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SECTION II.
CHAPTER XXVI.
THE ATTENDING SURGEON`S OFFICE, WASHINGTON, D. C.
The attending surgeon`s office in Washington, D. C., was not properly a part of the Surgeon General`s Office during the World War in the sense that were the other divisions which are discussed in this history. For many years before the World War, as well as during the time it was in progress, officially the attending surgeon`s office was directly under the War Department and not directly under the Surgeon General`s Office. Yet, during the war, in point of fact, a direct relationship was maintained between the Surgeon General`s Office and that of the attending surgeon, and the latter was actually shown in organization charts of the Surgeon General`s Office made at the time. (See Chart XXIII.) This being the case, the attending surgeon`s office is discussed here.
At the time of our entry into the World War the Washington attending surgeon`s office, a part of which was an Army dispensary, was located at 1106Connecticut Avenue, occupying portions of the second and third floors of the building. The function of the attending surgeon was to supply medical care for the active officers and enlisted men of the Army in Washington, and for their families as well, and also for retired officers and enlisted men residing there.` The three medical officers on duty in this office were almost swamped with work as soon as war was declared. A great increase in the numbers of officers and enlisted men in Washington occurred and the families of many Regular officers flocked there when these officers were ordered abroad. This put an added strain on the already overworked doctors. Expansion was started. In July, 1917, more medical officers were secured and the entire second and third floors of the building in which the office was located were leased.
Finally, the influx to Washington of officers, enlisted men, and civilian clerks for whom the Army now furnished emergency treatment was so great, while at the same time the local doctors were much lessened in numbers, as many went into the military service, that a rather serious condition of affairs resulted which required immediate relief. Pertinent recommendations to this end were made, therefore, by the Surgeon General, and acted upon favorably, as indicated in the following correspondence: 2
MARCH 4, 1918.
From: The Surgeon General of the Army.
To: The Secretary of War. Subject: Dispensary and emergency station.
1. Authority is requested to establish a War Department dispensary and emergency station at Unit C, Henry Park Building, Sixth and B Streets NW., for the purpose of meeting the unusual and urgent demands for dispensary service for officers and their families, and emergency work for civilian employees. This request is in compliance with the request of the Secretary of War.
(Signed) W. C. GORGAS,
Surgeon General, United States Army.
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Chart XXIII.–Attending Surgeon’s Office, June, 1918.
531
(Ist.ind.)
WAR DEPARTMENT, March 6, 1918.
Approved.
(Signed) B. CROWELL,
Acting Secretary of War.
MARCH 5, 1918.
From: The Surgeon General.
To: The Secretary of War.
Subject: Additional dispensary and emergency station.
1. In connection with a suggestion for the establishment and conduct of an additional (temporary) dispensary and emergency station in the Henry Park Building at Sixth and B Streets NW., at which it would be possible to afford emergency treatment to the civilian employees of the War Department, and dispensary service for officers (and their families) connected with bureaus located in this section of the city, this office will recommend to The Adjutant General the issuance of the necessary orders assigning a sufficient number of medical officers, nurses (to include visiting nurse service), and enlisted men to such a dispensary as soon as it may be established.
2. Such medical supplies and equipment as may be necessary in the dispensary and medical supplies for the emergency station and rest rooms will be issued by the Medical Department as to other dispensaries maintained by it.
3.It is understood that the Medical Department personnel, including medical officers, nurses, and enlisted men, will remain under the supervision of the Surgeon General and that he will be responsible for their selection.
4. This office is prepared to recommend the issuance of the necessary orders upon receipt of your approval of the establishment of the dispensary and rest station and the assignment of the space necessary.
For the Surgeon General:
(Signed) C. L. FURBUSH,
Lieutenant Colonel, Medical Corps, National Army.
(Ist ind.)
WAR DEPARTMENT, March 6, 1918.
The foregoing plan as outlined by the Surgeon General is approved, attention being invited to the approval of the establishment of an additional dispensary and emergency station as indicated on a separate paper herewith.
The Surgeon General is requested to confer with Mr. G. H. Dorr, room 242, Secretary`s Office, War Department Building, as to the amount of space which will be required.
(Signed)
B. CROWELL,
Acting Secretary of War.
REGULATIONS GOVERNING THE OPERATION OF DISPENSARY, EMERGENCY, AND REST ROOMS IN
BUILDINGS OF THE WAR DEPARTMENT, WASHINGTON.
I. Dispensary has been established at Sixth and B Streets, Unit C, with emergency rooms or rest rooms in other War Department buildings, all under the exclusive jurisdiction of the Surgeon General of the Army in so far as medical administration and care of sick and emergency cases are concerned.
