SECTION IV
DEVELOPMENT BATTALIONS
CONVALESCENT CENTERS
DEVELOPMENT BATTALIONS
The thought of instituting special training organizations for the reclamation of incipient physical defects in the large mobilization camps throughout the United States during the World War had its inception in reports received from orthopedic surgeons of several of the camps. The earliest of these, November 23, 1917, was from the orthopedic surgeon, Camp Kearny, Calif., who reported:1
The treatment of foot conditions presents an enormous problem in the training camp and an attempt has been made here also to systematize, as much as possible, this branch of the work. All cases in the regiment having symptoms that are evidence of insufficient muscular development are listed by company, and the list is submitted to the regimental surgeon. The men are organized into squads in their respective companies, and special foot exercises, at stated times, are given them. The medical and line officers of each regiment are receiving two lectures of one hour each on the subject of feet, the lectures following closely along the lines outlined in instructions received from the Office of the Surgeon General. The company commanders having received these instructions are held personally responsible that these foot exercises are given at the time and in the manner recommended, while it is the duty of the medical officer in each unit to supervise in a general way the whole work. It has been found advisable to number the different movements of these exercises in orderthat they may be given by the count. In practically all cases showing symptoms the heels of the shoes are being tilted, and shoemakers with equipment and material have been detailed for this purpose by the commanding general. Careful watch is maintained for the presence of symptoms due to wearing short shoes, a condition that is all too prevalent in the Army.
On December 15, 1917, the orthopedic surgeon, Camp Cody, N. Mex., recommended that special squads be organized to drill and strengthen soldiers who were convalescent or who had beginning foot strain before returning them to full duty.1 Again, on January 31, 1918, the following report to the Surgeon General was made by the orthopedic surgeon, Camp Cody, N. Mex.: 1
Owing partly to the fact that this division is composed largely of National Guard men with previous military service, but chiefly to the active interest and vigorous measures taken by the division surgeon, the orthopedic conditions and prospects are more hopeful in this camp than in any yet seen.
Until a comparatively recent date the number of men discharged upon surgeon's cer- tificate of disability by the orthopedic surgeon was alarmingly large-some 250 in all, of which 191 were classified by the orthopedic surgeon as "flat foot" of various degrees and "broken anterior arch." This resulted in the inauguration by the division surgeon of the orthopedic casual detachment. * * * All foot cases of the less acute and severe types are detailed to this detachment for observation and treatment, the detachment being under the command of a very competent line officer and under the professional supervision of First Lieut. Marion Trucheart, the orthopedic surgeon on duty with the division. The result up to the present time of the activities of the detachment has been the admission of something over 70 cases of varying foot conditions, with the return to duty of about 25 per cent and the discharge upon certificate of disability of less than 2 percent. From present indications this organization will prove a very valuable experiment for both the division and the orthopedic service. Lieutenant Trueheart has been requested to submit a detailed report of the methods employed as of possible value for adoption in other camps.
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On January 31, 1918, a report from Camp Hancock, Ga., was made to the Surgeon General as follows: 1
Am working on the matter of organizing physical training squads in the 112th Infantry. This work presents ever so many minor difficulties. To get the proper officers and noncommissioned officers and to create the proper spirit and get the men isolated are among the most important considerations. Should be glad to see this work in the hands of the physical training department, with the orthopedic surgeon only advising. Just at this time, though, I think it is necessary to get under the proposition and push. The principal points in the organization attempted now are that the bayonet instructor will supervise the physical training, assisted by a competent sergeant. A sergeant is detailed also from the Medical Department to help with this work to treat corns, callosities, etc., and to see that such men as are indicated reach the surgeon. The orthopedic surgeon has an enlisted assistant, formerly a Y. M. C. A. physical director, who assists at the beginning of each new group of exercises by demonstrating each motion during its performance by the class. The exercises are in 12 groups, as per Special Order 23, but the position of "feet parallel" is incorporated, and all exercises are given from this position. The cadence is reduced and every effort is made for accuracy in performance. Men in the squads will not be allowed to relax from military discipline in the slightest degree. There are about 60 men taking the work in this regiment; an additional number will come in soon.
Thus it will be seen that the inception and furtherance of the idea of developing battalions practically was coincident in three widely separated parts of the United States, and as time went on more and more data concerning this phase of physical development appeared in the semimonthly reports of camp orthopedic surgeons made to the Surgeon General. For example, statistics appeared for the first time in the report of the orthopedic surgeon, Camp Cody, N. Mex., February 4, 1918, as follows:
Men reported to the detachment Jan. 14 to 31 | 71 |
Men graduated and returned to duty | 18 |
Men transferred to base hospital | 4 |
Remaining, Jan 31 | 48 |
Total | 71 |
Early in 1918 a memorandum was prepared in the orthopedic division of the Surgeon General's Office, with the view of obtaining authorization of the War Department for the general organization of these special training battalions, but no action was taken on this memorandum at the time.1 However, on March 8, 1918, the following letter was issued, which, in effect, became the basis of the organization of development battalions later: 2
1. Division, depot brigade, and replacement training camp commanders will make necessary provision within their respective commands for the proper physical care and training of their officers and men. Convalescents will be grouped into squads or companies for special physical treatment and, when necessary or advisable, for theoretical instruction in military duties.
