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SECTION II.
CHAPTER XI.
HOSPITAL DIVISION.
DEVELOPMENT.
Before the United States entered the World War, the organization of the Surgeon General`s Office did not provide for a Hospital Division. The peace-time program was such that all hospital projects were authorized by the Surgeon General personally, often as the result of conferences, in which other officers of his staff joined. Three or four clerks who were draftsmen were employed in sketching preliminary plans for new buildings or for alterations and extensions of existing buildings. These preliminary outline plans, with supporting data, were the media for conveying to the Construction Branch of the Quarter-master Department the needs and desires of the Surgeon General.1 Soon after the United States entered the war, the need of a definite hospitalization program of larger scope became apparent, and accordingly, early in July, 1917, the Hospital Division of the Surgeon General`s Office was organized. 2
The work of the division soon increased enormously, requiring a reorganization for the purpose of effecting a more satisfactory distribution of responsibility and of securing more efficient service. The organization, as it was developed by June, 1918, is shown in Chart XII.
Thus the Hospital Division was charged with the responsibility of handling the entire program of hospitalization.
In the early stages of preparation effort was concentrated on the base hospitals for overseas and those for the large mobilization camps of this country. Fortunately a good start had been made in the organization of 50 Red Cross base hospitals with equipment, in cooperation with leading civil hospitals and universities.3 This had proceeded to a point that made it possible to send eight base hospitals to the British forces in May, 1917, and to our own forces as rapidly as they were needed, up to about the end of the first quarter of 1918, and as rapidly thereafter as transportation was available.
The problem was more acute with reference to the hospitals for the large mobilization camps in this country. Thirty-two large camps were scheduled to open in the autumn of 1917. It was necessary, therefore, to prepare plans for the erection of hospitals for larger camps of various capacities and to select personnel. This was the most urgent task of the Hospital Division.
These, then, were the two phases of the problem which received first consideration because of their urgency. In addition to the planning and organization of hospitals for the mobilization camps, the program included the organization of medical units for overseas duty, the organization of smaller camp hospitals, excepting in aviation camps, a the acquisition and organization
a The Aviation Section of the Signal Corps, created a separate section by act of Congress, June 3, 1916 (Bull. No. 16, War Dept., June 22, 1916), was materially enlarged by act of Congress, July 24, 1917 (Bull. No. 46, August 15, 1917), in the provision of which authorization was given for the necessary construction, maintenance and repair of hospitals at aviation stations. (For further details, see Volume V, Hospitals, United States.)
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Chart XII.--Hospital Division, Surgeon General`s Office, June, 1918.
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of hospital trains and the acquisition of buildings suitable as hospitals for the reception and treatment of returned sick and wounded.
In general the basis for hospitalization overseas was very indefinite, but base hospitals were called for at the rate of four to each division. These were organized, each on a 500-bed basis. 4
Generally speaking, the organization of the services followed the plan outlined by the Surgeon General for the guidance of officers of medical officers` training camps and mobilization camps, as follows: 5
NOVEMBER, 11, 1917.
Attention is called to the fact that the memorandum previously issued by the Surgeon General (recognition of sections representing specialists) and paragraph 290 is amended to provide for three services, namely, Surgical, Medical, and Laboratory, with a chief for each service, and, further, to provide that each of these services shall include the following special sections, or as many as may be necessary (500-bed basis):
Surgical Service.
1 chief of service-General, chest.
4 surgeons-Abdomen, fractures.
4 surgeons, head section-Brain, eye, ear, nose and throat, plastic (face and mouth).
1 surgeon-Orthopedic.
1 surgeon-Urology.
1 roentgenologist.
2 dentists.
Medical Service.
1 chief of service.
4 physicians (including 1 neurologist), 1 or 2 psychiatrists (in camp hospitals in United States).
Laboratory Service.
(Include pathology, bacteriology, serology, chemistry, morgue, and public-health laboratory Work for the command.)
1 chief of service (to cover pathology, bacteriology, serology).
(All other laboratory workers are under the chief of this service.)
For the head section a section chief may be designated, if desired.
The commanding officer will organize a convalescent camp as the conditions warrant.
The Nursing Service remains as at present, with the provision that the number of nurses may vary according to the needs of the service.
Paragraph 307 is amended to include laboratory chiefs.
Attention is called to the fact that the provision of the several specialists in the medical and surgical organization is solely for the purpose of providing competent professional attention for the sick and wounded. The individual members of the staff, although assigned to duty with the organization for the purpose of providing special skilled service as the occasion may warrant, are nevertheless to be used as the chiefs of service and the commanding officer may direct. This provision is made in order that the work may be properly covered at all times and in order to accomplish the results expected from good organization and administration.
Early in 1918 this personnel was increased on a basis of 1,000 beds, the officers being increased to the number of 35, the nurses from 65 to 100, and the enlisted men from 150 to 200.6
In the beginning, and in fact to the end, no definite mobilization camp for medical organizations was provided, which was a great handicap. Difficulty was encountered particularly in mobilizing the first 50 Red Cross base hospitals. It had to be taken into consideration that these were entirely civilian organizations; that, for the most part, they were entirely ignorant of Army procedure; and that they would continue as such until mobilized and a
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commanding officer assigned to train their personnel. It became necessary to mobilize these organizations considerably in advance of their sailing orders because of the difficulty of transportation and the fact that no equipment was issued to the enlisted men until they were mobilized.