II. Civilian employees of the department may secure emergency treatment at the dispensary and emergency rooms and such assistance as it may be possible to provide at rest rooms.
III.A visiting nurse service has been organized and it is directed that the names and addresses of all employees reporting sick or who are absent and unaccounted for be reported promptly to the emergency dispensary, Sixth and B Streets, each day in conformity to the schedule arranged by the Surgeon General. The importance and necessity of this to the department and the full cooperation of all bureaus and offices is essential to secure the results desired.
IV. It should be understood that the facilities available are intended only for emergency cases, and that with respect to chronic cases of illness the medical officers will limit their assistance to advice that a civilian physician be consulted by the employees.
Approved:
(Signed)
N. D. BAKER,
APRIL 20, 1918
Secretary of War.
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The conditions necessitating this expansion were described in the following report: 3
Without any additional provision in the way of housing, without any addition in the way of hospital facilities, and with the usual number of doctors and nurses greatly reduced to meet the needs of the Army and Navy between the date of the declaration of war by the United States and the 1stof January, 1918, Washington as a city was called upon to adjust itself to the enormous burden of housing, feeding, and otherwise caring for an addition to its population of nearly 100,000 people. The urgent cry of the War Department for clerical help in its various branches resulted in a never-ending stream of thousands of willing workers, mostly girls, pouring into the city, a large percentage of whom were experiencing for the first time the difficulties of establishing themselves in a strange town away from friends and relatives.
In spite of the enormous numbers coming to Washington, it began to be noticed that those coining to work soon lost their enthusiasm, gave up their work, and returned to their homes. The short period of service assumed the aspect of a very serious and expensive problem In some divisions the "labor turnover" amounted to as much as 15 to 20 per cent per month.
* * * * * * *
A tremendous effort was made to increase and improve living facilities, particularly for the girls coming to Washington.
The next big problem was to meet the need for medical service. The knowledge that in a great number of cases girls left the work here in a panic over inability to get medical service made it seem necessary to devise a system of medical service which could be easily and promptly reached in case cf an emergency. In April, 1918, on order of the Secretary of War, a dispensary system was established for emergency service for civilian employees of the War Department. This work was organized by the Surgeon General of the Army and placed under the immediate supervision of the attending surgeon. The system consisted of four divisions, viz:
1. A central dispensary, equipped for all sorts of emergency care and manned by medical officers, contract surgeons (women), and trained nurses.
2. “Emergency rooms," one in each building occupied by the War Department. Each room in charge of a trained nurse.
3. A group of visiting nurses.
4. Volunteer health committees in each bureau of the War Department.
The general plan of operation provided that any employee who felt ill while at work would report to the nurse in charge of the nearest emergency room. The great majority of all complaints could thus be relieved at once and the employee immediately be enabled to return to duty. More serious cases were held and a doctor called from the central dispensary or the patient sent or taken direct to the dispensary. The great majority of all cases coming to the dispensary were not of a serious nature and were treated and at once returned to duty or at most relieved by a day or two of rest in bed at home. Those cases of a more serious nature were seen in their homes by visiting nurses and doctors from the dispensary, if the patients were unable to get their own physicians. By cooperation with the various city hospitals, patients requiring hospital care were admitted and attended by the dispensary staff.
Before the war there was a lack of hospital beds in Washington to meet the ordinary needs of the city. It was early recognized by the attending surgeon that even in a mild epidemic there would be many more hospital beds needed than would be available. Plans were under way by the Housing Corporation and also by the attending surgeon to provide additional hospital beds, but the arrival of the influenza epidemic made it necessary to institute emergency measures. This emergency was met by the establishment of emergency hospitals by the Public Health Service. A recurrence of the epidemic has made it necessary to establish another hospital. This is now (December, 1918) being conducted under the cooperation of the Public Health, the District Health Office, the Red Cross, and the attending surgeon. The present arrangement can of necessity be only an emergency and temporary arrangement. Washington still needs from 500 to 1,000 additional hospital beds, and the health hazard here can only adequately be met when the District has made such provision.
Those who were taken ill while at home were visited by a "visiting " nurse, who rendered nursing care and arranged for such other service that might be necessary.
A steady growth in the various bureaus of the War Department made it necessary to increase from time to time the number of emergency rooms, the number of dispensaries, and the number of
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nurses and doctors. The maximum number of emergency rooms was 22, the maximum number of dispensaries 3; the maximum staff consisted of 18 doctors (8 medical officers, 10 women contract surgeons) and 45 nurses.
