History

The

MEDICAL DEPARTMENT

OF THE UNITED STATES ARMY

IN THE WORLD WAR

VOLUME I

THE

SURGEON GENERAL`S

OFFICE

PREPARED UNDER THE DIRECTION OF

MAJ. GEN. M. W. IRELAND, M. D.,

Surgeon General of the Army

COL. CHARLES LYNCH, M. C.

LIEUT. COL. FRANK W. WEED, M. C.

LOY McAFEE, A. M., M. D

WASHINGTON: GOVERNMENT PRINTING OFFICE 1923

LETTER OF TRANSMISSION.

I have the honor to submit herewith Volume I of the history of the Medical Department of the United States Army in the World War. As this is the first volume, and as the work is an exhaustive one, it seems appropriate here to state the purposes of the history in question, and to give certain other information to enable the reader to study it with fuller knowledge. Nor can I permit this opportunity to pass without expressing appreciation of the notable services rendered by our World War Medical Department.

The purpose of the history of the Medical Department in the World War is twofold. It is intended not only as the permanent written record of the accomplishments of the Medical Department in the war, thus rendered available for study with a view to the betterment of that department for the future, but also as a contribution to medical science. That it will be of great value from both standpoints may fairly be assumed, judging by what has happened with similar histories previously published. Of this, our own history of the Civil War is one of the most notable examples. Described in its pages is the masterly medical organization of Letterman, on which has been based that of all modern armies, and which, in certain subjects even vet, notwithstanding revolutionary changes in medical, surgical, and sanitary practice in the meantime, is accepted throughout the world as one of the highest authorities on mass scientific information, to be gathered only from war experience involving carefully kept records based on observations ma(le on hundreds of thousands of men.

This history should be regarded, too, as a monument to those who, constituting the Medical Department of the Army, contributed to the success of our Nation at arms by preventing disease, by rapid cure of ill and injured, with restoration to duty, and by sustaining morale through prompt rescue of wounded in battle; and who, at all times, gave skillful and tender care to sick and wounded officers and soldiers. That such a monument might actually be erected is due to the liberality of the Congress of the United States.

No just estimate can be made of the work of the Medical Department during the war unless one knows its status when war began for us. My first duty, therefore, would appear to be briefly to summarize this. At that time, our medical officers were of three classes, numbering, Regular Army, 491; Medical Reserve Corps, 342 (in active service); and National Guard, 1,267. Those in the Regular Establishment were highly trained, so far as peace-time training could go. The Medical Corps, National Guard, had some highly trained and experienced officers, but about 50 per cent had recently joined. The small Medical Officers` Reserve Corps comprised a few officers trained from the military standpoint, but, in the majority of instances, without any military experience. This reserve, being actually provided for by law, was a matter of

great moment, however, as it permitted immediate expansion. In addition, our country afforded a very large and generally able medical profession practically without military training but with a few influential members who, from recent experience abroad, could speak with some authority regarding war hospital organization, especially is this had to do with the proper utilization of professional personnel. Professional skill was of a very high order among the leaders of the medical profession and good among a considerably larger number. The possibilities of making professional skill of military value were far greater than in any previous war because of greater knowledge of medicine, surgery, and sanitation. Before the war valuable machinery for obtaining and classifying civilian doctors was made ready to operate. This consisted of the Committee on Medicine of the Council of National Defense. and the American Medical Association.

For a considerable number of years before the war, dental officers had been commissioned in both the Regular Army and the National Guard. Though they numbered but 335, they had adequate experience for the administrative duties likely to be required of the Dental Corps, and had behind them a capable dental profession in the country at large. An active dental section also existed in the Committee on Medicine, Council of National Defense.

Only 135 veterinary officers were available when war came. Veterinary service under the Medical Department was a new thing in our Army, as prior to the passage of the national defense act in 1916 the Quartermaster`s Department had controlled matters in this respect.

There was a small force of enlisted men (6,619) in the Regular Establishment when war began. Exact figures are not available for the National Guard Medical Department on this date, April 6, 1917. When finally mustered into the Federal service, August 5, 1917, the National Guard enlisted strength, Medical Department, amounted to 16,623. Most of these men were newly joined, it being a well-known fact that the Medical Department, National Guard, suffered a material depletion after the unpopular border service of 1916.The enlisted force, especially in the Regular Army, was a great asset on account of the highly trained noncommissioned officers. The number of these, however, was comparatively small. The enlisted reserve was very small and not important.

A sufficient and trained nucleus of women nurses existed in the Regular Army (403), with an excellent reserve organized by the Red Cross (8,014), among which were found many capable executives.

Of other corps there was none.

War Department plans and national sentiment indicated that liberal appropriations would be forthcoming. Actually on hand were field medical supplies for an army of 300,000 men, though in this respect there was a great shortage of motor transport. Cooperation had been established with medical supply houses, largely through the Mexican border mobilization, supplemented by the efforts of the Committee on Medicine, Council of National Defense.

Four general hospitals were in operation, two only for general cases. Of these two one was well situated for World War use; the other was on the west coast. In addition, there were two relatively important department base hospitals which had been established during the Mexican border mobilization.