Finally some were mobilized at medical officers` training camps; at the Presidio, San Francisco; at Fort McPherson, Ga., which was a large general hospital; but many were mobilized in armories in their home cities and one in a large auditorium in Milwaukee. Finally the large concentration camps were in operation and the balance of these units were mobilized in these camps.`
Eventually the overseas hospitalization program was formulated, and, following the experience of the British and French, the basis was adopted of providing beds equal to 15 per cent of the troops overseas. 8 From this time on the rapid organization of base hospitals became necessary, and these units were formed in the medical officers` training camps and from the surplus personnel of the so-called camp base hospitals at the mobilization camps for the National Army. Wherever these organizations were formed at the camps it was with difficulty that a fully satisfactory staff was held back for the camp hospital, because nearly all officers wished to go overseas, and the commanding officer of the camp hospital usually selected himself for the overseas unit and then proceeded to select the best of the staff for his overseas hospital.
It soon became a very difficult task to find men of executive ability and administrative experience to command hospitals, either at home or abroad. Many of the officers of the Regular Army were needed for field organizations. Some had to be kept at home, however, for administrative and educational work, for the organization of new general hospitals, and to command the large camp hospitals. Competent administrators of civil hospitals were called into service, but the number of these was small, and eventually instructions were issued to all large camp hospital commanders to train understudies, in order to supply the demand. By December, 1917, The Adjutant General had authorized 138 base hospitals for overseas, and the number continued to increase. 9
The other overseas units mentioned were mobilized, generally speaking, according to tables of organizations, the personnel being increased in some instances to conform to the needs developed in such unprecedented warfare. They were organized in the medical officers` training camps, at the Allentown camp for ambulance companies, and at the large concentration camps.
HOSPITALIZATION PROGRAM FOR THE UNITED STATES.
Before the United States entered the World War, the hospitalization for the Army was as follows: 10 Post hospitals, 131, with bed capacity 5,380; general hospitals, 4, with bed capacity 1,200; base hospitals, 5, with bed capacity 2,950; total bed capacity, 9,530.
Of the post hospitals, 60 per cent were in the interior and 40 per cent at Coast Artillery stations; the majority of these were small, providing from 6 to 48 beds each. The others ranged from 48 to 178 beds in capacity.
Of the general hospitals, 400 beds were for tuberculosis alone, and 250 of the beds at the Army and Navy Hospital at Hot Springs were for special chronic conditions likely to be benefited by the springs. The department base hospitals were provided for the work along the Mexican border, and were located in
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Texas at Fort Sam Houston (750 beds), Fort Bliss (900 beds), Brownsville(500 beds), Eagle Pass (500 beds), and at Nogales, Ariz. (300 beds).
It soon became apparent that a tremendously increased bed capacity would be required in many hospitals. Excluding the post and camp hospitals, the main problem concerned two general groups of hospitals-those for the larger mobilization camps and those for the reception of the sick and wounded from overseas. A third group became necessary later in connection with the various students` Army training camps.
The 32 mobilization camps each required a large hospital.11 The time was short and plans were rapidly developed, considering the limited personnel and equipment available at the time. In the completed plans (prepared along lines radically different from the usual Army type), it was supposed that ample pro-vision had been made for laboratories, infectious diseases, wards for the insane, eye, ear, nose and throat patients, a dental infirmary, utility departments, operating rooms, general medical and surgical wards, staff and nurses` quarters, and administration. That the plans were faulty in some respects was due to the spur and necessity of haste and will not seem remarkable if considered in connection with the time it takes to develop plans for much smaller hospitals in civil life. The chief defects were the inadequacy of administrative quarters, in-sufficient number of wards in many instances, insufficient space for laboratories and enlisted men`s barracks and mess rooms, inadequate lavatory, toilet and bathing facilities for handling infectious diseases, inadequate and faulty quarters for nurses and officers. The erection of the component parts of great camps such as these required the cooperation of many different departments. As in all large undertakings, the difficulty lay in obtaining perfect coordination. One of the greatest mistakes that was made was the erection of the hospital group of buildings among the last, with the result that in most camps the hospitals were not ready when troops arrived and the cases of sickness began to appear. Furthermore, the hospitals were of ten badly located, in relation to the camp proper, when better sites were available. This could have been avoided by conference with the Medical Department.
The opinion was generally entertained that the National Guard camps in the South would not need heated buildings. This worked a great hardship on the sick men confined to unheated, and at best, to poorly heated hospitals.
The hospitals for the mobilization camps were planned on a basis of beds for 3 1/2 per cent of the troops. This would undoubtedly have been enough for troops protected against contagious diseases by the hardening process of long service, but proved entirely inadequate for an Army of raw recruits. The hospital was later put upon a 41 per cent basis and this program was nearly completed. In most camps the hospital beds eventually reached 4 1/2 per cent. Except for the epidemics and the large number of men who were brought in under the draft with physical defects requiring operations for hernia, diseased tonsils, and adenoids, the hospitals in the end were generally adequate.
These hospitals were large and for all sorts of ailments; usually they were of from 500 to 1,500 bed capacity, some, however, reaching a capacity of from2,000 to 3,000beds. They were organized eventually on the same lines as those for overseas, with three professional divisions-medicine, surgery, and
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laboratory-each having subdepartments to cover the specialties, such as eye, ear, nose and throat, orthopedics, dentistry, and psychiatry. For a short time the hospital organization called for eight services. In October, 1917, the Surgeon General ordered the adoption of a plan which provided for the recognition of the medical and surgical specialties, so that medical officers coming from civil practice would be able to serve in the special lines for which their experience had fitted them. This plan 12 called for eight sections: Internal medicine; general surgery; orthopedics; venereal and skin diseases and genitourinary surgery; surgery of the head; laboratories and infectious diseases: neurology, psychiatry, and psychology; roentgenology. This policy gave rise to considerable confusion, which, in some hospitals, was never completely overcome. On November 11, 1917, an order was promulgated 5 by which the services fell under three general divisions, surgery, medicine, and laboratories.