2. When officers and men are released from "sick in hospital" or from "sick in quarters," the surgeon should consider whether treatment in a convalescent organization is necessary and recommend accordingly.
3. The line officers and noncommissioned officers placed on duty with convalescent organizations will be carefully selected, especial consideration being given to their qualifications as instructors in the various physical exercises and sports and for their sympathy and interest in this class of work. Medical Corps officers will also be assigned to duties connected with the special physical treatment of convalescents and required to observe individual cases and to make frequent examinations of those under instruction.
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4. No officer or man who is physically unable to perform full military duty will be permitted to accompany his organization to France unless it is believed by the medical officers on duty with the organization that he will be able to perform full duty within two weeks from date of departure.
5. Whenever it is believed that officers or privates will be physically unfit to accompany their commands to France, they will be examined by a board of two or more medical officers. In case the board recommends that they be left behind, proper steps will be taken to secure their transfer to depot brigades or other organizations and to obtain other officers or men in place of those transferred.
6. Noncommissioned officers left behind on account of sickness will not be transferred from their organizations. As soon as they are fit to perform full military duty, they will be ordered to join their commands.
The immediate effect in the Surgeon General's Office of the above-quoted instructions was the formulation of the following letter by the chief of the orthopedic division, which, as will be seen, was utilized to a certain extent in the preparation of General Orders No. 45, War Department, May 9, 1918, referred to in greater detail below: 3
In order to standardize the "rehabilitation of the physically unfit" as prescribed in a circular letter from The Adjutant General of the Army to the commanding generals of all Regular Army, National Army, and National Guard divisions, under date of March 8,1918,it is recommended that the following plan of procedure be adopted:
1. Physical training organizations shall be planned to include all the physically unfit, but more especially the following classes of cases: (a) Men of poor muscular development, general or local; (b) men of faulty posture, general or special, including faulty foot posture without symptoms; (c) men with definite trouble, but capable of being made fit for: (I) general duty; (II) special duty; (d) men recovering from illness or operation, but requiring graduated exercise prior to return to full duty.
2. The men in classes A and B should be assigned to the physical training detachment directly from the detention camp before assignment to line organizations. The men in class C will be partly assigned from detention camp and partly from line organizations where they have broken down under training. The men in class D will be assigned from base hospitals somewhat as to a convalescent camp.
3. Organization.- It is proposed that this organization be designated "The Special Training Detachment" as a descriptive title that avoids the suggestion of physical disability It should be under the immediate command of a selected line officer, who should have the necessary commissioned and noncommissioned assistants. A physical director should be especially assigned for duty with this organization. One of the orthopedic surgeons assigned to camp duty should be further assigned to duty with this detachment and should be in attendance at least twice daily for the purpose of observation and necessary direction. The necessary medical attendance should be obtained by special assignment or by the utilization of the regimental medical officers of neighboring line organizations. It is believed that this organization could be best conducted as a separate battalion of the depot brigade. Under this arrangement men from the detention camp could be directly assigned as to any other military organization and patients from base hospitals and men breaking down in other organizations could be transferred. The battalion could be mustered, paid, and subsisted as any independent organization. The battalion organization would allow the recognition of four different degrees of disability and their segregation into the four companies of the battalion.
4. Training.- The training in this organization should be graduated in the four companies to correspond to the degree of disability. The training should be so arranged and graduated that military duties will so far as possible be used in place of or in conjunction with developmental exercises. Camp police, signal drill, manual of arms, and similar light duties can be used to some extent in nearly all cases, and the heavier military duties may be gradually approached by patients with lesser degrees of disability. It is believed that by this method men graduated back to full duty from this detachment will be able to join line organizations without detriment to either the organization or the individual.
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5. Assignment.- Men should be assigned to this organization upon the recommendation, after a thorough examination, of special physical examining boards officiating in each division. An orthopedic surgeon should be a member of each such board. The physical examining board officiating in the detention camp or depot brigade should be instructed to take special precautions to assure the assignment of all physically unfit and potentially weak men to the special training detachment.
6. There should be established in connection with each such organization a cobbling shop, to be equipped with the regular regimental cobbling outfit and to have assigned to it one or more trained cobblers who can make minor shoe alterations under the supervision and direction of the orthopedic surgeon.
7. After a reasonable and sufficient period of special training, the members of training detachment may be recommended as follows: (a) For general duty; (b) for selected special duty; (c) for discharge.
It was now found that sufficient authority existed for a general organization of a physical developmental movement in the camps, and at a convention of orthopedic surgeons, held in Washington, April 22 to 25, 1918, the suggestion was made by the Surgeon General's representatives, to camp orthopedic surgeons that the subject be gone into by them at once.1 As a result 12 organizations in as many different camps were formed shortly.1
After a series of consultations among representatives of the Surgeon General's Office, The Adjutant General's Office, and the General Staff, definite instructions for the formation of development battalions were issued in General Orders, No. 45, War Department, May 9,1918. This order provided that there be organized at each National Army, National Guard, and Regular Army divisional camp, and in such other camps as might be directed by the Secretary of War, one or more development battalions.
The functions of the development battalions were to be to relieve divisions, replacement, and other organizations, etc., of unfit men; to conduct intensive training with a view of developing unfit men for duty with combatant or noncombatant forces, either within the United States or for service abroad; to promptly rid the service of all men who, after thorough trial and examination, were found physically, mentally, or morally incapable of performing the duties of a soldier.
