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SECTION II.
CHAPTER XIX.
DIVISION OF ROENTGENOLOGY.
Prior to the war only the larger of our military hospitals were equipped with X-ray apparatus. As these larger hospitals were comparatively few in number, there was no organized effort to maintain a selected group of officers whose sole or principal specialty was roentgenology. In the curriculum of the Army Medical School theoretical and practical instruction in roentgenology was included for the training of the student body,` but it was intended primarily as a broadening educational feature rather than with the view to the creation of specialists. As a matter of fact, the occurrence was rare when the X-ray work of even the largest of our hospitals demanded the full-time attention of an officer and it was the usual practice for roentgenology to be assigned to an officer as an additional duty. Specialization in roentgenology was thus a fortuitous circumstance and was dependent almost entirely on an officer`s initiative. X-ray equipment and supplies were handled as part of the general question of finance and supply of the Medical Department.
CENTRAL ORGANIZATION.
In May, 1917, the officer in charge of the supply division of the Surgeon General`s Office recommended that an officer familiar with roentgenological requirements be assigned to the Surgeon General`s Office for general supervision of the whole X-ray problem, including the purchase, distribution, and installation of X-ray apparatus.2 Based on this recommendation, a roentgenologist was ordered to report for duty in the Surgeon General`s Office s and was verbally assigned to the Supply Division, wherein was organized an X-ray section, of which he was given charge. Included among this officer`s duties was that of a disbursing officer of the Medical Department for disbursing funds connected with the purchase of X-ray apparatus and supplies. 4 While there was, of necessity, close liaison of the X-ray Section of the Supply Division (the latter the newly organized Division of Finance and Supply, q. v.), and the different professional divisions of the Surgeon General`s Office, roentgenology, as an office entity, continued to function under the Finance and Supply Division until July 10, 1918, when the Division of Roentgenology was established. 5 (See Chart XX.) On December 1, 1918, the division ceased to exist as such, becoming the Section of Roentgenology of the Division of Surgery.6 (See Chart XXIV.)
In the following report of the roentgenological activities of the Surgeon General`s Office no attempt is made to maintain a distinct line of cleavage between the activities as carried on within the Supply Division or Division of Finance and Supply, the Division of Roentgenology, and the Section of Roentgenology of the Division of Surgery. For the two chief problems involved in the administration of the roentgenological service, namely, the supply of suit-
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Chart XX. –Division of Roentgenology, Surgeon General’s Office, June, 1918.
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able apparatus and other equipment in sufficient quantities and the acquisition of a sufficient number of roentgenologists, the administrative routine varied little, whether executed by a section of another division or by the Division of Roentgenology itself, since apparatus and equipment had to be provided for through the Division of Finance and Supply and the personnel through the Personnel Division.
X-RAY SUPPLIES.
On April 15, 1917, before a roentgenologist bad been assigned to the Surgeon General`s Office, as noted, a committee was appointed by the Council of National Defense for the purpose of standardizing X-ray apparatus and supplies. 7 This committee promptly prepared specifications covering all types of X-ray supplies and apparatus, and drew plans covering the construction of X-ray laboratories in the military camps to be established. The committee also compiled a list of staple medical and surgical supplies which was finally issued by the Council of National Defense and later adopted by the War Industries Board. 8 The list of X-ray supplies thus compiled, with a few alterations and additions, served as the official supply list for the Army throughout the war.
Procurement.-Invitations were given to a number of manufacturers of X-ray apparatus to submit samples of transformers for investigation and test. Five manufacturers responded and machines manufactured by various firms were subjected to investigation and tests. These investigations and tests were effected at the X-ray School, New York City, so long as that school operated, and upon its discontinuance, at the Army Medical School, Washington, D. C. Purchases of X-ray apparatus were confined to the types found satisfactory in these tests.9 An inspection of the factories of the different manufacturers of X-ray apparatus was undertaken from the Surgeon General`s Office in order that information might be made available concerning the capacity of each of the plants. Contracts for apparatus were therefore divided into parts subject to the ability of the manufacturers concerned to make prompt deliveries. 9An electric company was persuaded to enlarge its facilities for the manufacture of a special type of radiator Coolidge tube. This having been done, there was never at any time a shortage of these tubes, but, on the contrary, large numbers were released at various times to the different allied Governments.
