CHAPTER XXIV
EMBARKATION HOSPITAL, NEWPORT NEWS, VA.a
LOCATION
The embarkation hospital at Newport News, Va., was located to the east of the city of Newport News, along the shore of Hampton Roads and adjacent to Camp Stuart on the northeast, the total area occupied by the hospital being in the neighborhood of 35 acres. As 19 of the wards of the hospital were constructed along the north shore of Hampton Roads, within a few feet of the water`s edge, a beautiful outlook was afforded. The advantages of the location, however, were somewhat offset by the presence of Salters Creek, a small tidal stream which skirted the boundary of the hospital grounds and created a considerable expanse of lowland marsh. The creek was also disadvantageous in that it was the means of conveying a large amount of sewage from the northeastern portion of the city of Newport News; and the marshes required a great amount of drainage and filling in in order to prevent them from becoming a serious menace by reason of the favorable conditions they presented for mosquito breeding.
The terrain was flat and the country open for the greater part of the hospital site. This ground had formerly been used for a truck garden and was in a high stage of cultivation. Its soil was of sand and as the hospital site was exposed there was a resultant high degree of discomfort from flying dust in dry weather, ameliorated somewhat by subsequent planting of grass and flowers.
The climate was moderate in winter and the heat of summer was tempered by breezes.
Good roads of concrete or macadam ran directly to the hospital, making for ease of access from the camps and the city of Newport News, and a main line of the street-car system passed directly through the northeast corner of the hospital grounds.
BUILDINGS
Construction of the hospital continued through five projects. It was originally designed to accommodate about 250 beds, and consisted of 8 wards with the necessary kitchens, mess halls, quarters, latrines, and storehouses, but before they were ready for occupancy it became necessary to increase the number of wards to 16. Six wards were of the standard one-story type, designed for base hospitals, with screened porches on the front and one side. The second addition to the hospital was begun early in the spring of 1918, and consisted of three two-story barrack wards, one of wood and two of hollow tile
aThe statements of fact appearing herein are based on the "History, Embarkation Hospital, Newport News, Va.," by Maj. W. C. Rucker, U. S. P. H. S., 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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and stucco construction. At the same time, the original buildings designed as barracks for the detachment of the Medical Department were converted into wards, made possible by utilizing camp barrack buildings for barracks for the hospital personnel. The third addition to the hospital was started early in the summer of 1918, and comprised three isolation wards, six two-story barrack wards and five two-story standard wards. In addition to these wards, one prison-ward building, one large kitchen and mess hall, and additional nurses` quarters were developed by the conversion of the buildings originally designed as storehouses; and one building was especially designed for the housing of the activities of head surgery, the dental department, and the department of eye, ear, nose, and throat.
The fourth addition was started before the completion of the third, in the midsummer of 1918, and consisted of the development of the necessary
FIG. 159.-Headquarters, Debarkation Hospital, Newport News, Va.
utilities to serve the increased capacity of the hospital. Additional officers` quarters, storehouses, and the conversion of two standard one-story wards into a building for the accommodation of patient officers were included. This last phase of construction was completed about January 1, 1919.
A specially designed laboratory, a large two-story hollow tile and stucco building completely equipped for this special purpose, was erected during the winter of 1918. Early in the spring of 1918 a detention camp for venereal disease was constructed in block 17 of Camp Stuart, to the northwest of the hospital grounds. This detention camp was composed of 103 tent frames, a large mess hall, and a treatment house, the entire camp being surrounded by an 8-inch wire-mesh fence.
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During the fall of 1918 two more camps of a similar nature were designed, and these were erected on a tract of leased property to the west of Camp Stuart, and extended from Hampton Roads northward for one-half mile. Construction of these two later camps was completed early in December, 1918.
The bed capacity of the hospital at its completion was 1,754 in the hospital proper, and 1,800 in the three venereal camps, making a total bed capacity of 3,564.
In a general way, the main line of wards extended directly along the shore of Hampton Roads; and the buildings used for administrative purposes, mess
FIG. 160.-General view of Embarkation Hospital, Newport News, Va., showing central heating plant
hall, quarters for officers, quarters for nurses, storehouses, etc., extended inland from the wards, all buildings being connected with covered corridors.
OCCUPATION OF BUILDINGS
The first group of overseas patients arrived on the U. S. S. George Washington, on January 18, 1918, and on January 21, 1918, the hospital proper was opened, but the barracks in block 2 of Camp Stuart continued to be used for hospital purposes until finally closed and turned back to the camp authorities on April 2, 1918.
HOSPITAL WATER SUPPLY
The hospital water supply was identical with that of Camp Stuart and the city of Newport News; the supply for Camp Stuart was taken directly from the city mains. Three large storage tanks located near the entrance to the camp guaranteed an adequate reserve and sufficient pressure for emergencies and for fire protection.
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SEWAGE
The sewage from the hospital drained into the main sewer of Camp Stuart, through which it was carried to two septic tanks, the affluent flowing into Salter Creek and then to the James River. The septic tanks were of sufficient size to allow for five to six hours settling time, which was adequate to render the affluent free of harmful organic matter. Surface drainage of the grounds was maintained by ditching and by storm sewers which emptied from one main outlet directly into the James River.
HOSPITAL GARBAGE DISPOSAL
Garbage and other wastes were separated into the following classes: Fats, bone, paper, bottles, rope, tin cans, and other garbage. Most of this waste was turned over to the reclamation service, the remainder being disposed of by a private concern.
LAVATORIES AND BATHS
All the wards except the temporary wards had separate bathrooms with shower and tub baths, washbowls, urinals, and closets. The temporary wards, venereal tent hospital, and barracks for enlisted personnel were equipped with standard latrines adapted for camp use. These latrines furnished toilet facilities and were also fitted with shower baths and the necessary apparatus for heating water. All of the hospital baths and latrines were fitted with modern plumbing and drained into the general sewerage system of the camp.
HEATING
The hospital was steam heated from a central plant, which also furnished hot water for the various wards and kitchens by a high and low pressure system. The plant was equipped with 10 boilers. There was in addition a separate smaller plant for maintaining the sterilizers and for heating the operating rooms in case of emergency.
HOSPITAL LIGHTING
The buildings and the grounds of the hospital were lighted by electricity, which was obtained from Newport News. For lighting purposes this was adequate, but much difficulty was encountered in securing the current necessary for the successful operation of the X-ray apparatus.
HOSPITAL KITCHEN AND MESS
The hospital mess comprised three separate establishments: One for officers, one for nurses, and one for the patients and enlisted personnel. The officers` mess consisted of two kitchens and mess halls, each of which had its own organization and management. The nurses` mess comprised one kitchen and mess hall, located in the nurses` quarters, and was operated under the supervision of the chief nurse. For the feeding of the enlisted personnel and patients seven kitchens and mess halls were maintained under the direction of the hospital mess officer. Five of these kitchens were of the standard type, built
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for the various camps and cantonments, for the feeding of troops, two of them being used for feeding the detachment of enlisted men, and three were connected with the venereal camp hospital and the temporary wards, where the patients were suffering only from such ailments as would not prevent their going a short distance for their meals. The remaining two kitchens were for feeding patients at the hospital proper. One of these, a smaller kitchen originally designed for the mess of the detachment, prepared only regular diets for patients from wards 14 to 19. All of the other cooking was accomplished at the main kitchen, which was located centrally and was equipped with modern kitchen appliances, such as steam boilers, ranges, and dish-washing machinery. One of these rooms was entirely devoted to the preparation of
FIG. 161.-Interior of power and heating plant, Embarkation Hospital, Newport News, Va.
special diets, with a trained dietitian in charge. The main storeroom for food supplies and for meats was also located at this place. Foods to be served in the wards were conveyed from the kitchen in food carts. Each ward had a small diet kitchen, equipped with an electric stove and steam table, where the food received from the main kitchen could, if necessary, be reheated and served. Easily cooked articles, such as eggs, were prepared in these ward kitchens, and cutlery and dishes for use in the wards were also cleaned and stored there. An additional kitchen and mess hall to be used exclusively for wards containing patients suffering from contagious diseases was later constructed.