The following procedure in connection with the transfer of men to development battalions was to be observed in camps where the establishment of such battalions was authorized: When an enlisted man was inapt or did not possess the required degree of adaptability for military service, or gave evidence of habits or traits of character other than those for which trial by court-martial should be employed that rendered his service in the organization undesirable, or was disqualified for service physically through his own misconduct or other-wise, and not subject to immediate discharge on surgeon's certificate, or was an alien enemy, or who was an alien who was not a declarant and had been drafted through his ignorance of his rights under the selective service law, or for any other reason was not fitted to perform the duties of a soldier at home or abroad, his company or detachment commander was to report the facts to the commanding officer, who was to request that the transfer to the development battalion be made. Soldiers who had not sufficient knowledge of the English language to enable them properly to perform their duties might be transferred to the development battalions, where instruction to the necessary
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extent was to be imparted. Within the development battalions the men were to be grouped in classes, depending upon their aptitude and degree of training.
Aside from the statements of organization and functions of the battalions, this order has two outstanding features: First, the provision for both physical and educational treatment of unfit soldiers, thus definitely linking the development battalion with the reconstruction program; second, the failure to separate in any way those physically unfit in line of duty from the venereal cases, the morally or mentally degenerate, alien enemies, draft evaders, and conscientious objectors. Adequate provision of barracks and other accommodations was not made beforehand, and over 98,000 men were transferred to the battalions by August 31, 1918.4 These factors, together with the indiscriminate mixing of all classes of men, resulted in a great confusion and a partial failure to effect the results contemplated.
Instructions concerning the operation of development battalions were issued by the War Department early in the summer of 1918.5
The purpose of these instructions is to make clear certain points in General Orders 45and put before all commanders such general principles with reference to the practical working of the order as will insure uniformity in operation and full use of such features as experience has shown to be essential for full success of the plan as a whole.
The basic purposes of General Orders 45 is to relieve divisions and other organizations of all unfit soldiers as soon as encountered, and the reclamation of such men so far as possible in an organization constructed for that special purpose, thereby leaving the division free to function as a machine with perfect members.
It is important, therefore, that General Orders 45 be interpreted broadly and in this spirit. For example, the second paragraph of section 6, stating " Men who * * * will be discharged," should be interpreted to permit a commanding officer to give any form of discharge which in his opinion fits the case.
Soldiers transferred to development battalions will be of two general classes- (a) those transferred to it because of physical disability; (b) those transferred to it on account of all other causes, as stated in section 1, paragraph 4a, and section 2 (G. 0. 45, 1918).
When there are more than one development battalion in a camp, each will be numbered as follows: Development Battalion, No. 1, Camp ; Development Battalion, No. 2,Camp ; and so on.
The term "rating" is employed in these instructions to indicate the relative military or combat fitness of men. It is not dependent on physical condition alone, which the Medical Department could settle, but involves the consideration of a combination of physical and other causes and conditions having to do with education, training, religion, nationality, etc.
A man's rating indicates the opinion of the development battalion commanding officer, based on a summary of all facts bearing on that man's general fitness. In determining this rating he considers the detailed information furnished by medical and personnel officers as a result of observation and investigation in their respective fields up to the time the man is rated.
The development battalion commanding officer will instruct the personnel officer to enter on the man's qualification card rating 1, rating 2, or rating 3, as the conditions warrant, and the medical officer's remarks or limitations as to the character and amount of work the man may safely be called upon to perform. The personnel officer will thereafter be governed by such rating in making assignments.
Rating 1 is the designation employed to indicate that a man is physically classed by the Surgeon as "A" and that he is considered by the commanding officer satisfactory mentally and morally and from all other standpoints is regarded as acceptable for any character of general military service.
Rating 2 is used to designate those whom the commanding officer regards as hardly suited for rating 1. This includes men classed by the surgeon as physically class "A" yet
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found lacking in other respects--as, for instance, of uncertainty of ability to speak, read, and write English, or of slow mentality. It also includes men classed physically as "B "-i. e., "not quite fit for general military service" and free from serious organic disease, but other- wise competent and most desirable. These may be used for any domestic and any but the heaviest combat service (overseas).
Rating 3 designated all those clearly unsuited for ratings 1 and 2, yet of such physical classification ("B" or "C") that they could be utilized, and whose other characteristics may or may not be of the highest, yet are such as to warrant the retention of these men for restricted or limited domestic service.
The following instructions describe in detail the medical classification to be employed by medical officers, the method of rating, and the report form to be used in transmitting periodic reports of the operation of the battalion.
This development battalion report will be forwarded to The Adjutant General, Com- mittee on Classification of Personnel, Washington, D. C.
As fast as the development battalion reports from the various camps are received by the committee on classification of personnel, they will be tabulated on a summary sheet, which will constitute the consolidated report showing the numbers, classification, and dispositions of all men in all of the development battalions throughout the country.
The purpose of this summary report is to enable The Adjutant General, the General Staff, or others empowered to act to analyze the physical and, to some extent, medical conditions of men rejected from depot brigades and other depots to determine on policy affecting operation of the Army and disposition of such men.
INSTRUCTIONS
1. Soldiers transferred to the development battalion because of physical disability will be from the following sources:
(a) From divisional units, replacement organizations, etc., other than depot brigade. These are men who have been accepted as "fit for general military service," but in whom a disability has developed or been discovered since "muster in."
