100
These two schools were combined in April, 1918, and became the School of Internal Medicine, which designation was later changed to the School of Military Medicine.103
In the assignment of students to this school, the same methods followed in other schools obtained. Most of the students were taken from those reserved by the Surgeon General’s Office for this class of work. After one month’s military instruction, which was afterwards reduced to two weeks, the entire time of the student was devoted to his special training. Unfortunately, the demands of the service were so great that very few of these students were allowed to remain until the completion of the course. This greatly curtailed the usefulness of the school.
In July, 1918, the instruction at the school was widened to include instruction in general medicine and gastroenterology, in addition to the instruction in cardiovascular and lung diseases.104?????
The work increased greatly during the last half of 1918, as may be seen from the numerical list of student officers for the month of September.105
a. Total number in school during September...................................................114
b. Total number carried over from August........................................................32
c. Total number reported for instruct-ions during September.............................82
d. Total number found, after preliminary work, not to be qualified......................12
e. Total number ordered away while in course.....................................................9
f. Total number completing course during September...........................................4
g. Total number carried over into October.........................................................89
During October, 1918, work in this school came to a standstill, owing to the occurrence of the severe influenza epidemic. All of the instructors and many student officers were made available for the treatment of the large number of patients, and many student officers were ordered to other camps for the same duty. The school was formally closed December 23, 1918. 106
SCHOOL OF MILITARY PSYCHOLOGY
The establishment of the School of Military Psychology was authorized by the Secretary of War in January, 1918, in reply to a letter from the Surgeon General to The Adjutant General, December 7, 1917, concerning the extension of psychological examining.107 The constitution of the school was outlined in a letter from the Surgeon General to the commandant of Camp Greenleaf in January, 1918.108
JANUARY 5, 1918.
From: The Surgeon General, United States Army.
To: Commandant, Medical Officers’ Training Camp, Fort Oglethorpe, Ga.
Subject: School in Military Psychology.
1. A school for military psychologists will be established, as a special course for selected student officers, as part of the general scheme of instructions carried out in the Medical Officers’ Training Camp at Fort Oglethorpe, Ga.
2. The purpose of thus school is to conduct training of psychologists along military lines, from the military viewpoint, and in the military environment; and coincidently to develop its officers physically and train them in subjects which they should know under the conditions in which they would practice their specialty, including organization, regulations, paper work, relations with enlisted men, and their general functions as officers.
3. About 50 psychologists will be required monthly. Classes under instruction should be arranged for on the basis of a course lasting two months.
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4. The senior instructor in psychology detailed by this office on the staff of instructors of the training camp will, under the supervision of the commandant thereof, be in direct charge of the course. In addition to his educational duties, he will continuously investigate the qualifications and suitability of officers and enlisted men under general instruction relative to detail as psychologists.
5. The routine work of psychologists at your camp will, as far as possible, be demonstrated and utilized as part of the subjects of instruction.??
6. Thegeneral instruction to begiven will relate to the principles of psychological examination. Detailed information as to the general nature and scope of the work to be done will he furnished by the psychology section of this office. The course of instruction in psychology, based thereon, will be prescribed by the commandant of the training camp after conference with the instructor in psychology.
7. The course in general training and psychology will cover a minimum of two months. In addition to instruction in other subjects, the course in psychology will comprise a total of 167 hours.??? ?
8. Officersunder training asspecialists mo military psychology will he quartered and subsisted inthe medicalofficers’ training camp and subject to its discipline at all times.
9. They will be organized as a special company. Hours of instruction in military psychology will be arranged by the commandant of the training camp.
10.The schedule for the first month is as follows: b
** **
PSYCHOLOGICAL INSTRUCTION
Hours
Organization and administrations of psychological examination ................................................ 6
Paper work, relating to psychological examining...............................................6
Group examining, practice...............................................10
Scoring, organization and methods, checking, filing, etc.......................................................12
Individual examining, practice.........................................14
Statistical method.........................................10
11. The schedule for the second month is as follows:
*******
12. About 25 to 50 selected enlisted men, to work under the division of psychology, will be kept at your camp under instruction therefor. Some of them will be sent with a view to being tried out as to their fitness for appointment as officers of the Sanitary Corps under the divisions of psychology. All should be given such part of the basic course for enlisted men, including the physical, military, and professional, as might be of advantage to them in their special service with psychologists.
Their further special training under the psychology division will he outlined by the representative of that division on your staff of instructors subject to your approval. They should be organized as a separate company under officers of the Sanitary Corps serving under the division of psychology.
13. Receipt of this letter to be acknowledged.
By direction of the Surgeon General:
E. L. MUNSON, Colonel, Medical Corps.
The course was designed to cover, in a minimum of two months, 365 instruction hours. 109 It was provided that about 50 officers of the Sanitary Corps and 25 to 50 enlisted men, selected from psychologists already in service, or gained through voluntary inductions into the Medical Department, should be trained
b Sec pp. 78, 79.
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each month, until the authorized numbers should be secured. Provision was also made for the organization of psychologists into 2 companies, 1 commissioned and 1 enlisted. It was permitted that on the basis of abilities and qualities exhibited in training, about 50 men from the total enlisted group should be recommended for appointment as commissioned officers, 62 as sergeants, and 62 as corporals.?
On February 4, 1918, officers and enlisted men detailed for instruction began to arrive. No barracks for the use of additional companies were at that time available, so that until a sufficient number of officers to form a company of 25 to 30 should arrive, commissioned psychologists were assigned to Companies 13, 14, 15, and 16, which were already formed of officers in the Medical Department. Similarly, until facilities and adequate personnel for the formation of a company of enlisted psychologists were obtained, these men were assigned to the Camp Greenleaf infirmary detachment. On February 8, 22 commissioned psychologists then in camp, together with certain other officers of t.he Sanitary and Veterinary Corps, were combined in Company 15. Until February 16, when the psychological officers of this company became Company 28, 7th Battalion, medical officers? training camp, and moved to a section of the camp where facilities for special training were available, commissioned psychologists received the same training as that given regularly to medical officers. 109
On March 7 the enlisted psychologists, then numbering 49, were moved from the infirmary to the tents of the recruit section of the division of hospitals and sanitary trains, 14th Battalion, and formed Company F of that battalion. In addition to their military training, special psychological training for these soldiers was begun at that time. On April 20 Company F became psychological Company No. 1, and, together with the commissioned psychologists of Company 28, was moved to more commodious quarters, formerly occupied by base and field hospitals. On June 20 a building specially constructed for psychological examining was completed and both groups of psychologists were consolidated and quartered, the officers in the psychological building itself and the enlisted men in the near-by barracks of the motor sanitary units in Camp Greenleaf annex. Formal instruction in military psychology was discontinued August 1, 1918. 109????
The psychological instruction to be given in this school was outlined in a syllabus prepared under the direction of the Surgeon General : 110
ORGANIZATION AND ADMINISTRATION OF PSYCHOLOGICAL EXAMINING
(First month, six hours; lectures by senior instructor)
First lecture: History of organizations; general purposes; present official status; general relations to Medical Department and to psychiatric work; to personnel department; to line organizations.
Second lecture: Summary of previous camp work. General outline of system of examining in camp; the building; the course of examining. The alpha examination; the beta examination; the individual examinations. Method of calling and handling examinees. Scoring and reporting.
Third lecture: The psychological personnel and their tasks. Duty of the chief examiner; the assistant examiners; the clinical psychologists; the sergeants and corporals; the copy clerks; the orderlies. Efficiency records and weekly reports.
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Fourth lecture: The alpha examinationin detail. First trial and revision; the Washington revision. Reasonsforchanging particular tests. Results thus obtained in camps.
Fifthlecture: The beta examinationin detail. Sources of material; purposes; general principles ofconstruction andgraduation. The individual examination in detail. Principles offormation, sources, results of application.
Sixth lecture: Model lecture forbringing out the main points to be emphasized in conferences withcompany andother commanders. Information which may and information which may notbe given the general public.
PAPER WORK RELATING TO PSYCHOLOGICAL EXAMINING
(First month, 6 hours; lectures and problems)
This course is to be conducted in connection with the courses given all medical officers in paper work relating to the Medical Department and paper work relating to the Quartermaster’s Department. It will relate to problems peculiar to the work in psychological examining such as channels, reports and correspondence, numbering and filing systems, use of the Scott rating scale, and memoranda, vouchers, transfers, etc. In practice students will be required to compose letters and memoranda, making reports, and filling out vouchers, etc., such as most frequently used in work of psychological examining.
GROUP EXAMINING PRACTICE
(First month, 10 hours; second month,40 hours)
Students in military psychology, and other officers in training, will first be examined by instructors in order that the general character of the alpha examinations shall become familiar to students. Thereafter, coaching and recitation in giving the alpha examinations will be required of all students under criticism, as to voice, emphasis, technique of handling group, etc. Instruction and practice in giving and scoring the literacy test and the beta examinations will follow. Students serve as examiners and as orderlies until complete uniformity is obtained.
SCORING ORGANIZATION AND METHODS
(First month, 12 hours; practice and conferences)
Systems of scoringpreviously used inthe camps will be tried out and improvements attempted. Students willberequired to hold, for a limited time, the followingpositions: In general charge, in charge ofcopying, of scoring, of table, and as clerk. Experimental determinationof scoringsystem which shall accompany maximum of work and minimum of errors in agiven time.
INDIVIDUAL EXAMINING PRACTICE
(First month, 14 hours; second month,36 hours)
Under direction amid with criticism, practice with the Stanford revision (complete forms), abbreviated Stanford for illiterates, the point scale, the performance scales, the test for suspected psychotics. Qualitative types of response. Separate scores, variability. Scoring and report to medical officer.
STATISTICAL METHODS AND PRACTICE
(First month, 10 hours; second month,10 hours)
Lectures, recitation, computations, and reports. Frequency distributions, tables, and graphs. The frequency surface and ogive. Measures of variability. The determinations of percentile scores by smoothing the ogive. The absolute value of scores by the theorem of normal distribution. Correlation: Product-moments; rank differences; unlike signs. Labor-saving devices. Formulation, validation, graduation, and integration of new tests and test series.
351420—27----S
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The greater portion of the work will consist in actual computation and report upomo assigned problems, using the material collected in the alpha, beta, and individual test series. Readings will be assigned in Rugg’s Statistical Methods Applied to Education, and in Thorn-dike’s introduction to Mental and Social Measurements.
MENTAL INCOMPETENTS
(Second months, 10 hours; lectures, reports, and, if feasible, clinics)
Lectures on insanity amid feeble-mindedness by psychological instructors and medical authorities. Assigned readings in White’s Outlines of Psychiatry and Tredgold’s Mental Deficiency. Recitations as time permits.
SERVICE ORGANIZATIONS
(Second month, 2 hours; lectures to be arranged)
MALINGERING
(Second month, 6 hours; lectures and clinics, assigned readings, and reports)
Lectures by psychiatrists and by psychological instructors. Assigned readings in Jones and Llewellyn’s Malingering and other socks. Demonstrations of methods for the detection of malingering.
REPORTING RESULTS
(Second month, 2 hours; conferences)
Summary of previous methods and recommending system for future reporting.
The general instruction for commissioned officers was given chiefly by battalion and company commanders and by the corps of medical instructors of the medical officers’ training camp.109 Until the McLean auditorium was constructed the lecture courses were given in the annex of the Young Men’s Christian Association near camp headquarters.
The general instruction for enlisted psychologists followed as closely as possible that given to the officers, save that in certain cases, such as Army Regulations and Manual for the Medical Department, abbreviations and substitutes were made and parts of Mason’s Handbook for the Sanitary Troops were used as a text. This instruction was conducted by officers of the school.109
The first lectures were given in a lecture room formed by throwing together rooms in former officers’ quarters; later, mess halls, and still later, a lecturers table in the open air, before an amphitheater under the trees, were used, until in June a special psychological building became available.109 This building was located centrally in Camp Greenleaf, near the headquarters of the division of hospitals and sanitary trains. It was two stories, 120 by 30 feet. The lower floor at the eastern end of the building was a large room, with benches and lap wall boards for the use of about 200 men in the alpha group examination. At the opposite end of the building was a similar room, fitted with benches, tables, shelves, and special lighting arrangements for the beta group examination, for about 100 illiterates and foreigners. Between these two roomns was a hallway, with a drinking fountain and supply room, which was used also as a library and fitted with shelves and counter. Above the beta room was a well-lighted scoring room, provided with tables, chairs, and shelves and sufficiently large to accommodate 50 clerks and scorers. The remainder of the upper floor consisted of 5 rooms for individual examining, 2 offices, a record
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room, a supply room, 2 lavatories, and 4 rooms which served as quarters for the commissioned examining staff. For use and instruction, necessary books, guides, blanks, office, and examining apparatus and materials were provided. Blackboards for the two large rooms were purchased from battalion and company funds.
Psychologicaltraining, outlinedabove, was supplemented in several ways.109 A course offourlectures on the political and religious creeds commonly held byconscientious objectors wasgiven. Upon three occasions, lectures were given by personnel officersand supervisors, andpractical experience in personnel interviewing was secured by studentofficers and men at recruitdepot, Fort Oglethorpe, and at Camp Forrest. Special lectures on thepsychological aspects ofreconstruction were given by officers from the reconstruction divisionof the Surgeon General’sOffice. Considerable practical experience in actual examining, both ofgroups and of individuals,was also given to students. The instructor in psychology twice had theopportunity of givinggeneral lectures on the nature and purpose of psychological examiningto the medical studentofficers, as a part of their scheduled instruction. Psychologicalinstruction was conducted almostexclusively by officers of the school.
The lectures on organization and administration of psychological examining covered the following subtopics: History; purposes and official status of the work; relations to Medical Department (especially to neuropsychiatry); relations to personnel work; relation to line organizations; summary of camp results; outline of system of examining; scoring; filing; reporting; camp psychological personnel and their duties; construction, revision, and results of the alpha, beta, and performance scale examinations.109 The course in paper work relating to psychological examining consisted of lectures on the form of letters, indorsements, memoranda, telegrams, and psychological reports, on rules as to channels, titles, expressions, and as to the making of vouchers, receipts, and other papers relating to supplies. Practical problems relating to paper work were set and their solutions criticized. Moss’s Army Paper Work was used as a partial text.?? ?
Inthe alpha examining practice, thestudent, after taking the examination, scoring papers,listening several times to the examination as given by a practicedexaminer, and in some casesrepeating it in unison with the group, was required to give theexamination individually undercriticism. When uniformity and accuracy in voice, emphasis, and speedwere obtained, studentswere given practice with groups in actual examination, in order topeifect technique.
The practice in beta examining was similarly conducted. Students acted at various times as examiner and as chief orderly, until precision and uniformity of action and gesture were secured.
Lectures and practical demonstrations of the organization and methods of scoring group examinations were given. Methods to secure accuracy and speed of scoring were specially emphasized. Students were required to score papers during a period long enough to make all details of scoring and glading perfectly familiar. ??? ?
Practicein individual examiningconsisted in lectures, study, and recitations on the structure andrules of the Yerkes-Bridges point scale, the Stanford-
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Binet age scale, and the performancescale examinations. Students were required to write outbrief “pocket rules” for giving and scoring the tests. When the generalnature, principles, anddetailed rules of the examinations were clearly in mind, students weregrouped in pairs eachmember of which gave his partner the examinations. Long practice inaccurate scoring andregarding actual papers, discussions of typical cases of “border-line”intelligence, of foreignersand illiterates, of the feeble-minded, of the insane, and ofmalingerers, interpretation of “scatter”and of atypical reactions, and of the basis of recommendations asdependent upon mental age,education status, personal, family, economic, and social history, weremade features of theinstruction before tests on actual cases were made.
The courses in statistical method comprised, in part, five or more lectures on graphic representations, measurement of central tendencies and of variability, and of correlations and their interpretation. The greater part of the work, however, consisted in practical computations based on data collected in the camp. Assigned readings were made in Rugg’s Statistical Methods and in Thorndike’s Mental and Social Measurements. In connection with the course in statistics, data bearing on the revision and improvement of methods, the assignment of grades, and the equalization of scores on various scales were obtained and reported to the division of psychology of the Surgeon General’s Office.
The courses in mental incompetency and in malingering were given in close connection with that on individual examining. In the former course, the lectures were supplemented by readings in Tredgold’s Mental Deficiency and in White’s Outlines of Psychiatry, and in the latter course, by Jones and Llewellyn’s Malingering. In both, however, references were continually made to actual cases handled by the lectures, in order to make concrete the generalizations and typical pictures.
The following is a typical daily program of instruction: 109
5:45 a.m...............................................First call.
6 a.m.. ................................................. Reveille.
6.30 a. m................................................. Mess.
7 to 9.15 a.m.........................................Setting-up exercises and drill.
9.30 to 11.30 a.m ............................... Military lectures (commissioned group). Psychological lectures (enlisted group).
12 m........................................................Mess.
1 to 2 p. m. ........................................... Quiz (commissioned group). Military lectures (enlisted group).
2 to 4..................................................... Psychological lectures or practice, or drill (enlisted group).
5..............................................................Retreat.
5.30.........................................................Mess.
6 to 7........................................................Study (commissioned group). Singing and quiz (enlisted group).
9.30.........................................................Taps.
Inspection and military orpsychological lectures composed the program for Saturday mornings.
Psychologists upon arrival in camp were given alpha examination and filled out a modified officer’s qualification card. On this card were listed student’s topics of specialization and publication and their amount and variety of psychological and applied psychological training, as well as their preferences as to psychological duties. Their abilities in the practice courses were continually
107
estimated and recorded by the instructors in charge; the officer’s’ military grades were reported weekly by the company commander to the battalion commander, who revised them. In lecture courses, grades were determined by recitations and final examinations. Recommendations as to promotion and assignment of commissioned psychologists were made by a board of examiner’s.
For enlisted men, the data on the qualification cards, the report of the company commander as to military records, and the marks obtained in the training course were similarly secured. A written examination on general psychological topics and an oral examination furnished a further basis of recommendation by a board composed of officers of the school.