Both were in Texas and not so well located for present use. Two hospital trains were ready but no hospital ships. During peace time the great majority of Army patients had been cared for in small post hospitals. These post hospitals were not capable of much expansion for war, but a number of Army posts were suitable for use as hospitals, though only after considerable time-consuming additions and alterations. When war began for us a start had already been made by the Committee on Medicine, Council of National Defense, to list civil hospitals of the country suitable for Army use. This plan actually proved of small value, as civil hospitals are not capable of Army use save very exceptionally.

The organization of our Army, as this affected the Medical Department, was much better than at the beginning of any of our previous wars, but it was untried in dealing with vast armies; it was therefore subject to more changes than if the contrary had been the case. Medical Department field units were few but efficient. They were found in both Regular Army and National Guard, and comprised the following: Regular Army, 7 field hospitals, 9 ambulance companies; National Guard, 38 field hospitals, 26 ambulance companies. No divisions existed of which they formed an integral part. Red Cross base hospitals were important assets. They numbered 33 when we entered the war.

Responsibility for the care of sick and wounded and for the prevention of disease in troops has always devolved, in the last analysis, on the Medical Department. At the beginning of the war its power in the premises was greater than at the beginning of any of our previous wars. Then, too, scientific knowledge of sanitation had advanced to the stage where it had become possible to control all communicable diseases except those of the respiratory group. Un-fortunately, diseases of this group were scattered among potential troops throughout the country who formed part of a large population nonimmune to the diseases which commonly precede the pneumonias. On the other hand, an effective method for the prevention of typhoid and paratyphoid fevers by vaccination was in practical operation in the Army, and there was no considerable amount of intestinal disease in the United States. It is also worthy of note that popular interest in sanitation existed to an extent which had not prevailed in any of our previous wars. The spirit of the crusader was capable of being encouraged, and it was likely to prove far more effective in personal hygiene than was the spirit manifested in previous wars in which the soldier was considered a hardy man whom nothing could injure. One unfavorable factor remains to be mentioned. Only a small Army was in being, with the vast majority of troops to be raised, and with practically all shelter, including incidental sanitary conveniences, still to be constructed when war came. In this connection it is to be understood that the Army posts which existed were too small for war mobilization, though capable of use for small units.

This review of our assets when we entered the war would be incomplete if mention were not made of certain volunteer agencies in being when war came. The Committee on Medicine, Council of National Defense, had been organized under the authority granted by the national defense act of Congress, approved June 3, 1916. Its work of preparedness in lining up the medical and dental professions and in respect to medical supplies and facilities proved of great value when war came. Some years before the war the

American National Red Cross had been officially recognized as the authorized volunteer agency to represent the American people in cooperation with the Medical Department of the Army. In none of our previous wars had a strong organization of this character been in existence before the war. The advantage of this to the Medical Department was very great.

The beginning of the World War for the United States found the medical profession of the country a unit in the desire to play a worthy part. By the time of the armistice, 30,591 physicians-a larger number than was ever assembled in any other army-were in service. The administrative machine, mainly operated, and well operated, by trained officers of the Regular Army and the National Guard, did, it is true, creak and strain at times with the enormous load it had to carry in untrained personnel, but there was never any breakdown, and at home and abroad the Army had at its disposal the best professional skill that the country afforded in till branches of medicine, surgery, and sanitation.

Back of the doctors who actually saw service in the Medical Department during the World War stood other members of the medical profession, both men and women, who, by reason of age or physical disability, or for other valid reason, were unable to go on active duty. Their readiness to help in any manner commensurate with the circumstances was evidenced by enrollment in the Volunteer Medical Service Corps. The medical profession of the United States has every reason to take great pride in the part it played in the World War, and in my opinion the honor of belonging to it has been greatly enhanced thereby.

In many of the activities of the Medical Department the newly created Sanitary Corps assisted notably. Among the 2,929 officers who constituted this corps at its maximum were found scientists in branches related to medicine, surgery, and sanitation, as well as selected former noncommissioned officers who had been commissioned especially that their services might be utilized for important administrative positions.

One of the first requests of our Allies when we entered the war was assistance for their medical service at the front. For this purpose the American Ambulance Corps was organized. This served with great credit with the French and Italian Armies, as well as with our own Army. The highest administrative positions and others of less importance in the Ambulance Corps were filled by medical officers.

The members of the dental profession also played their part not only in the lines of their particular specialty, but also as assistant medical officers at the front in time of battle. At the time of the armistice 4,620 dental officers were in service. The enlisted men of this corps also came from the Medical Department.

In the Veterinary Corps, before the close of the war, a force amounting to2,234 officers had been commissioned. Their services unquestionably resulted in the saving of many animals and thus proved an important factor in promoting military efficiency.

Women nurses are now regarded as essential in the medical departments of armies. A total of 21,480 nurses were in service with the Army Nurse Corps during the war. They were found at the front, on lines of evacuation,

and in hospitals at home, wherever serious illness or injury necessitated skilled nursing. which they supplied in ample measure.