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HOSPITAL LAUNDRY
Although a building was erected for use as a hospital laundry, it was never placed in operation because of the impossibility of obtaining essential machinery. A large steam sterilizer for the sterilization of clothing and bedding occupied one end of this building, the remaining space being used largely for storage purposes. The need of a laundry for the hospital was felt greatly, as the laundry at Camp Stuart was often overtaxed and therefore unable to render the prompt service necessary to meet hospital demands.
QUARTERS
Officers on duty at the embarkation hospital were furnished quarters at the hospital. Two buildings were in use for this purpose and were known as
FIG. 162.-Nurses` recreation building. Embarkation Hospital, Newport News, Va.
officers` quarters No. 1 and No. 2. Officers` quarters No. 1 was the building originally designed for housing the officers, but, although additions were made later, it proved entirely inadequate, and on April 1, 1918, officers` quarters No. 2 was established in the barracks originally occupied by officers of one of the Infantry regiments. The hospital then had quarters for the accommodation of about 90 officers. The buildings were partitioned into rooms, each of which was occupied by two officers. Bathrooms and mess halls were located in each building. A four-room cottage pleasantly located on the back, overlooking Hampton Roads, was set aside for quarters for the commanding officer of the hospital.
The rapid growth of the hospital, requiring, as it did, increased quarters for officers, likewise soon led to a shortage of quarters for nurses. As originally planned the nurses` quarters were identical in size and construction with the
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officers` quarters and did not permit of further additions. Consequently, authority was requested and granted to make the changes necessary to convert storehouse No. 1, located near by, into a suitable nurses` quarters. This was done and they were occupied on July 6, 1918. Storehouse No. 2 was transformed into quarters with an accommodation of about 150 nurses. The nurses` quarters were very comfortable and well heated. A recreation house for the nurses was supplied by the American Red Cross and was completed in October, 1918. It was located in a very desirable place on the water front and was a source of great pleasure and usefulness to the nurses.
HOSPITAL STOREHOUSES
There were two large storehouses connected with the hospital. One of these storehouses was used for the storage of Medical Department supplies and one for the storage of quartermaster property. They contained the offices of the medical supply officer and the quartermaster, respectively. Storage space, however, was entirely inadequate and it was necessary to use temporary structures for this purpose.
FIRE PROTECTION
At its inception the embarkation hospital had practically no protection against fire. Four telephones were installed in November, 1917, providing the only means of communication through Camp Stuart to the nearest fire company, a municipal company on Twenty-fifth Street. No additional telephones were installed until January 1, 1918, when an order was issued causing the installation of a switchboard and 20 telephones. In December, 1918, owing to the rapid growth of the hospital, a new switchboard to accommodate 100 telephones was authorized, although this was not installed until April, 1919. While not comparable in rapidity and accuracy with fire-alarm boxes for the report of a fire to the engine house, the telephone system, until April 15, 1919, was almost the only communication with fire-engine companies. In January, 1918, Engine Company No. 3, consisting of 15 men, was recruited from among the firemen of the larger cities and placed in commission at Camp Stuart on the 25th of that month. Engine Company No. 4, in Camp Stuart, recruited from post organizations, did not go into commission until September, 1918. The first fire-alarm boxes were installed but their installation was not completed until September 28, 1918. They were placed at long intervals and were completely omitted from the isolation and Chestnut group of buildings.
In the fall of 1918 the constructing quartermaster began work on the roads and fire trails around and through the hospital. Previous to that time two tarvia roads had been built, one in front of officers` quarters, administration building, and receiving wards, and the other running past the power plant and nurses` quarters to storehouses Nos. 4 and 5. Necessarily, in muddy weather, a great portion of the hospital could not be reached by the heavy fire trucks, so beginning in October, 1918, ramps were cut across all corridors and tarvia fire trails were built, thus making fire hydrants easily accessible to fire-fighting apparatus. One fire trail was greatly delayed in the building because of the hydraulic fill. In place of the tarvia road over this fill, a roadway of 2-inch lumber was built from the laundry, thus making the fire hydrants
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in that section easy of access. In January, 1918, three hose reels were installed by the constructing quartermaster, one on the corridor of ward 6, one at ward 16, and the other at officers` quarters No. 2.
In January, 1918, seven months after the opening of the hospital, the first chemical fire extinguishers were put in, numbering about 70. Six months later 50 additional extinguishers were obtained, but it was not until March, 1919, that the hospital was able to secure chemical carts, at which time 14 40-gallon pumps were delivered and placed advantageously about the corridors. The full equipment in April, 1919, comprised 309 3-gallon extinguishers, 14 40-gallon chemical trucks, and 3 hose reels, complete.
Until October, 1918, one 6-inch main from Camp Stuart furnished the hospital with water. In this month an additional 8-inch main was connected with the hospital system, the two mains giving ample water supply when Camp Stuart was not full of troops, but when many water outlets were in use those farthest from the main could not get water at all. Camp Stuart itself had but one 12-inch main until April, 1919, when an additional 16-inch main was laid.
In April, 1919, the Aero Fire Alarm Company completed the installation of the fire-alarm system. This system was both automatic and mechanical. The automatic part consisted of circuits of one-sixteenth-inch copper tubing, terminating in unit sets of fire-alarm boxes. This tubing, strung over the ceilings of rooms and corridors, contained air at atmospheric pressure which, expanding when subjected to heat, vibrated a delicate diaphragm releasing a drop, thus completing the circuit to the transmitter which, in turn, transmitted the current to all the devices that rang the gongs and punched the recording tapes at all such installed apparatus. An automatic interlocking device prevented any confusion resulting from simultaneous alarms, one alarm being held until the other was completed, allowing an appreciable interval, when the second alarm was released and recorded by gongs and tape. An automatic device recorded the air pressure so as to prevent false alarms resulting from a sudden rise in temperature due to natural causes.
In the embarkation hospital the automatic-alarm system comprised 62 circuits, using approximately 95,000 feet of tubing. The whole hospital was thoroughly wired, and the 62 unit sets were placed one in each ward and at frequent intervals elsewhere about the hospital. Gongs were placed in the home of the commanding officer, in the administration building, in the main mess hall, in officers` quarters No. 1, and in the nurses` quarters. Punch registers, which accurately recorded the number of the box sending in the alarm, were placed in the administrative building and in the mess hall.
So far as equipment went, the embarkation hospital was not completely protected until after the hospital had been in service 17 months. During the construction period the heaps of d?bris from carpenter work constituted a dangerous fire hazard. "No smoking" signs were posted and armed guards enforced the order so far as it was possible. A fire patrol was on duty day and night and all persons working or living in the hospital were warned that extreme caution was necessary to prevent the start of a fire, on account of the hazard existing in the wooden structures of which the hospital was composed. The detachment, Medical Department, was drilled three times a week in the mechanism of minor fire-fighting appliances, and all equipment was inspected daily.
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ORGANIZATION
In the discussion of the general hospitalization problem of the port of embarkation, Newport News, mention was made of the difficulties incident to the acquisition of adequate hospital facilities during the year 1917, and the necessity for the use of converted barracks buildings pending the completion of the specially constructed embarkation hospital. Thus, though troops were hospitalized in the converted barracks as a temporary expedient, an organization was affected to permit of their proper use as a hospital in November, 1917. As a matter of fact, however, the permanent organization of the hospital dates from the opening of the main hospital group, January 14, 1918.