During the period in which formal instruction was given in the school, psychological examinat-ions were made and reports were submitted on the various activities.109
In July, 1918, it was directed that early examination of all organizations in Camp Greenleaf be made.109
A complete critical and constructive report on the revision of the psychological examinations and examiner’s guide, as well as 10 special reports dealing with psychological methods, the equation of grades on various scales, and the examination of conscientious objectors were made from this school.109
Sixty-eight officers and two hundred and twenty-six enlisted men received instruction in this school. 109
In the period from August 7, 1918, to October 1, 1918, very little instructional work was undertaken, as the entire time was occupied with the examination of incoming drafts, the preparation of distributions, and the summarizing of examinations.” Although no special classes were held, much practical instruction in group and individual examining and scoring was given, incident to the examining. The number of men in the school was small. From October 1 to 13, the influenza epidemic was at its height in this camp. As the psychology building was used as an infirmary for influenza suspects, hardly any examinations were given. Instruction was also necessarily limited. From October 14 to November 9 definite classes in psychological examining ere held as a considerable number of enlisted men and officers had reported for the new school of psychology. Instruction during that period was given in lectures as ins (a) Organization and administration of psychological examining; (b) statistics; (c) group examining practice; (d) scoring filing; individual examining, lectures, and practice. During this period numerous psychological examinations were given, particularly at Camp Forrest. In the week from November 11 to 16 a course of instruction on personnel work, taking the entire time of the men for three days, was given by The Adjutant General’s Department, committee on classification of personnel. In the evening an officer from the Surgeon General’s Office gave lectures on reconstruction and reeducational work. The remainder of the week was spent in practice in personnel work (interview, tabbing, etc.). From November 16 to December 7 instruction was given in reconstruction work and individual examining, the mimeographed revised Manual for the Medical Department, chapter 2, “Military hospital organization and administration,” being used as the basis of instruction. Other reconstruction literature and the circular “Army Mental
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Tests” were also studied. The entire week of December 9 to 14 was spent in a special course in trade testing. The instruction consisted of lectures on oral and picture tests, together with examining practice. During the two weeks from December 16 to 28 the time was chiefly spent in athletic exercise and drill. Several lectures on deception tests were given and some experiments tried.
On December 30 and 31 orders were issued from headquarters, Camp Greenleaf, demobilizing practically all of Camp Greenleaf. The psychological detachment- was included in these orders, and in the period from December 31, 1918, to January 9, 1919, practically all the men were discharged or transferred for discharge, thus bringing the school to a close. Twenty-one officers and fifty-five enlisted men attended this second school.111
SCHOOL OF MILITARY ORTHOPEDIC SURGERY
The first step in the development of the School of Military Orthopedic Surgery was the inauguration, in the early days of the camp, November, 1917, of the School of Applied Surgical Mechanics, the purpose of which was to teach as many officers as possible the principles of the care of gunshot wounds and the splinting of fractures in the military service.19, c Most of the students who attended the school at its inception were officers reserved for orthopedic service and those detailed for duty with evacuation hospitals.92 In this school a great deal of work in the preparation of mechanical appliances was done, and a large number of plaster and gelatin casts of different parts of the body, to illustrate military surgical work, were made. These casts formed the nucleus of a museum of casts to be used in the teaching of military surgery.95, 112
Another phase of orthopedic work was covered in the School for Care of Feet, in which were taught elementary orthopedics, including the fitting of shoes and the treatment of minor injuries of the foot.8, 113 This school also conducted a gymnastic course for the reclamation of men who otherwise would have been discharged on account of flat foot. All student officers were required to attend this course.113
In December, 1917, the Surgeon General outlined a plan for the organization of the School of Military Orthopedics.114 In accordance with these instructions, the two schools already in operation were combined with a new course in didactic and clinical work, thus forming the School of Military Orthopedic Surgery,115 which continued to operate as such until December 24, 1918.116 The work of the newly organized school fell under three categories: 113, 115, 117, 118
Course A. - The soldier’s foot. To teach the care of the feet, shoe fitting, normal anatomy, and the common deformities of the soldier’s foot.
Course B. - Applied mechanics. To teach the mechanics of fracture dressings and appliances.
Course C.-Didactic and clinical. To conduct the didactic and clinical work of the school.
Student officers taking the first two courses were also in the basic course of the camp, but when they advanced to the third course their time was devoted exclusively to professional work.113 118
This professional work was outlined as follows:119
c This school afterwards became part of the School of Military Surgery (q. v.).
109
1.Subjects taught:
(a) Anatomy (30 hours).
(b) Pathology of bones (6 hours).
(c) Orthopedic surgery, didactic (24 hours).
(d) Orthopedic surgery, clinical (48 hours).
(e) Fractures (6 hours).
(f) Minor foot ailments ins military service (6 hours).
(g) Carrel-Dakin method (3 hours).
(h) Military hospital (6 hours).
(i) Ligations and amputations (3 honors).
(j) Nerve surgery (3 hours).
(k) X ray (6 hours).
(1) Neurology (3 hours).
(m) ?Literature Club? class (44 hours).
This consisted of the preparations of abstracts of the recent orthopedic bone and joint literature, their presentation to the class, and discussion thereon,.
2.Objects of course: In the absence of definite instructions the director of the course load the following objects in mind:
(a) The making of intelligent orthopedic assistants.
(b) Giving a thorough groundwork for future training in orthopedic surgery.
(c) Turning out medical officers sufficiently well equipped to become orthopedists in various types of field hospitals and, in some instances, base hospitals.
3. Duration of course, four weeks.
4. Total number of hours in course, 188.
This school continued in a rather unsatisfactory way until July, 1918, when it was reorganized and placed on a better footing. During this time small classes ranging from 15 to 25 officers took the course. 120, 121, 122, 123 After the reorganization instruction was given to officers reserved for orthopedic surgery and other officers desirous of taking this course. Before being assigned to the orthopedic school each officer must have completed at least two weeks basic instruction, though at first one month’s basic course was prescribed.” 118, 6
The following letter from the Surgeon General’s Office outlined the policy to be followed with the officers assigned to this school : 124
JULY 12, 1918.
From: The Surgeons General, United States Army.
To: The Commandant, Medical Officers’ Training Camp, Camp Creenleaf, Ga.
Subject: Student officers’ division of orthopedic surgery.
1. In order to present confusion and to expedite the handling of orthopedic personnel, the following procedure is recommended:
I. Student officers will be assigned to the camp in the usual way, in order that they may receive military training prior to assignment to special courses. This trainning should preferably be four weeks or longer.
II. Lists of student officers so ordered will be forwarded by this office to the commandant, and a second list forwarded the director of the School of Orthopedic Surgery, through the commandant. These lists will go forward as separate inclosures in order to lessens the chance of loss.
III. The personnel for special courses in orthopedic surgery will be chosen by the commandant and the list of available memo should be forwarded to this office on the 15th of each month; the assignment being effective the 1st of the following month.
IV. Orders for the removal of personnel from training camp will not ordinarily be requested by this office until information is obtained by telegraph or letter from the commandant regarding advisability of the same.
V. The director of the School of Orthopedic Surgery should report on the individuals of the special courses, on the forms provided, and these reports should reach this office not
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later than the 20th of the months. It is understood that these reports will necessarily not be complete but will give this office some data which, taken in connection with the report from the examining board, will facilitate distribution of the personnel.
VI. It is suggested that the director of the School of Orthopedics be given a copy of this letter and that he be empowered to communicate with this office, through channels, in in regard to personnel on duty at the above-named camp.
VII. It is suggested that the director of the School of Orthopedic Surgery prepare a card index covering the men in the various phases of training who are assigned to the above-named camp and reserved for the division of orthopedic surgery.
By direction of the Surgeon General:
DAVID SILVER,
Lieutenant Colonel, Medical Corps, N. .4.
The first class received the following instruction :122
Hours
Shop work.................................................................30
Anatomy....................................................................10
Lectures---didactic and clinical; quizzes and discussions of abstracts from orthopedic
publications...............................................................10
Pathology.....................................................................5
Xray............................................................................5
This allotment of hours was only tentative and is included to show the relative amount of instruction given in each division of the subject.
The instruction was divided into three parts:125 (1) A practical course for all officers in the medical officers’ training camp. (2) A similar but slightly less technical course given to 4 percent of all the medical enlisted personnel. (3) A special course for medical officers who were assigned to the orthopedic division. The general course for the medical officers’ training camp included lectures on the normal foot, with special reference to weight bearing and joint function; foot defects, including flat foot, weak foot, hallux valgus, hallux rigidus, hammertoe, bunion, etc., foot strain and its best treatment; the prevention and treatment of minor foot ailments and injuries, such as corns, calluses, blisters, etc., and the fitting and care of shoes. The second part of this course wa s special instruction in the use and application of splints used in the Army, and drills for the purpose of making enlisted men proficient in the rapid application of such splints as are used for the transportation of the wounded. The third division of instruction comprised lectures on the disabilities of joints.
Four percent of all enlisted men passing through this camp received a similar course of orthopedic instruction, with the exception of the lectures on joints.125
The special course for officers assigned to the orthopedic division was of four weeks’ duration and comprised didactic and clinical instruction in all branches of orthopedic surgery useful in the Army. Special effort was put forth to make the work practical and to eliminate everything which was unnecessary from the military standpoint.125 The work of the four weeks’ course was pportioned as follow: 125
During the first two weeks of the special school, a course in anatomy of the bones, joints, and muscles, particularly of the extremities, with the nerve and blood supply, was given. The latter part of this time was occupied with the actual performance upon the cadaver of the more common operations in this branch of surgery. The course was given in the school of anatomy.
111
During the third week, each morning was spent in the orthopedic shop in the basement of ward R, where a course was given in the manufacture of the standard Army splints, seven in number. The officers were taught welding, brazing, forging, and leather work so that they could make any apparatus ordinarily required. The manufacture and application of plaster of Paris splints was taught to sections of the class during the third and fourth weeks, in connection with the shop work, as the plaster room was too small to accommodate all of the class at once.
In the afternoons of the third and fourth weeks, clinical demonstrations of cases from the wards and out-patient department were held twice or three times a week. Didactic lectures were given by the staff on orthopedic subjects, such as injuries and diseases of the bones, joints, muscles, tendons, and nerves. The soldier’s foot and the military shoe were carefully considered. Four hours were devoted to work in the school of military Roentgenology, interpretation of plates being especially studied. The classes attended the lectures in the school of military surgery, on the use of the Carrel-Dakin method and the use of dichloramine-T. Experts from the neurosurgical school gave two lectures on peripheral nerve injuries and paralysis. The ward surgeon gave a demonstration of ward administration and paper work. The practical use of the standard splints and the Thomas splint drill were taught. A course in pathology, occupying the last hour of each day, was given by the laboratory school, and was attended by both the surgical and the orthopedic classes.
A new class was started every two weeks, so that while the old class was having its didactic and clinical work at ward R, the new class was in the dissecting room at Chattanooga.126 It was found that, as a rule, the members of the classes needed the most elementary instruction in anatomy, and in consequence the work in the dissecting room was of the highest importance. The weekly programs were made out in advance in consultation with the adjutant of the school of military surgery, and some of the lectures and demonstrations in both divisions were attended by both the orthopedic and the surgical classes. The Medical War Manual No. 4 was used as the standard textbook. The shop instruction for the four weeks’ course covered the following work:127
First week - Instructions in the principles of mechanical drawing and in the interpretation and making of such drawings, each man during this period making working drawings of the skeleton hyperextension splint (crab sphint) No. 714 and of the combined leg amid ankle splint No. 707.
Second and third weeks. - Men were instructed in shop practice and in the simpler metal-working operations, such as laying out, cutting, bending, forming, drilling, riveting, brazing, finishing, etc.
During this period each man made one of the following splints:
Skeleton hyperextension splint (crab splint), No. 714.
Combined leg and ankle splint, No, 707.
Thomas knee splint, No. 703 B.
In the case of several of the more apt men they also each made a hyperextension hand splint (cock-up), No. 713.
Fourth week. - During this period the time was devoted to plaster work. Instruction was given in the materials used and their properties, equipment necessary, preparation of bandages and their care, and in the technique of plaster application and use of apparatus.
Each man applied the following dressings: Straight cock-up splint of wrist, coaptation splint of arm, neutral elbow splint, neutral ankle splint, bracketed splint of leg.
Each two men applied: One of the various plaster jackets, spica of hip, humerus abduction dressing.
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The following schedules outline in detail the instruction given in the entire four weeks’ course in this school:128
FIRST WEEK
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 a.m. | Holiday | Postures and | Pathology | Patholody | Pathology | 9 to 11.30 a.m. |
10 to 11.30 a.m. | Holiday | Standard splints | Standard splints | Standard splints | As above |
11.30 a.m. to 1 p.m. | Lunch |
1 to 2 p.m. | Holiday | Trench foot | Quiz on splint drill | Septic arthritis, knees | Pott's fracture | Half holiday |
2 to 3 p.m. | Holiday | X ray | Tuberculous joints | X ray | Peripheral nerve | Half holiday |
3 4o 4 p.m. | Holiday | Back conditions | Osteomyelitis | Quiz | Half holiday |
SECOND WEEK
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 a.m. | Pathology | Pathology | Pathology | Pathology | Pathology | |
10 to 11.30 a.m. | Standard splints | Quiz | Examination | Quiz | Quiz | Feet and shoes |
Lunch
1 to 2 p.m. | Shopwork and plasterwork | Shopwork and plasterwork | Shopwork and plasterwork | Half holiday | ||
2 to 3 p.m. | Shopwork and plasterwork | X ray | shopwork and plasterwork | X ray | Half holiday | |
3 to 4 p.m. | Shopwork and plasterwork | Shopwork and plasterwork | Tuberculousjoints | Half holiday |
THIRD WEEK
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 a.m. | Shopwork and plasterwork | Anatomy, at University of Chattanooga |
10 to 11.30 a.m. | Shopwork and plasterwork | Anatomy, at University of Chattanooga |
Lunch |
1 to 2 p.m. | Clinic | Pathology | Pathology | Anatomy, at University of Chattanooga | Half holiday |
2 to 3 p.m. | Arthritis | X ray | Joint lesions | Anatomy, at | Half Holiday |
3 to 4 p.m. | Pathology | Clinic | Differential diagnosis | Anatomy, at | Half holiday |
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FOURTH WEEK
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 a.m. | Anatomy, at University of Chattanooga | Shop and plaster work |
Lunch |
1 to 2 p.m. | Anatomy, at University of Chattanooga | Patholody | Half Holiday |
2 to 3 p.m. | Anatomy, at University of Chattanooga | Half holiday |
3 to 4 p.m. | Anatomy, at University | Development battalion work | Draft examinations | Half holiday |
The school was originally quartered in ward R of General Hospital No. 14, which was one half of a two-company barrack in the post of Fort Oglethorpe. In October, 1918, the space was found inadequate and the other half of the building, ward Q, was assigned to the school. Ward R was used exclusively for classrooms and shops, and ward Q was used for the treatment of all orthopedic cases in this hospital and also was the out-patient department.129
The school closed December 24, 1918.116
SCHOOL OF MILITARY SURGERY
Prior to August, 1918, the only instruction given in general surgery was that included in the work of the School of Applied Surgical Mechanics.19 From the standpoint of general surgery this did not prove altogether satisfactory, 130 and on August 14, 1918, the School of Applied Surgical Mechanics was developed into the School of Military Surgery.131 The school thus organized completed its work and was closed December 24, 1918. 131
All officers reserved for surgery by the Surgeon General’s Office were required to take this course, after two weeks in the regular basic course.6 Even after work was started in the school the students were required to take military instruction until 9 a. m. and be present at retreat. The professional work was planned so as to minimize the didactic and accentuate the clinical and manual instruction.132 The hours devoted to instruction were 9 a. m. to 12 noon, and 1 to 4 p.m., except Saturday, when a half holiday was given.133 A study hour from 7 to 8 p. m. was also adopted. A student instructor was in charge during the study hour, and absolute quiet was maintained. From 8 to 8.15 p. m. a quiz was held.
After the armistice the general plan of the course was changed. Formerly, the surgery of acute and general traumatic conditions was taught, but later special emphasis was laid upon the surgery of convalescent and chronic types of cases, with the idea of preparing the student to care for the large number of such cases soon to arrive from overseas.134
A total of 701 officers received instruction in this school. 131
After completion of the course the students were classified as follows: 131 AA, Exceptionally good surgeons capable of high-class surgery and executive work; A, surgeons capable of conducting operating teams; B, surgeons capable of doing regular routine surgery, as hernias, appendectomies, etc.; C, qualified assistants; D, good ward men.
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Any officers found not capable of qualifying in any of the five groups were ordered back to the basic course, and recommendation was made to the Surgeon General’s Office to remove their names from the reserved list. 131
The course as outlined covered the following subjects: 131
Surgical anatomy.
Operative work on the cadaver.
Surgical pathology, particularly the reaction to trauma and infection.
Applied anatomy-operative work on the dog.
Trauma and infections of the urogenital tract from the military standpoint. (This was given to the first class.)
Trauma and infections of the eye and its appendages.
Opthalmoscopic examinations--every man, in sections.
Trauma and infections of the ear, throat, and nose.
Otoscopic examinations--every man, in sectiomos.
Fractures, splints, traction, plaster of Paris.
Application of standard Army splints. Every man was required to apply the Thomas splints to other men in the class.
Shock, hemorrhage.
Operative technique.
Trauma of Use cranium. (This was only givesn to the first class.)
Trauma of the face, jaws, and teeth. (This was eliminated from the later instruction.)
Ward technique:
Carrel-Dakin technique.
(a) Setting up of apparatus.
(b) Titration--every man in class.
(c) Application to patient.
Dichloramine-T technique. Dressing of patients.
Bacteriological control of infections.
Needling and transfusion. Every man in class; demonstration on each other.
Laboratory technique as applied to surgery:
Blood pressure.
Acidosis.
Application and interpretation of the flouroscope and X rays.
The disabling foot.
The disabling knee .
The disabling back.
Trauma of the chest.
Trauma of the abdomen.
The surgical complications of pneumonia.
Trench foot.
Gas gangrene.
Burns.
The acute abdomen.
The follow on to complete recovery.