The enlisted strength of the Medical Department amounted to 281,341 on November 15, 1918, when it was at its maximum. This number, it will be noted, is much greater than the strength of our whole Army immediately before the World War. In modern warfare great responsibilities rest on the enlisted man, as well as on the officer, and I believe the Medical Department enlisted force fully measured up to their responsibilities.

In the World War, modern medical methods were found to require certain classes of civilian hospital personnel which were quite new to armies. In our service, laboratory technicians, dietitians, and reconstruction aides for teaching disabled soldiers and for physiotherapy were found necessary. They filled important places not otherwise provided for. In addition to this technical civilian personnel, miscellaneous civilian personnel, so-called, was employed at hospitals and supply depots. This class, made up of individuals who, for one reason or another-, were not fit to serve as soldiers, left free for active duty soldiers who otherwise must have been employed to fill these important positions: their contribution, therefore, was truly a valuable, patriotic one. The maximum number of civilian employees was 10,695 on November 15, 1918.

The members of the permanent clerical force of the Medical Department, on duty mainly in Washington but in small numbers at other headquarters, have been valuable public servants for many years. In fact, to how great an extent they have been responsible for carrying on the routine business of the Medical Department has never been generally appreciated. During the war, with vastly increased responsibilities, they fully maintained their hard-earned reputation for efficiency. At the outbreak of the war for us, a great many people flocked to Washington, and to other Army centers to a less extent, to help in any way they could. Naturally, being debarred from many war activities, most of these were women. From them came largely the war temporary clerical force in Washington and elsewhere in this country. It seems to me that the Medical Department was peculiarly fortunate in its war clerical staff. Very probably other bureau chiefs feel a like sense of gratitude toward their clerks, but at all events, it is certain that those of the Medical Department gave most loyal service to the Government.

I feel that I would fail in my duty if I did not assume the pleasant task of acknowledging the indebtedness of our Army and of our Nation to the tens of thousands of patriotic men and women who, together, constituted our World War Medical Department.

It has been stated that a distinct line is drawn between all previous wars and the World War in that the latter was not a war of armies but of nations. This proved to be the case with us, for never has voluntary aid poured out in such a flood. The value of the services of the Committee on Medicine of the Council of National Defense and of the Red Cross in connection with preparation for war have already been mentioned. This was but the earnest of the still more valuable services for sick and wounded that both organizations performed throughout the war in cooperation with the Medical Department of the Army. Many other large societies served sick and wounded as part of the war duties which they took upon themselves. The ill and injured owe them much for

whole-hearted assistance. Many smaller societies, as well as hosts of individual volunteers, contributed services of value.

Comments on contributions to the success of the Medical Department in the war have been confined so far to those of our own Nation but this does not end the story. At home, and to a greater extent in France, in England, in Italy, in fact, whterever the American forces served, the resources of our Allies were freely placed at our disposal. In the turmoil of war, laboring under the greatest strain to do for their own, their medical departments were always found ready to assist us to the very limit of their ability. I can not say more.

With the very large medical personnel engaged in a war in which they braved the risks of contagion as well as those from the missiles of the enemy, and in which thousands shared the dangers of their brothers of the line, as was to be expected, the supreme sacrifice was required of all too many.

The losses of the Medical Department were as follows: Officers, 540; nurses, 250; enlisted men, 2,257. Names of medical officers who died in service will be found in Appendix I. Turning now to the actual preparation of the history, many of the contributions to its pages have been made by officers no longer in active service and therefore at their own expense and at the sacrifice of much of their valuable time. The situation in this respect has not differed materially with the permanent officer contributors, for almost universally their historical work has been done in addition to the performance of the regular duties expected of them. In acknowledging the cordial aid of Medical Department officers the valuable assistance of officers of other branches of the service must not be overlooked; nor should the spirit of helpfulness displayed by the Government Printing Office on all occasions remain unacknowledged.

MERRITTE W. IRELAND,

Surgeon General, United States Army.

The SECRETARY OF WAR.

EDITORIAL BOARD. ^a

Col. CHARLES LYNCH, AI. C., Editor in Chief.

Dr. Loy MCAFEE, C. S., Assistant Editor in Chief.

MEMBERS.

Col. BAILEY K. ASHFORD, M. C.

Col. FRANK BILLINGS, M. C.

Col. THOMAS R. BOGGS, M. C.

Col. GEORGE E. BREWER, M. C.

Col. W. P. CHAMBERLAIN, M. C.

Col. C. F. CRAIG, M. C.

Col. HAVEN EMERSON, M. C.

Brig. Gen. JOHN M. T. FINNEY, M. D.

Col. J. H. FORD, M. C.

Lieut. Col. FIELDING H. GARRISON, M. C.

Col. II. L. GILCHRIST, M. C.

Brig. Gen. JEFFERSON KEAN, M. D.

Lieut. Col. A. G. LOVE, M. C.

Col. JAMES F. MCKERNON, M. C.

Col. S. J. MORRIS, M. C.

Col. C. F. MORSE, M. C.

Col. R. T. OLIVER, D. C.