In securing and assembling X-ray supplies, both for X-ray laboratories and military hospitals of the United States and abroad, difficulties were encountered on account of the national shortage in certain essential models. In part of this work the United States Bureau of Standards assisted the Division of Roentgenology, investigating various matters, notably the protective value of the various lead glass bowls, tube shields, and tube boxes.10
Improved apparatus.-An X-ray table was designed at the plant of the Kelly-Koett Manufacturing Co., Covington, Ky., and, having proved satisfactory, was adopted as a standard for Army use. 11
A portable X-ray apparatus had been devised by the General Electric Co., and having been investigated by the Division of Roentgenology of the Surgeon General`s Office and found superior to anything devised up to that time, was adopted for field use. 12 This device consists of a special Delco gas electric set, 1-kilowatt capacity, small transformer and Coolidge filament transformer, and
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a special air-cooled type of radiator Coolidge tube, capable of rectifying a high voltage, alternating current. There was thus provided an independent X-ray equipment capable of generating its own current by means of a small portable engine, and comprising a tube capable of self-rectification, thereby doing away, at a stroke, with all synchronous motors, mechanical rectifying devices, rotating switches, mercury interrupters, and other devices.
A bedside X-ray unit was designed to permit X-ray examination in wards to be made with a minimum of disturbance of the patient. This unit consisted of a combined cabinet and tube stand, a radiator type Coolidge tube, special lead glass shield, and a transformer and control apparatus.13
Much other X-ray apparatus suitable for war work was promptly designed, and thus the question of suitable and standard types was satisfactorily dis-posed of at an early date.
United States Army X-ray ambulances.-To provide X-ray equipment for mobile hospitals and mobile surgical units, X-ray apparatus was installed in a standard Army ambulance after it had been modified by removing the seats and making a few simple additions to enable it to carry a field portable outfit and one bedside unit. In May, 1918, the first completed X-ray ambulance was sent from Washington on a road test to Canada. This test proved a success and subsequently other X-ray ambulances were modeled on it. 14
At about the time of the armistice there had been shipped overseas 150 complete base hospital X-ray equipments, 250 bedside equipments, 264 port-able X-ray equipments, and 55 X-ray ambulances, in addition to many other separate articles of X-ray equipment. 15
PERSONNEL.
Procurement and training.-In June, 1917, the Committee on Preparedness of the American Roentgen Ray Society, recognizing that many roentgenologists would be required in the Army, called a meeting in New York of a number of leading specialists in roentgenology. At this meeting it was decided to recommend the establishment of a number of schools of roentgenology. It was further proposed at the meeting, which was attended by the officer in charge of X-ray supplies in the Surgeon General`s Office, that these schools be placed under the direct control of the War Department and that the trained roentgenologists in charge of them be commissioned in the Officers` Reserve Corps. These suggestions were favorably acted upon 16 and schools were promptly opened in New York City, Boston, Philadelphia, Baltimore, Rich-mond, Pittsburgh, Chicago, Kansas City, and Los Angeles. Medical officers in groups of 10 were assigned to the various schools, and upon the completion of the courses of instruction of those destined for overseas they were ordered to New York for final examination and further instructions before any were ordered overseas.
One of these schools soon performed an important service in addition to the instruction of personnel. At the New York School of Roentgenology the investigation and tests to which sample apparatus were subjected were carried out while they were employed in the instruction of the students. It has been noted previously that no contracts were let until after samples of X-ray apparatus had been found satisfactory in practical tests.
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At the end of six months after their establishment, the schools, with the exception of the one in New York City, having fulfilled their function, were directed to close. 17 The training of roentgenologists still proceeded rapidly at the New York school, which in the meantime had been enlarged and provided with an augmented teaching personnel. Various technicians experienced in the installation and repair of X-ray apparatus were commissioned in the Sanitary Corps and given a short course of instruction at the New York school.18
Preliminary schools were early established at the medical officers` training camps at Camp Greenleaf, Ga., and Fort Riley, Kans., where men were selected from the officers at the two camps and given preliminary steps in roentgen training. 15
In May, 1918, arrangements had been completed for concentrating all instruction in X-ray work at the Medical Officers` Training Camp, Camp Greenleaf, Ga.20 A preliminary (draft of the proposed curriculum was made in the Surgeon General`s Office, and at the same time selected officers as instructors were asked for. Complete specifications for all apparatus required at this school, as well as requisite changes in building plans, were also prepared. It was planned that the school turn out a minimum of 25 trained roentgenologists a month. A school for the instruction of enlisted men in large numbers, at least two for each roentgenologist, was also instituted at Camp Greenleaf.