Practical work:
The application of the regular splints, svith special reference to tise Thomas splints. Every man applied this splint to other men in the section.
Needling of veins.
Blood typing.
Carrel-Dakin solution titration.Dicloramine-T dressings.
Assignment to wards in the hospital
The following schedule of professional work shows the course followed by this school; 135
115
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
8 to 9 | Surgery: Mechanics and | Surgery: Basic principles on | Surgery: Hemorrhage, shock | Surgery: Infections and their | Surgery: Infections and their | Surgery: Trauma of skin |
9 to 10 | Pathology: Natural history of | Urology: Lesions of the | Pathology: Specific infecftions | Urology: Specific and nonspecific | Pathology: Repair of wounds | Urology: Affections of the |
10 to 12 | Practical demonstrations will be given every day. The students will be divided into | Orthopedics, |
1.30 to 2.30 | Medicine: Infectious diseases | Medicine: Infectious diseases | Medicine: | Medicine : Diseases of digestive system | Medicine: Diseases | Medicine: Dutyof the medical |
2.30 to 3.30 | Otolaryngology: | X ray: Cooperation between | Otolaryngology: | X ray: Uses and limitations of | Otolaryngology: Acute affections of | Laboratory: Lecture and |
3.30 to 4.30 | Quiz | Quiz | Quiz | Quiz | Quiz | |
Study | Study | Study | Study | Study |
SECOND WEEK
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
8 to 9 | Surgery: Trauma of skin | Surgery: Trauma of bones | Surgery: Trauma of bones | Surgery: Trauma of thorax | Surgery: Trauma of abdomen and | Surgery: The acute |
9 to 10 | Surgery: Injuries of the head | Urology: Affections of the | Ophthalmology: Injuries of the eye | Urology: Affections of the ureters and | Burns | Urology: Syphilis |
10 to 12 | Practical demonstrations will be given every day. The students will be divided into groups. These student groups will receive 4 hours instruction in each subject on 2 successive days. (See demonstration schedule) | Orthopedics:Care of feet |
1.30 to 2.30 | Medicine: Physical examination | Medicine: Acute diseases of the lungs | Medicine: Chronic diseases of the lungs | Medicine: Physical examination | Medicine: Common diseases | Medicine: |
2.30 to 3.30 | Orthopedics: | Laboratory: The laboratory service in the army | Orthopedics: Foot deformities, disabilities, and shoes | Surgery: Gas gangrene | Orthopedics: Derangements and dissabilities of joints | Laboratory: |
3.30 to 4.30 | Quiz | Quiz | Quiz | Quiz | Quiz | |
Study | Study | Study | Study | Study |
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SCHOOL OF NEUROSURGERY
The School of Neurosurgery was organized May 9, 1918,136 Lectures and clinics were held in the classroom set apart for this work and in the wards of General Hospital No. 14, Fort Oglethorpe. Selected medical officers sent to Camp Greenleaf for training were given full-time military training for 30 days, after which they were assigned to the school for instruction. By special arrangement the military training during the 30-day period stopped at 2 p.m., and from 2 to 5 p.m. the student officers received instruction in this school. From 6 to 8 p.m. dissections, post-mortems, quizzes, and reviews of current literature were held. All student officers assigned to Camp Greenleaf who had received any neurosurgical experience were examined by the director of the school, and those found qualified for this instruction were assigned to the school.
The instruction consisted of didactic lectures covering the anatomy, physiology, and pathology of the brain, spinal cored, and peripheral nerves; treatment of cerebral traumatisms, infections, etc., clinical material from General Hospital No.14 was utilized in the demonstration of nervous diseases. This work was divided as follows: 137
Lectures
10 hours. Physiological anatomy of brains, spinal cord and cranial nerves, with regional diagnosis.
14 hours. Gunshot injuries and traumatisms of the same with diagnosis, pathology, and the indications for treatment, technique, etc.
9 hours. Peripheral nerves, diagnostic syndromes, anatomy, and indications for treatment.
20 hours. Lectures and clinics on functional and organic nervous diseases.
8 hours. Pathology of meningitis, tumors, syphilis, wound repair, ductless glands.
8 hours. Eye, ear, nose, and throatin relation to intracranial lesions and diagnosis.0
Laboratory instruction:
16 hours. Bacterial counts, blood and spinal fluid examinations, post-mortem examinations, removal and preservation of specimens.
6 hours. General quizzing.
X-ray demonstrations:
4 hours. Interpretation of plates, fractures, brains tumors, foreign bodies, etc.
In July, 1918, the school was temporarily discontinued following the departure of the officers in charge to overseas duty.138 The section of brain surgery arranged to continue the school along the lines established by this officer, but his successor, after several months of observation of the conditions at Camp Greenleaf, officially advised against the reorganization of the school. His report embodied the suggestion that it was not possible to conduct such a school at Greenleaf. This was not approved by the director of the surgical services at General Hospital No.14, and this disapproval was concurred in by the Surgeon General. It became apparent to the section of brain surgery in September that the available neurosurgical personnel would be insufficient to meet the requirements of the Army if, as it then seemed likely, the war should continue until the spring of 1919. It was believed that the only available source of further personnel for the section was the Medical Officers’ Training Camp, Camp Greenleaf, where the majority of the members of the Medical Corps entered strictly military service. Such student medical officers, after military instruction for two weeks in the basic course, were generally assigned to the special schools in the camp for courses of professional instruction.
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The reorganized school opened November 12, 1918. 138 Quarters were provided for the school in the building occupied by the School of Military Surgery. The schools of military surgery, pathology, ophthalmology, otolaryngology, Roentgenology, and plastic and oral surgery cooperated in the organization of this school, and lectures by members of the staffs of these schools constituted an important feature of the course. The hours of instruction were 9 to 11.30 a.m., 1 to 4, and 6 to 8 p.m. Twenty student officers were admitted to the reorganized school after examination to determine their qualifications for this branch of surgery. As a general rule only those men were accepted who had experience in general surgery, although exceptions were made in the cases of recent graduates who had served an internship in some hospital where the neurosurgical service was in charge of men of recognized ability. A few of the students exhibited marked aptitude for the course, the majority showed great progress, and all were enthusiastic. It did not appear to the instructors that the possible element of risk involved in teaching so vast a subject in such limited time would constitute a real menace to well-established and approved lines of training in neurosurgery.
The aims of the school were primarily to make a more intelligent selection of personnel for the enlarging demands upon the section of brain surgery and to give such personnel instruction in the fundamentals of the subject as a preparation for further clinical instruction either at the New York Neurosurgical School or at some Army hospital with adequate clinical facilities.139 The instructors realized the impossibility of developing neurosurgeons by such a short course with the very limited clinical facilities at the camp. It was believed, however, that much could be accomplished by teaching the anatomy and physiology of the nervous system and the methods of routine neurological examination. The operative procedures in common use for brain trauma were emphasized. By arrangement with the University of Chattanooga, the anatomical department of this institution was used for work upon the cadaver and animal experimentation. It was thus possible to give a complete course in anatomy and to demonstrate a number of important physiological experiments having a direct bearing upon the problems of neurosurgery.
The schedule for the first week, November 12 to 16, 1918, was not full, owing to lack of instructors, but a full schedule was presented the week beginning November 18, 1918.140
The instruction in the reorganized school was outlined as follows:139
1. Anatomy and physiology (32 ½) hours). - These two subjects were taught together, so as to correlate closely structure and function. The subjects were taken up under seven topics, each topic considered in three ways:
(a) Lectures on the physiological anatomy.
(b) Anatomical demonstrations on the cadaver.
(c) Physiological experiments on animals.
The topics were as follows::
(1) Scalp, surface markings, osteology, blood supply, cerebrospinal circulation of the central nervous system.
(2) Vegetative nervous system, and glands of internal secretion.
(3) Peripheral nerves.
(4) Spinal cord.
(5) Hind-brain and mid-brain,.
(6) Cerebellumn and thalamus.
(7) Cerebrum.
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2. Pathology (3 hours). - Study of cerebrospinal fluid--normal and pathologic; hemorrhage, infections, tumors of cord and brain, thrombosis, embolism, abscess, syphilis; repair of nerves, with especial emphasis on degeneration; muscle atrophy, and the obstacles to normal repair of injured nerves arising from infection; autopsies and methods of preservation of specimens.
3. Operative surgery (cadaver) (29 hours) . - Demonstrations and lectures--immediate care of patients with war wounds of the nervous system; methods of wound sterilization and closure; treatment of hemorrhage and fracture, concussion, compression, contusion of brain; discussions of indications for surgical relief of traumatic intracranial pressure and decompression; prevention and treatment of hernia and fungus cerebri; discussion of foreign bodies; ventricular puncture and spinal puncture; injuries of spinal column and cord; laminectomy; injuries of peripheral nerves; methods of nerve repair; tumor of brain and cord; hydrocephalus; abscess; meningitis.
Operative surgery (animal); brain hemorrhage and laceration; wound closures; laminectomy and nerve suture.
4. Clinical neurology (18 ¾ hours) . - The course in clinical neurology comprised lectures, quizzes, and presentation of cases.
(1) History taking and writing.
(2) Physical examination and record.
(3)Sensory charts.
(4)Visual fields.
(5)Lumbar puncture indications; demonstration with pressure reading; interpreting in gross character of cerebrospinal fluid; laboratory examinations indicated; dangers and precautions.
(6)Epidural injections--indications; demonstration.
(7)Bárány test--purpose; interpretations; demonstrations.
(8) Fundi examinations.
(9)Case presentations.
(10) Symposium on syphilis.
(11) Lectures on the following: Paralysis; tremors; trophic disorders; diagnosis and localization of diseases of spinal cord; gaits; ataxia; convulsions; sensation; reflexes; eye, with regard to physical signs of pupil, physical signs aside from pupil, eye reflexes; speech disturbances; aphasias; cerebrospinal fluid; electrical reactions.
5. Ophthalmology (4 hours) .--Functional tests of ocular muscles, reflexes pupils, fundus. (Course by School of Ophthalmology.)
6.(a) Military surgery (4 hours).--Trauma, shock, hemorrhage, transfusion; early management of war wounds; principles of wound sterilization and healing; fractures, splints; Carrel-Dakin and dichloramine T technique. (Course by School of Military Surgery.)
(b) Roentgenology (2 hours) .--Fracture of skull and spine; localization of foreign bodies; Roentgenology in its relation to war wounds of the nervous system. (Course by School of Roentgenology.)
(c) Otology (3 hours) .--Tests for equilibrium; middle ear infections in their relation to sinus thrombosis and infections of the brain and its coverings. (Course by School of Otology.)
(d) Surgical technique.--Demonstration of surgical technique, at operations upon patients in General Hospital No. 14. Such patients were studied by the students whenever possible before and after operation. Whenever feasible, students assisted in operations.
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School of Neurosurgery--Class 1
FIRST WEEK (NOVEMBER 12 TO 16, 1918)
Tuesday | 9 TO 10 | 10.39 TO 12 |
Wednesday | 10 to 11:30 | 1 to 2:30 |
Thursday | 10 to 11 | L | 1 to 2:30 | 2 to 3 | |
Friday | 9 to 10 | 10 to 11 | N | 1 to 2 | 2 to 3 |
Saturday | 9 to 10 | 10 to 11:30 | P O |
SECOND WEEK (NOVEMBER 18 to 23, 1918)
Monday | 9 to 10 | 10 to 11.30 | 1.30 to 2.30 | 2.45 to 3.45 | 7 to 8 |
Tuesday | 9 to 10 | 10 to 11.30 | 1 to 3 |
| 7 to 8 |
Wednesday | 10 to 12 | 12.30 to 2 | 2 to 3 | 7 to 8 |
|
Thursday | 9 to 10 | 10 to 11.30 | 1 to 2 | 2 to 3.45 |
|
Friday | 10 to 12 | 12.30 to 2 | 2 to 3 | 6.30 to 7.30 |
|
Saturday | 9 to 10 | 10.15 to 11.30 | Half holiday |
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School of Neurosurgery--Class1--Continued
THIRD WEEK (NOVEMBER 25 TO 30, 1918)
Monday | 9 to 10 | 10 to 11.30 | 1 to 2 | 2 to 3 |
Tuesday | 10 to 12 | 1 to 3 | 6.30 to 8 | |||
Wednesday | 9 to 9.45 | 9.45 to 10.30 | 10.30 to 11.30 | 1 to 2 | 2 to 3 | 6 to 7.30 |
Thursday | 9 to 10 | 10 to 11.30 | 1 to 2 | 2 to 3 | ||
Friday | 9 to 12 | 1 to 3 | ||||
Saturday | 9 to 10 | 10 to 10.45 | 10.45 to 11.30 | Half holiday |
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Professional school-Practical demonstration daily, 10 to 12 a.m.
Subject | Place | Days | Numbers (all numbers are inclusive | |
Group 1.... | Splints and their application.. | Young Men's Christian Association annex at the medical | Monday and Tuesday. | 1-4 |
Each man will be numbered. According to the number given him, and by consulting this schedule, he will report to the group assigned his number, on that day., where the roll will be called, also by number.
The most serious defect of the course was the scarcity of clinical material for operative purposes.138 While the wards of General Hospital No.14 furnished a reasonable amount of material for the study of organic neurology, there were very few cases requiring surgical operation. It was possible, however, with the available cases to demonstrate thoroughly the methods of neurological examination, and in a more limited way a number of neurological lesions.
The element of time in the training of medical officers was important, for the camp school permitted both the strictly military training and professional instruction to be given during the same period.138 A further advantage of the camp school was the full-time service of the instructors, and this enabled an amount of individual instruction not usually found when private work is combined with teaching. It is admitted that the scope of such a school is necessarily limited and preparatory in character, but it may be reasonably claimed that under the conditions existing previous to the armistice, such a school could perform a service of definite and decided value.
Examinations were held at the completion of the course to determine the qualifications of the students for neurosurgical assignments.138 As a result of these examinations 7 of the 20 men admitted to the school were found fitted for assignments either as assistants or ward surgeons in a neurosurgical service. A number of the remaining 13 did not complete the course either because of leave, transfer orders, or discharge from the service.
The school was closed by a camp order, December 24, 1918.138
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SCHOOL OF OTOLARYNGOLOGY
The School of Otolaryngology was organized May 12, 1918, and the first class began its work on the 18th of the same month.142 A considerable number of student officers awaited instruction, and a class of 16 was detailed for that purpose. A room in ward Q of the general hospital was set aside as the lecture room and equipment sufficient to permit of beginning work the following week was gathered together. The school was operated in connection with the ear, nose, and throat department of General Hospital No. 14, and soon outgrew the quarters assigned to it. This led to the removal of the wards and the school, in July of that year, to McDonald Field, where two buildings and a half of a third building were assigned for its use. The lower floor of one of these (ward No. 29) was set aside for clinical and teaching purposes. It contained two treatment rooms, 31 by 10 feet, with concrete floors, electric lights, etc.; a well-lighted operating room, 24 by 21 feet, with concrete floor; a sterilizing room; a private treatment room for officers; a dispensary room; an office for the director; and a lecture room 48 by 24 feet in size. All of these were conveniently connected one with the other. The three wards together contained 128 beds, most of which were constantly occupied.
At the beginning the equipment of the department was exceedingly meager; one nasal speculum and a tongue depressor virtually represented all that the staff had to work with.142 A requisition for a complete list of instruments and equipment was early sent in, and in due time everything that was needed in an up-to-date ear, nose, and throat clinic, both for treatment and for teaching, was provided. Without such equipment it would have been impossible to do the work that was accomplished. The operating room was fitted up with two operating tables and a Holmes operating chair, an Ohio Chemical & Manufacturing Co. gas-and-oxygen outfit, an instrument cabinet, dressing cases, and other needed equipment. The sterilizing room was provided with an electric American Sterilizing Co. apparatus, capable of sterilizing all dressings and instruments for the department. Each treatment room contained four places for examination and treatment of patients, with a wash bowl at each place serving as cuspidor, and electric connections for lights. At the end of each room there was a place for the assistant in charge of the clinic to work. Each room was provided with a modern Wappler suction apparatus. The private treatment room also was well equipped and contained a Wappler suction outfit. The lecture room was provided with blackboards and a Bârâny turning chair.
The school was particularly fortunate in possessing an unusually valuable collection of sections of the head d, a good supply of wet specimens of the head c, a fine collection of lantern slides of the accessory sinuses f, and a collection of excellent slides of the ear.142 g Without these collections, satisfactory teaching would have been impossible.
The clinical material was abundant at times.142 At no time were there less than 1,200 patients, and often as many as 2,000 or 2,500, in the hospital. In
d Loaned by Lieut, Col. Harris P. Mosher, M. C., Boston, Mass., and Lieut. Col. William H. Haskin, M. C., New York City.
e A gift of Lieut. Col. C. W. Richardson, M. C., Washington, D. C.
f A gift of Maj. H. W. Loeb, M. C., St. Louis, Mo.
g A gift of Dr. B. Alexander Randall, Philadelphia, Pa.
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addition to this, the various camps scattered throughout the park contained as many as 60,000 troops at times and served as feeders.
Altogether, 110 student officers passed through the school.142 These were selected after careful examination by the director or his assistant, and represented only a portion of those who desired to take the course. On account of the limited time it was impossible to admit beginners, only those showing real fitness being received, and these were not allowed to continue the course in case they proved, after a short time, to be incompetent.
The course was planned to run from 4 to 6 weeks, but from the fact that the War Department did not order the men away at the end of that time it extended in may cases to 8 and 10 weeks.142 It was the endeavor to make the course as thorough as possible in the time allotted for it. It consisted of lectures and practical work, observation of operations, ward walks, and the performance of operations by the pupil himself as he showed his ability.