Col. CHARLES R. REYNOLDS, M. C.

Col. THOMAS W. SALMON, M. C.

Lieut. Col. G. E. DE SCHWEINlTZ, M. C.

Col. J. F. SILER, M. C.

Brig. Gen. W. S. THAYER, M. D.

Col. A. D. TUTTLE, M. C.

Col. F. W. WEED, M. C.

Col. WILLIAM H. WELCH, M. C.

Col. E. P. WOLFE, M. C.

Lieut. Col. CASEY A. WOOD, M. C.

Col. HANS ZINSSER, M. C.

^a The highest rank held during the World War has been used in the case of each officer.

PREFACE.

It is proposed in the history of the Medical Department of the United States Army in the World War to discuss the subject from both administrative and scientific standpoints. In addition, elaborate statistics of professional interest will be included. Illustrations, maps, and charts, so far as may be necessary to a clear understanding of the text, will be found in its pages. Fifteen volumes are contemplated for the history and some of these volumes will be published in parts. The subjects of the various volumes will be essentially as follows: Volume I, The Surgeon General`s Office; Volume II, Administration, American Expeditionary Forces (Central Administration; Hospitalization); Volume III, Finance and Supply (United States; American Expeditionary Forces); Volume IV, Camps, Posts, and Ports; Volume V, Hospitals (United States);Volume VI, Sanitation (United States; American Expeditionary Forces);Volume VII, Instruction and Training; Volume VIII, Field Operations, American Expeditionary Forces; Volume IX, Communicable and Other Diseases; Volume X, Neuropsychiatry; Volume XI, Surgery (General Surgery; Empyema; Maxillofacial Surgery; Ophthalmology; Otolaryngology; Neurological Surgery; Orthopedic Surgery); Volume XII, Roentgenology; Volume XIII, Physical Reconstruction; Nursing Service; Volume XIV, Gas Poisoning; Volume XV, Statistics (Army Anthropology; Medical and Casualty Statistics).

In the interests of completeness, mention is made of certain other historical volumes, covering restricted activities of the Medical Department in the World War. These are: Air Service Medical, prepared by the Division of Military Aeronautics, War Department, and printed at the Government Printing Office, Washington, 1919; Defects Found in Drafted Men, prepared under the direction of the Surgeon General, United States Army, and printed at the Government Printing Office, Washington, 1920; and Psychological Examining in the United States Army, Memoirs of the National Academy of Sciences, Volume XV, printed at the Government Printing Office, Washington, 1921.

Work on the history was begun in the Surgeon General`s Office in 1917, in compliance with War Department orders, issued in August of that year, which provided for the organization of an historical board. While all administrative details respecting its progress will be found in the. account of the Historical Division, which appears in this volume, an important policy adopted at the start and pursued throughout should be mentioned here. It is essential, of course, in an official history, that every effort be made to insure the absolute correctness of all statements which are made. In order to effect this, in so far as possible, in all cases the subjects to be covered in the history were assigned to authors who had been intimately connected with the activities concerned during the war, and who, therefore, had first-hand knowledge of the facts.

The general plan for War Department historical publications was announced on April 5, 1920, in a letter from The Adjutant General. addressed to the chiefs of all staff bureaus and to the Chief, Historical Branch, War Plans Division, General Staff, now the Historical Section of the Army War College. The subject of the letter in question was unification of historical publications. Paragraphs, in so far as they are of interest in the present connection, are quoted in full:

In order that historical publications prepared by the several services, departments, and corps may be unified and fit into some general scheme, and to prevent duplication and to assure that the important activities of every service during the World War are made of record, the following plan of historical publication is announced:

GENERAL PLAN, ALL SERVICES, DEPARTMENTS, AND CORPS OF THE WAR DEPARTMENT, FOR THE PREPARATION OF HISTORICAL PUBLICATION.

1. Basic principles of plan.-All historical publications will be supervised by the Historical Branch, War Plans Division, General Staff.

Historical publications relating to the technical activities of a service from the point of view of the service itself will be prepared by the service historical officer. The Historical Branch in such cases will be concerned only with the selection of supporting documents and the form in which the necessary references to such documents appear.^a

2. Service historical officers.-Upon receipt of this general plan each chief of service, department, or corps contemplating the publication of historical matter will designate a qualified officer as historical officer, also the necessary clerical assistance. This officer will inform himself of the policy of his service as to historical publications. The names of these service historical officers will be communicated as soon as practicable by the chiefs of services to the historical Branch, War Plans Division, General Staff, Building "B," Washington Barracks.^b

3. Conferences of service historical officers.-After the designation of service historical officers, conferences will be held at such time as may hereafter be designated by the Historical Branch, War Plans Division, General Staff. At these conferences the policies and requirements of each service in the matter of historical publications will be presented and a special plan drawn up giving a detailed plan of publication for each service.

* * * * * * * *

7. Form of publication.-To insure accuracy, all publications will be based upon existing primary documents when practicable. That this care in the preparation of work has been taken should be evident on the face of publication itself by attaching to each paper prepared a list of documents constituting sources consulted and giving the location and brief description of these documents: and to facilitate further study of the subject, references should appear in the body of the work to the particular documents of the source list relied upon as a basis for every important statement of fact or conclusion.