(b) From the depot brigade. These are men who have been accepted for general military service but in whose case observation for a period of from one week to one month has shown that a physical weakness exists which may or may not have been noted on original examination, the nature of the defect making it desirable to transfer the men to development battalion. Probably the majority of these will be men in need of graduated physical training to assure their fitness for general military service. Others will have permanent defects placing them in the group for "special and limited service."
(c) Registrants, classed by local boards as fit for "special and limited service in a named occupation or capacity," who are sent to camps as results of calls for this class of men.
(d) Those sent out from other camps and stations under section 1, paragraph 8 (G. 0. 45, 1918).
(e) Under regulations at present in force governing the physical examination of men called for general military service, those found by medical officers to be fit for "special and limited service only" or in the class formerly accepted as "fit for general military service when cured of" (naming a specific disability), now the "deferred remediable group," can not be accepted as in those classes and assigned to development battalions. Such men must be returned to local boards for reclassification unless, in the case of those fit for "special and limited service," their services are needed in the camp or station at that particular time. If needed at the camp or station, this class may be accepted. If so accepted, they should enter development battalion for rating. All men falling in the "deferred remediable group" must be returned to local boards for reclassification.
2. It is evident that those with whom the cause of transfer to a development battalion is physical disability may be suffering from a variety of pathological conditions. The task of the medical staff is to examine as soon as possible and tentatively classify each man.
All men as they arrive in development battalions will fall into one of the following classes:
(a) Clearly unfit for any service, ready for surgeon's certificate of disability at once.
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(b) Needing hospital treatment at once. These are to be transferred to base hospitalor to general hospital.
(c) To enter such special treatment and training as is provided within the development battalion.
3. As treatment and training of men included in Class 2 above, paragraph (c), progresses, each man will ultimately be placed in one of the following physical classes. This is the final classification usually to be made after observation and treatment and training:
Class A. Fit physically for general military service.
Class B. Not quite fit physically for general military service, but free from serious organic disease; able to do an average day's work; able to walk 5 miles; to see and hear well enough for ordinary purposes; able to perform duty equivalent to garrison duty, labor battalion, shop work (in a trade), at home or abroad or combat service at home (United States Guards).
Class C. Fit only for duty in a selected occupation or in a restricted capacity to which they must be limited.
Soldiers in Class C have more serious disabilities and must be considered individually. When it is clear that the physical disability is not of too great severity to exclude him from Class A or B, yet the surgeon believes that this disability is not of too great severity to prevent his retention in the service for duty in a special capacity, he will consult the soldier's " qualification card," note the occupations in which qualified, and direct the personnel officer, as custodian of all personnel records, to indorse on the card in the case of each named occupation the medical officer's opinion as to whether or not the soldier can safely be employed in the named occupations, and whether the disability prevents the soldier being 100 per cent physically efficient in the occupations named on the card. If not 100 per cent physically efficient the percentage of efficiency will be noted. Unless a soldier is 80 per cent or more efficient in at least one trade, he should not be retained in the service.
Class D. Physically unfit for any military service.
Men transferred to development battalions because of causes other than physical disability will also be classified physically at the proper time before being rated.
4. It may be desirable at the end of each month for the surgeon of development battalion to furnish a report to the battalion commander showing the names and the number of men who have been classed physically for assignment during the month just ended. This report should cover and account for all cases in the battalion during the month, showing separately those of Classes A and B, paragraph 1, herewith. The following information should be shown on this report:
(a) Number remaining unclassified physically at end of previous month.
(b) Number received in battalion during the month.
(c) Number disposed of during the month (physically)-
To physical Class A.
To physical Class B.
To physical Class C.
(d) To physical Class D
(e) Remaining unclassified physically.
5. In each development battalion arrangements will be made for giving physical training to such convalescents as may be sent to the battalion for hardening. Patients who are no longer in need of treatment, but who require hardening before being returned to full duty, may be sent to development battalions by commanding officers of base hospitals or other proper medical officers. They will be carried as attached. At the time they are sent to the development battalion these patients will be returned to a duty status.
When in the opinion of the commanding officer of the development battalion these men have received the necessary hardening, they will be returned to their organizations. Men from base or other hospitals will not be attached to development battalions for physical training unless it is practically certain that they will be able to rejoin their commands within six weeks. If a period longer than six weeks is to be required, the commanding officer of the base hospital or other medical officer concerned should return the patient to quarters at the proper time with recommendation to the organization commander that the
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patient be transferred to the development battalion. Commanding officers of development battalions receiving convalescent patients for hardening will take such steps as will insure arrangements by the medical officers of the battalion to the effect that the training to be received by these convalescents is proper, suited to their condition, and that they are not injured thereby.
6. The development battalion is a part of the camp activities, and its medical activities are under the general supervision of the camp surgeon. All communications relating to tie medical work of development battalions must pass through the office of the camp surgeon.
7. The medical work of the development battalion will be developed under the immediate direction of the surgeon, depot brigade, if a part of the depot brigade. He will arrange for the assignment to development battalion of a medical officer as surgeon who is especially qualified temperamentally and by experience and training for the work. If no such medical officer is available in the depot brigade and the camp surgeon is unable to furnish one, the needed request will be made to the Surgeon General by wire for the assignment of such an officer. The same general qualifications should be possessed by the officer assigned as assistant surgeon, development battalion. The two medical officers just mentioned are assigned regularly to development battalions and constitute its administrative medical staff. If it is found by experience that additional assistants are required by the surgeon, they may be attached from any junior medical officer available.