The personnel was drawn almost entirely from civil life, officers, men, and nurses, all entirely unfamiliar with Army life and Army methods. An effort was made to place a competent medical officer of the Regular Army in command of each of these hospitals, with three or four regular noncommissioned officers for the training of the enlisted men and as a nucleus for an organization.
The following expanded table of organization for a permanent staff for a1,000-bed hospital was adopted 13: One colonel or lieutenant colonel and four majors, M. C.; one captain or lieutenant, Q. M. C.; two captains or lieutenants, S. C.; 12 captains and 13 lieutenants, M. C.; two captains or lieutenants, D. C..400 enlisted men, 100 nurses, A. N. C.
Mention has been made of the fact that, with the exception of the medical officers` training camps, the Medical Department had no mobilization camps. Accordingly, when Medical Reserve officers were coming into service by the hundreds and thousands, the policy was adopted of sending all who could be accommodated, and usually more, to the camp hospitals for experience and training. In consequence, these hospitals often, in fact usually, had double and, in some instances, treble staffs. This resulted in overcrowding, but it was good policy on account of the training received and the provision at , all times of a staff sufficient for any emergency. Orders were issued to institute regular courses of instruction for the better training of all, particularly of the substandard officers. 14
The organization of the Army hospital 15 provided that the ward master he in charge of enlisted personnel working on the ward, the discipline of the ward, its general cleanliness, and the care of ward property. The nurses were in charge of all nursing care of the patients. This was distinctly different from the organization of the best civil hospitals and caused much friction, since the vast majority of the nurses were fresh from service in civil hospitals, where nurses rank next to the doctors, and orderlies, who correspond to the enlisted men, are under the nurses. Eventually, instructions were issued to the effect that the head nurse of the ward be in charge of the ward and next in authority to the doctor.16
The other main group of hospitals which had to be provided was composed of those required for the reception and care of the sick and wounded front overseas. That these would be numerous became early apparent from the
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experience of the British and French. It was finally decided that provision would have to be made for 5 per cent casualties and 2 per cent sickness, the percentage referring to total number of troops overseas and indicating the number estimated to require treatment and care on their return to the United States. This would make a total of beds equal to 7 per cent of the troops. It was estimated that a turnover could be made on the average every six months; a 3 1/2 per cent basis was therefore adopted as the hospitalization necessary for returning sick and wounded. 17 As the country had been divided into 61draft districts, the policy was adopted of providing hospitals in each draft district, the number of hospitals and beds to be in proportion to the size of the draft in each district. How best to procure these hospital facilities was given careful consideration. An incomplete but instructive survey of the civil hospitals of the country was made by questionnaire early in 1917, which apparently showed that 21,435 beds were at once available, while about 48,000 beds could be made available on a week`s notice,18 but these, for the most part, were in small units and located in widely scattered and inconvenient places. Lists of these hospitals were sent to all department surgeons with instructions to use them, whenever necessary, during the mobilization of troops and at any other time.19 After due consideration, however, it was decided that the use of civil hospitals for the care and treatment of troops was not feasible because of the uncertainty of the supply of beds, the impracticability of taking over entirely civil hospitals in sufficient number without working a hardship on the civil population, and because of the difficulty in operating a military and a civil organization in the same institution. Repeated representations were made by committees of one organization or another urging the use of civil hospitals, and offering advice of one sort or another as to how best to meet the situation, but the Hospital Division decided that a program must be developed for obtaining a sufficient number of hospitals absolutely under military control, and it proceeded to develop such a program.
It was decided, after careful study of all aspects of the situation, to provide these hospitals by the following measures: 20
By the use of existing military posts.-It was believed, and subsequently it was determined, that a limited number of Army posts were suitably located to make them desirable for use as hospitals. This plan, as shown by the hospital lists, proved to be economical and fairly satisfactory.
By the use of buildings to be obtained by lease.-The spirit of patriotic service which swept the country prompted many individuals to offer their properties to the War Department for hospital purposes. These offers included properties of every conceivable kind, such as loft buildings, department stores, sanatoria, hotels, private estates, hospitals, and private homes, including truck gardens and chicken yards. Most of these offers referred to properties entirely unsuitable for hospital purposes. Upon investigation, however, it was found that many properties, such as hotels, loft buildings, sanatoria, and other large buildings, could be utilized to advantage, and could be obtained and converted into hospitals much more quickly and at less cost than barrack hospitals could be built. Accordingly, dependence was placed in greatest degree upon this source of supply, although many of these buildings required extensive remodeling and additional construction.
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By new construction.-In a few instances, for special reasons relating to location, special requirement, climate, etc., new frame hospitals of the barrack type were decided upon and the necessary action taken which led to their completion in time for service.
As already mentioned, the hospitals for returning sick and wounded were to be located in the various draft districts in numbers and of capacity commensurate with the size of the draft of that district. This policy was adopted in order that men invalided home might be returned to their home district, so far as possible, and because it was felt that any other policy, no matter what its merit, would be bitterly opposed.
One class of hospitals was a new departure, namely, the embarkation hospitals located at the shipping points in and around New York City and New- port News; Va. These hospitals were necessary because of the large numbers of sick who had to be left behind at the ports when their organizations sailed. They were used also for the reception of sick and wounded from abroad. After the armistice, when the movement of the sick and wounded became very rapid, some of them were designated as debarkation hospitals.
TYPES OF HOSPITALS.