While care was exercised in the preliminary examination to exclude all who were not qualified, it was early found that every officer, without exception, required systematic instruction in the fundamental branches of medicine. To that end particular attention was directed to the anatomy of the nose, throat, and ear, and to the symptomatology, diagnosis, and treatment of the affections of those organs.143
Anatomy was taught by means of wet and dry specimens, by lantern slides, and upon the cadaver. The diagnosis and treatment of the various affections of the upper respiratory tract were taught by the various members of the staff. Illustrated and comprehensive lectures on the pathology of the upper respiratory tract were given by the department of laboratories. The importance of the X ray with reference to the diagnosis of the diseases of the upper respiratory tract was emphasized. The director of Roentgenology presented this subject to each class in a series of lectures, making use of the large collection of plates at his disposal. The director of the School of Ophthalmology lectured each month on the relationship of diseases of the eye to those of the ear, nose, and throat. It was felt that every student officer should have correct knowledge of the various anesthetics for operations on the ear, nose, and throat; accordingly, a course of lectures was given each month by the chief anesthetist of the hospital. The close relationship of otology to neurosurgery was recognized, and a series of lectures was given by the director of the School of Neurosurgery. The relation of diseases of the teeth to the specialty and the important subject of wound sterilization were also presented. A brief course of lectures on the history and literature of otolaryngology was given each month by the director, which included two clinical conferences.
The subject matter of all lectures was carefully reviewed each week by a series of quizzes which served to emphasize the principal points. While it was felt that the theoretical work was essential, it was recognized that the practical work was of greater importance. For this purpose the class was divided into groups of three or four and assigned to an individual instructor, under whose direction each student officer, provided with the proper instruments, each day worked in the clinic of the department, making examinations and following out treatments. The afternoons were largely devoted to witnessing operations, of which General Hospital No. 14 afforded a rich variety, and to ward walks.
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As an officer showed himself qualified, he was permitted to perform or to assist in various operations under proper supervision. Those who had shown particular ability in the course, upon its completion were taken into the wards as student assistants. This afforded an opportunity for them to receive more careful instruction and also allowed a more complete estimate of their qualifications. Those who showed particular merit were assigned to the hospital staff and remained in this capacity until they were ordered out of the camp. In this way a constant succession of qualified officers passed through the hospital, the wards of this department serving, as it were, as an advanced postgraduate training school.
Each month the class was taken into the school of anatomy (q. v.) and given an opportunity to perform the principal operations on the nose, throat, and ear under the direction of an instructor. At the end of the course each student officer was given a patient of whom he was required to make a complete examination and to report his findings in writing. A written examination covering the lectures of the course was given to each officer. Based upon the results of the examinations, together with his work in the quiz and in the practical courses the officer was rated.143
The school closed in December, 1918.72
SCHOOL OF OPHTHALMOLOGY
This school had been in contemplation for a considerable period of time prior to its organization, and from June 15 to June 20, 1918, with the approval of the commandant of the camp, a preliminary survey was made of the available buildings and of the clinical material, the possible courses of instruction in ophthalmic work, and, in cooperation with other schools already established or in process of establishment, of the laboratory facilities, the staff required, and the standards for admission. The results of this survey, incorporated in a report which was submitted to the Surgeon General and to the commandant of the camp, were approved.144 On August 7, 1918, preliminary lectures and demonstrations were begun, and on August 12 the formal opening of the school took place. The building. - A new two-story ward building of General Hospital No. 14 was placed at the disposal of this school, to which building, after completion of the necessary alterations, the ophthalmic service was transferred. The first floor was arranged and equipped as follows: There were two rooms for refraction, each provided with trial cases, standard test-type cards, all the necessary apparatus for muscle testing, and with blackboards utilized during the hours of instruction.
Adjoining the rooms for refraction, eight stalls for retinoscopy and ophthalmoscopy were erected. These stalls faced a large room where the class of student officers might gather during the hours of didactic instruction and lantern demonstration, and where perimetry was taught and practiced. The stalls for retinoscopy and ophthalmoscopy were hung with heavy curtains, which could be drawn aside or not, as the conditions required, and in the central one a lantern screen was readily adjusted, its dark surroundings enhancing the distinctness of the pictures. If necessary, the lantern could be moved to either
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of the refraction rooms, where it was used in the lectures on the theory of refraction and physiologic optics. The refraction room, and the one containing the retinoscopy stalls were in communication with it through a doorway. There was a large room in one end of which the appliances for the practical optician’s work were stationed, and where all of the adjustment was made of the spectacle frames in which the lenses, ground according to the formulas furnished by the ophthalmologists, were mounted. In this room, as arranged, were also the tables for the clinical clerk, who recorded each patient referred to the service and who made the preliminary visual tests and took the history. Between the area devoted to the optician’s worktable and the record table there was ample space and equipment for the treatment of the external diseases of the eye. This room communicated by a double doorway with a covered porch which ran the whole length of the building, and which was utilized during the summer as a waiting room. Facing the large room previously described was a room for operations on animals’ eyes (pigs’ eyes, sheeps’ heads, etc.), a small, well-equipped room for operations on human eyes, and an office for the chief of service and for storing the records. A commodious, admirably appointed operating room in the otolaryngological building, which adjoins the eye ward, was also at the service of the ophthalmologic staff. Operations requiring general anesthesia were performed here.
In the remaining space of the first floor of the eye building was situated a ward of 16 beds. Rooms for nurses, linen, toilets, etc., had their usual relationship to this ward.
Such an arrangement of communicating rooms rendered the examination and the assortment of patients easy, and was advantageous in the division of the student officers into classes, according to the work to which they were assigned; that is, the treatment of external diseases of the eye, perimetry, retinoscopy, ophthalmoscopy, ward instruction, operations, refraction, etc.
Equipment. - In addition to the usual equipment for an active eye service which was to be utilized in teaching, to wit: Trial cases, perimeters, surgical instruments, stereoscopes, giant magnets, tonometer, etc., certain special equipment was procured as follows: (1) A lantern for the projection of opaque objects and slides; (2) several hundred lantern slides h (3) about 200 microscopic slides illustrating the histology and pathology of the eye; (4) sets of Oat-man’s plates (“Diagnostics of the Fundus Oculi”), with the necessary stereoscopes; (5) a thermophor.
The clinical material . - The material for the clinic and the course of instruction was obtained (a) from the regular dispensary service of General Hospital No. 14; (b) from the patients in the eye ward of the same hospital; (c) from the recruits as they were examined in the camp infirmary of Camp Greenleaf and the recruit depot at Lytle; (d) from the patients in the general medical, surgical, and the neurological wards of General Hospital No. 14.
The student officers. - The student officers in the medical officers’ training camp were assigned to the various schools in operation as they qualified in the preliminary examinations, which were held daily for the purpose of making
h For the most part these were duplicates of slides used by Lieutenant Colonel de Schweinitz in the University of Pennsylvania, to which, through the kindness of Dr. Howard F. Hansell and Dr. William M. Sweet, a number of slides were added, duplications of those employed in Jefferson Medical College, Philadelphia.
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this selection. The largest number of those who found entrance into the School of Ophthalmology had, prior to their assignment to Camp Greenleaf, been “exempt to ophthalmology,” on the files of the Surgeon General’s Office; but, a certain number were selected from among those who had entered the service without such exemption, but who at their original investigation on arrival at the camp had expressed a preference for this special type of medical and surgical work. The preliminary entrance examinations were always conducted by the director of the School of Ophthalmology, or by one of his staff, and should the applicant qualify for the school, as soon as he had completed his period of military training he received his assignment, these assignments being made on the first and fifteenth of each month.
Length and outline of the course. - The length of the course was four weeks. The hours of instruction were daily from 9.30 to 11.30 a. m., and 1.30 to 4.30 p. m., except on Saturdays, when the instruction, which consisted in a series of quizzes covering the week’s work, concluded at 11.30 a. m.
The outline of the course may be briefly summarized, as follows: Two hours daily, except on Saturdays, of systematic didactic teaching, including a review of the theory of refraction, muscle testing, other functional testing, anatomy and histology of the eye and its appendages, external diseases, ophthalmoscopy, ophthalmic neurology, and operations. These lectures were illustrated by means of the lantern, diagrams, freehand drawings, etc. Particularizing as to the days: On Mondays and Tuesdays three and one-half hours, and on Wednesdays, Thursdays, and Fridays one and one-half hours, were devoted to practical instruction in refraction, muscle testing, and diseases of the eye. On Wednesdays, Thursdays, and Fridays, two hours of each day were devoted to operative ophthalmology, the director or one of the staff performing operations on the patients who came to the eye service in General Hospital No. 14, and on patients referred to the director through the courtesy of one of the eye surgeons in Chattanooga. The student officers themselves performed the usual operations on pigs’ eyes and sheeps’ heads.
During each course two lectures of two hours each were given to the combined class of ophthalmology and otolaryngology, one on the eye complications of sinus and mastoid diseases, and one devoted to the subject from the standpoint of the otolaryngologist. At the request of the director of the School of General Surgery, two lectures were given to his classes during the course on the treatment of injuries of the eye, and two hours per week were devoted to practical work in ophthalmoscopy.
During the course two hours were set aside for instruction in the bacteriology and pathology of the eye; and this instruction was given in conjunction with the department of pathology, and concerned itself with the study of the sections to which reference has been made and with the bacteriologic examinations of the conjunctival sac, corneal ulcers, etc. One hour was devoted during the course to X-ray localization of foreign bodies in the eye, under the auspices of the X-ray department. Through the courtesy of the department of surgery, the class in ophthalmology had the opportunity of devoting one hour daily to eye work in the genitourinary ward of United States General Hospital No. 14, going to these wards in sections, and having the advantage, therefore, of
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studying the specific infections of the eye. The same opportunity, and in a similar manner, was afforded the class in the medical, neurologic, and surgical wards of the hospital, whereby a wide range of ophthalmoscopic work was covered.
Each Saturday morning a quiz was conducted by the director and instructors, one hour for the class as a whole, and one hour for sections of the class. The quizzes were both oral and written, and the week’s work was reviewed. During ward instruction, practical paper work, the method of keeping records and cross indexing were demonstrated. Naturally, the schedule of instruction was elastic, and the number of hours assigned to any particular topic might be altered as was deemed necessary.
Examinations. - The examinations for entrance into the School of Ophthalmology have been briefly referred to. At the conclusion of each four weeks’ course the student officers of the class were graded according to their personality, according to the character of their work, both practical and theoretical, of which cognizance had been taken by each instructor, who turned in his report on each officer with whose work he had been specially concerned, and, according to an examination which was both oral and written. All reports and examination papers were reviewed by the director of the school, who determined the grade. It was upon this final examination, thus arranged, that the officer‘s ultimate retention for ophthalmic work in the Army was based.
The staff. - It was determined that the personnel of the staff of the School of Ophthalmology should consist of a director of the school, who should also be chief of the ophthalmic service of General Hospital No. 14, and eight instructors, one of whom should also act as ward surgeon. Naturally, the number of instructors was subject to change, according to the needs of the school and the character of the classes. The instructors were carefully selected according to their qualifications, determined by their records as teachers and practical ophthalmic surgeons in civilian life, prior to their entrance into the Medical Corps of the Army.
Instruction. - The School of Ophthalmology was organized and was in operation for the purpose of training ophthalmologists who had entered the service as such and were assigned to the medical officers’ training camp for instruct-ion. It afforded to student officers, even though they had in civilian life devoted long periods of time to eye work, an opportunity for postgraduate ophthalmic instruction which proved to be of the utmost service. It permitted all who were engaged in this work, either as instructors or as student officers, to approach their duties from the military standpoint and its necessities, not only as they existed here, but as they obtained overseas. The advantage of observing and learning the technique of the ocular examination of recruits and registrants was a good example of the type of such work. In so far as possible, emphasis was placed on the instruction which fitted the officers for ophthalmologic service abroad. In this respect the observations which were made during several months of inspection in France and England of British, French, and our own hospital systems, had been utilized in preparing the schedules of instruction, supplemented by advices received from time to time from the overseas eye service.
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A feature of importance in the School of Ophthalmology was the work which had been maintained in cooperation with the other schools at Fort Oglethorpe, to which reference has already been made, notably the School of Surgery and the School of Anatomy, the School of Otolaryngology, the X-ray department, and the departments of pathology and bacteriology. The excellent opportunities for medical ophthalmoscopv in the wards of General Hospital No.14 have been noted. The recently established School of Oral and Plastic Surgery had already made it- possible for the student officers of the ophthalmic classes to learn in a broad sense the principles of plastic surgery so necessary in acquiring the technique of blepharoplastic work--operative work of the utmost importance in ophthalmic war surgery.
The school and its work put the Surgeon General in possession of information according to which requests for the assignment of ophthalmologists to various base hospitals in this country and base and evacuation hospitals abroad could be made with an intelligent understanding of their capabilities, because each week the records of the student officers in practical work and their grades acquired according to examinations were transmitted to those who were responsible for their assignment.
As has been pointed out, the preliminary examinations for entrance into the School of Ophthalmology decided whether it was desirable that the student officer should enter the class for ophthalmic training, or whether his acquirements were such that he could be more suitably employed in some other department of military medical or sanitary science. These examinations further decided whether the previous training and experience of the student officer in civilian life had been such that it was necessary for him to add to his ophthalmic qualifications, i. e., whether he should be at the conclusion of his military training immediately assigned to ophthalmic duties here and abroad. But for those who entered the school it was the final examination after the completion of the course which determined whether an officer should continue his work in the Army as an ophthalmic surgeon, or should be assigned to other types of work for which he was more definitely suited.
The clinical material which was available for this school was unusually rich, largely on account of the permission which was granted that the recruits who were examined, as before stated, should be utilized for ophthalmic examination. The cases which came under observation and those retained for treatment compared favorably with those in any active ophthalmic service in civilian life.
Although the number of operations on human eyes was comparatively limited, excellent material in this respect was available, and all the important ophthalmic operations were readily demonstrated by means of sheep’s heads and pigs’ eyes, and not only demonstrated, but the student officers themselves were given the opportunity to perform them. The pigs’ eyes were removed with all of their orbital attachments and surrounded by a considerable area of the skin, and therefore with complete preservation of the lids, making it possible to perform the important ophthalmic operations exactly as if they were being done on the human subject. According to an arrangement with the School of Anatomy, ophthalmic operations on the cadaver were performed.
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Prior to the establishment of the Ophthalmic School the attendance in the eye service was about 260 new patients a month. This attendance rapidly increased until the new patients per month amounted to between 500 and 600, and during periods when large numbers of recruits were sent from the recruit depot and camp infirmary for examination (and all of the recruits presenting interesting ocular findings were referred to the eye clinic) as many as 1,500 new patients were examined in one month. Naturally, the recruits were not retained as patients, but none the less they were utilized in the ophthalmic instruction.144
Even with this number lack of clinical material was the biggest defect in making for the best possible course.145 This could have been overcome partly by placing the director of the school in charge of all of the eye work in the entire camp, as a great deal of good material was lost by not referring interesting and important cases to the school. An exception was the camp infirmary, which heartily cooperated in every way.
Inadequate space for handling large classes was perhaps of secondary importance. At one time there were 61 student officers in the school and it was utterly impossible to properly take care of them. Equipment had been lacking in the way of refraction cases, trial frames, proper illuminating fixtures for test charts, etc. Painful delay was often experienced in securing batteries for electric ophthalmoscopes and such minor things.145
If the course had been lengthened to eight weeks, or even six weeks, instead of four, the men could have been trained to much better advantage, and a great number of officers could have been taken in the school and used as assistants afterwards who were lost to the department.
The total number of student officers examined for the course in ophthalmology was 185, of whom 129 were found qualified for the course; of these, 109 were assigned to the course, 93 being finally qualified.145
The dominant thought in teaching was primarily to instill the idea of system and thoroughness--systematic method of making external examinations, and of making records and reports. It was found that even with physicians with practical ability and excellent reputation, the lack of system, admittedly, was their most serious defect.145
Schedule of course in ophthalmology for December, 1918.145
FIRST WEEK
Monday | Tuesday | Wednesday | Thursday | Friday | |
9 to 10 a.m. | Lecture: "Routine of examination of patients" | Lecture: "Retinoscopy | Lecture: "Physiological optics" | Lecture: "Functional testing" | Lecture: "Lids and lacrymal apparatus" |
10 to 11:30a.m. | Practical work | Practical work | Practical work | Practical work | Practical work |
1:30 to 2:30p.m. | Lecture: "Refraction" | Lecture: "Muscle testing" | Lecture: "Surgery of lids" | Lecture: "Principles of plastic surgery" | Lecture: "Surgery of conjunctiva" |
2.30 to 3.30p.m. | Practcal work | Practical work | Practical work | Practical work | Practical work |
3.30 to 3.45p.m. | Quiz; conference | Quiz; conference | Quiz; conference | Quiz; conference | Quiz; conference |
Saturday, 9 to 11 a.m., quiz
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Schedule of coterse in ophthalmology for December, 1918--Continued
SECOND WEEK
9 to 10 a.m. | Lecture: "Conjunctiva | Lecture: "Cornea" | Lecture: "Uveal tract" | Lecture: "Media and sclera | Lecture: "Fundus" |
10.30 to 11.30 a.m. | Practical work | Practical work | Practical work | Practical work | Practical work |
1.30 to 2.30 p.m. | Microscopical pathology; progressive sectional groups | Microscopical pathology; progressive sectional groups | Lecture: "Surgery of conjunctiva" | Lecture: "Surgery of eye muscles" | Lecture: "Surgery of orbit" |
2.30 to 3.30 | Practical work | Practical work | Practical work | Practical work | Practical work |
3 to 4 p.m. | Lecture: "Accesory sinuses" | ||||
3.30 to 3.45 p.m. | Quiz; conference | Quiz; conference | Quiz; conference | Quiz; conference |
Saturday. 9 to 11 a.m., quiz
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Practical work in the course included :145 Refraction; muscle testing; outlining visual fields and scotomata; examinations of fundi in wards and clinic; examination of external diseases in patients in wards and clinic; operations on pigs’ eyes and on patients in General Hospitals No. 14 and in West-Ellis Hospital in Chattanooga. The talks on surgery were illustrated by lantern slides and drawings and were followed by the operation itself on animals’ eyes, patients, or cadaver; also practical paper work and demonstration of method of keeping records and cross indexing. In quiz conference held daily at 3.30 p. m., the student officers asked questions of the director concerning anything that had come up during the day. This schedule showed the final development of the school.