FUNCTION
As its name implies, the original intention for the use of this hospital was as an embarkation hospital for the main purpose of caring for the physically incapacitated eliminated from troops embarking for overseas; but, as it was the earliest large hospital opened at Newport News, and, throughout, was the only hospital at the port possessing facilities for the care of contagious disease cases, its operation in a dual capacity was forced: combining the functions of base hospital, serving the personnel on duty at the port, with those of an essential embarkation hospital. Later, after the armistice, when the human tide turned and the overseas sick and wounded began to be debarked in great numbers, the embarkation hospital had its r?le partly reversed and it became the principal debarkation hospital at the port of Newport News.
ADMINISTRATION
The threefold phase of the character of work performed at the hospital necessitated that its administrative functions be so arranged as to readily meet the needs of the varying situation. It was practically impossible to develop any immediate relations between the hospital and the various regimental infirmaries, such as those which existed at the large cantonments where the organizations were more permanent.
The troops arriving at the port were given a medical examination before their departure, and it frequently happened that large groups of patients were sent to the hospital only a few hours, or at best but a few days, before the organization to which they belonged embarked. Regimental surgeons and camp commanders were pressed with the business of getting the troops aboard, which added to the administrative difficulties in the hospital. It necessitated an elastic organization which could meet the routine needs and at the same time be prepared for the rapid reception and evacuation of large numbers of sick and wounded. The vast amount of paper work comprehended in the admission, classification, payment, and transshipment of several hundred patients in a single day made it necessary to correlate the functions of the hospital so that when occasion demanded work could be performed at top speed without maintaining an extravagantly large office force between peak loads. This force was kept at a minimum until the receipt of large numbers of overseas sick and wounded made enlargement imperative, to permit the speedy handling of patients who had to be received, classified, and evacuated rapidly, in order to prevent permanent congestion of the port.
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The organization of the hospital was the result of a series of evolutionary changes, and while it was, in some respects, quite different from the average base hospital, it may be stated that its organization scheme was so successful as to warrant its adoption, with very slight modifications, for any future hospital for embarking and debarking troops.
All of the functions of the hospital were grouped under the commanding officer, with the executive officer and adjutant as intermediaries.
EXECUTIVE OFFICER
In a broad way the executive officer handled administrative details, which included sanitation, discipline, prisoners, morale, intelligence, inspections, fire prevention, construction, utilities, the distribution of labor, and the coordination of nonmilitary activities.
DISTRIBUTION OF LABOR
The distribution of labor was effected through a permanent labor cadre to each department, the labor in excess of actual needs being thrown into a labor pool which was used for outside police and similar duties. From this pool labor was assigned to the various departments as need arose, and when an emergency ceased it was returned to the pool.
NONMILITARY ACTIVITIES
In order to harmonize the various organizations of the nonmilitary activities, they were placed under the direction of the executive officer. The provisions of General Orders, No. 17, War Department, 1918, gave the fullest military recognition to the personnel of the American Red Cross, and the detachment of officers from this organization were thereafter attached to the commanding officer of the hospital, who issued orders whereby the senior Red Cross officer was designated as director. The subordinates of the director reported to him, and were then placed on duty in the hospital by competent military authority. Orders were transmitted through the director to his subordinates, and all communications were forwarded through the director to the commanding officer. Copies of letters from the director to higher authorities of the American Red Cross involving questions of policy, administration, or supply were furnished the commanding officer. Strict orders were issued that no supplies were to be furnished to the various divisions of the hospital or to individuals unless approval of the executive officer had been obtained.
Weekly meetings were held of a board composed of the executive officer, the chaplain, and representatives of the American Red Cross, Knights of Columbus, Young Men`s Christian Association, and Young Men`s Hebrew Association. This board discussed questions of policy and activities as they affected the personnel and patients of the hospital.
ADJUTANT
The duties of the adjutant did not differ materially from those usually vested in that officer.
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INFORMATION OFFICE
The information office was organized as a subdivision of the adjutant`s office about the middle of March, 1918, an officer being assigned as information officer. His duties in the beginning were mainly to ascertain from the ward surgeons the names of all seriously ill, and to send notes by letter or telegram, depending upon the seriousness of the case, to the nearest relative, giving information as to the condition of the patient in question. Subsequent telegrams were sent until the patient was out of danger. The information officer also interviewed visiting relatives of seriously ill patients, explaining the condition of the patients and assisting the relatives in any way possible, and all inquiries concerning the physical condition of patients were referred to the information office.
In compliance with instructions from the port surgeon and orders from the Surgeon General`s Office, the information officer was also directed to send notes as soon as possible to the relatives of all patients received from overseas, including a brief statement of the patient`s injury and whether or not the condition was serious or likely to lead to immediate death. In order to accomplish this, ward surgeons were charged with the duty of filling out cards bearing the necessary data for the information officer. The Red Cross officers assisted in sending out these notices.
Upon receipt of General Orders No. 84, Headquarters, Port of Embarkation, 1918, which directed that a special officer be appointed to take charge of the necessary work in connection with deaths at the hospital, the information officer was assigned as the officer in charge of deaths, in addition to his other duties. Upon the death of a soldier in the hospital his commanding officer was at once notified by telephone and this message was confirmed by letter.
Reports required by Army Regulations were made out by the information officer and the desired disposition of the body of a deceased patient was requested by telegram, from the patient`s relatives. When no information of disposition was received after the lapse of 72 hours, authority was granted to bury the deceased at the Hampton National Cemetery. In such cases it was the duty of the information officer to arrange for the proper burial of the dead, which meant obtaining the necessary transportation to the cemetery, securing the firing squad and the services of a chaplain and sending the proper notification to the superintendent of the cemetery. In cases where relatives of the deceased were present at the time of death, it devolved upon the information officer to interview them and acquaint them with the provisions of Army Regulations covering deaths of soldiers; to obtain from them the necessary disposition of the effects of the deceased; when it was their desire to have a military escort accompany the body home, to obtain the necessary orders for such escort; and, in general, to assist the relatives in any way possible.
The signing of the armistice made it possible to allow a greater degree of freedom to the patients and to persons coming to the hospital as visitors. The question then of the entertainment of returned overseas patients who were ambulatory and were able to leave the hospital arose. Numerous requests were constantly received that patients might be allowed to leave the hospital to visit homes of civilians in the city and in neighboring towns, and from theaters and moving picture places that groups of soldiers be sent there for
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free entertainment. These requests became so numerous that frequently it was impracticable to give them adequate attention. The information officer was charged with the duty of receiving all such requests and instructing persons as to existing orders on this subject, as well as obtaining men who were in proper physical condition for the assignment of them as assistants to the patients granted leave from the hospital.
EVACUATION OF PATIENTS
As the number of overseas patients rapidly increased from January 18, 1918, authority was obtained to evacuate them as soon as practicable, and the following system was instituted: On their arrival, overseas patients were examined and classified by medical officers, the result of this classification being at once telegraphed to the Surgeon General who assigned cases to various hospitals in the interior. Based upon these destinations furnished by the Surgeon General, authority was obtained from the commanding general to move patients to the hospitals indicated. This system not only permitted of speedy evacuation but resulted in the disabled soldier being sent to the place where he received the best care, in an institution as near his home as possible.
After the disposition of patients had been obtained from the Surgeon General and the necessary orders had been received from headquarters of the port, a second letter was sent to relatives notifying them to what hospital and upon what date various patients were transferred, in order that any further inquiries could be correctly addressed.
REGISTRAR`S OFFICE
While the organization of the registrar`s office was quite similar to that in the ordinary base hospitals, it was so arranged that it met many special situations as they arose. To this end the personnel adjutant was placed under the registrar instead of under the adjutant. This was found necessary because of the very complicated service records and pay accounts of debarking patients who were under command of the commanding officer of patients and therefore under jurisdiction of the registrar. The personnel officer assumed charge of the service records of all patients in the hospital. Pay cards were kept and pay rolls prepared so that patients in the hospital were paid at the end of the month without recourse to their company or regimental organizations. In accordance with the provisions of a general order issued by the commanding general of the port, all service records of soldiers entering the hospital were to be delivered at the hospital within 24 hours thereafter. This order also specified definitely just what property was to be sent to the hospital with the soldier. With actual control of the soldier patient thus given the hospital, much of the confusion prior to that time was done away with, and the personnel office so discharged its functions as to prove the wisdom of this addition to the hospital organization.