8. The necessary arrangements will be made by the camp surgeon to place at the disposal of the surgeon, development battalion, the services of the necessary specialists in cardiovascular disease, tuberculosis, orthopedic surgery, physical training, etc., as may be required. Ordinarily no staff of specialists will be assigned to development battalions, the necessary specialist assistance being obtained from specialist medical officers on duty at the camp and base hospital.
9. It is suggested that separate companies should be set aside to receive those trans- ferred to the battalion because of physical disability, others to receive those transferred to the battalion on account of all other causes. Satisfactory work with these physically unfit men is dependent upon correct physical grading and their assignment to a section of their company in which the work should be given is--
(a) Not too great for their physical powers; and
(b) of such a character that it tends to correct the disability from which a man suffers. The classification in the companies should be such as to separate the ones who are in need of hospital treatment and those who are so hopelessly unfit as to be proper subjects for immediate discharge. The others should be assigned carefully, the necessary specialist consultants being called in. Following this the man is assigned to a section of the com pany for training purposes. The organization of these sections can not be laid down in absolute detail. A number of methods may be followed. It is not considered desirable to attempt to make detail regulations on this subject at this time.
10. It is believed that separate accommodations for venereal cases are required in devel-opment battalions. Presumably the number of such cases transferred to development battalions will be rather large. This problem may, perhaps, be best met by establishing within the battalions what is, in effect, a unit for the treatment and training of chronic venereal cases. This should have special facilities for administering the necessary treatment, and a course of training should be devised such as will permit the use of the necessary time by the men forgoing to and from their treatment.
DESCRIPTION OF FORM CCP-601-CAMP DEVELOPMENT BATTALION PERIODIC SUMMARY
REPORT AND INSTRUCTIONS AS TO ITS USE
11. The purpose of this report is to present a clear picture of the actual operation of the entire development battalion during the period covered by the report. The report will provide the depot brigade and battalion commanding officers and The Adjutant General with all essential facts to determine the kinds and numbers of men reclaimed and made useful or removed from the Army because past any possible use.
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12. The report is to cover one month from 12 o'clock midday of the last day of the month to 12 o'clock midday of the last day of the next month. It must be mailed to The Adjutant General (Committee on Classification in the Army), Washington, D. C., within 24 hours after the closing time.
13. The horizontal headings across the top of the report sheet are clearly stated. Totals of whites, totals of colored, and the sum or total of these are given in each case. The vertical headings down the left side of the sheet are also self-explanatory. Through the use of these cross headings the report is made to show the actual number and increase or decrease under any horizontal heading-for example, "How many mentally unfit cases were corrected during the month and rated 2?" Under the heading " Mental" (15) in horizontal line look down the column until the side heading (9), "Rated 2 since last report" is found. The figure found in the intersecting square will give the actual number of men suffering from some form of mental disability that will include and put into rating 2 for transfer out during period covering the report. Again, "How many colored men with functional heart condition were discharged to Enlisted Reserve (civilian operated plants)?" Under the heading "Functional heart condition," column (16) and side heading (16), "Transferred to Enlisted Reserve" (civilian operated plants) will be found the number, if any, who were so transferred during the month. These examples will serve to indicate method of making up and using the report.
14. A duplicate of each report will be retained for analysis and comparison to insure the battalion performing its purpose of reclaiming the maximum number of men and to prevent the accumulation of permanently unfit and undesirable men.
It will be observed that these instructions made express provision for the transfer of convalescents from base hospitals to development battalions to undergo a hardening process before their return to routine duty. This also released a considerable number of beds in base hospitals which were urgently needed at that time.
A circular published by the War Department at about the same time prescribed that a course of instruction in English be given to those members of each development battalion who had not sufficient knowledge of the language to receive, execute, and transmit verbal messages intelligently, and to read and understand such ordinary written or printed matter as was contained in the various drill regulations, etc.6 The normal course was to continue for four months, and the psychological division of the Sanitary Corps would be called upon to assist in determining the rate of progress of slow-learning men and the reason for their backwardness, to the end that all scientific and practical means might be used to determine the best training that should be given those undeveloped mentally as well as educationally.
A large proportion of the men transferred to the development battalions consisted of venereal cases which required treatment but not confinement to a hospital. For convenience, and as an economical measure from the administrative standpoint, buildings were adapted to this special purpose. Plans for a special building for this use were drawn in the Surgeon General's Office.7
A board, consisting of a medical officer attached to the division of physical reconstruction of the Surgeon General's Office, a member of the General Staff, and a civilian, was appointed by the Secretary of War on June 10, 1918, "for the purpose of coordinating the work in connection with the establishment of development battalion." 8 The early plans for the medical phases of the work were entirely in the hands of this medical officer from the date of establishment of development battalions up to September 9, 1918.
