department. On file, Record Room, S. G. O., Correspondence File, 632 (Newport News, Va.) N.
(5) Memo. from the Surgeon General to the Chief of Staff, dated Nov. 2, 1918. Subject: Debarkation hospitals. On file, Record Room, S. G. O., Correspondence File, 721.6 (Sick and Wounded Overseas).
(6) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1148.
(7) Ibid., 1167.
(8) Third indorsement from the Surgeon General of the Army to Bureau of Medicine and Surgery of the Navy, dated Dec. 7, 1917. Subject: Transportation of sick and wounded from overseas. On file, Record Room, S. G. O., Correspondence File, 721.6 (Sick and Wounded Overseas).
38
(9) Ambulatory sick, percentage of returned from overseas: Based on "Weekly reports of sick and wounded from overseas." On file, Record Room, S. G. O., Correspondence File, 721.6 (Sick and Wounded Overseas).
(10) Cablegram No. 2176 from Harris to Pershing, dated Nov. 12, 1918, subparagraph A. On file, Record Room, S. G. O., Cablegram File.
(11) Annual Report of the Surgeon General, U. S. Army, 1917, 79.
(12) Semiannual Report, Division of Neurology and Psychiatry, from Maj. Pearce Bailey to the Surgeon General, dated Jan. 2, 1918. On file, Record Room, S. G. O., Weekly Report File (Neurology and Psychiatry).
(13) Memo. for the Surgeon General from Col. C. R. Darnall, M. C., dated Nov. 13, 1918. Subject: Care of insane, epileptics, and war neuroses. On file, Record Room, S. G. O., Correspondence File 701 (Care of Insane).
(14) Memo. from Maj. Pearce Bailey to Hospital Division, Surgeon General`s Office, dated June 13, 1918. Subject: Alterations in psychiatric ward. On file, Record Room, S. G. O., Correspondence File, .024-10 (Neurology and Psychiatry).
(15) Letter from the Surgeon General to the Quartermaster General, dated May 26, 1917. Subject: Estimates for base hospitals for cantonments. On file, Record Room, S. G. O., Correspondence File, 176796-R. (Old Files).