By order of the Secretary of War:

(Signed) H. G. LEARNARD,

Adjutant General.

This history is concerned only with the technical activities of the Medical Department from the point of view of that service itself and is therefore prepared under the direction of the service historical officer. Numerous conferences have been held, however, with the Chief of the Historical Branch, Army War College, who passes upon all manuscripts before they are sent to the Secretary of War for final approval for publication.

No further explanation is thought necessary regarding the military rules under which the history is published save in one respect. The General Staff

^a The history of the Medical Department in the World War relates to its technical activities from the point of view of that service itself, and therefore falls in this class.

^b The editor in chief of the Medical History was at once appointed by the Surgeon General as the historical officer of the Medical Service.

has determined, according to general military practice, that "effort should be made to omit names from the text where this can be done without injury to the sense or to the historical value." The history of the Medical Department forms no exception to this rule.

In 1920 an appropriation to publish the history was obtained from Congress. The item covering this expenditure applied to the Surgeon General`s Office and appeared in the sundry civil bill providing for the year ending June 30, 1921. It is as follows:

Medical and Surgical History of the War with Germany: toward the preparation for publication, under direction of the Secretary of War, of the Medical and Surgical History of the War with Germany, including printing and binding at the Government Printing Office, and the necessary engravings and illustrations, $50,000: Provided, That the cost of such history shall not exceed $150,000.

An additional appropriation of $50,000 was made the next year.

The scope of the present volume of the history has been changed to a considerable extent from that originally contemplated, and included in the tentative plan for the history as a whole outlined by Lieutenant Colonel Garrison, M. C., in The Military Surgeon for May, 1919. It was intended that this volume be divided into two parts, the first to give the history of each of the administrative divisions of the Surgeon General`s Office, the second to give a narrative account of the so-called correlated activities, including all agencies which assisted in carrying out the general purposes of the Medical Department as prescribed by law and regulations or established by custom. Further study indicated that this plan was not sufficiently comprehensive to give a clear idea of central Medical Department administration, which was the real purpose of the volume. Certain additions, therefore, have been made, as may be seen from the text.

During the earlier stages of the preparation. of the volume Lieutenant Colonel Garrison, M. C., was in direct charge of the compilation of the administrative histories of the divisions of the Surgeon General`s Office, as well as of editing the volume as a whole. Lieutenant Colonel Casey A. Wood, M. C.,was charged with the preparation of the correlated activities. These officers did much valuable work on their respective assignments, but the exigencies of the military service resulted in their separation from the activities connected with the history, except as members of the Editorial Board. This separation occurred with Lieutenant Colonel Garrison in December, 1920, and with Lieutenant Colonel Wood in October, 1920. Since these dates all editorial work on the volume has been handled in the Historical Division.

The idea of preparing official medical and surgical histories of wars apparently originated with the Medical and Surgical History of the British Army which served in Turkey and the Crimea during the War against Russia in the years 1854-55-56, published by the British Army medical department in 1858.This history owed its inception to the fact that Andrew Smith, then director general of the British Army medical establishment, was unable to find in records of previous wars any data which might be of value in making plans for the care of the sick and wounded. He determined, therefore, that those who came after him should encounter no similar perplexities. Accordingly, he proposed to the Minister of State for War and to the commander in

chief of the army that there be prepared a precis, or descriptive index, of all letters relating to the war, as well as an analysis of all professional documents sent from the front by medical officers. This pre cis was published in two volumes and was followed by the history proper in two volumes. Histories of French and Russian participation in the Crimean War, by J. C. Chenu, published by the French Government, and C. von Hübbenet, published in Berlin, appeared in 1865 and 1871, respectively. Thus the medical record of what, from the viewpoint of lack of medical preparedness. faulty sanitation, and disease incidence, was a most disastrous war, was amply preserved for future generations of medical officers, and undoubtedly had an important effect in hastening improvements in army reorganization after that event.

In acknowledging indebtedness to the British medical and surgical history of the Crimean War, Woodward, one of the principal editors of the Medical and Surgical History of the War of the Rebellion, said: "It had proved of great value in giving direction to our efforts. What was the direction these efforts took, what were the results obtained, why our soldiers die, and how this can be best and most economically prevented in future wars, are questions upon which the experience of the present struggle as recorded in the official reports and documents can throw `a flood of light." ¹¹ Such a publication, therefore, in Woodward`s opinion, "becomes one of the most important duties of the Medical Department of the Army; a duty the evasion or neglect of which would be a grave crime against the Army of the United States and against every American citizen who, in future wars, volunteers in the defense of his country." As it proved, the Civil War medical and surgical history fulfilled a much larger purpose than this, for the carefully gathered material which found permanent record in its pages was actually made use of as largely by the civilian as by the military practitioner of medicine, and, consequently, the civilian benefited no less than the soldier patient from what, as Woodward expressed it, was truly "a flood of light."