PERSONNEL OFFICE
The personnel office was opened on June 1, 1918, but received very few overseas patients before September 2, 1918, when the first sick and wounded from overseas began arriving regularly at this hospital. As these patients
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were unaccompanied by service records, a partial payment plan was used and a partial payment of $7.50 was made to each patient who desired pay. From that time until December 15, 1918, 587 men were paid in this manner. On the latter date a letter was received from the Director of Finance, War Department, under date of December 12, 1918, giving authority for the full payment of all overseas patients arriving at the hospital and having pay due. The methods pursued thereafter were in the following manner: A list of patients sent to each ward was obtained from the receiving office and the wards divided into four groups, each group containing about the same number of patients. An officer (with summary court power), eight typists and two clerks were assigned to each group or section; and the procedure of taking affidavits, arranging service records, pay cards, and pay rolls was commenced. Seven of the typists were assigned to take affidavits, one clerk to make service records and pay cards, the summary court officer following the team to administer oaths to the patients and to collect the affidavits. These records were turned over to the pay-roll team, one clerk and one typist. One clerk figured on the allotments and insurance, from information on the affidavits, and dictated the pay-roll data to the typist. After the roll was completed for each ward, it was signed and immediately sent to the quartermaster for figuring while the team proceeded with the work in other wards.
After all the rules were completed and sent to the quartermaster, and the money was ready for payment, practically the same method as that described above was used for the payment of the men. The rolls were divided into four sections; and two officers and enlisted men were assigned to each section, the money being taken to the wards and paid to the men directly.
The work connected with the preparation of affidavits was very slow because of the necessity for accuracy, so that a team of one officer, eight typists, and two clerks could complete only about 200 affidavits, service records, and pay cards per day, although a maximum of 250 was reached. The personnel office during the months of December, 1918, and January, 1919, was equipped to take affidavits, make service records and pay cards, and indorse them to general and base hospitals at the rate of about 250 per day; and that schedule was maintained from December 15, 1918, until the middle of January, 1919, when the shipments from overseas were greatly decreased. From the time that full payment to overseas patients was commenced, on December 15, 1918, until April 15, 1919, approximately 11,000 cases were handled. These all received their full pay on their own affidavits except about 400 men who were either absent, too ill to sign the rolls, or had no pay due them. Of the 11,000 cases received after December 15, 1918, only about 2,400 were accompanied by service records, and later about 40 per cent of the patients were received with records in their possession.
Because of the fact that very few service records accompanied the patients returned from overseas, and also because the few that were received were incomplete regarding pay status, it became customary to take affidavits from all patients arriving. On comparing affidavits and service records few discrepancies were found. As nearly all of the patients were anxious to have their pay records straightened out before going to a general hospital, and as some wished to go home on furlough, full payment on affidavits was welcomed by all of them.
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SURGEON`S CERTIFICATE OF DISABILITY
Many of the patients, sent to the hospital as a result of the port embarkation inspection of troops, were found to be unfit for further service in the Army, or at least for foreign service; consequently, there were discharged from the hospital alone several hundred patients, on surgeon`s certificate of disability, which number does not include patients who returned to their organizations for discharge on surgeon`s certificate of disability. In addition to those recommended for discharge, approximately 600 patients were classed as fit for domestic service only.
For a considerable time all men selected as suitable for discharge for disability, were admitted to the hospital as patients, examined, carried through to completion of their papers, and discharged at the hospital. This plan was found to operate much more smoothly than by having numerous boards scattered throughout the command. Later, the scheme was modified to the extent that after the fourth indorsement of the certificate of disability had been completed, the man concerned was transferred to either Camp Hill or Camp Alexander, and the actual discharge given at one or the other of these places by the local commanding officer. All of the papers in the case, however, were prepared by the disability board of the hospital.
PROPERTY ADMINISTRATION
As will be readily understood, it was not necessary to keep the entire hospital plant in operation at any one time, excepting during periods of stress produced by the sudden reception of large bodies of sick and wounded. Therefore, in order to obtain the maximum flexibility in property administration and to provide for the constant opening and closing of wards and the continual expansion and contraction of patient personnel, questions of property in the medical and surgical service were handled through one officer detailed to each service. Each of these officers was under the command of the respective chief of service. This made it possible for the chief of service to keep constantly in touch with the situation of the service and to shift property from one place to another so as to settle emergencies as they arose, at the same time keeping track of the property and the property accountability of persons connected therewith. Thus it was practicable to perform the maximum amount of work with the minimum amount of property. The plan worked extremely well and the amount of property shortage was reduced to a very small figure. It had the additional advantage of relieving men who were doing technical professional work from a series of vexatious details which would have materially interfered with the performance of medical and surgical duties.
PROFESSIONAL DEPARTMENTS
MEDICAL SERVICE
In the organization of the clinical service at the hospital two large divisions were maintained, that is, medical and surgical. Each of these was subdivided into the groups of disease occurring under them, with a medical officer in charge who was directly responsible to the chief of service. Thus, the medical service included general medical cases, contagious diseases, and neuropsychiatric conditions.
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The medical service at the embarkation hospital presented problems that were unique, fascinating, and a real test of efficiency. Few other American military hospitals presented so complete a range of medical military service. It had, first, the sick from the camps tributary to and served by the port, which furnished all the medical problems, clinical and pathological, found at the cantonments; second, the handling and disposition of the physically defective culled through the physical preembarkation examination of organizations going overseas; third, the examination, classification, treatment, and clearing of the sick and wounded returned from overseas. Thus, it was necessary to render service to every class of soldier except those immediately on the firing line. The bulk and variety of work handled, therefore, required a highly versatile specialized organization. Any delay or inefficiency would have speedily resulted in the hopeless clogging of the plant which was receiving patients from every direction. All officers, from the chiefs of service down, came from civilian life and included very few who had spent more than a few days or weeks at one of the training camps, which rendered them more or less proficient along general lines, but of little service so far as hospital administration was concerned. In addition to the professional and military duties, certain of the officers were ordered to duty as transport surgeons, or to fill vacancies arising in organizations prior to going overseas. Thus, the medical staff of the embarkation hospital became a reserve for those purposes. For the above outlined reasons and to establish a uniformity of technique, clinics and classes for instruction, both along professional, administrative and military lines, were established in the medical service and they proved to be of tremendous value both for the reasons indicated and for the establishment of a splendid esprit de corps. The clinical material was so abundant and of such exceptional interest that every officer grew tremendously in professional value. This applied especially to the clinics using the cardiovascular, contagious, and nervous diseases material.
The ward surgeons were compelled to make accurate diagnoses and establish efficient therapeutics; and to insure that such was done, a system of ward supervision was established. The chief of service made daily rounds of all wards, seeing cases in consultation and checking ward administration. The assistant chiefs made frequent bed checks of all wards, sending a written report to the chief as to the status of each patient. This kept the ward surgeons from becoming careless in the handling of patients and gave needed help in the diagnosis and treatment of difficult cases.
One of the assistant chiefs of service saw each patient who was to be discharged from the hospital, at the ward on the day before discharge and again at the receiving ward on the morning of discharge, to make certain that no patient was sent out of the hospital who was not sufficiently recovered to go safely to duty or to quarters. This proved a very valuable procedure.
A ward report of disease incidence was furnished the chief daily, and a consolidated report was made therefrom. This also proved its worth: it made for accurate and speedy diagnosis and indicated wards in which existed problems needing attention; undetermined diagnoses were reduced to a minimum; chronic disorders such as arthritis or heart disease could be checked for investigation by the disability board: and any rise in disease incidence could be determined from day to day.