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The medical and administrative problems arising in connection with the establishment and operation of these organizations were numerous and often involved questions of policy in which several divisions of the Surgeon General's Office were immediately concerned. This complicated matters, and in their earlier stages development battalion activities in the Surgeon General's Office were not so well coordinated as might have been desired. The Acting Surgeon General, therefore, on September 9, 1918, ordered the transfer of the officer in charge of this work in the division of physical reconstruction to the division of sanitation "for the purpose of assuming the duty in connection with the activities of development battalions, the work of which is placed under the direction of the officer in charge of the division of sanitation." 9 Subsequent to this order all medical activities relating to development battalions were coordinated and directed by the officer in charge of the division of sanitation through the officer in immediate charge of the work.
When the development battalions were transferred to the division of sanitation, immediate steps were taken to organize a group of inspector-instructors10 composed of specially selected medical officers who were more or less familiar with problems of physical training and reconstruction. Several of these officers were brought together in the Surgeon General's Office, where they were familiarized with all published orders relating to development battalions and with previous plans for these organizations. Solutions were worked out to meet such defects in organization and administration as had already appeared. Information relative to the defects in question was based chiefly upon reports from medical officers in the various camps where battalions already had been formed. The inspector-instructors were then ordered to Camp Meade, Md., where a very efficient organization had been developed. They remained there several days under intensive instruction with the development battalion in that camp. Having been thus familiarized with the work at Camp Meade, they were then ordered to other camps, where they gave instruction using the development battalion at Camp Meade as a model."' Each inspector-instructor was required to remain at a camp until satisfied that the development battalion was properly organized and equipped and was functioning as intended. Upon the completion of this work he rendered a report to the Surgeon General covering in detail the conditions found by him within the battalion, in so far as this concerned Medical Department activities, and the results of his efforts to improve matters. Twenty-seven camps were visited by these inspector-instructors and in all of them the foundations were laid for efficient development battalions. The main points which these instructors were to convey to the development battalion were:12 The formation of a board of medical officers and one personnel officer to examine and pass on every case before admission to development battalions; the rapid but accurate final classification of all men in development battalions; a limit of two months was to be fixed as the time men might be held, the need of physical training of the men under the direction and as often as possible the supervision of the medical officers. Since the morale of the men had a decided influence upon their physical and mental betterment, suggestions to improve morale were to be made. Close cooperation between the medical officers and personnel officers was to be established in order to select
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duties for the men in the battalion according to their physical and occupational qualifications. The usual period required for discharge for disability for all men placed in D class was to be shortened.
Chiefly through the efforts of medical inspector-instructors, about 15 camps developed very efficient systems in their development battalions before the signing of the armistice on November 11, 1918. The men were more rapidly classified and disposed of than was the case at first, and better cooperation between line and medical officers was secured. Physical development work was established on a proper basis and carried out systematically under the immediate supervision of medical officers. Segregation of the ambulant venereal cases from the remainder of the men in the battalion was accomplished whenever possible. In a number of camps schools for instruction in English were established for the benefit of illiterates and for non-English-speaking soldiers, as well as other schools for special training in occupations useful to the Army. Recreation, games, and other amusements tending to improve morale were promoted and proved of great value. The enrollment in the development battalions during October, 1918, in the more important camps is shown in Table 3.
TABLE 3.- Numerical changes in development battalions during the month of October, 191813
All efforts to conserve physically unfit men for military use were terminated by the signing of the armistice; consequently the value of development battalions as such was at an end. Statistics as of November 11, 1918,14 com-
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piled from final reports which are incomplete, indicate that at least 68 per cent(152,807) of the men transferred to development battalions were reclaimed and assigned to some duty in the Army, thus releasing an equal number of able-bodied soldiers for combat service. Without the development battalions the majority of these men would have have been discharged. Table 4 shows the sources of these men from the disease standpoint; Table 5, their disposi-
tions.14
TABLE 4.- Classification of men enrolled in development battalions 14
TABLE 5.- Disposition of men from development battalions.14
CONVALESCENT CENTERS
Following the signing of the armistice a change became necessary in the program of physical reconstruction of disabled soldiers and in the work of development battalions. Previous to this date, development battalions had functioned as outlined above; soldiers discharged from base hospitals, and yet not sufficiently recovered to return to a full-duty status, and soldiers who were physically or mentally unable to continue on a full-duty status were transferred to development battalions where they were made fit for either full duty or limited service.
After the armistice was signed the attention of the medical officers who were concerned with the physical reclamation of our soldiers, was centered upon making the soldier fit to return to civil life as a productive unit of society.
With this in view, the board on development battalions, General Staff, War Department, recommended in November, 1918, that development battalions be utilized to the fullest extent in the disposal of all unfit men, including non-English speaking and illiterates; that immediate steps be taken to curtail discharges on certificates of disability until the aforesaid plan could be put into operation; that the work of carrying out the details of this plan, including the establishment of thorough cooperation with all interested agencies, both military and civil, be delegated to the board on development battalions. 15
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On November 25, 1918, the establishment of overseas convalescent detachments was provided for: 16
1. Soldiers who have been or who may be incapacitated while on duty overseas and who are convalescent in this country will not be transferred to development battalions in the future. General Orders, No. 45, War Department, 1918, is hereby modified in accordance with the above.
2. In each camp, cantonment, and post where oversea convalescents may be assembled there will be formed an oversea convalescent detachment. This detachment will consist of such officers, noncommissioned officers, cooks, and other grades of enlisted men as it maybe necessary to detail for the purpose of administration, supply, and training, and such convalescents as are sent to the camp, cantonment, or post who have been incapacitated by virtue of having been on duty overseas. The detachment will be quartered and messed separately. While serving in oversea convalescent detachments, men will be carried on the detachment rolls in the grades held by them in their permanent organization.