The number of people cared for by the dispensary through its various divisions rapidly increased from the time of its organization in April till in July there was an average of over 500 cases per day. This number continued to increase and reached its maximum in October, when the average for the entire month was over 1 ,000( patients per day. This number decreased in November to about 800 patients per day; in December there was a still further decrease to about 700 per day.
In spite of the increase of equipment and staff it became increasingly evident that the need for this service was much greater than could be furnished. The various rooms became much congested and the staff became exhausted from overwork. Volunteer helpers were solicited and were found to be of great assistance in caring for the cases of minor illness and as nurses` aids in attending the sick. The lack of trained workers became more and more acute every day and it was seen that the only source of relief would be through partially trained volunteers. With the approval of the Surgeon General, the attending surgeon submitted to the Secretary of War a plan for the organization and training of volunteer health committees. This plan was approved October 31, 1918. Since then these committees have been organized in all the larger War Department bureaus and have been a great help to the dispensary in satisfactorily meeting the requests for service.
It has been shown here, just as in many industrial establishments, that the service of the dispensary and its staff has made it possible for thousands of clerks to continue at their work when but for this service they would be at home, and it is safe to say that the encouraging word of a nurse or doctor has been the means of preventing hundreds of girls from becoming discouraged and deserting jobs where they were badly needed.
The war over, conditions changed rapidly. Doctors who left Washington to go into Government service soon got back to their old obligations as civilian practitioners. Conditions soon became such that civilian employees could get adequate service without assistance from the attending surgeon.
The maintenance of emergency rooms, however, has been recognized for some time by all business efficiency experts as a necessity in all offices, stores, and other industrial establishments. Hundreds of cases of half-day absences can be prevented in a year by a few minutes` attention of a competent trained nurse.
When the armistice was signed, November 11, 1918, the attending surgeon`s office consisted of the main dispensary, 1106 Connecticut Avenue (this having been increased to include one section of the ground floor in addition to second and third floors); sub dispensary No. 1, at Sixth and B Streets NW.; sub dispensary No. 2, at State, War, and Navy Building; sub dispensary No. 3, in the Munitions Building; and 22 emergency or rest rooms in various War Department buildings, each in charge of a trained nurse and six supervising and visiting nurses. 4
Following a recommendation to the Surgeon General by the attending surgeon, a dental department was opened in the main dispensary on July 20, 1917, and was gradually increased to eight chairs, with a complete dental laboratory. 5 In August, 1918, enlisted dental assistants were released for field service and trained women dental hygienists were installed. 6 Likewise, in the other departments men were released and women appointed to such positions as they could fill. When the emergency treatment of civilian employees was authorized, women physicians were employed as contract surgeons I and assigned to the dispensaries where the young women employees might consult them.
During the influenza epidemic, when the civil and military hospitals of Washington were filled to their maximum capacity, a Public Health Service hospital was opened on Virginia Avenue in a temporary building, under the supervision of the attending surgeon. This afforded hospitalization for a
534
large number of war workers. 4 Later a building at 612 F Street NW., converted into a hospital for influenza patients, was controlled jointly by the attending surgeon, the city health department, the United States Public Health Service, and the American Red Cross. The attending surgeon established an office in the building, through which he supplied the nursing, enlisted, and medical personnel for the hospital. 4
The city was divided into six districts, to each of which a visiting physician was assigned.
Up to the time of the signing of the armistice all departments in the attending surgeon`s office were being actively expanded; but with the beginning of the year 1919, the coincident cessation of influenza and the diminution of commissioned and enlisted personnel in Washington, a reduction was demanded. 8 The personnel in the four dispensaries and 22 emergency rooms then in operation was 35 medical officers, 9 women contract surgeons, 8 dental surgeons, 5 Sanitary Corps officers, 2 laboratory technicians (women), 61 nurses, 33 civilian employees, 32 enlisted men (including 4 men borrowed from Walter Reed General Hospital for use in the influenza hospital), making a total of 185 persons attached to the attending surgeon`s office in its various departments. February 12, 1919, that part of the influenza hospital, 612 F Street, assigned to the attending surgeon was released and its Army personnel withdrawn. On May 9, 1919, 4 dispensaries and 11 emergency rooms were in operation with a personnel of 15 medical officers, 6 contract surgeons (women), 8 dental surgeons, 1 Sanitary Corps officer, 1 laboratory technician, 44 nurses, 15 enlisted men, 26 civilian employees, showing a reduction of 95. The personnel was further reduced as soon as authorization was received to close all sub dispensaries. 8 Later the main office of the attending surgeon was organized on the group unit plan, with a Chief of Medical Service, Chief of Surgical Service, Chief of Ear, Nose, and Throat Department, Chief of Eye Department, Chief of Dental Department, and a Chief of Laboratory Division. X-ray and Obstetrical Departments which had been previously maintained were abolished as departments and placed under the Medical Service.