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The above plan provided uniform methods of procedure, trained the staff to a high degree of professional and administrative efficiency, established a marked degree of esprit de corps, and assured ready consultation and checking by the chief and his assistants. The elasticity and effectiveness of the service enabled it to meet and surmount every crisis as it arose. The influenza epidemic and the sudden influx of overseas patients which occurred from time to time, frequently causing a doubling or tripling of the service in a day, were all managed with ease and efficiency.
In the handling of the overseas cases the hospital was not content to rest on the order to classify and transfer patients on the overseas diagnosis. Every case was examined before classification and the present status determined. A record of the condition of each man while he was a patient was maintained. As many members of the staff as were needed were detailed to the overseas ward and the examination and classification of patients were completely and accurately accomplished. Prior to January 1, 1919, no overseas arrivals required more than 24 hours for admission, bathing, delousing, examination, and classification. When speed was essential the above routine was accomplished on the day of admission.
The method of handling overseas patients debarking at the port was in detail as follows: Overseas patients were transported, in ambulances, from the port to the receiving office of the hospital, and were assigned to wards by the medical officer. On reaching the ward they were examined for contagious disease and vermin, given a bath, dressed in hospital clothes and assigned to beds. As soon as practicable the ward surgeon made his examination and filled out a classification sheet, giving the following data: Name, rank, organization; a concise diagnosis, and the classification according to specific instructions from the Surgeon General`s Office; whether the patient was ambulatory or a litter patient; his home district; number of ward and the name of the examining surgeon. These classification sheets were collected and sent to the chiefs of the services for their approval. They were often passed on to the evacuation officer whose duty it was to distribute the patients to the hospital nearest their homes for treatment, reconstruction, vocational training, or discharge.
These interior hospitals to which overseas patients were sent at first were all general hospitals with the exception of one, the base hospital at Des Moines, Iowa, and very explicit instructions were given by the War Department to have men with certain diseases or injuries sent to hospitals which made a specialty of treating these conditions. If possible the men were sent to the hospital nearest their home.
As the hospital rapidly filled and more beds were required, orders were issued to send patients to the base hospitals in National Army cantonments and in National Guard camps, but no special instructions were given as to the nature of the cases to be sent to those hospitals. Thereafter, the policy was adopted of sending the convalescents and medical and surgical patients not requiring special treatment to the base hospitals.
On January 22, 1919, specific orders were sent out from the Surgeon General`s Office, designating the exact nature of the cases to be sent to the various hospitals, general and base. These instructions did not make any
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material change in the distribution of patients, but soldiers could not be discharged from either a demobilizing camp hospital or from a general hospital. Therefore, men who were convalescent or suffering from minor medical or surgical complaints were sent to the base hospital nearest their homes instead of to a general hospital.
After the distribution of the patients to the various wards was completed, the Surgeon General`s Office was communicated with by telephone and advised as to the number of patients on hand for each hospital, as well as the number in each class of cases. The classification sheet was then arranged according to rank of the patients and a nominal list was made. Several copies of the nominal list were made and sent to the port surgeon, with request for transportation.
In the course of 48 hours the schedule of the train provided was sent by the port surgeon, to the embarkation hospital with information as to the time and place of entrainment. When the time came for their departure from the hospital, the patients were fed and taken to the train in ambulances. Each group of men was put in charge of a medical officer, and was accompanied by several enlisted men of the Medical Department, the number varying with the total number of patients, the number of litter cases and the number of mental cases requiring special attendants. The above description of the handling of patients applied not only to enlisted men but to officers. Officers who were well enough to travel unattended were classified and distributed to the hospitals nearest their homes, their disposition being confirmed by the War Department within a few hours after their entrance to the hospital. A separate letter was written to the surgeon of the port for special orders for this class of patients. As soon as the orders were received the officers were furnished free transportation by the quartermaster and departed.
Of 33,676 admissions, 15,695 were medical cases and 17,981 surgical. This may be accounted for largely by the fact that the average length of time a surgical patient remained in the hospital was much more than that for the medical patient. Again, the minor infectious diseases and the influenza epidemic, made up a great part of the medical cases, as is illustrated by the following list:
|
Mumps |
3,225 |
Cerebrospinal meningitis |
93 |
|
Measles |
1,251 |
Scarlet fever |
71 |
|
Pneumonia |
1,364 |
Diphtheria |
80 |
|
Pneumococcus meningitis |
5 |
Anthrax |
4 |
|
Pulmonary tuberculosis |
1,047 | ||
|
Tuberculous meningitis |
6 |
Total |
7,146 |
Those suffering with mumps began to be admitted to the hospital in large numbers the 1st of January, 1918, after which date there was an average of 170 cases present at all times.
The majority of measles cases also appeared during the winter months as evidenced by the fact that of the total of 1,251 cases admitted 513, or approximately 41 per cent, occurred before the 1st of March, 1918. It is interesting to note that the first patient admitted to the hospital suffered from measles. No accurate data are available as to the total number of cases of pneumonia which followed an attack of measles, but from the period March 1, 1918, to
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January 1, 1919, out of the 322 deaths due to pneumonia, in four cases pneumonia appeared as a complication of measles. So soon as the laboratory permitted, bacteriological examinations were made of the throat of every patient entering the measles ward, detected streptococcus carriers being segregated. All cases were separated by means of the cubicle system which was accomplished by hanging sheets between the beds to reduce opportunities for cross infection. Patients developing pneumonia were at once moved into a separate ward. One case of hemorrhagic measles, with recovery, occurred.
Beginning April 1, 1918, all cases of pneumonia were typed and serum treatment was instituted in all types of cases where the laboratory returns were received prior to the crisis. Separate wards in which there was the cubicle system, as employed in the measles ward, were maintained for the use of pneumonia convalescents.
Influenza became epidemic at this hospital about the middle of September, 1918. During the height of the epidemic, September 20, to October 20, 2,523 cases were treated, which, together with those cared for after these dates, brought the total up to about 3,000. Many other cases were cared for in the temporary hospitals, only the more serious cases being sent to the embarkation hospital. Between the dates above noted, 623 cases of pneumonia came under the care of the hospital. The mortality record of pneumonia of all types before, during, and after the influenza epidemic was very good; 14 per cent preceding the epidemic; 25 per cent during the epidemic when 650 cases were treated; and only about 4 per cent for 80 cases during November and December, 1918.
Of the many complications to be expected and which appeared, empyema was noted for its small incidence, only 3 cases appearing out of the 623 pneumonias.
The Pfeiffer bacillus was found in only 1.8 per cent out of a total of 1,148 examinations made, and was apparently not an etiological factor in this epidemic.
Of the secondary infections the streptococcus hemolyticus showed only a 6 per cent incidence, and to its absence was attributed the low empyema rate.
For the care of patients of whom a diagnosis of pulmonary tuberculosis had been made a large two-story building, originally constructed for housing members of the detachment, Medical Department, was used. Covered porches for both floors extended the entire length of this building and permitted of the proper fresh-air treatment so necessary for this class of patients. Except for bed-ridden patients, this ward served simply as a clearing station, as all tuberculosis patients, as soon as a positive diagnosis was made, were sent to one of the general hospitals where there were special facilities for their care. Of the 441 deaths in the hospital, 34 were due to pulmonary tuberculosis.
Ninety-three cases of cerebrospinal meningitis were treated. The majority of these occurred during the months of December, 1917, and January, 1918, at which time the disease may be said to have been epidemic among the colored labor organizations stationed at Camp Hill and Alexander. After that date there were the usual sporadic cases found among large bodies of troops. Probably because the majority of cases were negroes, the mortality was high, about 38 per cent. Meningitis patients were kept in strict isolation and received the usual serum treatment administered by means of spinal puncture.
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Four cases of cross infection developed in the hospital. Each of the four patients had been in the hospital longer than one month at the time of infection. Two of them were convalescent from diphtheria, one from meningitis, and one from whooping cough.