Very soon after his appointment steps were taken by the Surgeon General, William A. Hammond, to promote the preparation of a medical and surgical history of the Civil War. On May 21, 1862, he made provision, by modification in the returns from medical officers, for obtaining more exact and detailed reports of sick and wounded. announcing on the same day (Circular No. 2, Surgeon General`s Office) that tn Army Medical Museum would be established, with instructions to medical officers " diligently to collect and to forward to the Office of the Surgeon General all specimens of morbid anatomy, surgical or medical, which may be regarded as valuable, together with projectiles and foreign bodies removed, and such other matters as may prove of interest in the stud! of military medicine and surgery." On June 9, 1862, he published a circular to all medical officers announcing the intention of his department to prepare a medical and surgical history, Surgs. John H. Brinton and Joseph Janvier Woodward having been ordered to duty in his office for that purpose on June 4. On August 1, 1862, Brinton was made virtual curator of the Military Medical Museum. The order directing him to collect and arrange spec- imens in the museum terminates with the following significant sentence: "Should any medical officer of the Army decline or neglect to furnish such Preparations for the museum, you will report the name of such officer to this

office." By July 1, 1863, Brinton had already prepared and published an interim consolidated statement of gunshot wounds, and on September 8, Wood-ward, then in charge of medical records, published a Report on Sickness and Mortality of the Army during the First Year of the War. Progress there-after was rapid. The forms for returns of sick and wounded were revised and improved during 1863-64. The orders for return of statistical and clinical data, while not so peremptory as were those for collecting specimens for the museum, were of similar intention, and it is plain that the preparation of material for the history was regarded as a duty and was so announced by the Surgeon General. This should not be held to mean, however, that medical officers generally tried to escape doing their part in the preparation of the history. Quite the contrary was the fact; and the value of the medical history of the Civil War, as is true of every similar history, is due in equal measure to the work of the many medical officers in the field, and to that of the few who gathered their records together and finally published them as a history. During 1865-66, medical directors of departments and of armies in the field were directed by Surg. Gen. Charles 11. Crane to forward to his office all copies of divisional or field hospital reports, registers and records of sick and wounded, and individual case reports of gunshot wounds which might be available for historical purposes. Thus all the necessary material was ultimately assembled in the Surgeon General`s Office. On September 29, 1864, Brinton was relieved by Asst. Surg. George A. Otis. On November 1, 1865, Circular No. 6, Surgeon General`s Office, was issued, being "Reports on the Extent and Nature of the Materials Available for the Preparation of a Medical and Surgical History of the Rebellion," by Woodward. This was a quarto volume of 166pages, issued and distributed in an edition of 7,500 copies. With this start, and through the influence of Secretary of War Stanton, who took the deepest interest in the work, a congressional appropriation was finally granted on June 6,1868, for the preparation for publication of 5,000 copies of the first part of the history, and on March 3, a joint resolution of Congress authorized that these5,000 copies be printed at the Government Printing Office. Subsequent appropriations were made for the remaining volumes. The history appeared during1870-1888, in six massive quarto volumes, three medical and three surgical, of " family Bible " size and shape. Woodward died in 1884, and the third medical volume was completed by Col. Charles Smart, M. C., while the third surgical volume was completed by Otis and Col. David L. Huntington, M. C. The two series are preceded by masterly introductions by Woodward and Otis, and are arranged as follows: Medical Series: Volume I (1870) gives statistics of sickness and mortality, followed by historical reports of medical officers on separate battles and military operations, arranged in chronological order; Volume II (1876) treats of the diarrheas and dysenteries ("Alvine fluxes");Volume III (1888) gives an analysis of the medical statistics of the war, followed by chapters on the continued and eruptive fevers, respiratory, cardiac and other conditions affecting the soldiers during the war, ending with an important chapter on the general hospitals, including plans. Surgical Series: Volume I (1870) begins with a chronological summary of Union and Confederate losses in killed, wounded, and missing, by battles and engagements, followed by sections on injuries of the head and neck; Volume 11 (1876) deals with injuries

of the abdomen, pelvis, back, and upper extremities; Volume III (1883) deals with injuries of the lower extremities, and injuries and surgical diseases of all other parts of the body, concluding with important chapters on anesthetics, duties of the medical staff, surgical materiel, and modes of transportation of the wounded. Otis concludes his introduction to Volume I with a list of United States medical officers (Regular and Volunteer) killed in battle, died from wounds, and wounded in battle.

This work, with its wonderful array of bibliographic footnotes, its pioneer accounts of the effects of gunshot injuries of nerves (Weir Mitchell, Morehouse, Keen), irritable heart of soldiers (Da Costa), the ipecac treatment of dysentery (Woodhull), ambulance service (Letterman), trench nephritis, and venereal prevention, was at once received with enthusiasm by the medical profession of the entire world. In some respects it was the outstanding production of American medicine during the period, and was hailed as such by no less an authority than Virchow.^a The narratives by medical officers of battles and campaigns were used by subsequent military historians, and the chapter on hospital construction afforded a valuable repository of information during the World War.