The school closed December 24, 1918.72
SCHOOL OF UROLOGY
The School of Urology was organized during February, 1918. The first course of instruction began on March 1.146 The school was established in the base hospital at the camp, the genitourinary service of which was thoroughly reorganized and an excellent clinic arranged for purposes of teaching. The courses given were intensive, but thorough. The curriculum provided for theoretical instruction and the practical application of the most advanced methods, the clinical material being provided at the hospital. All laboratory work in connection with this service, with the exception of Wassermann tests, was done in the genitourinary ward, by student officers under competent supervision. Dark field illumination examinations were made daily and every man was taught the use of the endoscope and the cystoscope.146
Many of the applicants for instruction in the school were found, upon examination, to be better suited to other branches of medicine, and were transferred accordingly.147 In order to select properly qualified men, all student officers who applied were examined before they were taken into the classes, the examinations being oral, written, and practical. It was the object of the director to take such qualified men as were left, and to give them the excellent advantages offered by the clinic.
It was not hoped to make surgeons of these students, but the purpose was to acquaint them with the important points in urology. The subjects taught comprised differential diagnosis, genitourinary therapy, clinical laboratory work, minor surgery, endoscopy, cystoscopy, urethral catheterization, renal functions, diagnosis and treatment of lues.148
The diagnosis and treatment of chronic gonorrheal urethritis and its complications was stressed in order that officers who became qualified for assignment to organizations, would be fully equipped to aid in the solution of the problem of noneffectives, the result of gonorrhea, many thousand of such cases having been accumulated in development battalions.148
It was soon found desirable by the director to secure an assistant, especially trained in laboratory and clinical microscopy; this proved of great advantage, not only to the student body, but also to the general hospital, in the recognition and intelligent conduct of such cases classified as venereal and genitourinary. About the same time it was also found necessary to have assigned to the school
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an assistant especially trained in the diagnosis and treatment of dermatological cases.149
The course of instruction extended over a period of approximately one month. The first two classes contained 7 and 8 students, respectively, 150 but later the classes became much larger, reaching approximately 40 men in September, 1918. 151
The school closed the latter part of December, 1918.72
SCHOOL OF PLASTIC ANDORAL SURGERY
The School of Plastic and OralSurgery began its work October 22, 1918.152
Only twoclasses receivedinstruction, and the school closed December 24, 1918.153
Theclassrooms used were in the building occupied by the School of MilitarySurgery. The course given from October 22 to November 16, 1918,with the amount of time devoted to the various subjects, is outlinedbelow: 152
Surgical anatomy of head and neck: Hours
Demonstrated by specialdissections oncadaver.....................................15
Demonstrated by specialdissections on bones of theface.......................5
Demonstrated by lantern-slideillustrations..............................................2
Didactic lectures andrecitations................................................................5
Total...............................................................27
Operative course:
Principles of plastic surgery(didactic).....................................................10
Plastic methods on thecadaver.................................................................15
Plastic methods on anesthetizedanimal.......................................................2
Plastic methods on eyelids andconjunctiva (pigs' headsused)...................4
Total....................................................31
Fractures of jaws:
Fractures and theory of jawsplinting(didactic)..............................................3
Descriptions and lantern-slideillustrations on types ofsplints......................................................1
Practical demonstration of dentalappliances used in treatment of jawfractures.............................1
Practical demonstration ofprosthetic appliances used in maintaining contour of face during
period ofreconstruction...................................................1
Total.................................................................6
Anesthesia:
Local anesthesia -
Varieties, methods of use,technique, anatomic locations of points fornerve
blocking, conditions in which applicable, whenadvisable...................................4
General anesthesia—
Varieties and methods of administration. Precautions to be taken before,
during, and after operations, intratracheal method described in detailand
technique of introduction of tube shown on cadaver intrapharyngeal
and intranasalmethods............................................................3
Total..............................................................7
Wounds of face, mouth, and jaws:
Trauma of skin and underlying softparts........................................1
Injuries to salivary glands and their ducts, salivaryfistula.................................2
Wounddressings....................................................2
Value of rest in treatment ofwounds.....................................................1
Infections and theircontrol.......................................................2
Complications and theirtreatment.....................................................3
Total.......................................................11
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Miscellaneous subjects: Hours
Mouth infections............................................................2
Necrosis of jaw....................................................1
Tumors of the jaw and the tongue...................................2
Diseases of the sinus maxillaris of oral origin....................2
Burns and methods of treatment.....................................1
Deformities due to scar tissue contractions........................2
Skin grafting—Varieties and technique........................2
Hemorrhage and shock...............................................2
Intravenous injections and blood transfusion..............................1
Postoperative care ofpatients.............................................1
Nerve trauma in repair—Repair of divided nerves,neuralgia...........3
Roentgenology in its relation to plastic and oral surgery.................2
Total..................................................21
Total length of course.........................................................103
Subjects of lectures and demonstrations given to class No. 1 by the staff of the School of Plastic and Oral Surgery, Camp Greenleaf, Chickamauga Park, Ga., from October 22 to November 16, 1918:
Basic principles of plastic surgery.
War injuries of face and jaws. Types and treatment.
Demonstrations of plastic methods and types of operations shown on cadaver and on anesthetized animals.
Fractures of jaws. Varieties of splints most applicable.
Mouth infections. Necrosis of jaw.
Bone grafts and cartilage transplants.
Skin grafting.
Scar tissue contractions. Results of operative measures to correct.
Salivary fistula. Ranula.
Surgical anatomy of head and neck, with demonstrations of special dissections.
Principles of plastic surgery.
Plastic operations on cadaver and anesthetized animal.
Local anesthesia. Detailed technique.
General anesthesia. Precautions before, during, and after. Intratracheal and intrapharyngeal technique.
Injuries of the tongue and floor of the mouth.
Fractures of the jaws.
Complications following mouth injuries.
Tumors of jaw.
Nasal deformities.
Injuries of salivary glands and ducts.
Burns.
Skin grafts: Varieties. Technique.
Hemorrhage and shock.
Intravenous injections and blood transfusion.
Semiweekly reviews and quizzes on important practical points.
Review of principles of plastic surgery.
Subjects of cooperative lectures and demonstrations given the students in the School of Plastic and Oral Surgery by the directors and instructors of other schools at Camp Greenleaf from October 22 to November 16, 1918:
School of Military Surgery
Trauma.
Infections and their control.
Value of rest in the treatment of wounds.
Demonstration of wound dressing.
Bacteriologic control of wounds.
Carrel-Dakin treatment.
Dichloramine-T.
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School of Otolaryngology -
Surgical anatomy of the nasal area.
Infections of the sinus maxillaris of traumaic origin.
School of Ophthalmology -
Emergency treatment of eye injuries.
Plastic operations on eyelids and conjunctiva. (Demonstrated on pigs’ heads.)
School of Roentgenology - X ray in its relation to plastic and oral surgery.
School of Neurosurgery -
Nerve trauma.
Nerve repair.
Neuralgia.
School of Dental Surgery -
Dental appliances used in treatment of jaw fractures.
Prosthetic appliances used in maintaining contour of face during period of reconstruction.
The schedules for the first class were as follows: 112
Class 1. - School of Plastic and Oral Surgery
FIRST WEEK (OCTOBER 22 TO 26, 1918)
Hours | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 | Head injuries | Fractures of jaws (illustrated by lantern slides) | |||
10 to 11 | Demonstration of elasticity of tissue; transverse incision suturing | Anatomy of scalp and superficial portions of face and neck | Treatment of fractured jaws | ||
10 to 11:15 | Muscles of mastication; their influence in misplacing fragments in fractured jaws;burns and scalds | Entire day given to addresses by surgeons of England, France, and Italy dealing with surgical procedures used to greatest advantage in dealing with was wounds | |||
11 to 12 | Demonstration of lip and mouth injuries approximated so as to form a red epithelial border; flap from forehead to repair defect in cheek; flap from neck to repair defect in cheek; flap from forehead to form a new nose. | Wonds and contusions and the principles underlying their treatment; special consideration of wounds of the mouth and their complications |
135
Class 1. - School of Plastic and Oral Surgery--Continued
FIRST WEEK (OCTOBER 22 to 26, 1918) - Continued
Hours | Tuesday | Wednesday | Thursday | Friday | Saturday |
12 to 2 | Lunch and study |
2 to 4 | Importance of suffcient width of base, and |
| Practical demonstrations of wound dressings | Hal holiday |
2 to 3 | Mouth infections | |||
3 to 4 | Lantern demonstration of operative results |
SECOND WEEK (OCTOBER 28 TO NOVEMBER 2, 1918)
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 | Surgical anatomy of the nasal area; wet and dry | Surgical anatomy | Surgical anatomy | Principles of | Entire day's work in anatomic rooms | Value of rest in |
10 to 111.30 | Injury to salivary glands and their | Mouth infections, necrosis | (Anatomic room.) | Traumatic conditions of | Ligations of vessels of neck. | Hemorrhage and |
12 to 2 | Lunch and study |
2 to 3 | Complicationsfollowing injuries about face jaws, and treatment | Relations of bones of faceand points | Operations upon anesthetized | Dental appliances used in | Plastic operations reconstructing area about eyes; resections of temporomandibular joint | Half holiday |
3 to 4 | Trauma of skin and underlying soft parts |
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Class 1.- School of Plastic and Oral Surgery
(THIRD WEEK (NOVEMBER 4 TO 9, 1918)
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 | Entire day devoted to anatomic work | Entire day devoted to anatomic demonstrations | Nerve trauma; | Trauma | Infections and | Local anesthesia |
10 to 11.30 | Specially prepared dissections of head | Quiz and review of basic principles of plastic | General anethesia, varieties | X ray in its relation to plastic | Weekly reviewof practial |
11.30 to 1.30 | Lunch and study |
1.30 to 2.30 | Plastic surgery in the area | Plastic surgeryof the | ||
2.30 to 4 | The nasal accessory sinuses in | Practical work;operations, | Practical work operations | Half holiday |
FOURTH WEEK (NOVEMBER 11 TO 18, 1918)
Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 10 | 9 to 10 | 9 to 10 | 8.30 to 12 | 9.30 to 12 | Diseases of the maxillary sinus |
10 to 11.30 | 10 to 11.30 | 10 to 11.30 | 10 to 11.30 |
11.30 to 2 | 12 to 1 | 11.30 to 2 |
2 to 3 | 2 to 3 | 2 to 3 | 1 to 3 | 1 to 3 | Half holiday |
3 to 3.45 | 3 to 3.45 | 3 to 3.45 |
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SCHOOL OF MILITARY ROENTGENOLOGY
The School of Military Roentgenology was established January 2, 19 18,154 and closed in January, 1919. 106
The function of the school at this time was to select the medical officers best. fitted for service as Roentgenologists, and to give them a preliminary course of instruction in the following subjects: Principles of interpretation anatomy (particularly of the bones and joints) as revealed by X-ray plates; pathologic changes; standard radiographic positions (drill); fluoroscopy; stereoscopy; report writing, and the handling of exposed plates. This work was carried on in the X-ray department of the base hospital, Fort Oglethorpe (General Hospital No. 14), which consisted of a radiographic room, a fluoroscopic room, and a very small developing room. The space was inadequate, but the clinical material was extensive, and the enthusiasm of the instructors, as well as student officers, was of a high degree. It was apparent that much could be accomplished in larger quarters, and it was the early conviction of the director that with adequate accommodation and equipment, there were many advantages in favor of making this a school for a complete course of training, where all such training in. the United States could be accomplished.
Because of the crowded condition of the hospital, extra space was difficult to obtain. During the latter part of March steps were taken to secure post barracks building S for the X-ray department of the hospital. The localization laboratory, consisting of six complete units, was installed in temporary quarters, so that instruction in localization of foreign bodies was started on July 17. The elementary and advanced physical laboratories were installed in hospital tents and were ready for operation when electric current was first available on July 24. By working three sections a day the student officers of the previous classes had received their final instruction in machine construction, repair and operation, and in localization of foreign bodies, by August 6, and their work was so arranged that the class entering the school August 1 could take up the regular assignments of the complete course. Work in the tents and temporary localization laboratory continued throughout the time that the building S was being arranged for the X-ray laboratory of the hospital for the permanent quarters of the school. These changes were practically completed by the middle of August, 1918.
No sooner had the new building been occupied than it. was called upon to take larger classes. The space and assignment sheet permitted of doubling the output, and it was decided to shorten the course to two months in order to hasten the supply of Roentgenologists. In shortening the course, the more advanced clinical instruction was sacrificed more than work in localization of foreign bodies, the machine course, and the anatomy and position drill.
By the middle of September the school was called upon, in the following communication, again to double the number of student officers and enlisted men; or, in other words, to furnish 100 officers and 100 enlisted men each month.155
1 Based, in the main, on: The Camp Greenleaf School of Roentgenology” by Lieut. Col. Willis F. Manges, M. C published in the Americas Journal of Roentqenology, New York, 1919, vi, n. s., No. 7, 305.
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SEPTEMBER 28, 1918.
From:The Acting Surgeon General, United States Army.
To:Maj. Willis F. Manges (through the commandant), Camp Greenleaf, Ga.
Subject: Memorandum on enlargement of school of Roentgenology.
1. Arrangement of course. - Capacity of school desired:
Medical officers each month.......................96
Manipulators each month...........................96
Manipulators, to be trained at Army Medical School during temporary stress, per month.........48
The principal business of the Camp Greenleaf school is to properly train medical officers,
and this should not be lost sight of in the effort to turn out manipulators. A greater number of
manipulators than 96 would be welcome, but it is believed that it would interfere with giving
proper attention to the medical officers. Of the medical officers, the training is to be as follows:
Men qualified in interpretation and the medical phases of the work to handle base
hospitals........................................................72
Men well qualified only for localization..................................24
96
Men especially qualified to operate base hospital type of apparatus.................24
Men especially qualified to operate portable unit......................................72
96
Of the manipulators, training to be substantially equal for all men. The courses as arranged in the outline submitted is excellent and should prove very workable. The use of trays for developing instruction is indorsed. It conforms to practice of the schools of aerial photography at Rochester and Ithaca. Present plans for the manipulators’ course are heartily approved. A copy of the outline of the course and series of questions for the guidance of instructors, as mentioned in the plan of instruction of manipulators just submitted, is desired by this office when the outline is compiled.
It is the firm opinion of the undersigned that four students per machine can not be properly instructed in the elementary laboratory. There just isn’t room for 24 men and the necessary instructors in the laboratory at one time, and there are not machines enough to keep the men busy. Better work, fewer men, and less time per section, and double the number of sections until such time as additional instruction units can be had. Parts for these are under order, as listed under “New equipment.”
Ambulance - The rate of training of teams for the ambulance should be at present about 10 teams each month. Each team is to consist of a medical officer and two enlisted men. This output is subject to revision in accordance with news from overseas.
By direction of the Acting Surgeon General:
GEO. C. JOHNSTON,
Lieutenant Colonel, Medical Corps, United States Army.
This required both additional space and a rearrangement of the assignments so that 50 officers and 50 enlisted men could be taken into the school each two weeks. Accordingly the adjoining building, known as T, was secured and fitted up for the purpose.
The teaching staff had to be enlarged each time the demands were increased. A medical officer who had been in active service in France for more than one year came to the school early in September and delivered a course of lectures with a view of bringing to the instructors and student officers an intimate knowledge of the conditions at the front. This close contact with one who had been at the front was a factor of appreciable value to the director as well
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as to the instructors and students. Instructors at all times were selected solely on their fitness to teach some particular phase of the work, and in the majority of instances were officers who previously had been student officers in the school. In this way the desired results were obtained without at any time having kept at the school large numbers of men who had a wide practical experience. Each instructor was given the opportunity of selecting his own assistants from the classes; and, wherever it was possible, enlisted men or noncommissioned officers or Sanitary Corps officers were used in the strictly technical or mechanical phases of the instruction; for example, in the developing room, physical laboratories, and mobile unit manipulation. The instruction to manipulators was given entirely by Sanitary Corps officers and enlisted personnel.
The curriculum of the school was at all times based on the idea that men were being trained to do the kind of X-ray work that was met with at the front, both in the forward hospitals and those farther from the fighting line. It was of prime importance that the officer should be able to operate properly any type of machine; and to keep his machine in operation even under the most trying circumstances, that he should know all parts of his apparatus thoroughly so as to be able to directly supervise the installation or dismantling and transportation. The instruction in development of plates was given with more intensity to the manipulators than to the officers.
The course in anatomy and position and exposure drill was looked upon as one of the important features, since the whole subject of reports, whether of localization of foreign bodies, of fractures, or other lesion, is based upon an accurate use of anatomical terms, and knowledge of the appearance of the normal was considered essential to the easy recognition of the abnormal. It also afforded the opportunity to all of the students of making practical application of the instruction they had just received in the machine course. This course was further augmented by fluoroscopy of the normal.
Localization of the foreign bodies was taught just as thoroughly as possible, with complete equipment and models containing foreign bodies. It was one of the most satisfactory features of the course, as well as one of the most important.
Of the clinical subjects, most attention was paid to fractures and diseases of the bones and joints, especially the infections following war injuries. In addition to the lecture course, in which carefully selected lantern slides were used for illustration, a large collection of original radiographs was studied by sections of the class under the guidance of assistant instructors. Special consideration was given to the matter of report writing in such cases.
The instruction with reference to the chest and its contents followed very closely the text of the United States Army X-ray Manual, and lantern slides were depended upon largely for instruction in interpretation. The hospital furnished a large amount of lung material, so that each student studied numbers of patients both fluoroscopically and by means of stereoscopic plates, or single plates taken at the bedside. The time allotted for this instruction permitted close attention only to the more gross lesions, such as fairly well advanced tuberculosis, pneumonic consolid at-ions, effusions, and pneumothorax. The
140
diseases of accessory sinuses, mastoids, and teeth were taught by means of lantern slides as well as by section work in the radiographic and view box rooms. The clinical material was at all times abundant.
Instruction in the diseases of the gastrointestinal tract and urinary tract was given by means of slides and in the radiographic and fluoroscopic rooms. No attempt was made to be thorough except in the matter of technique. This class of patients, however, furnished opportunity for a large amount of fluoroscopy, and no occasion was lost to give the student officers opportunity to use the fluoroscopic apparatus.