3. In order to relieve congestion in general hospitals, commanding officers of such hospitals are hereby authorized to send oversea convalescents, whose hospital treatment has been completed, to oversea convalescent detachments in the following camps: Beauregard, Custer, Devens, Dix, Dodge, Funston, Gordon, Grant, Hancock, Jackson, Kearny, Lee, Lewis, MacArthur, McClellan, Meade, Logan, Pike, Sevier, Shelby, Sherman, Sheridan, Taylor, Travis, Upton, Wadsworth, and Wheeler.
Since it is the intention to discharge all oversea convalescents as soon as possible, consistent with the maximum physical improvement, commanders of general hospitals will, as far as practicable, send convalescents to the camps nearest to the homes of the men to be discharged. Intensive treatment and training of all convalescents assembled in oversea convalescent detachments will be immediately undertaken and continued in order that their cure or maximum improvement and subsequent discharge may be accomplished in the shortest possible time. On the last of each month commanders will report to The Adjutant General of the Army the number of men received in and the number of men discharged from oversea convalescent detachments.
4. Commanding officers, upon whom the duty of organizing oversea convalescent detachments devolves, should bear in mind the importance of the work to be performed in these detachments. It is only by the selection of competent line and medical officers and thorough cooperation on the part of these that the best results can be obtained. The object sought is the return to civil life of these men in the best physical and mental condition.
5. Convalescents whose treatment and training has been completed will be promptly discharged in accordance with existing instructions without reference to the War Department.
Since the above provisions (Circular No. 90) concerned oversea convalescents only, and since the base hospitals in the United States contained many patients who never had served overseas but who were in need of convalescent camp care, the Surgeon General, in December, 1918, recommended that convalescents from the forces in this country be given the same care as oversea convalescents, in order that they might be returned to civil life in the best physical and mental condition attainable.17 Accordingly, Circular No. 90 was so modified as to include all convalescent soldiers from general and base hospitals, and the designation " oversea convalescent detachments " was changed to "convalescent centers." Since these instructions contained many interpretations concerning the discharge of disabled soldiers, which are of present interest, they are reproduced here in full: 18
1. In order that the provisions of paragraph 2, Section II, Bulletin No. 36, War Department, 1918, may not unduly retard the discharge from the service of men clearly unfit for military service, the following interpretation of the spirit of this paragraph is published:
(a) Subparagraph (a) is intended to provide for the complete cure or maximum restoration of men incapacitated because of military service. Subparagraph (b) is intended to
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provide for the retention in the service of such disabled men until such time as their maximum restoration has been obtained. There will be many cases that will not be benefited by further sojourn in hospitals, convalescent centers, or development battalions. These should be promptly discharged. The surgeon who has the case in hand must be the judge as to whether or not maximum restoration has been secured, or if, after treatment in the hospital in which the patient is located is completed, the case will be further benefited by transfer to another hospital, convalescent center, or development battalion. Cases which, in the opinion of the surgeon, will be further benefited should be promptly transferred.
There will, furthermore, be many cases of disabled men who either possess funds or who have relatives or friends in position to afford them specialized care after discharge. In these cases disabled men may be discharged but not until the responsible commanding officer has fully determined that continued treatment and care is assured. The fact that a man (his continued treatment and care being assured) is being discharged, either at his own request or at the request of the relative or friend, will be noted on the report rendered in connection with the soldier's physical examination prior to discharge. This notation will include the name and addresses of the persons assuming responsibility for such continued treatment and care.
The provisions of paragraph 2, Section II, Bulletin No. 36, War Department, 1918, as interpreted above, will govern both for officers and enlisted or drafted men. In this connection, convalescent centers and development battalions are intended for enlisted or drafted men only. (b) The provisions of paragraph 1, Circular No. 93, War Department, 1918, intend that the cases of all men who have acquired a lower physical standard than that given them when they entered the service, shall be promptly acted upon by the Board of Review in order that men may be discharged immediately after the Board of Review certifies that the maximum improvement has been obtained or that physical disabilities have not been exaggerated or accentuated as a result of service in line of duty. Instructions on page 4, Form No. 135-3, A. G. O., should be harmonized accordingly.
2. During the demobilization of the present army commanding officers of general hospitals will dispose of patients in such hospitals who are enlisted or drafted men as follows:
(a) Men who entered the service since April 1, 1917, and who after hospital treatment are fit to return to full duty, will be sent for discharge to the demobilization center nearest their place of entrance into service as indicated in Circular No. 106, War Department, 1918,amended by Circular No. 122, War Department, 1918.
(b) Men without regard to date of entry into the service who have since become disabled or who had disabilities prior to their entrance into the service which have been aggravated or made worse by service, said disabilities not being due to their own misconduct, will be transferred to convalescent centers as prescribed in Circular No. 90, War Department,1918, amended by Circular No. 183, War Department, 1918, providing further benefit can be expected by additional treatment, training, and hardening processes.
(c) Men without regard to date of entry into the service who have become disabled either prior to or since entry into the service, due to venereal disease, and who need further treatment but do not necessarily require hospital care, will be transferred to the development battalion nearest their place of entrance into service.