The Personnel Division of the Surgeon General`s Office found it necessary, at about this time, to cooperate with the Division of Roentgenology to secure suitable candidates for training as roentgenologists. As the School of Roentgenology at Camp Greenleaf was now in position to take large classes, the New York school was dismantled of apparatus. 21 To overcome the shortage in roentgenologists which become apparent in August, 1918, a conference was held in the Surgeon General`s Office, with the other divisions concerned, on the ways and means of the doubling of the capacity and output of the Camp Green-leaf school, and increasing that of the Army Medical School, Washington, D. C. The plan adopted was expected to produce 120 roentgenologists a month from the Camp Greenleaf school and 150 manipulators from the Army Medical School. Arrangements were also made for the reopening of the New York school. 22 A medical officer, who was also a specialist in roentgenology, was assigned to the New York school for duty in connection with the instruction of experienced roentgenologists who received from him short courses in localization and the manipulation of Army types of apparatus. This made them available as chiefs of service in this country to fill vacancies caused by the depletion of X-ray personal to supply experienced roentgenologists to the American Expeditionary Forces. Overseas personnel.-Personnel was sent abroad, attached to base and evacution hospital units, and as casuals. Subsequent to September 6, 1918, X-ray personnel furnished base and evacuation hospital units under orders for overseas duty consisted of one roentgenologist and two trained enlisted manipulators. 23
The United States Army X-ray Manual appeared in its first edition in 1918.24 This manual was the production of the joint efforts of a large number of roentgenologists and it was devoted chiefly to electrophysics, localization methods, and to description of the special apparatus employed in the United States Army. A second edition, a very much more pretentious volume, con-
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taining all the matter of the first and in addition a very comprehensive section devoted to roentgen diagnosis, was published in the spring of 1919. 24
X-RAY LABORATORIES.
When the committee of the Council of National Defense drew up plans for the construction of X-ray laboratories of the military camps, already noted, the military authorities contemplated the construction of base hospitals, with a maximum capacity of 500 beds. The plans were approved in the Surgeon General`s Office and employed in the construction of X-ray laboratories at the various divisional camps. 25 In spite of the fact that the size of the division camp base hospital was increased until their capacity in many cases was 2,000 or more beds, this simple plan of construction, which provided very limited space, was not changed for a year, during which time these X-ray laboratories in their restricted space successfully met the many increased demands of the hospital of which they formed a part.
The equipment of the laboratories of the various hospitals proceeded rapidly. It was the aim of the division of roentgenology in every case to have complete roentgen equipment installed and in operation in charge of a competent roentgenologist on or before any of these hospitals opened. This was accomplished in every instance.
In August, 1918, it was found necessary to make more elaborate and larger plans for X-ray laboratories in the hospitals, 28 which in the meantime had been expanded. This was done by this division, which turned the modified plans over to the Hospital Division. The new design figured on a laboratory, operating 10 hours a day, to take care of not to exceed 2,000 patients.28
ACTIVITIES SUBSEQUENT TO ARMISTICE.
The armistice was signed just as the efforts of the Division of Roentgenology had reached the peak of production of roentgenologists, apparatus, and supplies. Immediate steps were taken to cancel orders for material where possible, and to stop production in every instance without waiting for any authorization. 27 This action resulted in the saving of many thousands of dollars, and obviate embarrassing a number of manufacturers. As it was assumed that, regardless of the cessation of hostilities, a large Army of occupation would be required, esti-mates for apparatus and supplies, sufficient for an Army of 80 divisions for a period of six months, were prepared and submitted to the Division of Finance and Supply. 27 The cancellation of contracts for apparatus and supplies was based on the possibility of the maintenance of such a force in the field. Considerable quantities of apparatus of the Army standard type were released to the Bureau of Purchases of the American Red Cross.27
The Camp Greenleaf School was continued at full capacity, it being considered that even though officers under instruction there might not be required overseas, yet they could be well employed in the home military hospitals, which had been dangerously depleted of roentgenologists in order to supply the great demand for roentgenologists overseas. Finally, it was decided to keep this school open until February, 1919; actually it ceased to function at the end of the vear 1918, when much of its equipment was sent to the Army Medical School.28
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In December, 1918, following the transfer of the major portion of the activities of the Division of Finance and Supply of the Surgeon General`s Office tothe Director of Purchase, Storage and Traffic of the General Staff, the Section of Roentgenology (as previously explained, the change of its status from division to section was effected at this time) continued to maintain close liaison with the Medical Supply Division, so that the obtaining of its supplies and equipment was on much the same basis as before.