Record keeping was standardized, a central filing system for patients` records was installed, a medical secretary was employed, and clinical histories were ordered kept in all cases. Minor cases requiring little study were simply noted with the diagnosis and treatment outlined.
A complete X-ray plant, with the bedside machine, was installed at the dispensary. This was found adequate for all except intestinal cases, which were sent to the Army Medical School. After the war the emergency treatment rooms for War Department employees were still maintained in charge of nurses, but the sub dispensaries were closed, as employees no longer had difficulty in securing civilian medical attention.
From May 1, 1918, to April 30, 1919, there were treated in the emergency rooms and sub dispensaries 254,069 war workers, in addition to the officers and enlisted men and their families in the District of Columbia, amounting to many thousands more. 9
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PERSONNEL.a
(April, 1917, to December, 1919.)
Lyster, Theodore C., Brig. Gen., M. D., attending surgeon.
Metcalfe, Raymond F., Col., M. C., attending surgeon.
Beeuwkes, Henry, Col.,M. C.
Bernheim, Julien R., Col., M. C.
Carpenter, Alden, Col., D. C.
McAfee, Larry B., Col., M. C.
Dear, William R., Lieut. Col., M. C.
Doane, Philip S., Lieut. Col., M. C.
Harris, Seale, Lieut. Col., M. C.
Rice, William S., Lieut. Col., D. C.
Skinner, John O., Lieut. Col., M. C.
Bannister, Guy P., Maj., D. C.
Bowers, Daniel T., Maj., D. C.
Britton, James A., Maj., M. C.
Clay, Calvin E., Maj., M. C.
Cornell, Donald D., Maj., D. C.
Darnall, Moses H., Maj., M. C.
Davis, William T., Maj., M. C.
Deiber, Harry M., Maj., D. C.
Erving, William G., Maj., M. C.
France, Gerald D., Maj., M. C.
Frazier, Max C., Maj., D. C.
Henshaw, Frederic R., Maj., D. C.
Holmes, Claude D., Maj., M. C.
Hyde, Charles W., Maj., M. C.
Krupp, Peter C., Maj., D. C.
Lewis, Charles H., Maj., M. C.
Lyon, James A., Maj., M. C.
Mitchell, Leonard G., Maj., D. C.
Morris, Bascom F., Maj., M. C.
Neill, Thomas E., Maj., M. C.
Newcomb, John R., Maj., M. C.
Parker, Henry P., Maj., M. C.
Patten, William F., Maj., M. C.
Quickel, Herbert L., Maj., M. C.
Richardson, Walter H., Maj., D. C.
Skelton, Oscar G., Maj., D. C.
Strong, Robert A., Maj., M. C.
Sullivan, R. Y., Maj., M. C.
Thomas, Philip M., Maj., M. C.
Tobias, Henry W., Maj., M. C.
____________
a In this list have been included the names of those who at one time or another were assigned to the attending surgeon’s office during the period, April 6,1917, to December 31,1919.
There are two primary groups-attending surgeons and assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
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Wells, W. A., Maj., M. C.
White, William C., Maj., M. C.
Willson, Prentiss, Maj., M. C.
Wright, Frederick T., Maj., M. C.
Alley, Richard M., Capt., S. C.
Carothers, Herbert C., Capt., M. C.
Chandlee, William H., Capt., M. C.
Christman, Paul W., Capt., M. C.
Clark, Orton H., Capt., M. C.
Dameron, Ernest P., Capt., D. C.
Dawson, John H., Capt., S. C.
Deming, William C., Capt., M. C.
Doyle, George F., Capt., M. C.
Ellis, George R., Capt., D. C.
Faulkner, Ralph L., Capt., D. C.
Goodell, William, Capt., M. C.
Garnett, Alexander Y. P., Capt., M. C.
Goodwin, Thomas G., Capt., S. C.
Hoblitzell, William H., Capt., D. C.
Houck, Alfred T., Capt., S. C.
Hughes, Lawrence J., Capt., M. C.
Hughes, Lee W., Capt., M. C.
Johnson, Stuart C., Capt., M. C.
Kennebeck, George R., Capt., D. C.
Kilgore, Harry L., Capt., M. C.
Keogh, John V., Capt., M. C.
MacLay, Otis H., Capt., M. C.
Marriott, Charles W., Capt., D. C.
Martell, Leon A., Capt., M. C.