The hospitals at the cantonments or mobilization camps were called base hospitals, which, being under the jurisdiction of the camp commander, were in reality camp hospitals and should have been so designated. Aside from the port of embarkation hospitals, the hospitals for the sick and wounded from overseas were, in the main, general hospitals in every sense of the word; "general" in the sense in which the word is used in civil life, designating a hospital in which all classes of patients are received, and "general" in the Army usage, as designating a hospital under the direct control of the Surgeon General. It was attempted to make all of these hospitals general hospitals in the Army sense, where this could properly be done, as it was found that greater efficiency resulted, through the nature of their function, than in the department hospital. The majority were general hospitals.
In conforming to the very desirable program of returning soldiers to hospitals near home, it was found to be advantageous to organize the majority of them for handling all kinds of medical and surgical work; in other words, as general hospitals in the sense of civil usage.
In some instances it was necessary to organize special hospitals for the treatment of special conditions, e.g., those for the treatment of tuberculosis, where segregation and climate were factors to be considered; for the treatment of orthopedic conditions; for oral and plastic surgery; and for mental diseases. The reasons for special hospitals for the tuberculous and the insane are self-evident. Special hospitals for orthopedic cases and for amputation cases were necessary because it was impossible to assign competent orthopedic surgeons to all hospitals and impossible to set up the necessary shops for the manufacture of special prostheses and artificial appliances in all. For the same reason it was not feasible to provide for oral and plastic surgery in all hospitals. Specialists in this work were relatively few and could be supplied to only a few centers. In some instances, the entire hospital was given over to special work, such as caring for mental, tuberculous, and orthopedic patients. In others,
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required for the different hospitals, kept track of officers who showed administrative ability, and selected and assigned all commanding officers to hospitals.
A system of circular letters containing information for the guidance of commanding oflicers was inaugurated, by means of which desirable features obtaining in some, hospitals were brought to the attention of the officers in command of others. Similarly, undesirable or unsatisfactory methods of administration were eliminated and a more uniform system of administration accomplished. Conferences were held at the Surgeon General`s Office, to which groups of commanding officers were ordered. At these conferences questions of hospital administration, problems peculiar to the different types of hospitals, and obscure or important points were discussed. These conferences were profitable in bringing about a better understanding of the policy of the Surgeon General as represented by the Hospital Division, creating confidence and enthusiasm, and standardizing administrative procedure.
An officer of extensive experience was designated as follow-up officer. It was his duty to follow up all requisitions from the various hospitals, to see that they reached the proper division or department, and to follow the action, in order to insure promptness by correcting any misunderstanding and by impressing the urgency of each case upon those responsible for action. This officer examined all inspection reports received from the Inspector General and from the medical inspectors of the Division of Sanitation. He analyzed all such reports, called for an explanation from the commanding officers concerned, and required reports of the steps taken to correct faulty conditions. His analyses were often the basis of circulars issued to the various hospitals calling attention to errors to be avoided and to methods of proved worth to be adopted.
The Army Nurse Corps in the beginning was under the Personnel Division, but naturally came into intimate contact daily with the Hospital Division. Subsequently it came to function as a part of the Hospital Division and so continued until the reorganization of the Surgeon General`s Office after the armistice, when it reverted to the Personnel Division. (See Chart XXIV.) Inasmuch as it functioned as part of the Personnel Division for the major part of the war period, its history will be found in the chapter devoted to that division.
The Army School of Nursing came into existence to meet the need for nurses and nurses` aides, being an entirely new undertaking. This, like the Army Nurse Corps, belonged properly in the Personnel Division, but because of the constant contact with the Hospital Division it functioned for a time under this division. In course of time it reverted to its proper place in the Personnel Division.
Two or three well-trained nurses of large executive experience in the best civil hospitals were assigned to duty as inspecting nurses. They systematically visited the various Army hospitals, inspected them thoroughly, particularly with regard to the nursing, noting any points with reference to administration of the wards which required comment, and reporting their findings to the Surgeon General. 26 The reports so obtained did much to stimulate better organization, better administration, and better care of the sick. These reports were often much more to the point and much more constructive in criticism
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than those from any other source. As a result of these reports, it was plain that, with the pick of the nursing profession available, the system of holding examinations for chief nurses was not the best way to obtain competent chief nurses, since the best would seldom take the examination. The most efficient method was found to be the selection of those known to have had the best training and the most successful experience.
HOSPITAL TRAINS.
At the beginning of the war the Medical Department had at its disposal one hospital train consisting of 10 cars, viz, one kitchen and personnel car, three 16-section patient cars, three bed cars, one operating car, one storage and baggage car, one officers` car. 27 These cars were all of wood construction, consisting of old Pullman cars remodeled for service on the Mexican border. The capacity of this train was 225 patients and 31 personnel. It soon became evident that it would be necessary to have additional trains in order to handle the sick and wounded from the port of debarkation. In October, 1917, request was made by the Surgeon General for an appropriation sufficient to construct three additional trains of six cars each, to which was added, one to each train, a bed car from train No. 1. On February 13, 1918, authority was obtained for the purchase of these 18 additional cars, and in June, 1918, the cars had been purchased, remodeled, and placed in service. This made a total of four trains of seven cars each, with a capacity of 141 patients and 31 personnel for each train.27
After a short experience it was found that a much larger equipment would be necessary and that the complete trains were not the best solution of the problem. It was decided to use unit cars, 27 so called because each car was a complete unit, with a kitchen, toilets, beds for patients and for a limited personnel. After a careful study of the situation, a request was made in October,1918, for authority to purchase 20 cars and to have them remodeled into unit cars.27 This authority was granted on October 25, 1918. The matter was then taken up with the Pullman Co., and, after considerable correspondence relative to increased cost, it was found that 20 steel underframe Pullman parlor cars were available and could be overhauled and remodeled in a short time. The cars were all completed and in service by January 21, 1918.27 They were fitted with Glennan adjustable bunks, large kitchens, refrigerators, axle devices, and lighting system.28 Ten of these unit cars were sent to the port of Hoboken and 10 to Newport News. A unit car provided cooking facilities not only for patients carried by it alone, but for a considerable excess over that number. It should be remembered that overseas patients were very widely distributed in hospitals throughout the country. The plan followed was to put one unit car with a maximum of four sleepers. The unit car proceded to the final point of destination, feeding all patients en route. The other cars, however, were dropped off as soon as the particular destination of its patients was reached. Sometimes 3 unit cars, or even more, would be found in a train when it left a port of embarkation, such a number, in fact, as was necessary to insure all patients being supplied with cooking factilities to destination, though the original train had been broken up long before that time.