In this same month a circular letter was addressed to the commanding officers of all military hospitals, directing that a selection be made of all X-ray plates showing interesting pathological conditions preparatory to sending these to the Army Medical Museum for incorporation in a library of X-ray pathology. At the end of the year an inspection of the X-ray laboratories throughout the country showed a generally satisfactory condition of affairs, except for the inadequate space in many instances. Loss of experienced roentgenologists by discharge now became excessive, and it proved necessary to send telegraphic notification to all commanding officers to discharge no more roentgenologists without the authority of the Surgeon General`s Office. 28
The School of Roentgenology, New York, was officially closed January 21,1919.29 This school trained 244 officers in its regular course, while 58 officers received supplementary courses and 11 roentgenologists of wide experience were given some instruction. 29
Throughout the earlier months of 1919 the policy of substituting regular medical officers for emergency officers, so that the latter might be discharged, was systematically carried out; at the same time special instruction was given the former that they might do so. 30
The records of the division show the following: 31 From February to June,1919,there were admitted to the hospitals in the United States 258,988 patients, 140,205 of whom were examined by X-ray films. Twenty-four thousand five hundred and one fluoroscopies were performed. Each roentgenologist examined per month an average of 227 patients. An average number of 142 roentgenologists were on duty; each roentgenologist served an average of 364 patients and in hospitals of 364 beds 227 of the patients were examined each month; 54.1 per cent of all patients admitted to army hospitals were given an examination by X-ray; 15 per cent of all patients were examined by X-ray with the fluoroscope.
An important work of the section at the end was preparing for the General Staff statements showing the exact amount of apparatus, equipment, and supplies necessary for the initial equipment and maintenance in the field of an army of one-half million men 32 and in the section files are data covering every possible aspect of military roentgenology up to the time of its incorporation in the Division of Surgery (Dec. 6, 1918).
The efforts of the officer in charge were finally directed toward obtaining as Medical Reserve Corps officers a sufficient number of experienced military roentgenologists to insure that in the event of necessity there would be avail-able enough to take entire charge of the X-ray work in all military hospitals.
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PERSONNEL.a
(April, 1917, to December, 1919.)
Christie, Arthur C., Col., M. C., chief.
Johnston, George C., Col., M. C., Chief.
Merritt, E. A., Lieut. Col., Al. C.
Shearer, John S., Lieut. Col., M. C.
Brown, Percy, Maj., M. C.
Bushy, A. H., Maj., M. C.
Cochran, H. B., Capt., S. C.
Herendeen, Ralph E., Capt., M. C
Middleditch, L. S. C., Capt., S. C.
Mooradian, A. P., Capt., S. C.
Moyer, H. D., Capt., S. C.
Palmer, Myron B., Capt., M. C.
Weir, A. H., Capt., S. C.
Rogers, L. L., First Lieut., A. C.
Wentzel, Charles E., First Lieut., S.C.
REFERENCES.
(I) Manual for the Medical Department, 1916, par. 143
(2) Memo. for Maj. R. A. Noble, M. C., from Lieut. Col. 11. C. Fisher, M. C. (Chief of Supply Division), May 14, 1917. On file, Record Room, S. G. O., 201 (Christie, Arthur C.).
(3) S. O., No. 114, par. 49, W. D., May 17, 1917.
(4) Memo. for Maj. Edwin P. Wolfe, June 27, 1917, Scheme of Organization of Supply Division. On file, Record Room, S. G. O., 024. Supply Division, copy of requisition for disbursing funds, No. 114363, July 5, 1917. On file, Record Room, S. G. O., Requisition Books.
(5) Office Order, No. 66, S. G. O., July 10, 1918. On file, Record Room, S. G. O., 024.14 (Division of Roentgenology).
(6) Office order No. 97, S. G. O., November 30, 1918. On file, Record Room, S. G. O., 024.1 (Administrative Division).
(7) Correspondence. Subject: Council of National Defense. On file, Record Room, S. G. O., Correspondence File, 156772 (Old Files).
(8) List of Staple Medical and Surgical Supplies Selected to Meet War Conditions; Part IV, X-Ray Apparatus and Supplies. Compiled by the Council of National Defense, Washington, D. C. Washington, D. C., Government Printing Office, 1918.