Musgrave, Charles A., Capt., D. C.
Parkhurst, Guy McM., Capt., M. C.
Potter, Ward E., Capt., M. C.
Pruett, Harry J., Capt., M. C.
Robinson, Daniel W., Capt., S. C.
Rogers, Clarke, Capt., M. C.
Ruggles, Everett H., Capt., D. C.
Sawyer, Harold P., Capt., M. C.
Sibley, George J., Capt., D. C
Smith, George C., Capt., M. C.
Spoon, Thomas L., Capt., D. C.
Stewart, Harry E., Capt., M. C.
Tyler, Benjamin F., Capt., S. C.
Williams, Herbert L., Capt., M. C.
Zeidler, John C., Capt., D. C.
Arnold, Alphonse A., First Lieut., D. C.
Bailey, Alfred S., First Lieut., M. C.
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Blair, Mortimer W., First Lieut., M. C.
Blanco, Pio, First Lieut., M. C.
Camp, Walter E., First Lieut., M. C.
Corey, Charles W., First Lieut., M. C.
Creighton, William J., First Lieut., M. C.
Dawson, Drexel L., First Lieut., M. C.
Donoho, Fitz W., First Lieut., S. C.
Emmert, Carl S., First Lieut., D. C.
Foster, Edward E., First Lieut., D. C.
Hare, Earl H., First Lieut., M. C.
Hollis, William A., First Lieut., M. C.
Johann, Albert E., First Lieut., M. C.
Larkin, Bernard, J., First Lieut., M. C.
Leibell, Casimir F. X., First Lieut., M. C.
Long, Frank H., First Lieut., M. C.
Lormor, Earl H., First Lieut., M. C.
McGrath, James H., First Lieut., D. C.
Mattes, Abraham, First Lieut., M. C.
Reisenberg, Max, First Lieut., S. C.
Ryder, Ollie A., First Lieut., M. C.
Sargent, Arthur F., First Lieut., M. C.
Scherer, Walter H., First Lieut., D. C.
Smith, Malcolm K., First Lieut., M. C.
Snodgrass, Frank B., First Lieut., M. C.
Thornburg, Harvey D.; First Lieut., M. C.
Walters, Roy W., First Lieut., D. C.
Wieck, William F., First Lieut., D. C.
Mills, Joseph P., Second Lieut., S. C.
Romeo, Robert R., Second Lieut., S. C.
Snodgrass, Harry C., Second Lieut., S. C.
Baker, Lucy H., Contract Surg.
Cleverdon, Ella, Contract Surg.
Dassill, Margaret M. N., Contract Surg.
Donohue, Julia M., Contract Surg.
Johnstone, Mary M. S., Contract Surg.
Karpeles, Kate B., Contract Surg.
Kratz, Esther C., Contract Surg.
McKnight, Mary Pearson, Contract Surg.
Maher, Loretta K., Contract Surg.
Scott, Jessie T., Contract Surg.
Smith, Olive E., Contract Surg.
Stephenson, Nellis W., Contract Surg.
Walker, Marie W., Contract Surg.
Wilson, Sylvia McQ., Contract Surg.
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REFERENCES.
(1) United States Army Regulations, 1913, corrected to April 15, 1917, par. 1473. Manual for the Medical Department, 1916, par. 375-6.
(2) Correspondence between the Secretary of War and the Surgeon General. On file, Record Room, S. G. O., Correspondence File, 230.61.
(3) Report of Maj. James A. Britton, 1918. On file, Record Room, S. G. O., 230.61 (Washington, D. C.).
(4) Annual report, War Emergency Dispensary Branch, Attending Surgeon`s Office, Washington, D. C., year ending December 31, 1918. On file, Record Room, S. G. O., 230.61 (Washington, D. C.) (F).
(5) Correspondence. Subject: Personnel. On file, Record Room, S. G. O., Correspondence File 142079 (Old Files).
(6) Correspondence. Subject: Dental Hygienists. On file, Record Room, S. G. O., 231 (Hygienists, Dental).
(7) Correspondence. Subject: Contract Surgeons (female). On file, Record Room, S. G. O., 211 (Women Physicians).
(8) Letter from Attending Surgeon to the Surgeon General, May 31, 1919. Subject: Discontinuing Sub dispensaries and Emergency Rest Rooms. Second indorsement, W. D., A. G. O., June 11, 1919, approved to take effect June 30, 1919. On file, Record Room, S. G. O., 230.61 (Washington, D. C.) (F).
(9) Summary of work done by months, from May, 1918, to February, 1919. On file, Record Room, S. G. O., 230.61 (Washington, D. C.) (F).