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While waiting for the unit cars to be delivered, provision had to be made for the immediate problem of handling the incoming patients. They were being transported in ordinary Pullman or tourist sleepers, but very unsatisfactorily, as the proper facilities for providing them with food were not always available. Therefore authority was obtained and in the latter part of November, 1918,two kitchen tourist cars, two hotel kitchen cars, and six private cars with kitchens were secured from the Railroad Administration, at a rental of $15 per day each, and were sent to the port of Hoboken.27 At the same time and on the same terms seven kitchen tourist cars, one hotel car, and two private cars were obtained and sent to Newport News. These were used as unit cars. It was intended to release these cars as soon as the unit cars were delivered, but the influx of patients was so great that they were retained until June, 1919,when they were all turned back. With this total equipment of four complete trains. 20 unit cars, and 20 leased kitchen cars the situation was well covered.
CENSUS AND DISTRIBUTION OF PATIENTS.
The section for the census and distribution of patients functioned as indicated by the title. From the beginning the division received daily reports of the occupied and vacant beds in the various hospitals, so that exact information was obtained daily as to available bed capacity. This became a matter of much greater importance when the return of sick and wounded through the ports of embarkation became very rapid, as it did immediately after the armistice.
Up to this time the distribution of such patients was a comparatively simple matter; in fact, the transfers from camps to general hospitals were much heavier than those from the ports. When the big movement homeward began it was a different story. The debarkation hospitals at the ports had to be kept free and the large numbers of patients had to be moved to the hospitals in the interior most appropriate for each case. Heretofore it had been a routine procedure for the port surgeon to telegraph to this office a recommendation for transfer; and after this was approved, the transfer was accomplished. It now became necessary to provide a definite system by which the patients could be quickly differentiated and assigned at the ports to hospital, according to the diseases or injuries treated therein. The list of hospitals designated for the reception of overseas patients was revised accordingly.29
Working by this classification the lists for transfer were made, the patients being assigned according to disease or injury and the geographical area from which they came. These lists were transmitted by telephone to the distribution officer of the Hospital Division, each list being read off to him in detail. This he checked up immediately to ascertain that beds were available and that no error had been made, and gave authorization at once or as soon as necessary correction had been made. This check and authorization took only a few minutes, rarely more than an hour. The telephone conference was later confirmed by wire, the list being wired and the authorization likewise. By arrangement with The Adjutant General`s Office, the distribution officer was empowered by the post surgeon to authorize transfers, confirming them later by telegram prepared for signatures, and on file in The Adjutant General`s Office. 30 To understand how well this worked in this office it must be remembered that the census and distribution officer of the Hospital Division received
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every morning a telegram from every military hospital of large size in the United States, giving the number of beds occupied and the number vacant. This was then checked up with the number en route or previously authorized to be ent to the different hospitals, and with the available beds as of that date accurately determined. When the rapid return flow from overseas was in progress, this section received copies of cables giving the ships which had sailed and the number of patients on board, roughly differentiated as surgical, medical, mental, etc., which made it possible to prevent congestion at the ports at all times. An effort was made to have the system changed and authority given to allow the port surgeons to make transfers without reference to the Hospital Division, except that the ports were to be given the bed report daily. This effort was thwarted because experience had demonstrated the necessity of a check, it having been noted that, probably from unavoidable haste, patients were often assigned to hospitals not suitable to their care, which meant that if the transfer was accomplished, a retransfer was necessary, involving expense, delay, and discomfort, if not actual suffering. Furthermore, It was evident that with transfers taking place from between 80 and 90 different hospitals of the interior and two ports, without check in a central office, congestion in some hospitals would be inevitable. The clearance through the Hospital Division was subsequently maintained throughout. The bed report was made up weekly and distributed to the ports and to all officers concerned, reaching finally a circulation of 300 copies weekly.
Shortly after the cessation of hostilities a cable was dispatched to the chief surgeon, American Expeditionary Forces, asking for information as to the total number of sick and wounded in hospitals overseas, the total number of these who would probably require hospital treatment on their arrival in the United States, and the number to be expected monthly. Information was given to the effect that 10,000 could be expected four months running. This word was received during the latter part of November, 1918, but for various reasons the number was greatly increased, and on December 20, 1918, 353 patients were received and distributed; on January 23, 1919, 419; on February 18, 837; on March 23, 107.3` Between November 11, 1918, and May 1, 1919, approximately 130,000 patients were received and distributed without any serious complication or breakdown of the service. During the period from July 1,1918, to June 30, 1919, 151,845 patients were received at ports of embarkation from overseas. During the year beginning July 1, 1918, and ending June 30,1919, this section authorized the transfer of 33,934 patients from hospital to hospital of the interior, 97,271 overseas patients from the port of Hoboken, N. J., and 37,564 from Newport News, Va.31 The transfer of this large number of patients from one hospital of the interior to another was due to the following factors: (a) The transfer of all patients requiring one or more months` treatment from base to general hospitals, in order that personnel at the former might be reduced; (b) the transfer from one general hospital to another, in order that the personnel of general hospitals might be reduced.