(9) Weekly reports, Division of Roentgenology. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(l0) Weekly report from chief of Division of Roentgenology to the Surgeon General of the Army April IS, 1918. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(11) letter from Maj. Arthur C. Christie to the Kelly-Koett Co., June 20, 1917. Subject: X-Ray Table Designed by Doctor Johnston and Professor Shearer. On file, Finance and Supply Division, S. G. O., 396 (Kelly-Koett Manufacturing Co.).
(12) Letter from the General Electric Co. to the Surgeon General, dated June 13, 1917. Subject: Specifications for Electrical Equipment for Portable X-Ray Outfit. On file, Finance and Supply Division, S. G. O., 263 (General Electric Co.).
(13, Letter from Maj. A. C. Christie to the Kelly-Koett Co., July 20, 1917. Subject: Bedside Unit. On file, Finance and Supply Division, S. G. O. (Kelly-Koett Co.).
a 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 I, 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 alplahatically by grades, irrespective of chronological sequence of service .
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(14) Weekly reports from chief of Division of Roentgenology to the Surgeon General, United States Army, May 10 and June 21, 1918, respectively. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(15) Weekly reports from chief of Division of Roentgenology to the Surgeon General, July 12 and 26, November 1, 8, and 15, respectively. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(16) Letter from Maj. A. C. Christie, M. R. C., to the Surgeon General, May 24, 1917. Subject: Organization of School of Roentgenology. On file, Record Room, S. G. O., 156755-17 (Old Files).
(17) Letter from Maj. A. C. Christie, M. R. C., to Maj. Alfred L. Gray, M. C., Medical College of Virginia, Richmond, Va., November 28, 1917. Subject: Closing of Schools of Roentgenology. On file, Finance and Supply Division, S. G. O. 231/18 (Gray, Alfred L.).
(18) Letter from the Surgeon General to Mr. Samuel G. Zuckerman, Department of Agriculture, July 28, 1917. Subject: Commission in Sanitary Corps for X-Ray Mechanics and Technicians. On file, Record Room, S. G. O., 193841 (Old Files).
(19) Letter from Surgeon General to commandant, Medical Officers` Training Camp, Fort Ogle thorpe, Ga., December 6, 1917. Subject: School in Military Roentgenology. On file, Record Room, S. G. O., Roentgenology School (Camp Greenleaf)(C).
(20) Weekly reports from chief of Division of Roentgenology to the Surgeon General of the Army, May 10, 1918, and June 7, 1918. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(21) Weekly report from the chief of Division of Roentgenology to the Surgeon General, United States Army, June 7, 1918. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(22) Weekly report of Chief of Division of Roentgenology to the Surgeon General, United States Army, September 20, 1918. On file, Record Room, S. G. O., Weekly Report File (Roent- genology).
(23) Weekly report from Chief of the Division of Roentgenology to the Surgeon General, United States Army, September 6, 1918. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(24) United States Army X-Ray Manual, authorized by the Surgeon General, United States Army. Paul B. Hoeber, New York; first edition, 1918; second edition, 1919.
(25) Plan F. (Incorporated in plans for base hospitals constructed, 1917, 1918.) On file, Hos- pital Division, S. G. O.
(26) Weekly report from the Chief of the Division of Roentgenology to the Surgeon General, August 9, 1918. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(27) Weekly report from Chief of Division of Roentgenology to the Surgeon General, November 15,1918. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(28) Weekly report from Chief of the Section of Roentgenology, Division of Surgery, December 30, 1918, and January 17, 1919, respectively. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(29) Weekly report from Section of Roentgenology, Division of Surgery, to the Surgeon General, February 21, 1919. Weekly Report File (Roentgenology). On file, Record Room, S. G. O.
(30) Weekly reports from Chief of Section of Roentgenology, Division of Surgery, to the Surgeon General, United States Army, April 24, 1919, and May 8, 1919. On file, Record Room, S. G. O., Weekly Report File (Roentgenology).
(31) Compiled from monthly X-ray reports. On file, Record Room, S. G. O., Correspondence File, 730 (Roentgenology).
(32) Letter from Dr. George E. Johnston, M. C., to Col. Charles Lynch, M. C., March 24, 1921. Subject: Apparatus, Equipment and Supplies. On file, Record Room, S. G. O., 444.3-1 (General)