A unique feature of the Medical and Surgical History of the War of the Rebellion is that not only was the experience of the Army to which it pertained made of permanent record there, but, in the interest of completeness, a good deal of valuable scientific data from other sources was incorporated. Confederate methods for making medical records were very similar to those on the Federal side, and many of these records were finally secured. After the war former medical officers of the Confederate service gave considerable assistance by contributing histories of cases, pathological specimens, statistical data, and facts concerning the termination of major injuries and operations. Data were obtained from the pension examiners, from the surgeon generals, and adjutant generals of States; in fact, no possible source of information was overlooked.

Neither the British South African War nor our own Spanish-American War was chronicled in an official history, though a great deal of interest and value regarding them has appeared in print. Boards of inquiry in each case were appointed after the war to investigate the conduct of the medical departments of the respective countries, each having failed to measure up to the standard demanded by the public. The historical student may find a great mass of information in the proceedings of the boards in question. Fortunate, though, is the medical department which does not have to write its history in this way; and it is noteworthy that, notwithstanding the magnitude of the task and our lack of preparation for it, there has been no suggestion of such a board for the World War.

^a Virchow, in an address on infectious diseases in the army (1879): That the French learned little or nothing in the Crimea and the North Americans so much in their civil War, that from that date onward begins a new era of military medicine-this depends not on the magnitude of the necessity which the Americans had to undergo, which in truth was not greater than the French underwent in the Crimea. It was far more the critical, genuinely scientific spirit, the open mind, the sound and practical intelligence, which in America penetrated step by step every department of army administration, and which under the wonderful I cooperation of a whole nation reached the highest development that, relative to humane achievements, had hitherto been attained in a great war. Whoever takes up and looks into the comprehensive reports of the military medical staff will be again and again astonished at the richness of the experiences chronicled therein. The utmost accuracy of detail, painstaking statistics embracing the minutest particulars, an erudite exposition comprehending every aspect of the practice of medicine, are here united in order to preserve and transmit to contemporaries and to posterity, in the most thorough way possible, the wisdom purchased at so tremendous a price.

Before concluding this preface, it is necessary to say a few words on how the march of events has irresistibly affected this history as compared with former histories of the same kind.

It should be noted that this is the first comprehensive official war history of medicine which has been published for many years. The only exceptions are the Japanese histories of the part their medical department played in the Chino-Japanese and in the Russo-Japanese Wars. That it did play a notable part is well known, but unfortunately the official histories in question have never been translated in their entirety so as to make them available to others than Japanese readers. Doubtless they have profited, but so far as almost all the readers of this history are concerned the historical standards of comparison date lack so many years that in the meantime we have actually passed from one epoch to another, both from the military and from the medical stand-point.

War has been changed fundamentally by new methods of warfare, and these military changes have affected the story of the Medical Department. At the time of our Civil War and much later the organization of the Medical Department was a fairly simple one. Today it must be far more complicated in order to fit into the more intricate military machine.

Increased complexity in army organization is not solely responsible for this change. In the earlier days, as the possibilities of the effect on military efficiency of an efficient medical department were not understood, so no very serious attempt was made in any army to develop it from this standpoint; today quite the contrary is the case. That is to say, in Civil War days and later, the subject of medical department organization and administration could be touched on lightly for there was comparatively little to tell. Nowadays volumes are required to cover all the complex details, rendered the more complex on account of the distance from our own shores at which the war was fought.

The space allotted in this history to organization and administration represents only the relative importance of these subjects, as shown in the World War records. It will have been well expended if it serves to show in detail to the medical administrator of the future what was done in these directions. With the increased and increasing complexity of modern warfare, it is certain that in the future medical department organization and administration will loom very large and that the officers charged with carrying on the medical service of a great army in campaign will need all possible aid in the way of historical records.

If, as has been the case, great changes have taken place on the military side since the earlier medical war histories were published, what has happened in the meantime on the medical side? Here an actual revolution has been effected. The wars represented by the earlier histories were carried on before modern medicine was born. For example, while the Medical and Surgical History of the War of the Rebellion is an inexhaustible mine of information regarding diseases and injuries, where often can be found facts available in the mass nowhere else, so far as its present value is concerned, it almost stops there, for medicine and surgery as practiced in that day are now discredited arts on account of the many scientific discoveries made in the interval. Then there

was no bacteriology, there were no laboratories, there was no sanitation according to modern standards, nor was there, in fact, much of anything relating to the present practice of medicine, surgery, and sanitation. Nor did doctors specialize to any extent.

The work of the Civil War medical historians was a masterly achievement which resulted in the publication of a classic. On the other hand, the scope of their scientific activities was necessarily limited by the medical knowledge of their time. Medical knowledge has increased by leaps and bounds since then, and so a history of to-day must treat of many things not even within the realm of scientific dreams in Civil War days. It would be unbecoming to conclude this preface without a general acknowledgment of the assistance given by literally hundreds of World War medical department officers. Each has been thanked individually so far as might be, but in the thousands of communications on the subject it is possible that some may have gone astray. It is desired nevertheless that every contributor realize from what is said here that his assistance is appreciated, that through it and through that of other contributors who played their important part in the war, and through this only, has it been possible to prepare this history. It is true that many contributors will not see in its pages exactly what thay have prepared, very often, doubtless, in a busy professional life, at the sacrifice of a great deal of valuable time. This does not mean that their material has not been used in the history or that their contributions have been lost and for-gotten. The limits set upon the size of the printed history were as liberal as it was possible to make them. Material was received in such amount that ten times as many volumes would have been required to publish it all. It was not possible, therefore, to print in extenso a great deal that well deserved the light. All this material was used first to get together the history. Now, it has been carefully preserved and will be disposed of in such a manner as to be available in the future to historical and other students.