As the cold weather of the winter of 1917-18 and the variable weather of the early spring of 1918 subsided, a very interesting change in the type of infections became noticeable. The respiratory diseases almost disappeared, while malaria and diseases of the dysentery type began to develop. The number of malaria cases up to January, 1919, was 141, 135 of them being tertian in type and six estivoautumnal. Many of these cases were received from organizations not stationed at the port.
Many interesting cases were found among men prevented from departing overseas as a result of diseases and injuries discovered at the preembarkation physical examination. Of these, the cardiovascular conditions were easily of first importance. There were 738 of these cases that were carefully classified; and if recovery could be secured in short time, they were kept under observation. This applied particularly to the postinfectious pericardial, endocardial, and myocardial conditions. Cases giving promise of recovery or improvement under more or less prolonged treatment, were sent to a general hospital affording special attention to cardiovascular conditions. Those who had reached the limit of improvement were either recommended for domestic service or discharge from the Army.
All sick prisoners of the port were treated at the embarkation hospital, the guard being furnished by the provost marshal.
The cases returned from overseas proved a source of much interest to the medical staff as indicating which type of constitution was the most likely to fall under the stress and strain of modern warfare. It was found that pulmonary tuberculosis, cardiovascular, and neuropsychiatric diseases, in the order named, are to be expected in this class of soldiers. Nephritis, diabetes, asthma, bronchitis, and laryngitis following gas poisoning, goiter and occasional gastroenteric conditions also were found.
NEUROPSYCHIATRIC SERVICE
The neuropsychiatric ward of the hospital was opened April 15, 1918. Previous to that time all mental and nervous cases were housed and treated in ward 13, a general medical ward. The service showed a steady increase in the cases from the local camps, being augmented by the return of overseas patients. On July 7, 1918, upon request to the Surgeon General`s Office, 11 enlisted men, including a graduate nurse, all of whom had received training in the handling of this type of patient, were sent from St. Elizabeth`s Hospital, Washington.
At first, the neuropsychiatric service had almost entirely the function of a clearing station: patients were kept only so long as was necessary to make a professional diagnosis and to recommend action as to what disposition should be made of them, after which they were either discharged on certificate of disability, assigned to domestic service only, sent to general hospitals for further observation, or, in rare instances, returned to duty.
Frequent clinics and classes of instruction for the staff of the medical service were held and efforts were made to establish uniform and thorough
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methods as to diagnosis and treatment, so that each patient might have every advantage tending to early recovery and return to active duty.
SURGICAL SERVICE
The surgical service at the embarkation hospital was subdivided in accordance with the following grouping: General surgical cases; venereal diseases; eye, ear, nose, and throat diseases, dermatological diseases; dental service, and X-ray service.
During the time the hospital occupied temporary structures, the surgical service was comparatively small and the facilities for operative work were limited. The operation room was located on the second floor of the barracks building with no provision for heating except an ordinary stove. As no nurses had been assigned to the hospital, enlisted men were the only available help in the preparation of surgical dressings and other materials necessary in an operating room. Sterilization of all material was accomplished either by boiling over a small alcohol stove or by the use of antiseptic solutions. With only such crude facilities on hand, operative surgery represented more a game of chance than technical skill; however, the first operation performed, an appendectomy, was entirely successful. With the opening of the hospital proper, all this was changed and a complete operating pavilion was supplied in which up to January l, 1919, 1,797 operations were performed.
VENEREAL SERVICE
The management of venereal diseases was always a difficult problem in the port and as the majority of cases usually found their way to the embarkation hospital, the largest share of the burden was thrown upon that institution. The presence of large numbers of colored troops, and the fact that no soldier with venereal disease was allowed to embark for overseas service, were the two facts which created the problem. It was soon recognized that to turn over the wards to the treatment of these diseases would leave little room for anything else. Moreover, the majority of these patients were not bedridden. Consequently, two wards in the surgical service were set aside for the treatment of such cases in which bed treatment was necessary. For the remainder, authority was obtained to institute a tent hospital; accordingly, on April 28, 1918, 23 pyramidal tents were set up in the open on a plot of ground near block 18 of Camp Stuart. Later, these tents were transformed into huts, and a barrack building, contiguous to this block, was assigned as administrative headquarters in which treatment was given. By evening of the same day practically all of the tents were filled, and from this beginning the camp increased rapidly in size until there were 103 huts and the daily reports of patients averaged between 400 and 500. On May 20, 1918, work was started to place the venereal disease section upon a more permanent basis. Frames were erected for each tent, a wooden floor was provided, and the sides and door screened. A large mess hall and kitchen were built and a special building designed in which treatments were given. This construction was completed June 21, 1918. Tents were arranged in rows, each row being lettered and the tents in each row numbered. Each tent furnished sleeping quarters for six men. Each row of tents was in charge of a medical officer
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who acted in the capacity of ward surgeon of his row. In the treatment building were special rooms for each row of tents and each room was lettered to correspond with the row. Each room had hot and cold water and the proper equipment for giving treatment. Here also were filed the clinical records for patients. There were also rooms for administering prophylaxis for members of the enlisted personnel, a separate room equipped for dark field examinations, and a small operating room fully equipped for minor surgery. One end of the building was given over to offices for the medical officer in charge, store rooms for medical supplies, post office, and rooms for holding sick call.
In the rear of the camp was an empty space used as exercise and play grounds. Here the Young Men`s Christian Association erected a large tent equipped with a stage, benches, and writing tables. Some form of entertainment was furnished twice weekly and these played an important part in the maintenance of contentment and discipline. As the camp increased in size difficulty was experienced in confining patients to the vicinity of the camp; therefore, a strong wire barricade was built to in close the whole area; and a camp guard composed of enlisted men of the Medical Department was organized. There were nine medical officers on duty at the venereal camp hospital, all of whom had been especially trained in the treatment of genitourinary diseases. Fifty enlisted men of the Medical Department were also assigned to duty there. As the patients were all ambulatory, it was the policy to have the light work about the camp, such as policing, making beds, and mess hall duty, performed by the patients themselves.
From May 3, 1918, to January 1, 1919, 2,809 cases were admitted to venereal camps Nos. 1 and 2. Of these, 1,354 cases were returned to duty, 457 were discharged on surgeon`s certificate of disability, and 998 remained under treatment.
EYE, EAR, NOSE, AND THROAT DEPARTMENT
The eye, ear, nose, and throat department was organized as a branch of the surgical service at the time when the hospital was opened; but prior to February 1, 1918, such work as arose was taken care of by a resident physician at Newport News, Va., employed as a contract surgeon. On February 1, however, a specialist in these diseases was assigned to the hospital and a ward was set aside for the care of this type of cases, operative work being done, when occasion arose, in the general operating room. The service rapidly increased and plans were soon made for the establishment of a separate building. For this purpose one-half of store room No. 1 was chosen and the necessary remodeling was finished on July 14, 1918, and the department equipped with its own operating room, treatment rooms, and dark rooms. Besides the care of patients in the wards of the hospital, a clinic was held daily between hours of 9 and 12 a. m., where all such patients came from outside points within the port of embarkation. This side of the work increased so that 20 to 30 such patients were treated each day.
A 30-bed ward was then set aside for the eye, ear, nose, and throat service, to which an equally large ward was added, giving in all accommodations for 60 bed patients to this service. Ultimately, the wards of the service were
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moved to a building of tile construction which had 100 beds in four wards, an office, diet, treatment, and isolation wards.
The out-patient clinic was at first held in the ward. This was soon transferred to a small room in the operating pavilion, refractions being done in the corridor. On July 14, 1918, a new building, 25 by 75 feet, was opened, containing waiting, operating, treatment, and dark rooms, all fairly well equipped for most of the ordinary work.