All departments of the hospital were encouraged to request bedside examinations of patients too ill to be moved. This work was done mainly by the students under the supervision of a capable instructor. The results were of surprising excellence, and the number of patients examined per day was usually quite large. This bedside work was thoroughly appreciated by the various chiefs of service, and was of the utmost value to the school as a means of instruction.
Instruction in the therapeutic use of the X ray was limited to individual training in operation of the Coolidge tube at a standard treatment exposure set of conditions, and in the use of filters, protection of surrounding parts, etc. No attempt was made to teach the application to any particular disease.
Instruction to enlisted men was limited to the operation, care, and repair of apparatus, to developing-room work, to assisting in the radiographic and fluoroscopic rooms, and to the filing of records and plates.
In addition to the instruction given to the students of the School of Roentgenology, courses of illustrated lectures or fluoroscopic demonstrations were given to the student officers of the various other schools at. Camp Greenleaf. For example, two lectures a week were given to the School of Surgery, two to the School of Orthopedic Surgery, one to students in otolaryngology, one in oral and plastic surgery, and occasional demonstrations to the School of Cardiovascular and Lung Diseases. The object of these lectures and demonstrations was to acquaint the several specialists with the sort of aid they might expect to get from the X-ray department, and to cultivate as much as possible a spirit of cooperation. This matter of cooperation was further carried out by having available at all times a capable instructor who could take plates and records to the surgical operating rooms or wards on occasioiis when such records might be of value in operations or in the instruction of the various classes. The instruction thus given to the various other specialties was started early in January, 1918, and was carried on throughout the year, with a great deal of benefit to all concerned. In fact, this very feature was looked upon as one of the important reasons for having a complete School of Roentgenology at Camp Greenleaf.
The floor plan of building S was arranged with special attention to the handling of a large number of patients; or, in other words, primarily as an X-ray department of the hospital, and secondarily for school purposes. Fortunately, the plan worked well for both, the first floor and part of the second floor being reserved especially for the accommodation of patients and the remaining part of the second floor, as well as two basement sections, being used for school pur-
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poses. All changes were planned in such a manner that by the mere tearing down of the partitions and removal of apparatus the building would be in its original condition without damage. The partitions, ventilation, light-proof shutters, and most of the wiring in this building was done by outside contractors, but all of the installations and a considerable amount of wiring was done by the officers and enlisted personnel of the school. All of the work in building T was done by the school organization and furnished a great deal of very valuable training, especially to the students of the enlisted personnel.
Selection of student officers for the School of Roentgenology was always a matter of considerable moment to the director, and the process went through a sort of evolution in keeping with the development of the camp as a whole. During the first months a great deal of individual effort was necessary in order to find the officers who had had previous X-ray experience, and it was at times difficult to get and especially to hold them. The plan of calling for volunteers by means of notices read to the companies brought forth a large number of applicants, among them many who were not well fitted for the work, but the plan did have the advantage of bringing the opportunity to the attention of those who had had previous experience. The greatest objection to this plan was the fact that it frequently turned out that the men selected had been retained in the Surgeon General ‘s Office for some other service, this being learned only when orders came taking such men from the school. Later, the board of examiners, who examined all officers entering the camp in surgery and medicine, referred to the X-ray school all officers who claimed to have had any experience whatever in X-ray work or who especially desired to take up the work. By this means a little more than half the desired number of students was obtained. In order to fill up the classes the president of the boa-rd of examiners selected from the files the cards of men who had passed good examinations in surgery but who had not been taken up by the surgical chief. It was considered a matter of importance that the student Roentgenologists should know surgery, for they were to be surgical assistants of the first degree of importance. With this class of officers, mostly under 40 years of age, some of the most gratifying results were obtained. They were particularly adaptable to training for forward hospitals where the work was largely a matter of localization of foreign bodies and the study of fractures. This plan was found to be the best obtainable and was fairly satisfactory.
The enlisted personnel was obtained entirely through various group commanders, being selected, as far as possible because of their fitness, from among the limited service men. Those who could not readily grasp the work were sent back to their former organizations.
The whole scheme of instruction worked well, and the schedule, as to the number of hours devoted to each phase of the subject, represented the minimum that was practicable for obtaining efficient results.
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OUTLINE OF COURSE IN X-RAY PHYSICS AND ELECTRICITY, ELEMENTARY AND ADVANCED LABORATORIES
Purpose of the course. - This course was designed to acquaint medical officers selected for X-ray service with the various types of apparatus they might be called upon to operate when assigned to duty. While there was no intention to attempt to make electricians or physicists of them, still a considerable amount of time was spent upon the principles underlying the production of X rays. This was deemed necessary in order that the men might have a basic knowledge that would enable them to render continuous efficient service under the varying and often adverse conditions of military Roentgenology.
Outline of instruction. - Laboratory work comprised the major part of this course. The sections and apparatus were so arranged that each man must himself do the work under the supervision of an instructor. The only objection to this plan was that it demanded more than the usual number of instructors and hence added expense. This objection was largely overcome by using selected enlisted men to act as assistants on the various units, all work being done under the direct supervision of a medical officer.
The laboratory work was given in several parts. First, the men gained a fundamental knowledge of electricity by making selected experiments on a unit called the “principles of electricity table.” Hereafter this unit is designated by the term “principles table.” The class was given instruction in the operation of the rectifying type of machine on units called “test machines.” Succeeding this, the following units were taken up: United States Army portable gas electric set, United States Army portable instrument, box, United States Army bedside unit, induction coil outfit (gas tubes) and, finally, the various makes of base hospital machines.
Each morning, before the class went into the laboratory, the lecture was given. The course of lectures was designed to parallel the laboratory work as closely as possible, and followed literally the text of the manual, with simple analogies for explanation. The last five lecture periods were devoted to review, and opportunity was given the class to clear up any points not made clear on first presentation.
The school day was made up as follows:
( a) For medical officers during their first month of instruction:
8.30 to 10.30..... Section work as assigned. | 1 to 2......... Lecture. |
10.30 to 11.30....Lecture | 2 to 4.30.....Section work |
11.30 to 1...........Mess |
(b) For medical officers during their second and third months of instruction:
8.30 to 9.30.....Lecture | 1 to 2 ..........Lecture. |
9.30 to 11.20...Section work as assigned. | 2 to 4...........Section work. |
11.30 to 1........Mess. |
(c) For enlisted men throughout their course:
8.30 to 9..... Care of the apparatus. | 1 to 2..........Lecture; |
9 to 11.30.....Section work as assigned. | 2 to 4.30.....Section work. |
11.30 to 1.....Mess |
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The lectures were divided among the various subjects as follows:
(a) Medical men during their first month (this series of lectures repeated monthly):
Physics and electricity...............................................15
Review quiz......................................................5
Developing...................................................................................5
X-ray anatomy............................................................................10
Positions..........................................................................5
(b) Medical men during their second and third months (this series of lectures repeated every two months):
Principles of interpretation................ 1 | Head and dental................... 10 |
(c) Enlisted men (this series of lectures repeated monthly):
Physics and electricity.............15 | Records and filing................. 2 |
MANIPULATORS’ SCHOOL
Instruction for manipulators was limited to the theory, operation, maintenance, and repair of the various types of apparatus. During the last few months only a small percentage of enlisted men were brought in contact with the large so-called base hospital machines. These were the men who, by reason of previous experience or education, were especially fitted for such instruction. Their course in the handling and caring for the portable types and induction coil out-fits, and especially in the Delco engine, was very thorough.
Their instruction in position and exposure drill was limited, and given in such a way that it served more to fasten in their minds the knowledge they had gained in the machine and developing work than to make real operators of them. Anatomical terms, other than those familiar to any schoolboy, were not used, and only the more common positions were practiced.
The instructors were Sanitary Corps officers or graduates of former classes. The teaching facilities were constantly increasing, so that there was a continuous demand for practical work in the way of wiring, both low and high tension; assembling and adjusting apparatus, and installing the various machines. The manipulators under the direction of their instructors made all the changes in building T, even to building the developing counters and to mounting the extra large step-down transformer. In short, it was the purpose of the school to t.rain them to be useful and practical assistants to medical officers, and to keep them just as far from actual professional duties as possible.
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The assignments of these men in the developing course were similar to those of the officers. Their hours in the machine course were so arranged as not to conflict with the officers.
Manipulator’s school schedule
|
| Machine course:Electricity and coil | Machine course:Portable units | Developing and dark room | Position andexposure drill |
8 to 11.30 | 1 to 4.30 | 8 to 11.30 | 1 to 4.30 | 8 to 11.30 | 1 to 4.30 | 8 to 11.30 | 1 to 4.30 | |
First week........ | A | B | ----- | ----- | B | A | ----- | ----- |
MACHINE COURSE
(Capacity: 48 men every two weeks, or 96 men per month)
[Chart]
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SCHOOL OF ANATOMY
The school was authorized by the Surgeon General on the receipt of the following letter: 156
HEADQUARTERS CAMP GREENLEAF,
Chickamauga Park, Ga., July 6, 1918.
From:Maj. A. S. Begg, M. R. C.
To: The Surgeon General of the Army, Washington, D. C. (through the commandant, medica1 officers’ training camp).
Subject: Proposed School of Anatomy.
It has become evident that for the proper conduct of the professional schools at this camp it is now necessary to carry on certain instruction in anatomy. This is especially true as regards the specialties, in which at the present time individual attempts are being made to supply the needed instruction. After conference with the heads of certain special courses it is proposed to correlate and centralize this fundamental teaching.
In order to carry out the above program it is necessary to provide space, apparatus teaching material, and instructors. The commandant of this camp, in conference, pointed out the inadvisability of such an establishment within the reservation, and further inquiry elicited the fact that excellent quarters would be supplied by the University of Chattanooga-, without cost to the Government.
Lieut. Robert J. Cook, M. R. C., now attached to instruction staff, is competent to assume charge of the work. The necessary additional instructors are also available, as is the necessary technical help, the latter being enlisted personnel.
The anatomical material can be obtained through the Tennessee authorities.
To properly carry out the above program, and begin at the earliest possible moment, it is requested that authority be granted to expend the sum of $400 as follows: Construction of storage facilities, $200; immediate purchase of chemicals, glassware and tools, $200.
The cost of anatomical material not being determined, and the purchase of emergency supplies from time to time being necessary, it is further requested that the sum of $200 per month be appropriated for this purpose.
It is recommended that authority requested above be communicated by telegraph.
** ***
A.S. BEGG.
[First indorsement]
HEADQUARTERS CAMP GREENLEAF,
Chickamauga Park, Ga., July 6, 1918.
To the SURGEON GENERAL OF THE ARMY,
Washington, D. C..
Forwarded.
1. Approval recommended.
2. The proposed course in anatomy is essential for the full efficiency of the courses in surgery, orthopedic surgery, eye, ear, nose, and throat, genitourinary work and other specialties.
3. It would appear inadvisable to do any anatomical dissection in this reservation, in view of the undesirable impression sure to be made among the great number of recruits here. Having it conducted in Chattanooga, readily accessible by motor and trolley, removes these difficulties. The anatomical facilities which it is proposed to occupy were formerly used by the old Chattanooga Medical College, now defunct, for the present purpose.
4. Requisition for the necessary post-mortesu instruments have been forwarded.
E. L. MUNSON,
Colonel, M. C., Commandant.
The school was originally intended to be only an integral part of the School of Military Surgery, but eventually almost every special professional school included a certain alloted time devoted to instruction in anatomy which was given at this school.157
The location of the school was the first consideration. Through the efforts of the director, the laboratory of the medical department of the University of
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Chattanooga, was secured for this work and a survey of the premises made. Dissecting tables were constructed, shelves and boxes prepared for the keeping of material, arrangements made with the medical supply officer for supplies to be used and for the purchase of anatomical material and emergency supplies which could not be obtained through the Quartermaster Department. An appropriation of $200 per month was secured from the Surgeon General’s Office. Later it was evident that this appropriation was too small and a larger one, of $1,000 per month, was obtained.157
Arrangements were made with Vanderbilt University to furnish material for dissection and operative work.157 State laws in regard to obtaining material from the penal and charitable institutions of this vicinity were investigated, and it was found that there is an act in Shannon’s Code of Laws for the State of Tennessee whereby anatomical schools are to receive unclaimed bodies from penal and charitable institutions. This was taken up with the authorities of the county and a number of bodies were received from that source. As there were so many student officers to go through this school and the scarcity of material prevented at least some of the men from doing work on the cadaver, it was apparent that it would be necessary, if every man was to have an opportunity of getting some applied operative work, to make available for them some other means. An operative and experimental course of operative surgery on the living dog was suggested. Preparations were then made, tables built, the room prepared for this work, and arrangements made to issue an order that all dogs running loose at Fort Oglethorpe should be caught for this work.
Instructors were selected for conducting this course, and from the first class in the School of Anatomy, beginning August 17, additional instructors were chosen to help conduct the work for the following class, and as each class passed through this school the best men were chosen for work with each succeeding class. To prevent the constant changing of instructors, as men were ordered to other camps, permanent instructors were assigned to the school.
The organization of a course of study whereby the student officers of the School of Military Surgery would be able to get a review of anatomy and of applied surgery as it was practiced in the war zone was perfected. A syllabus of anatomy which was to be covered by lectures, followed by demonstrations on dissected material of the regions covered by anatomy and surgical anatomy, was compiled. This course was of six days’ duration. The general plan of this work on the cadaver was to divide the men in groups of 10 for each cadaver. A schedule of operations was arranged so that, by subdividing this group of 10 men into 2 groups of 5 each, one group working on the right and one on the left side of the body, in a region far enough removed not to interfere with the other group, there was very little confusion, and as the group working on either side finished an operation in the regions of the head or neck, this group was moved to the opposite side and an operation was performed on a lower extremity. Work was thus available in practically every region for every man. In their work on the cadaver, a study of the anatomy of each particular region was insisted upon and gone into in detail by the instructors assigned to this group. Owing to the scarcity of material, student officers from the different schools utilized every part of the body. The oral-plastic surgeons conducted
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their course first. This was followed by classes from the School of Military Surgery, the School of Orthopedic Surgery, the School of Neurosurgery, the School of Otolaryngology, the School of Ophthalmology, and the School of Dentistry.
The following is a brief résumé of work accomplished month by month: 157 Beginning August 17, 1918, a series of lectures of three days’ duration was given to the class of surgery, consisting of 79 men. The work included a review of applied surgical anatomy and demonstrations of prepared specimens, skeletons, and charts. Seventeen men from this class and six men from the staff of General Hospital No. 14 were given a three-day course in operative surgery on the cadaver. After this class had finished, class No. 10, from the orthopedic school, numbering 30 men, was given a course in operations on the extremity and spine, which lasted for two days and was followed by a dissection of the extremities and back, extending over a period of eight days. Ratings of the class of the School of Military Surgery and of the class of orthopedic surgery were submitted to the directors of the respective schools at the end of the course. During the month of August 7 cadavers were obtained, only 3 of which were used, leaving 4 on hand to begin the work for the month of September.
During September a course of lectures and demonstrations of five days’ duration was given to 114 men from the School of Military Surgery; of this number, 46 men were given a course of operative surgery on the cadaver and 26 men were given a course of operative surgery on the dog. In addition to this, 20 student officers from the School of Orthopedic Surgery were given a course of five days’ duration, and 27 men from the School of Otolaryngology used the remaining available material for performing operations on the ear, nose, and sinuses. Four cadavers were used this month and four more were ordered from Nashville. Arrangements were perfected whereby the pauper dead of Hamilton County would be taken over for use in the school, and one body was received from the county. Five dogs were used this month for operative purposes.
The work for the month of October, on the same plan, was given to two classes from the School of Military Surgery, the first class numbering 77 men and the second class 134 men. All members of the first class were given an operative course of surgery on the cadaver and an additional 30 men were given an operative course on the dog; 6 dogs being used for this purpose. Of the second class in the month of October, 37 were given an operative course on the cadaver and 37 other men from this class were given a course in operative surgery on the dog. In this work, instrumental technique was insisted upon and the men were carefully rated by practical daily, oral and written quizzes on all work covered by lectures and demonstrations of dissected material and by operations on the cadaver and the dog. From the School of Orthopedic Surgery, during the month of October, the classes numbering 17 and 13 men, respectively, were given their course according to the plan adopted for orthopedic work. The first class devoted one week’s time to the study of regional anatomy, and the second class, two weeks. Twenty-seven student officers from the School of Otolaryngologv devoted three days to the study of regional
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anatomy and operative work on material which had previously been used for the Schools of Surgery and Orthopedics. Nine student officers from the School of Plastic and Oral Surgery spent one day in the performance of plastic surgery about the head and one day for the performance of operations on the dog. Twenty-five student officers from the School of Dentistry spent one day in the performance of operations about the jaw and in the study of regional anatomy. Four bodies were received from the local county officials for the work during this month.
In the month of November, a class from the School of Military Surgery, numbering 83 men, reported on November 4. The general plan of lectures and demonstrations and ratings of one week’s duration was given to this class and material was available for all members for operative work on the cadaver and the dog; 12 dogs being used for the purpose. On November 18 another class from the School of Military Surgery, numbering 102 men, reported and were given the same work, with the exception that no dogs were available for operative work for this class; however, every member was given work on the cadaver. From the School of Orthopedic Surgery, three classes, totaling 37 men, were given work and material on the plan adopted for the orthopedic classes. From the School of Otolaryngology, 10 men used material for operations and the study of regional anatomy. From the School of Plastic and Oral Surgery, 35 student officers spent 5 days here, 2 days of which were taken up by lectures and demonstrations and 3 days in the performance of plastic and surgical operations about the head and face. Nineteen student officers from the School of Dentistry spent two days in operative work on the cadaver and dissection of muscles, nerves, and vessels of the face. Twenty-five student-officers from the School of Ophthalmology were given four hours of lecture and demonstration of dissected specimens of the brain, spine, cranial nerves, and. contents of the orbit, and three hours operative work on the cadaver. Fourteen student officers from the School of Neurosurgery spent three days in the performance of operative work and dissection on the cadaver and experimental work on one live dog. During the month, the school received 3 bodies from the local and county officials and 12 bodies from Vanderbilt University at Nashville, Tenn. Only 13 of these bodies were utilized in the work, leaving 2 remaining for the work in December.