All in all the system of control instituted by the census and distribution section of the Hospital Division worked efficiently, as is demonstrated by the numbers handled and the fact that they were assigned promptly and with no breakdown, even under the most severe pressure.
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PLANNING AND CONSTRUCTION.
The Planning and Construction Branch, later designated Procurement Section of the Hospital Division, prepared plans for various hospitals and units of hospitals, maintained liaison with all agencies instrumental in producing hospital space and contemplated users, and expedited all hospital projects, after the section was well organized. Not until early in 1918 was this phase of the work well organized, the delay being due to faults in the general organization of the Surgeon General`s Office. For a time more or less confusion existed in consequence of the organization of the Division of Physical Reconstruction and the assumption, by the chief of that division, of the duties of inspecting and leasing properties for hospital purposes. This arrangement was in no way satisfactory, and finally the Procurement Section was organized. This section then prepared all estimates of requirement for the fiscal year, including all improvements and additions; studied the requests for construction received from the many hospitals, ports, and camps; recommended the action to be taken; and obtained the additional hospital facilities required. Through this section the necessary action to be taken was recommended to the Construction Division of the War Department, with which close and constant liaison was maintained by an officer from this section, whose duty it was to follow all projects through the various stages of construction. This liaison became a very important and necessary procedure because of the complicated process through which all construction projects had to pass. After plans had been developed in outline and further requirements noted, the project went to the Construction Division. Here the plans were perfected by architects and engineers developing the detailed plans and specifications. Before a project was released from that department, it had to receive the approval and signatures of six officers, including the chief of the division, after which it was sent to the Director of Finance, by whom, if the funds were available, clearance papers were issued. During the latter part of 1918, when prompt action was imperative and when the scarcity of materials and labor was greatest, each project involving more than $25,000 had to pass also through the War Industries Board and the Purchase, Storage, and Traffic Division, General Staff.23 It was then finally returned to the Construction Division of the War Department, from there going to the General Staff for final authorization of the Secretary of War. After a project was authorized and work started, the liaison officer conferred with the constructing quartermaster at frequent intervals in order to supply full information as to requirements and to promote prompt execution of the work. The Procurement Section also initiated all action for the leasing of property and later for the cancellation of leases.
A small drafting room was maintained in the Hospital Division of the Surgeon General`s Office, where all original sketches for hospital work were prepared. Later, when speed was imperative, five and six draftsmen were sent into the field by the Hospital Division and plans for the remodeling of buildings and for additions were prepared on the ground. The work of the Construction Division of the War Department, so far as related to the work of this office, was executed almost entirely under the advice of the architects of this section.
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HOSPITALIZATION AFTER THE ARMISTICE.
Immediately after the armistice became effective, consideration was given to the readjustment of the program. Action was based Upon the following factors: The number of sick and wounded overseas who would probably require hospital treatment on arrival in the United States and the number to be expected monthly, according to cable advice (which, however, proved very misleading); the number in hospitals in the United States and the strength of the forces in the United States; and the program of demobilization as set forth by the War Department.
In consideration of the decision to demobilize the reserve troops in the United States as rapidly as possible, thereby releasing thousands of beds in the cantonment hospitals, it was held that sufficient bed capacity was available for all needs by designating hospitals in the cantonments about to be abandoned as hospitals for overseas cases. Accordingly, as before stated, all projects not yet begun or nearing completion were abandoned and steps were taken to cancel leases or to make such other adjustments as were necessary.
Many of the base hospitals at the camps were designated for overseas cases and a new schedule for assignment of such cases was prepared. This policy resulted in the saving of millions of dollars, and it furnished adequate bed capacity for all needs. All hospitals not designated for overseas cases were reduced in capacity and personnel at intervals, as circumstances warranted. After the first few months in 1919, when the pressure had become less, the policy was adopted of abandoning all leased properties as rapidly as possible and concentrating, so far as was practicable, in Government-owned property. From this time on, bed capacity and personnel were reduced in all hospitals, whenever possible, in order to facilitate the release of officers and enlisted men of the Medical Department in conformity with the general plan of demobilization. This policy was determined first in the Hospital Division and then discussed in the general "round-table" conference held daily by the Surgeon General. As a result of the general policy above outlined, a gradual reduction in the number of both base and general hospitals was effected, and by May 24, 1919, most hospitals on leased properties had been discontinued. On that date, in order to secure uniformity of thought and action in reference to demobilization and care of chronic sick, it was agreed that the following general hospitals would be considered the most permanent: 32
Army and Navy General Hospital, Hot Springs, Ark.
Letterman General Hospital, San Francisco, Calif.
U. S. Army General Hospital No. 6, Fort McPherson, Ga.
U. S. Army General Hospital No. 19, Oteen, N. C.
U. S. Army General Hospital No. 21, Denver, Colo.
U. S. Army General Hospital No. 26, Fort Des Moines, Iowa.
U. S. Army, General Hospital No. 31, Carlisle, Pa.
Department base hospital, Fort Sam Houston, Tex.