The total number of treatments in the eye, ear, nose, and throat department was 2,270 and the operations numbered 481. The eye service admitted to its ward 587, furnished 7,414 treatments in the clinic to 1,608 patients, and treated in the clinic and hospital 3,367 patients prior to January 1, 1919. There were 987 patients refracted, for which the Medical Department issued 449 pairs of glasses, and 104 pairs were otherwise supplied to those not entitled to a gratuitous issue. Numerous daily examinations were made in the wards of patients unable to come to the clinic.
The very large amount of interesting material in this service was a source of satisfaction to the personnel, all of whom showed much interest in the work. No special courses were given, but general instruction was constantly given to the less experienced officers.
DERMATOLOGICAL DEPARTMENT
The dermatological department was established as a separate department of the surgical service on January 15, 1918. No separate ward was set aside for the treatment of skin cases except those of a contagious character, and in this case a group of tents known as ward B was used. The tents were of the same size and contained the same equipment as those of the venereal camp hospital, separate toilet and bathing facilities being provided.
By far the largest number of patients treated suffered from scabies. Since soldiers suffering from this condition were not allowed to embark for overseas, and as the organization from which they came remained at the port only a short time, it was of great importance that they receive prompt and speedy treatment. This treatment consisted of two parts, the actual medical and the prophylactic. The afflicted person began his treatment the first night, consisting of a vigorous scrubbing with soap under the shower bath, instructions having been given him to get the tops off as many lesions as possible. Thoroughness in this part of the treatment was stimulated by informing the man that the better his part was performed the sooner would he be discharged from the hospital. Following the bath each man rubbed in the ointment over the body below the chin. The ointment used was the official sulphur ointment, sometimes used alone and occasionally with an added balsam of Peru, 4.8 grams to 30 grams of the ointment. The ointment remained on throughout the day. The preventive part of the treatment was undertaken with a view to preventing reinfection in the individual and a spread of the disease to others. In the first place, the clothes of each man, after being checked, were sent to the hospital sterilizer and then to the laundry. All blankets, as well as bed linens and towels, were sterilized upon the discharge of the patient from the ward. Every case of scabies was reported promptly
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to the organization commander in order that the infected person`s clothing and blankets might be sterilized before his return to his company, and to prevent their use by others until sterilization had been effected. That the above system was successful is evidenced by the fact that only 3 cases of the 102 treated were readmitted to the scabies ward.
DENTAL DEPARTMENT
The dental department of the hospital at its opening consisted of two operating dental surgeons, a sergeant, and two enlisted assistants. The equipment at that time comprised one base and one portable outfit, and was located in a barrack building. The number of dental surgeons was increased in January, 1918, to eight, but equipment for that number of men did not arrive until some time later, and unfortunately, after its arrival, lack of space prevented its installation. Adequate space was finally provided in storeroom No. 1 of the hospital group, and patients were cared for in this building until it was necessary to transfer this organization to a part of the ward in order that the building could be remodeled and made suitable for an eye, ear, nose, and throat, and dental dispensary. The remodeled building was completed and occupied on July 15, 1918. The dental department occupied 2,200 square feet of floor space, which was divided into 10 operating rooms, offices, and laboratory, and was provided with complete white enamel operating equipment. The dental personnel consisted of nine operating dental surgeons, a sergeant, and nine enlisted assistants. The character of the work accomplished comprised minor oral surgery, operative and prosthetic dentistry, and porcelain crown work, but gold crown and bridge work could be successfully accomplished when materials were supplied. There were 10,867 patients given 16,904 sittings in the clinic.
X-RAY DEPARTMENT
Owing to the delays in transportation incident to wartime traffic, the roentgenological laboratory at this hospital was not installed until April, 1918, and was made ready for use the 15th of that month. Situated in a building between the administration building and the operating pavilion, and connected by closed corridors with all wards, its location was advantageous for both hospital and out-patient work. While the laboratory was primarily a part of the embarkation hospital, being in reality a port laboratory, all the X-ray work for the entire port of embarkation was done here. The naval transport service likewise made use of the laboratory for ambulatory cases rather than have them make the long trip to the Naval Hospital at Norfolk.
The equipment was a standard base hospital type in use in nearly all Army hospitals and comprised a high-tension transformer, a Kelly-Koett table with fluoroscopic attachment, an upright roentgenoscope, a Kelly-Koett plate changing device, a Wheatstone stereoscope, a Kelly-Koett tube stand, and all the necessary accessories for radiographic and fluoroscopic work. The Coolidge tube was used exclusively. A United States Army bedside unit was used for ward work.
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Ward surgeons, attending surgeons, regimental surgeons, and medical officers on duty at camp infirmaries were instructed to send their patients with Form 55l, Medical Department, properly filled out in duplicate. The patient`s name, rank, organization, and the portion of his body radiographed were then entered serially in a book provided for that purpose. He was given a number and the plates were marked with corresponding lead numbers at the time of exposure. The same information, with the additional data of the disposition of the plate, was then entered in another book with names arranged alphabetically. The plates were filed according to size in a specially constructed filing case which contained numbered and lettered compartments. The X-ray findings were typewritten in duplicate and both slips were sent by messenger to the ward surgeon or other medical officer concerned. The surgeon retained one slip and initialed the other, which was returned to the X-ray laboratory and retained as a receipt. All reports for out-patients were sent through the adjutant`s office.
Unless the emergency required an immediate report, all plates exposed during a day`s work were interpreted during the first hours of the following morning, the reports thereon being sent out as soon as written. Cases were received at the laboratory between 9 a. m. and 5 p. m. without previous appointment save in cases that demanded a special preparation, such as gastrointestinal, urinary tract, or gall-bladder.
With some variations the standard Army technique of 40 milliamperes, 5-inch gap, and 20-inch distance was used, the only departure being in gastrointestinal, pulmonary, and cardiovascular cases.
Nearly all pulmonary patients were fluoroscoped and all were radiographed stereoscopically and in the standing position, if practicable. The milliamperage was raised to 100, the tube plate distance was increased to 28 inches, and the time shortened to one second, the patient being instructed to hold a moderate inspiration until both exposures were made. Gastrointestinal patients were first fluoroscoped and then a series of immediate plates made, both in the erect and prone positions. Plates were made also at 1 hour, 6 hours, and 24 hours. The milliamperage used was 100, the spark gap 5 inches, the distance 24 inches, and the time one-third second. Intensifying screens were used. Cardiovascular cases were X-rayed in an erect position. The tube-plate distance was 72 inches, the milliamperage 100, the spark gap 6 inches, and the time one-half second with the intensifying screen. In the urologicol patients both kidneys, both ureters, and the bladder were X-rayed, using 40 milliamperage, 5-inch gap, and making compression with an inflated rubber ball. The time varied according to the size and weight of the patient. In mastoid cases both sides were taken on a single plate, the technique being 25 milliamperes, 5-inch gap, and 10 seconds. All bones were radiographed in two views. Hips and shoulders were stereoscoped. In suspected joint disease the corresponding joint was rayed for comparison.
The dark room was equipped for tank development. The developing solution was compounded for a developing time of 8 minutes at a temperature of 65? F. All plates were allowed to fix for 15 minutes and were washed in running water for 1 hour.
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The first case on record in the laboratory was X-rayed April 16, 1918; and from this date to August 22, 1919, the total number of patients examined in the laboratory was 3,392. A large number of patients examined was not admitted to the hospital, so that only about 7 per cent of that number were X-rayed.
LABORATORY
A specially designed laboratory, completely equipped, was occupied January 1, 1919, and though it was the port laboratory, it was located in the hospital grounds. Prior to November, 1918, the highest number of cases examined in a single month was 177, a daily average of 5.9 In November the cases jumped to 233, with a daily average of 7.5, and from that time the increase was steady, until in March, 1919, the number of cases advanced to 312, with a daily average of 10.06.