One hundred and fifteen student officers from the School of Military Surgery reported on December 2, and were given a 10-day course of lectures and demonstrations of dissected material, and operative surgery on the cadaver and the dog, eight cadavers and nine dogs being utilized in this work. Fifteen student officers from the School of Orthopedic Surgery followed out their general plan of work for two weeks, beginning December 2. Material was furnished to 80 men from the School of Dentistry for operative work and dissection in their particular region. Twenty-four student officers from the School of Otolaryngology used material for operative work on the sinuses, nose, and throat and for dissection in those regions. Fifteen student officers from the School of Plastic and Oral Surgery utilized material for the performance of plastic operations about the face. Fifteen student officers from the School of Neurosurgery spent three days here, one of which was devoted to experimental work on the live
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dog and the other two on dissection of cadaver material. Sixteen student officers from the School of Ophthalmology spent one day in demonstrations and dissections and operative work pertaining to their particular region. During the month, 8 cadavers and 10 dogs were used for operative work by the different classes. On December 16, 49 student officers from the School of Military Surgery reported for a series of lectures in a review of anatomy, and 9 student officers from the School of Orthopedic Surgery reported for work in their branch of surgery. On December 17 orders were received to discontinue work in the special courses to men who had been ordered to these schools subsequent to December 10; consequently the courses were discontinued.157
The following is the schedule of lectures and demonstrations:157
Monday:
A.m...........................................Scalp and skull as a whole; face and neck.
P.m........................................... Demonstration of above.
Tuesday:
A.m...........................................Thorax and diaphragm; shoulder, arm, foreman, and hand.
P.m............................................ Demonstrations of above.
Wednesday:
A.m........................................... Pelvis, hip, thigh, knee, and leg; vertebral column and spinal cord.
P.m............................................ Demonstrations of above.
Thursday:
A.m........................................... Abdominal wall, peritoneum, gastrointestinal tract, and fixed abdominal organs; genitourinary tract.
P.m............................................ Demonstrations of above.
Friday:
A.m........................................... Blood and vascular system; landmarks and ligations.
P.m............................................ Quiz.
Saturday:
A.m........................................... Quiz and written (final) examination.
OPERATIVE COURSE ON THE CADAVER
RIGHT SIDE
First day:
10 to 10.30.............................. Lumbar puncture--landmarks.
10.30 to 11 .15 ................... Subtemporal decompression.
11.15 to 12.............................. Ligation of posterior tibial artery in middle third of leg and at thebend of the ankle.
1 to 1.45.................................. Lumbar nephrectomy.???
1.45 to 2.45............................. Ligation of femoral artery. followed by dissection of Scarpa’s triangle.
2.45 to 3.30............................. Ligation of brachial artery at middle third of arm and exposure of musculospiral nerve.
Second day:
10 to 10.45.............................. Guillotine amputation of foot anterior to the tibialis anticus and peroneus longus.
10.45 to 11.15..................... Guillotine amputation of upper third of forearm.
11.15 to 12.............................. Guillotine amputation of lower third of thigh. Study of cross section of each.
1 to 1.45.................................. Blocking of second and third divisions of fifth nerve--landmarks.
1.45 to 2.15............................. Ligation of external carotid artery--landmarks and relations.
2.15 to 3.30............................. Dissection of perineum.
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Third day:
10 to 10:30.............................. Tracheotomy (high and low).
10.30 TO 11:15....................... Splenectomy.
11.15 TO 12.............................Removal of foreign body from prevertebral space following posterior border of sternomastoid muscle.
1 TO 2..................................... Repair of injury to diaphragm in the costophrenic sinus.
2 TO 2.45................................ Exploratory incision for gunshot wound of the abdomen.
2:45 TO 3.30........................... Ligation of the anterior branch of the middle meningeal artery.
Fourth day:
10 to 10.30.............................. Exploratory incision and suture of wound of liver.
10:30 to 11.15......................... Osteoplastic flap over motor area and tapping for lateral ventricle.
11.15 to 12.............................. Pericardial paracentesis and explorations.
LEFT SIDE
First day:
10 to 10.30.............................. Lumbar puncture--landmarks.
10.30 to 11.15......................... Ligation of popliteal artery and dissection of popliteal space.
11.15 to 12.............................. Laminectomy--eighth, ninth, and tenth thoracic.
1 to 1.45.................................. Suture of sciatic nerve in middle of thigh.
1.45 to 2.45............................. Ligation of axillary art.ery followed by dissection of axillary space.
2.45 to 3.30............................. Ligation of the anterior tibial artery and exposure of anterior tibial nerve.
Second day:
10 to 10.45.............................Guillotine amputation at the wrist joint-.
10.45 to 11.15.........................Guillotine amputation at upper third of leg.
11.15 to 12..............................Guillotine amputation of arm (supracondylar). Study of cross section of each.
1 to 1.45..................................Blocking of second and third divisions of fifth nerve—landmarks.
1.45 to 2.15.............................Extraperitoneal ligation of internal iliac artery.
2.15 to 3.30.............................Dissection of parotid gland, facial nerve and parotid portion of external carotid artery.
Third day:
10 to 10.30.............................. Suprapubic cystotomy.
10.30 to 11.15......................... Ligation of third portion of subclavian artery--relations.
11.15 to 12.............................. Transperitoneal nephrectomy.
1 to 2....................................... Exposure of cervical brachial plexus--relations.
2 to 2.45................................... Ligation of lingual artery--relations.
2.45 to 3.30.............................. Herniotomy (Andrew’s method).
Fourth day:
10 to 10.30............................. Ligation of posterior branch of middle meningeal artery--landmarks.
10.30 to 11.15......................... Thoracotomy. Resection of rib, evisceration and repair of lung wound.
11.15 to 12............................ ..Ligation of facial artery and complete dissection of side of face.
COURSE IN OPERATIVE SURGERY ON THE DOG
First day:
1. Blood transfusion, citrate method; typing blood.
2. Arterial suture (femoral artery) for injury to vessel wall.
3. Resection of the intestine, with end to end anastomosis, Connell stitch.
4. Splenectomy for hemorrhage, with discussion of danger points.
5. High tracheotomy.
6. Evisceration of the lung, with mattress suture to control hemorrhage; intratracheal insuffiation anesthesia.
7. Subtentorial decompression.
8. Guillotine amputation of the thigh, with quiz on cross section.
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Second day:
1. Lateral anastomosis of the small intestine.
2. Enterorrhaphy for penetrating wounds of intestines and stomach.
3. Suture for liver hemorrhage, using omentum and rectus muscle.
4. Transabdominal nephrectomy for hemorrhage.
5. Lumbar nephrectomy.
6. Suprapubic cystotomy.
7. Pericardiorrhaphy for stab wound or foreign body.
8. Decompression of Rolandic area.
Demonstrations were given of the following: Bones of head and face; head, trepanation landmarks, arteries, and motor area; base of skull; dura mater and sinuses; lateral and medial surface of brain; base of brain; facial nerve and artery, parotid gland, Steno‘s duct, superficial structures and triangles of neck; branches fifth nerve, landmarks for blocking internal maxillary artery; sagittal section, skull and face; deep vessels of neck and branches; nerves of neck; pharynx, larynx, trachea, and esophagus; cross section of neck at base of skull; cross section root of neck; sympathetic nerve system; spinal cord; osteology of spinal column; osteology of the upper extremity as a whole; brachial plexus; axillary space; shoulder joint, muscles, and ligaments; elbow and wrist joints and ligaments; muscles and nerves and vessels; muscles of forearm; nerves and vessels of forearm; muscles, nerves, and vessels of hand; musculospiral, median, radial, and ulnar nerves, with vessels; lungs and pleura; heart and pericardium; diaphragm and aorta; intestinal tract and fixed organs; viscera of pelvis and internal iliac artery; ligaments around pelvis and hip; ligaments of knee and ankle joint; hip flexors; nerves and vessels of thigh; nerves and vessels of leg and foot.
OPERATIVE COURSE IN ORTHOPEDIC SURGERY
Tenotomy of tendo Achillis.
Tendon lengthening--open method.
Removal bone-graft from shaft of tibia--save for Albee operation.
Astragalectomy--as a foot stabilizer.
Transplantation of peroneals to act as dorsal flexors of foot..
Knee--anterior median incisions--removal of portion of extersial semilunar cartilage.
Dislocation of patella--use of ligamentum patellae to prevent.
Transplantation biceps and semimembranosus or sartorius.
Fasciotomy of hip for hip flexion contracture.
Osteotomy lower end of femur.
Nerve suture--sciatic, musculospiral, brachial plexua.
Tendon fixation at ankle.
Arthroplasty at hip.
Fracture of humerus with bone splinting.
Arthrotomy of shoulder.
Excision of bones of wrist.
Resection of elbow joint--subperiosteal.
Laminectomy.
Hibbs spine operation or Albee.
Drainage of osteomyelitis.
Transplantation of triceps.
Transplantation pronator radii teres.
Dissection of extremities and back.
152
Number of men belonging to the different classes that passed through the School of Anatomy: 157
School of Military Surgery......................................................704
School of Orthopedic Surgery......................................................132
School of Dentistry...................................................124
School of Otolaryngology..............................................88
School of Plastic and Oral Surgery.....................................................59
School of Ophthalmology...............................................41
School of Neurosurgery................................................29
Total......................................................1,177
Number of cadavers used........................................................45
Number of live dogs used.................................45
LABORATORY SCHOOL
This school was ordered established by the following letter: 158
JANUARY 19, 1918.
From:The Surgeon General, United States Army.
To: Commandant, Medical Officers’ Training Camp, Fort Oglethorpe, Ga.
Subject: School for training of laboratory specialist officers.
1. A school for the training of medical officers as specialists in laboratory work will be established as part of the general scheme of instruction carried out in the Medical Officers’ Training Camp, Fort Oglethorpe, Ga.
2. The purpose of this school is to train medical officers for laboratory work by military methods for military purposes; and coincidently to develop them physically and train them in subjects which they should know under the conditions under which they would practice their specialty, including organization, paper work, applied military hygiene and sanitation, handling of enlisted men, and general functions as officers.
3. Classes will be arranged on a basis of a two months’ course.
About 20 officers trained as laboratory officers will be required monthly.
It is proposed to supply the entire needs for laboratory workers for the Army through this school.
4. The school for the training of laboratory workers will serve as the department laboratory, Southeastern Department, and perform all the duties heretofore devolving on the latter.
5. The school for the training of laboratory workers will affiliate with the base hospital, and receive advantage of its facilities, for all necessary professional purposes.
For research work, testing of apparatus, training of special men and similar purposes, it will also affiliate with the Camp Greenleaf School of Applied Hygiene and Sanitation.
6. The general professional instruction to be given will relate to laboratory methods. and technique as adapted to military conditions and purposes.
7. It is intended to erect a laboratory building convenient to the general hospital, reinoving thereto all personnel and equipment of the department laboratory now at Atlanta.
This laboratory will serve the functions of -
(a) Laboratory for the general hospital.
(b) Department laboratory.
(c) Training school for laboratory workers.
8. (a) The senior instructor for this school detailed by this office on the staff of instructors of the training camp will, under the commandant thereof, be in direct charge of the course.
(b) He will continuously investigate the qualifications and suitability for laboratory service of medical officers, and others, under instruction.
(c) As director of the department laboratory, and for all laboratory work other than that of training, he will be responsible directly to this office.
9. It is intended to construct barracks for 100 medical officers and for 100 enlisted men under instruction in this school.
153
These barracks will be part of the medical officers’ training camp.
10. Officers under training in this course will he organized as a special company, be quartered in the medical officers’ training camp, and be subjected to its discipline at all times.
11. Hours of instruction, participation in joint classes, etc., will be arranged by the commandant of the training camp.
12. The schedule for the first month will he as follows: b
**** **
SPECIAL SUBJECTS
The details of this part of the course, including organization, equipment, supply. use, and administration of fixed and mobile laboratories, will be arranged by you, after conference with the officer assigned by this office in charge of the course; 56 hours.
14. Following the basic instruction given in the first two months as above, special training over a variable period of time will be continued by personnel under instruction.
It is contemplated to keep a reserve under training at all times, and for such periods as their services may not be required elsewhere.
This special training will be prescribed by the officer in immediate charge of instruction under this course.
15. A number of selected enlisted men of the Medical Department, not exceeding 100 at any one time, will be kept at yotir camp under instruction. They will be organized as a special company and be under the discipline of the training camp at all times.
All such will be given such part of the basic course for enlisted men at your camp as might be of advantage to them in such service.
The scope of their special training in laboratory work, to be given during the first two months of training, will be prescribed by you after conference with the officer designated as in direct charge of the work.
16. Receipt of this letter to be acknowledged.
By direction of the Surgeon General:
E. L. MUNSON,
Colonel, Medical Corps.
In carrying out the instructions given in this letter, a school for bacteriology and pathology specialists and a school of pathology were established,159 constituting the laboratory school. The school progressed very slowly, the accommodations allotted being limited and providing for a class of only 10 officers and 20 enlisted men. 160 In July the school was closed for a while, as there were no student officers to instruct. 161
In October, 1918, the school was moved to another building, occupying one complete company barrack. This gave ample space for the instruction of all the officers assigned and also for 60 enlisted technicians monthly. When the armistice was signed the school was well under way with a full quota of students. Unfortunately, as most of the enlisted men were medical students, they were discharged shortly after the armistice by orders from the War Department.
A complete syllabus was compiled when the laboratory school was first started, and instruction was carried on according to this.162 The following schedules show in detail how the instruction for each week was divided.163, 164
b See pp. 78, 79.
154
Laboratory course for student officers, July 2 to 31, 1918
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 11.30 a.m. | Pathology | Clinical microscopy | General bacteriology | Clinical microscopy | Vaccine therapy | Serology |
1.30 to 4 p.m. | Biological chemistry | General bacteriology | Serology | Biological chemistry | Epidemiology |
Laboratory course for enlisted men, July 2 to 31, 1918
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 11.30 a.m. | Lectures and practical | Lectures and practical | Lectures and practical | Lectures and practical | Lectures and practical | Lectures and practical |
1.30 to 4 p.m. | Lectures and practical | Lectures and practical | Lectures and practical | Lectures and practical | Lectures and practical |
Labaoratory schedule for course of instruction for enlisted men, November 25, 1918
Hours | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
9 to 11.30 a.m. | Bacteriology | Bacteriology | Serology | Parasitology | Bacteriology | Bacteriology |
1.30 to 4 p.m. | Clinical microscopy | Chemistry | Clinical microscopy | Chemistry | Clinical microscopy |
SCHOOL OF NUTRITION
The following letter directed the organization of a school of nutrition at Camp Greenleaf: 165
MARCH 7, 1918.
From:The Surgeon General, United States Army.
To: Commandant, Medical Officers’ Training Camp, Fort Oglethorpe, Ga.
Subject: School for officers of the division of foods and nutrition, Sanitary Corps.
1. A school for officers of the division of foods and nutrition, Sanitary Corps, will be established as part of the general scheme of instruction carried out in the Medical Officers’ Training Camp, Fort Oglethorpe, Ga.
2. The purpose of this school is to conduct the training of these officers of the Sanitary Corps along military lines, from the military viewpoint, and in the military environment; and coincidently to develop them physically and train them in subjects which they should know under the conditions under which they would practice their specialty, including organization, regulations, paper work, relations with enlisted men, and their general functions as officers.
3. About 20 graduate food experts of the sanitary division are required monthly.
Classes should be arranged on the basis of a course lasting two months.
4. The senior instructor for this school, detailed by this office on the staff of instructors of the training camp, will, under the supervision of the commandant thereof, be in direct charge of the course.
In addition to his educational duties, he will continuously investigate the qualifications and suitability of officers and enlisted men under instruction.
155
5. The routine of all matters relating to food, messing, and nutrition in the various organizations at your camp will, as far as possible, be demonstrated and utilized as part of the subjects of instruction.
6. The general technical instruction to be given will relate to matters having to do with food and nutrition, and is briefly outlined in this letter of instructions.
The necessary details will be furnished by the food division, this office.
The course of instruction, based thereon, will be prescribed by the commandant, medical officers’ training camp, after conference with the senior instructor of the school.
7. The course in general training, together with food work, will cover a minimum of two months. That part of the course relating to food work will comprise a total of 110 hours.
8. Officers under training as specialists in food and nutrition work will be organized as a separate organization or detachment, will be quartered and subsisted in the medical officers’ training camp, and be subjected to its discipline at all times.
9. Hours of instruction and participation in joint courses will he arranged by the commandant of the training camp.
10. The schedule of the first month is as follows: b
**** **
SPECIAL
Hours
The principles of nutrition......................................20
The physiology of digestion......................................5
Food economy...............................................................5
Total......................................................30
11. The schedule of the second month is as follows: b
***** *
SPECIAL
Hours
Composition of foods........................................................................10
Fundamentals of mess cooking....................................................................15
Food inspection...................................................................20
Mess accounting...................................................................5
Mess management...................................................................10
Nutritional surveys......................................................................20
Total........................................................................80
12. A number of enlisted men will be kept at your camp under training to assist in food work. This number will be later announced.
All should he given such part of the basic course of enlisted men at your camp as might be of advantage to them in such service. The score of their special training in food work will be prescribed by you after conference with the senior instructor in charge of the course in food work.
13. Receipt of this letter to be acknowledged.
By direction of the Surgeon General:
E. L. MUNSON,
Colonel, Medical Corps.
Before this school was established according to these instructions, the division of food and nutrition was communicated with and asked to present a memorandum outlining the special features of such a course. 166
b See pp. 78, 79.
156
The following syllabus was the result of this correspondence:167
SYLLABUS OF INSTRUCTION COURSE FOR NUTRITION OFFICERS AT CAMP GREENLEAF
I. COMPOSITION OF FOODS
(Fifteen lectures of one hour each; textbook, Sherman’s Food Products)
1 Definition of food; essential elements (protein, fat, carbohydrates, mineral salts, accessories, water); caloric value of food elements.