It was agreed that the general hospitals next most permanent which would operate for a sufficient time after July 1, 1919, to care for chronic cases were: 32
U. S. Army General Hospital, Fort Bayard, N. Mex.
U. S. Army General Hospitals Nos. 2, 3, 8, 20, 28, 30, 41, 42, 43.
Base hospital, Fort Riley, Kans.
339
The geographical distribution of the patients, which had been consistently followed up to this time, was now to be disregarded, if beds in the proper geographical area were not available, when such patients were cleared from the ports; otherwise it would be followed as heretofore. While considerations arose from time to time to interfere somewhat with this program, it was followed in the main. Adequate care, personnel, location in relation to population, and cost of maintenance were the most important considerations in deciding upon abandonment or retention. Looking ahead into 1920, it was believed that it would be possible to concentrate all the sick and wound(etl ini a few well-appointed hospitals in the Northern and Eastern States near New York City, Chicago, Baltimore, Washington, and San Francisco.
The United States Public Health Service required hospitals for the care of discharged soldiers and sailors who had become beneficiaries of the War Risk Bureau under the provisions of the law. The Hospital Division cooperated closely with the public-health authorities and in accordance with the provisions of the act of Congress of March 3, 1919, the following hospitals had been turned over intact to the Public Health Service by July, 1919: 33
|
|
Bed capacity. |
|
Base hospital, Camp Beauregard, La. |
2,144 |
|
Base hospital, Camp Cody, N. Mex. |
1,289 |
|
Base hospital, Fremont, Calif. |
1,156 |
|
Base hospital, Camp Hancock, Ga. |
1,604 |
|
Base hospital, Camp Joseph E. Johnstone, Fla. |
816 |
|
Base hospital, Camp Logan, Tex. |
1,156 |
|
Base hospital, Camp Sevier, S.C. |
1,396 |
|
General hospital No. 13, Dansville, N.Y. |
288 |
|
General hospital No. 15, Corpus Christi, Tex. |
262 |
|
General hospital No. 34, East Norfolk, Mass. |
350 |
|
General hospital No. 10, Boston, Mass. |
750 |
|
General hospital No. 32, Chicago, Ill. |
530 |
|
General hospital No. 40, St. Louis, Mo. |
531 |
|
Norwegian Deaconesses Hospital, Brooklyn, N.Y. |
250 |
|
Total |
12,522 |
The Public Health Service had also indicated it desire to take over the following: 34
|
|
Beds. |
|
General hospital No. 16, New Haven, Conn. |
500 |
|
General hospital No. 24, Parkview, Pittsburgh, Pa. |
700 |
|
General hospital No. 36, Detroit, Mich. |
919 |
On August 8, 1919, the following tentative priority schedule for abandonment and reduction in general hospitals was agreed upon, 35 subject to change on all dates subsequent to September 8, 1919:
|
Total beds available in general hospitals August 8, 1919 |
33,414 |
|
Number of beds in general hospitals now closing and which will be entirely closed by September 1 |
3,433 |
|
|
29,981 |
340
Therefore, the number 29,981 includes the number of general hospital beds to be kept permanently as well as those to be ordered abandoned. It was believed that 3,750 beds (which is over 1 per cent of a 300,000 Army) was a sufficient number to hold permanently. This short table shows this selection as made.
[table]
The 3,750 held for permanent use are shown distributed in the table just above this schedule. The highest number of available beds was shown on the report of October 12, 1918, there being on that date 173,505 beds, of which131,213 were occupied by patients. 36 This was during the influenza outbreak, when many of the hospitals were overcrowded or enlarged by the use of barracks.
On November 11, 1918, the date of the armistice, there were in operation 40 general hospitals., 35 base hospitals, 14 debarkation hospitals, and 3 department base hospitals, with a total bed capacity of 120,916 beds and 76,964 patients in hospitals. 37 By October 3, 1919, as a result of the policy set forth above, the following hospitals were in operation, as shown by the bed report of that date, from which, by comparison with earlier lists, an accurate idea can be obtained of the rapidity of abandonment : 38
341
War Department, Surgeon General`s Office, Washington, October 9, 1919.
Hospitals under port of embarkation, Hoboken, N. J.
PERSONNEL. b
(April, 1917, to December, 1919.)
Noble, Robert H., Maj. Gen., M. D., chief.
Glennan, J. D., Brig. Gen., M. D., chief.
Brooke, Roger, Col., M. C., chief.
Shaw, Henry A., Col., M. C., chief.
Smith, Winford H., Col., M. C., chief.
Kramer, Floyd, Lieut. Col., M. C., chief.
Babcock, Warren L., Col., M. C.
Coburn, jr., H. C., Col., M. C.
Hart, W. L., Col., M. C.
Johnson, H. H., Col., M. C.
Jones, Percy L., Col., M. C.
Baldwin, L. B., Lieut. Col., M. C.
_
b In this list have been included the names of those who at one time or another were assigned to the division during the period, April 6, 1917, to December 31, 1919.
There are two primary groups-the chiefs of the division and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
342
Baylis, James E., Lieut. Col., M. C.
Daugherty, John E., Lieut. Col., M. C.
Evans, H. M., Lieut. Col., M. C.
Hornsby, John A., Lieut. Col., M. C.
King, Edgar, Lieut. Col., M. C.
Northington, Eugene C., Lieut. Col., M. C.
Owen, L. J., Lieut. Col., M. C.
Bachmeyer, A. C., Maj., M. C.
Bagley, Charles, jr., Maj., M. C.
Brown, C. L., Maj., S. C.
Crane, A. G., Maj., S. C.
Cutler, H. W., Maj., S. C.
Eckels, L. S., Maj., M. C.
Granger, F. B., Maj., M. C.