STERILIZATION AND DISINFECTION
Sterilization and disinfection were accomplished by steam, boiling in water, by chemicals, sunlight, soap and water, and incineration. Clothing, excepting hat, shoes, and raincoat, of each patient having or suspected of having an infectious or contagious disease, was put into a barrack bag and sterilized in a steam autoclave for 15 minutes. In the autoclave a vacuum was first produced, followed by a steam pressure of 15 pounds for 20 minutes. Before the autoclave was again opened a slight vacuum was used to hasten the drying of clothes, and the clothes were then stored until the patient was ready to leave the hospital.
Drinking cups, eating utensils, etc., were collected each meal and placed on a butler`s tray. This tray, with its contents, was placed directly in a galvanized iron lined box. The box had a tight-fitting lid, an inlet for steam and outlet for the water of condensation. After sterilization for 10 minutes the tray and dishes were taken into the kitchen, washed, dried, and put away.
All soiled articles were made into bundles, around which was wrapped a clean sheet. Before these bundles were taken to the laundry they were sterilized in the steam autoclave in the same manner as the clothing of patients was sterilized.
Immediately on discharge or other departure of a patient, the used mattress, blankets, and pillow, except in cases of measles or mumps, were sterilized in the steam autoclave.
Surgical dressings, sponges, towels, etc., were made by attendants or patients in the contagious wards and were put in a barrack bag and sterilized in the steam autoclave. In order that a sufficient supply of operating gowns should be on hand at all times, gowns used once, or not soiled, were placed in a barrack bag, sterilized in the steam autoclave and returned to the proper ward, to be used again. Medicine glasses, surgical instruments, syringes, lumbar puncture needles, rubber tubing, and catheters, were sterilized in boiling water for at least 10 minutes, on a gas range or electric plate. Face masks were sterilized by boiling in water for 10 minutes. Thermometers, when not in use, were kept in 1-1000 bichloride solution or liquor cresolis compositus, for one hour. Sputum cups, irrigating cans, bed pans, urinals, rubber blankets,
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rubber rings, hot water bags, and ice caps, were sterilized in a 10 to 25 per cent liquor cresolis compositus solution for one hour. A 10 percent solution of liquor cresolis compositus was used with which to wash the bedsteads, bedside tables, chairs, radiators, walls, doors, and doorknobs. The hands of attendants were disinfected by washing them in a 5 per cent solution of liquor cresolis compositus, and followed by hot water and soap.
Personal articles belonging to patients, such as foreign stamps, helmets, and razors, were sterilized with 70 per cent alcohol. Seventy per cent alcohol was likewise used to disinfect the hands.
The mattresses, pillows, and blankets used by patients having measles or mumps, were sterilized by placing them in the sunlight for one day.
Soiled dressings, swabs, tongue depressors, etc., were burned daily. All books, journals, and papers were burned upon a patient`s discharge or other departure.
All clothing infested with vermin or suspected of harboring vermin, was placed in a small autoclave and subjected to 15 pounds pressure of steam for 30 minutes. This process was repeated if any live vermin were found after the first treatment. Patients having vermin were shaved, and given a bath with a 1-500 bichloride solution. All patients returning from overseas were examined for vermin on the day of arrival, examined again three days before departure and on the day of departure.
NURSING SERVICE
The nursing service at the Embarkation Hospital, Camp Stuart, was inaugurated in January, 1918, when the chief nurse and 10 nurses reported and went immediately on duty. Eight-hour duty of three periods a day was begun and proved very satisfactory until April, 1918, when, due to the increased amount of work, it was found more practicable to have a night tour of duty consist of 12 hours and a day tour of 7 hours.
As the wards were completed and opened, more nurses were assigned to duty, and by March 31, 1918, 65 nurses were present. One was assigned as night supervisor, one as housekeeper, and one as assistant to the chief nurse. The night supervisor was changed monthly, as were all other night nurses.
From May 26, 1918, there were constant changes in the nursing personnel. After September, 1918, the number of nurses on duty averaged 150.
The nursing work was much the same as in any Army hospital with perhaps a little more paper work, due to the constant evacuation of patients returning from overseas. The surgical service, from the nursing point of view, was extremely heavy at times, as every surgical patient returned from overseas, and the majority of them were surgical, required one or more dressings. In wards of 100 patients, each one having to be dressed daily, the work of doing these dressings and keeping up supplies was no small task.
The ward for sick nurses was completed in August, 1918. It had a capacity of 35 beds, including the isolation department. Nurses returning from overseas were admitted to this ward, which was run exactly like other wards. The first nurses returning from overseas were admitted during August, and from that time until May 1, 1919, there was a total of 115 nurses returned through
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the embarkation hospital. Of this group 95 were patients and were transferred to general hospitals for further observation and treatment, and 20 were casuals, some of whom were discharged and others transferred to other hospitals for duty.
FIG. 163.-Nurses` wards, Embarkation Hospital, Newport News, Va.
AMBULANCE SERVICE
The ambulance service was originally under the control of the medical supply officer so far as equipment was concerned. It continued to be so administered until February 1, 1919, when all ambulances and their accessories at the hospital were transferred to the Motor Transport Corps. Truck and wagon transportation was obtained from Camp Hill truck and wagon companies, and later from the Motor Transport Corps. On the whole the transportation was adequate although at times difficulty was experienced in obtaining the requisite number of wagons and trucks.
MAINTENANCE OF GROUNDS AND BUILDINGS
The maintenance of grounds and buildings of the hospital was carried on by the supply department until November 1, 1918, when the maintenance of buildings was turned over to the detachment port utilities; and the maintenance of grounds and gardens was transferred to the control of the executive officer of the hospital.
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HOSPITAL ANNEXES
There was no Young Men`s Christian Association building connected with the embarkation hospital; hence a building was constructed by that association on Chestnut Avenue, in close proximity to the detachment buildings. It afforded a place of recreation for the enlisted men of the Medical Department and was conveniently located. A Young Men`s Christian Association tent was also maintained for the patients of the venereal camp hospital, and the main Young Men`s Christian Association hut of Camp Stuart was located just a few hundred feet from the administration building of the hospital. While this hut was open to patients it was a prominent gathering place for the enlisted personnel.
For the patients of the hospital, the American Red Cross had provided two separate buildings of the usual recreation type, known as the convalescent
FIG. 164.-Red Cross Convalescent House, Embarkation Hospital, Newport News, Va.
patients` house and the convalescent patients` theater. The latter building was originally constructed as a recreation house for colored troops, but was later converted into a theater. Both were large frame buildings fashioned in the form of a St. George cross, built upon piles and extending directly over the water of Hampton Roads in front of wards 8 and 9. This house was a recreational house for such patients as were able to use it. A large central room with brick fire place on either side served as main assembly hall for entertainment and recreation purposes. Small rooms to either side were used as library, offices, baths, etc. Other rooms were set aside for the accommodation of relatives of very sick patients who desired to stay near the hospital. The theater was used for moving picture shows and other entertainments.
Eight officers of the American Red Cross, who devoted their entire time to the welfare of patients, were assigned to the hospital. Besides the work carried
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on in the convalescent house the activities of the Red Cross covered a wide field and consisted of the filling of requisitions from the commanding officer of the hospital for materials needed quickly, or not regularly supplied by the War Department, but which, nevertheless, were necessary for the comfort and health of patients. Officials of the Red Cross visited the wards, collected and mailed letters, sold stamps, and stamped them free of charge where the patients were without money. They wrote letters, sent telegrams, and cashed checks, postal and telegraph money orders for the patients. Delayed payments of allotments were hastened by them and information regarding allotments and insurance was given. Relief was also furnished families of patients in financial trouble, and board and rooms were found for visiting relatives or friends of patients.
The embarkation hospital organized a school for illiterates in April, 1918, the purpose of which was the education of the enlisted men of the Medical Department. The chaplain exercised supervision over the school but the actual work of teaching was performed by a representative of the Young Men`s Christian Association. All that was attempted in the way of education was to teach the men to sign the pay roll and read simple orders. Attendance was an ordered duty, the school hours being credited as part of the working day.