2. Milk; evaporated milk; dried milk; reconstructed milk (homogenizer and emulsor); skimmed milk.
3. Dairy products (other than milk) and eggs (cream, cheese, buttermilk, ice cream); eggs (cold storage, frozen, dried).
4. Meat and meat products (meat, poultry, fish, shellfish); fresh, cured, refrigerated, frozen, dried, canned, dehydrated.
5. Bread and flour; grades of wheat flour; flour substitutes (sweet-potato flour, cottonseed flour, soy-bean flour, alfalfa flour, peanut flour).
6. Cereal products; breakfast foods; alimentary pastes; package versus bulk cereals.
7. Vegetables; high-protein starch; canning, preserving, drying dehydration; extent of canning industry.
8. Fruits and nuts; canning, preserving, drying; importance of fruit acids.
9. Edible fats and oils (butter, oleomargerine, nut margerine, nut butters, lard and lard substitutes, cottonseed oil, olive oil, coconut oil, corn oil, peanut oil, soy-bean oil).
10. Saccharine products (cane sugar, beet sugar, invert sugar, maple sugar, honey, molasses, sirups, glucose, jam, jelly, preserves, marmalade).
11. Coffee, tea, cocoa, and chocolate,
12. Soft drinks (cola preparation, near beers, pops, so-called tonics).
13. Spices and condiments (vinegar, ketchup, pickles, salt, extracts).
14. Food preservatives, their use and abuse (salt, vinegar, smoke, benzoic acid, boric acid); prohibited preservatives (formaldehyde, salicylic acid, sulphites, phenol, abrastol, formic acid, fluorids); artificial sweeteners (saccharin, dulcin, etc.); artificial colors (mineral, vegetable, coal-tar).
15. Confectionery.
To be supplemented by charts and samples of pure and adulterated foods.
II. THE PHYSIOLOGY OF DIGESTION
(Major Carlson’s lecture, Howell’s Physiology)
Hours
1. The motor phenomena of the alimentary tract, nervous control of......................................1
2. The sensations of the alimentary tract (flavor, appetite, hunger) and the
nervous control of secretions...................................................................1
3. Digestion in the stomach........................................................................1
4. Digestion in the intestines.....................................................................1
5. Absorption and utilization of food....................................................................1
(Diagrams of alimentary tract.)
III. THE PRINCIPLES OF NUTRITION
(Textbook, Lusk’s Science of Nutrition - part)
1. Calorimetry, direct and indirect.................................................................3
2. Fasting as a basis of nutritive requirements............................................................2
3. The maintenance of body temperature as a basis of energy requirements............................2
4. The influence of protein on metabolism...............................................................3
5. The influence of fat on metabolism...............................................................1
6. The influence of carbohydrate on metabolism...............................................................2
7. The influence of muscular work on metabolism......................................................1
8. What is the normal diet..................................................................2
9. The accessory substance in the food.............................................................1
10. Food requirements for growth..............................................................2
11. Food economics............................................................1
(Charts: Milner apparatus; bomb calorimeter; standard portions).
157
IV. FUNDAMENTALS OF MESS COOKING
(The Manual for Army Cooks)
1 The rations of the United States Army; rations of different allied armies...........................................................1
2. Construction of menus or bills of fare; ration balancing; a mechanical device for checking the proper
distribution of nutrients..........................................................3
3. Kitchen equipment for permanent camps and for field service.................................2
4. Actual experience in kitchen, as kitchen police, assistant cook, and cook...............10
(Set apart a kitchen especially for food division which will be a model in every respect.)
V. MESS MANAGEMENT AND ACCOUNTING
(Manual for Army Cooks and Manual for Mess Officers)
1. Mess sergeant’s duties, actual experience in mess accounting..............................3
2. Mess officer’s duties, actual experience..................................................................3
VI. PROTECTION OF FOOD AGAINST SPOILAGE AND DETERIORATION
1. The general phenomena of spoilage; fermentation, putrefaction; causes.
2. Cold storage; applicability, principles involved, results.
3. Dehydration; applicability, principles, results, microbic survivors.
4. The use of preservatives; salt, sugar, smoke, etc.; Pasteurization.
5. Sterilization by heat; canning, intermittent heating, cold pack, ctc.
VII. FOOD INSPECTION
(Leach’s Food Inspection and Analysis)
A. Didactic:
1. Inspection of vegetables and vegetable products, molds, rots, etc.
2. Inspection of breadstuffs, cereals, rice, etc.
3. Inspection of beef, hams, and other fresh or cured meat products.
4. Inspection of canned goods, milk, fruits, meats, vegetables.
5. Inspection of vinegar, ketchups, etc.; five hours laboratory demonstration.
B. Practical:
1.Inspection of quartermaster stores at camps adjacent; five hours.
2. Inspection trips to refrigerators and storage warehouses in Chattanooga.
VIII.NUTRITIONAL SURVEYS
(Orders to party leaders)
A. Didactic:
1. Purpose of nutritional surveys: To study food consumption; to study food waste.
2. Relations with officers of the camp (commanding officer, division surgeon, sanitary inspector, regimental surgeon, company commanders, mess officers).
3. Methods employed; inventories; accession to stock; methods of weighing.
4. Separation of garbage and reclamation; weighing and sampling; standards to be enforced (?).
5. Computation of food consumption and waste.
B. Practical:
I. Application of methods to individual messes in actual surveys.
2. Possibly start a piggery. Weigh garbage and weigh animals.
This school was started September 3, 1918, according to the instructions received, and the special nutritional instruction was based on the above syllabus. Some instruction along this line had been given since June 1, 1918. Naturally, this being a new method of teaching nutritional work, many changes in subjects and methods of instruction, even in the short life of the school, were made.168, 169, 170
158
It was found that the time allotted to this instruction was entirely too short and on that account the officers were not sufficiently prepared before leaving the school. This condition of affairs called forth the following: 171
SCHOOL OF NUTRITION, CAMP GREENLEAF,
Chickamauga Park, Ga., November 4, 1918.
From: Capt. R. J. Anderson, Sanitary Corps.
To: The Surgeon General, United States Army, Washington, D. C.
(Attention Lieutenant Colonel Murlin, through commandant).
Subject: Improving the course of instruction for nutrition officers.
1. In addition to the basic course of instruction given in this school, it would seem that some more practical work along the lines of nutrition in the Army would be very desirable, before our officers are sent to permanent posts. In this connection I would suggest, after completing the basic course, which includes a review of the composition of foods, physiology of digestion, metabolism, principles of nutrition, mess and food inspect-ion, waste studies, and nutritional surveys, as outlined in my letter of October 1, 1918, that our men be detailed as assistants to mess officers in the various units in this camp. I believe that arrangements could be made through the commandant with the various organizations such as the hospital, medical officers’ training camp, or training battalions to place officers from this school on duty with the mess officers in the different units mentioned above.
2. An extension of the work of student nutrition officers as suggested above would necessitate that their stay in this camp was prolonged possibly two weeks. If this extension of the time of training can possibly be arranged, I think that it would be well worth while in view of the greater experience that the officers would receive. At the end of the additional training they would have a more intimate knowledge of mess conditions and the problems connected4 with the handling of messes, menus, and mess accounts than it is possible for them to obtain under present conditions.
3. If necessary I will endeavor to cut the time of the basic course to four or five weeks. Then the men will be placed as assistants to the food inspector which we hope to establish and following that they will act as assistants to mess officers. The proposed time arrangement will be as follows: Military training, 2 weeks; basic school course, 5 weeks; food inspection, one-half week; mess officer, 1 or 2 weeks.
4. Please let me know if this plan meets with your approval so that necessary arrangements may be made with the camp authorities for the extension of our work.
R. J. ANDERSON,
Senior Instructor, School of Nutrition.
[Second indorsement]
SGO 353 Nutrition, Camp Greenleaf.
WAR DEPARTMENT, SURGEON GENERAL’S OFFICE,
November 11, 1918.
To Capt. R. J. ANDERSON,
Sanitary Corps, Nutrition School,
Camp Greenleaf, Chickamauga Park, Ga.
(Through commandant).
1. The plan for giving more practical work to the students at the School of Nutrition is approved. By reason of the urgent demand for officers, it may not be possible in all cases to extend the time of training by two weeks, and it is thought that the suggestions conveyed in paragraph 3 “to cut the time of the basic course to four or five weeks” would be wise.
By direction of the Surgeon General:
CASPAR W. MILLER,
Major, Medical Corps, Division of Food and Nutrition.
Unfortunately for this instruction, the school was closed December 12, 1918,168 only a short time after this letter was written and the authority asked for therein received. Fifty officers received instruction in this school.168 The
159
instruction which was given just before the final closure of the school was divided into three periods: 170
First period (two weeks). - On arrival in camp the new officers were assigned to one of the companies in Battalion 11 and received the general instruction given to all officers of the medical officers’ training camp, consisting of about four hours of military drill per day and the remainder of the time studying Army Regulations, Manual for Courts-Martial, etc., and attending the general lectures for all officers of the group. A quiz period of one to two hours per day was held to cover the work of the previous day.
Second period (two weeks). - At the beginning of the third week the student officers were relieved from afternoon drill and from the attendance upon the general lectures and quizzes and reported to the School of Nutrition for their technical training in nutrition. Three or four introductory lectures were usually given, covering the work that nutrition officers would be expected to do, various problems that would confront them in different types of camps, and the general methods of going about the work to overcome difficulties. One or more lectures were given covering the organization and management of the Army mess, the duties of mess officers, and the position of the mess sergeant. The various members of the class were then assigned subjects upon which to report. These subjects covered different phases of the following general headings and usually in the order given: (a) Carbohydrates, their composition, sources, uses in the body, etc.; (b) proteins, composition, sources, uses in the body; (e) fats, composition, sources, uses in the body; (d) mineral constituents of foods; (e) vitamines, their importance in the Army diet; (J) acid-base balance of the ration.
The textbooks which were most used as sources of information by the students were the following: Chemistry of Food and Nutrition, by Sherman; Food Products, by Sherman; Physiological Chemistry, by Mathews; and The Science of Nutrition, by Lusk. Practically all the technical work given is taken up rather thoroughly in one or the other of these textbooks.
During the second two weeks of the course the work was quite theoretical, but no opportunity was overlooked to connect theory and practice. In addition to the work of the classroom, two or three half-day periods were devoted to mess inspections. Usually the student officers were grouped in pairs and each pair told to inspect two to four messes and write reports giving criticisms and suggestions for changes. Prior to the beginning of this work a lecture was given on how to properly inspect a mess, good and bad features to look for, and the methods to be used in getting changes made.
Another very important assignment during this period was to prepare an Army menu for 100 men for 10 days, giving the quantities of ingredients to be used in each dish. When completed, the ration for the 10-day period must not cost above the Government allowance and must be approximately balanced in protein, fat, and carbohydrates. There must also be sufficient calcium present, and the acid-base balance must be neutral or an excess in favor of the base. The preparation of this menu involved a lot of practical work and was one of the best methods of getting a new officer acquainted with just what an army menu should look like, and of course he then knew how to criticize the ones present in the messes that he inspected later.
160
Third period (two weeks or longer). - At the beginning of the fifth week of the course the students were relieved from all military duty and were assigned in groups of two to four to run waste studies on various messes in camp. Each group studied one particular mess for a given period, usually two to three days. The primary purpose of this work was to get the student intimately acquainted with a mess and to enable him to see how it was managed, how the cooking was done, etc. Incidently, he got data on the amount and kinds of waste and learned how to reduce it to the minimum. Following the waste study, the party usually remained in the same mess for three to seven days longer to carry on a food survey. The following points are among the most important determined by the food survey: (a) Total calories consumed per man per day; (b) calories wasted per man per day; (c) number of calories derived from each of the three constituents, protein, fat, and carbohydrate; (d) cost of food per man per day; (e) cost of waste per man per day; (f) points of general criticism and suggestions for changes.
During the period of the food survey at least one of the students of the party was present in the mess at all times to get the weights of incoming supplies, weights of ingredients used in cooking, amounts of waste, and to note any items of interest. The constant contact with the mess operations was the only way to learn how a mess should be managed. If time permitted, at least two of these surveys were completed before the work of the student was complete.
The work was as well outlined as could be desired and gave a good combination of the theoretical and the practical. The men who passed through the school during the fall, almost without except-ion, knew the theoretical side of foods very well upon arrival in camp, but a large number of them, after completing the course and reporting for duty elsewhere, were handicapped because they were not thoroughly familiar with the practical side of different types of Army messes. Of course, it was impossible in such a brief time to give the new officer a thorough knowledge of military life and also to acquaint him with all phases of mess management. However, the aim was to emphasize the theoretical less and the practical more.
DENTAL SCHOOL
The Dental School was authorized by the following letter from the Surgeon General: 172
FEBRUARY 1, 1918.
From: The Surgeon General, United States Army.
To: Commandant, Medical Officers’ Training Camp, Fort Oglethorpe, Ga.
Subject: School for training officers of the Dental Corps.
1. A school for officers of the Dental Corps will be established as part of the general scheme of instruction carried out in the Medical Officers’ Training Camp, Fort Oglethorpe, Ga.
2. The purpose of this school is to train officers of the Dental Corps along military lines, from the military viewpoint, and in the military environment; and, coincidently, to develop them physically and instruct them in subjects which they should know under the conditions under which they would practice their specialty, including paper work, organization, relation to enlisted men, and general functions of officers.
3. Classes will be arranged on a basis of a course covering two months. About 80 trained dental surgeons will be required monthly.
161
It is intended that all newly appointed officers of the Dental Corps shall receive this course, together with such others as the needs of the service will permit of taking it.
4. The school for the training of officers of the Dental Corps will maintain and operate a dental clinic and dental laboratory for all the troops at Chickamauga Park, including the personnel of the general hospital, utilizing the clinical material available for purposes of practical dental instruction.
5. Where necessary, as for X-ray work, surgery of the face and jaws, and for other purposes, the school for officers of the Dental Corps will affiliate with other professional schools and courses maintained as part of time Medical Officers’ Training Camp, Fort Oglethorpe.
6. It is intended to erect a special building for practical clinical and laboratory purposes relating to the dental service, as well as for instruction purposes.
7. The senior instructor for this school detailed by this office on the staff of instructors of the training camp will, under the commandant thereof, be in direct charge of the course.
He will continuously investigate the qualifications for the dental service of officers and others under instruction.
8. The general professional instruction to be given will relate especially to the care and treatment of the teeth and conditions dependent thereon.
9. Officers of the Dental Corps will be organized as one or more special companies, be quartered in the medical officers’ training camp, and be subject to its discipline at all times.
10. Hours of instruction, participation in joint classes, etc., will be arranged by the commandant of the training camp.
11. The schedule for the first month is as follows: b
*** ***
SPECIAL DENTAL SUBJECTS
Dental supply table; nature, care, and replenishment of supplies.
Motor dental ambulances; their equipment and management.
Dental laboratory organizations; fixed and field.
Organization and management of department, division, and cantonment dental service.
Limitations of dental practice in the military service.
Practice of operative and prosthetic dentistry in the military service.
Minor dental oral surgery.
Conductive anesthesia.
Interpretation of radiographs.
Wound infections.
Other subjects not specified.
Total special subjects, 110 hours.
Time apportioned to each of the above special subjects to be fixed by the commandant, after conference with the officer in charge of time school for the Dental Corps.
13. The dental division will establish and maintain one or more mobile dental ambulances for purposes of training at your camp.
14. A number of enlisted men of the Medical Department will he maintained at your camp for training with a view to their assignment to duty as assistants to officers of the Dental Corps. This number will be announced later. It will probably be about the same as the number of dental surgeons under instruction.
All such should be given such part of the basic course for enlisted men as would properly form part of their general training for such special service. The scope of their special training in dental work will be prescribed by you.
15. Receipt of this letter to he acknowledged.
By direction of the Surgeon General:
E. L. MUNSON,Colonel, Medical Corps.
b See pp. 78, 79,
162
The school was organized in March, 1918.173 The first month of the instruction of dental officers consisted of the basic course given for medical officers. While dentists received a certain amount of instruction during this month that was perhaps not absolutely necessary, it was, in the main, excellent, especially as dental officers had been called upon frequently abroad to take the place of medical officers in the field, the instruction they had received during this first basic month, it is believed, making this possible. Universal satisfaction was expressed by dentists leaving camp because of the fact that they had received an introduction to the service arid at least a slight knowledge of the operation of other branches.174
The instruction to be given in the second month of training was as follows:
SECOND MONTH
FIRST WEEK
Setting-up exercises, drills, and marches..........................................................10
Manual for Courts-Martial and Military Law...............................................................2
Sanitary service..........................................................2
Rules of land warfare.................................................................1
Duties of the dental surgeon...................................................................1
Dental supplies and supply table......................................................................1
Special subjects:
Syphilitic lesions of the mouth........................................................................1
Bacteriology, general...................................................................2
Bacteriology, laboratory, practical.................................................................4
Inflammation, inception and termination; immunity, etc................................2
Dental caries, theory of.............................................................................1
Prosthetic dentistry, theory............................................................................1
Principles of surgical cleanliness, sterilization, etc..........................................2
Anesthesia, local, general consideration, drugs used.....................................1
Oral surgery, theory.........................................................................2
X ray, theory.........................................................................2
Root canals, pathology.........................................................................2
Root canals, treatment.................................................................4
Root canals, fi1ling.......................................................................4
SECOND WEEK
Hours
Setting-up exercises, drills, and marches.................................................10
Manual for Courts-Martial and Military Law................................................2
Rules of land warfare.................................................................................1
Organization of Medical Department and hospitals....................................1
Special subjects:
Theory of focalinfection.........................................................................2
Bacteriology, general..............................................................................2
Bacteriology, laboratory, practical..........................................................................4
Inflammation, special, dental..............................................................................2
Prosthetic dentistry, theory, splints and wiring..................................................2
Anesthesia, infiltration, and conductive, theory..................................................2
Oral surgery, theory........................................................................4
X ray, theory........................................................................4
X-ray interpretation, practical...................................................................4
Apicoectomy, theory....................................................................2
Exodontia, theory...................................................................2
Diseases of oral cavity...................................................................2