Kerns, H. N., Maj., M. C.
Murray, William K., Maj., M. C.
Perry, C. H., Maj., S. C.
Richardson, H. K., Maj., M. C.
Sexson, J. A., Maj., S. C.
Tandrop, Otto, Maj., S. C.
Voorhees, S. F., Maj., S. C.
Wyeth, Nathan C., Maj., S. C.
Allen, L. M., Capt., M. C.
Amthor, Franklin P., Maj., Signal Corps.
Bayliss, M. W., Capt., S. C.
Boyd, John G., Capt., S. C.
Burnham, A. W., Capt., Infantry.
Christensen, Jens, Capt., S. C.
Gillette, Leon N., Capt., S. C.
Johnson, John B., Capt., M. C.
Kettell, R. H., Capt., S. C.
Palmer, W. E., Capt., S. C.
Sands, John R., Capt., S. C.
Stone, Calvin P., Capt., S. C.
Van Houten, L. H., Capt., S. C.
Woodbridge, C. H., Capt., S. C.
Appenfelder, Fred A., First Lieut., Signal Corps.
Clymer, H. M., First Lieut., S. C.
Harlan, C. L., First Lieut., S. C.
Westrum, John L., First Lieut., Infantry.
Woodruff, W. II., Second Lieut., S. C.
REFERENCES.
(I) Manual for the Medical Department, 1916, pars. 294, 365h.
(2) Annual Report of the Surgeon General, United States Army, 1918, 304 et seq.
(3) Ibid., 313.
(4) Memo., S. G. O., June 14, 1917, for Chief, War College Division, General Staff. Subject: Base Hospitals. On file, Record Room, S. G. O., 172158-17 (Old Files).
(5) Circular letter, November 11, 1917, S. G. O. On file, Record Room, S. G. O., 211 (Specialists).
343
(6) Letter from the Adjutant General to the Surgeon General, September 1, 1917. Subject: Authority to increase size of Base hospitals. On file, Record Room, S. G. O., 320.2-1 (Base Hospitals) J. Also, 172158 (011 Files).
(7) Letters and telegrams from the Surgeon General to the C. O., various base hospitals, different dates. On file, Record Room, S. G. O., 370.01 (Base Hospitals), J.
(8) Annual Report of the Surgeon General, United States Army, 1919, Vol. 11, 1337.
(9) Letter, Surgeon General to The Adjutant General, December 6, 1917 (requesting authority) second indorsement, The Adjutant General to the Surgeon General, December 28, 1917 (authorization). On file, Record Room, S. G. O., 322.3 (Medical Units).
(10) Correspondence. On file, Record Room, S. G. O., 632.1
(11) Annual Report of the Surgeon General, United States Army, 1918, 305.
(12) Memo. (undated). Subject: Recognition of Sections Representing Specialists. On file, Record Room, S. G. 0., 024.1 (Administration of S. G. O.).
(13) Letter, Surgeon General to commanding officer, base hospital, December 18, 1917. Subject: Enlisted Men. On file, Record Room, S. G. O., 320.22-1. Annual Report of the Surgeon General, United States Army, 1918, 30,307. Circular letter (956), February 2,1918, Surgeon General to commanding oflicer, par. 11. Subject: Nurses. On file, Record Room, S. G. O., 322.15-2. Circular letter (A-169), Surgeon General, United States Army, to commanding officer, base hospital, March 7, 1918. Subject: Staff Organization. On file, Record Room, S. G. O., 322.15-2. Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1153 (B-Personnel).
(14) Letter, December 14, 1917, Surgeon General to commanding officer, base and general hospitals. On file, Record Room, S. G. O., 353.1.
(15) Manual for the Medical Department, 1916, par. 279 (b).
(16) Ibid. Changes No. 7, March 8&, 1918, p. 104, par. 313.
(17) Annual Report of the Surgeon General, United States Army, 1918, 305, 306.
(18) Statistical report (bed capacity) April 27, 1918. On file, Record Room, S. G. O., Weekly Report File (Statistical Report of Hospitals).
(19) Letter from the Surgeon General to department surgeons, June 13, 1917. Subject: Civil Hospitals. On file, Record Room, S. G. O., 182143 (Old Files). Weekly Report, hospital Division, S. G. O., September 9, 1917. On file, Record Room, S. G. O., Weekly Report File.
(20) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1140 et seq.
(21) Ibid., 1163.
(22) Statistical bed reports, hospital Division, November 9,1918. On file, Record Room, S. G. O., Weekly Report File.
(23) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1144.
(24) Bed reports, Hospital Division. On file, Record Room, S. G. O., Weekly Report File.
(25) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1152.
(26) Inspection reports, 1917-18, Army School of Nursing, S. G. O. On file, Army Nurse Corps, S. G. O.
(27) Annual Report of the Surgeon General, United States Army, 1919, Vol. 11, 1154 et se.
(28) Original plans on file, drafting room, Hospital Division, S. G. O.
(29) Revised list of hospitals designated for overseas cases. On file, Record Room, S. G. O., 701 (General).
(30) Copies of telegrams. On file, Record Room, S. G. O., File 705 (Hoboken).
(31) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1162.
(32) Ibid., 1159.
(33) Ibid., 1160.
(34) Ibid., 1161.
(35) Tentative priority schedule for abandonment and reduction in general hospitals. On file Record Room, S. G. O., 323.72-3.
(36) Bed report of Hospital Division, October 12, 1918. On file, S. G. O., Weekly Report File.
(37) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1163.
(38) Bed report, Hospital Division, S. G. 0. On file, Record Room, S. G. O., Weekly Report File.