Thanks are especially due to Dr. Mary Pearson McKnight, Contract Surgeon, U. S. Army, who is in general charge of the documentation of the history. This work would have been possible only to one combining, as she does, professional knowledge with exceptional qualifications for historical research and indefatigable patience and industry. The history has profited greatly also from the exact knowledge of Medical Department matters possessed by Lieut. Frank Steiner, M. A. C., a member of the Historical Division. An exceptionally able clerical staff has played its important part in compiling the history. The members thereof are as follows: Florence E. Brill, Bertha McDowell Carroll, Ruth F. Deegan, Lillian G. Knowles, Myer S. Lipshitch, Benjamin M. Oppenheim, D. Wilbur Parks, Mildred A. Robertson, Mabel A. Thrasher, and Lillie M. Wheeler.

TABLE OF CONTENTS.

PREFACE. By Col. Charles Lynch, M. C.

GENERAL INTRODUCTION:

I. Evolution of the Medical Department. By Col. Charles Lynch, M. C.

II. Development of Red Cross Medical Department Units. By Brig. Gen. Jefferson R. Kean, M. D.

SECTION I.

Relationships of the Medical Department within the War Department. By Col. F. W. Weed, M. C.

SECTION II.

Organization and administration of the Surgeon General`s Office

CHAPTER

I. The Surgeon General-The Surgeon General`s Office--Liaison Oflicers

II. Administrative Division. By Carl E. Truax, assistant chief clerk, Surgeon General`s Office

III. Personnel Division--
Section of Commissioned Personnel. By Col. Rueben B. Miller, M. C., and Col. Bert W. Caldwell, M. C.
Section of Medical Education (Medical Enlisted Reserve Corps). By Lieut. Col. Horace B. Arnold, M. C.
Section of Enlisted Personnel. By R. H. Garrett, chief clerk of section
Section of Army Nurse Corps. By Miss Dora E. Thompson, A. N. C.

IV. Dental Division. By Col. William H. G. Logan, M. C.

V. Veterinary Division. By Col. Charles F. Morse, M. C.

VI. Division of Medical Officers` Training Camps. By Brig. Gen. Edward L. Munson, M. D.

VII. Division of Finance and Supply. By Col. Edwin P. Wolfe, M. C.

VIII. Division of Sanitation. By Col. Deane C. Howard, M. C.

IX. Division of Infectious Diseases and Laboratories. By Lieut. Col. George R. Callender, M. C.

X. Division of Food and Nutrition. By Col. John R. Murlin, S. C.

XI. Hospital Division. By Col. Winford H. Smith, M.C.

XII. Overseas Hospital Division. By Col. S. J. Morris, M. C.

XIII. Division of Internal Medicine--

Tuberculosis Section. By Col. George R. Bushnell, M. C.

Cardiovascular Section. By Col. Lewis A. Connor, M. C.

Section of Gastroenterology. By Col. Seale Harris, M. C.

XIV. Division of Neurology and Psychiatry. By Col. Pearce Bailey, M. C.

XV. Division of Psychology. By Lieut. Col. Robert M. Yerkes, M. C.

XVI. Division of General Surgery. By Col. William H. Moncrief, M. C.

XVII. Division of Orthopedic Surgery. By Col. E. G. Brackett, M. C.

XVIII. Division of Surgery of the Head. By Col. Walter Parker, M.C.

Section of Ophthalmology. By Col. George E. de Schweinitz, M. C.

Section of Otolaryngology. By Col. Harris P. Mosher, M. C.

Section of Brain Surgery. By Lieut. Col. Charles Bagley, M. C. and Lient. Col. H. H. Kerr, M. C.

Section of Plastic and Oral Surgery. By Lieut. Col. V. P. Blair, M. C., and Lieut. Col. R. H. Ivy, M. C.

XIX. Division of Roentgenology. By Col. George C. Johnston, M. C.

CHAPTER

XX. Division of Physical Reconstruction. By Col. Frank Billings, M. C.

XXI. Division of Air Service Medical. By Brig. Gen. Theodore C. Lyster, M.D.

XXII. Division of Gas Defense. By Col. William J. L. Lyster, M. C.

XXIII. Museum and Library Division--

Army Medical Museum. By Col. William O. Owen, M. C.

Library of the Surgeon General`s Office. By Col. Champe C. McCulloch, jr., M. C.

XXIV. Board of Publications. By Dr. Loy McAfee, C. S.

General Publicity Board. By Capt. E. H. Pullmann, S. C.