(d) The cases that can not be benefited by further treatment in hospitals or by transfer to convalescent centers or development battalions will be discharged on Form No. 17, A. G. O.(certificate of disability), in accordance with existing conditions. Existing instructions will govern in the discharge of all cases of disability due to their own misconduct.
(e) Men who entered the service on or before April 1, 1917, who become fit for full duty, will be returned to their organizations if said organizations belong to the Regular Army and are stationed in this country. All other such men, except those belonging to the Cavalry and those whose branch of service is not represented in the Regular Army, will be sent to the nearest appropriate units of the 8th to 20th Divisions, inclusive, or to the nearest appropriate unit in the Regular Army in the United States not in those divisions. The names of such enlisted men in the Cavalry will be reported to the commanding general, Southern Department, for assignment. Those whose branch of service is not represented in the Regular Army
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will be sent to the nearest depot brigade. Men of these classes transferred will be assigned or attached to appropriate organizations in their present grades.
(f) Commanding officers of general hospitals are authorized to transfer direct the cases enumerated in subparagraphs (a), (b), (c), and (e) above and such other cases as may need treatment which can be given only in another hospital.
3. Whenever Form No. 17, A. G. O., is used in lieu of Form No. 135-3, A. G. O., a carbon copy will be prepared and transmitted to the Bureau of War Risk Insurance, as provided for in paragraph 2, Circular No. 73, War Department, 1918.
4. The designation "oversea convalescent detachments," as provided for in Circular No.90, War Department, 1918, is hereby changed to "convalescent centers." They will be used as concentration points not only for oversea convalescents but for convalescents from the forces in this country, including the few remaining cases in development battalions whose disabilities are not due to their own misconduct. The quarters selected for convalescent centers should be selected in an attractive part of the camps, and whenever practicable should be near the various welfare centers conducted by the Young Men's Christian Association, the American Red Cross, and other civilian organizations.
5. In view of the signing of the armistice and of the above provisions, the necessity for development battalions as organized under General Orders, No. 45, War Department, 1918,ceases to exist except for the further treatment of venereal cases and for men held for reasons other than physical disability who are awaiting discharge. Experienced personnel no longer needed in development battalions should be utilized in convalescent centers. In this connection, as stated in paragraph 4, Circular 90, War Department, 1918, it is only by thorough cooperation on the part of line and medical officers that the best results can be obtained. The results desired are the maximum restoration of these men in the shortest time possible. Therefore, the assignment to physical drill, exercises, fatigue, the granting of passes or furloughs, etc., should be made only after consultation between the responsible line and medical officers.
Following the promulgation of this order, the Surgeon General placed the supervision of medical work in convalescent centers under the division of physical reconstruction of his offices. To establish a general policy of the reconstruction division in the camps, the Surgeon General issued instructions in January, 1919, as follows: 19, 20
The policy approved by the War Department, which embraces the application of curative work and efficient physiotherapy in the treatment of sick and wounded soldiers, implies that this is to be carried on in the hospitals to hasten the restoration of disabled officers and soldiers to health and function as fully as possible, considering the nature of their disabilities, the limitations of their military service, and the other provisions which the Government has made for the care of the permanently disabled.
When the disabled soldier shall have received the treatment embraced in paragraph 9, he, by virtue of paragraph 4, Circular 188, W. D., should be discharged from the hospital and sent to the convalescent center. The soldier sent to the convalescent center is on a duty status and is therefore not a patient. He should therefore be in such condition when he is sent to the convalescent center as will justify his discharge within a few days or in a short period of time for the purpose of receiving exercise, drill, and appropriate play which will harden him and overcome as far as possible defects which are amenable to the measures which may be utilized in the convalescent center. Circular 188, W. D., indicates the location of convalescent centers in camps and contains general statements concerning their administration from a medical point of view.
In the administration of the curative workshop schedule and the utilization of physiotherapy in the base hospitals, it is suggested that the camp surgeon may utilize both curative work and physiotherapy for the convalescent soldiers on duty in convalescent centers by sending them to the workshops and physiotherapy rooms for such treatment as the medical personnel of the convalescent center may desire to be applied.
* * * * * *
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That the administration of the curative workshop schedule may be as efficient as pos- sible for all disabled men who may be benefited thereby, it is suggested that the convalescent center be located as near as possible to the base hospital.
While it is appreciated that the actual medical and surgical treatment of the men in the convalescent center will have been practically completed in the hospitals before they are assigned to duty in the convalescent centers, many of these men will need rehabilitation and a hardening process to improve their general morale and physical condition before they are recommended for discharge. This hardening process may be best obtained by supervised graduated physical exercises, drills, games, and, when necessary, by the utilization of the curative workshops in the educational center. Soldiers who may benefit by academic studies should be given this opportunity under the supervision of the chief educational officer and in this way may continue this study which was begun when the soldier was in a base or general hospital. The War Department commission on training camp activities has agreed to furnish the necessary physical directors and equipment in the recreational activities of the convalescent center. The American Red Cross, cooperating with the Young Men's Christian Association, the Knights of Columbus, the Salvation Army, and the Jewish Welfare Board, will furnish recreational activities in the base hospital and agencies which will stiffen the morale of the men by home service activities through local Red Cross chapters and other facilities which they command.
Several medical officers were directed to report to the reconstruction division, Surgeon General's Office, with the view of receiving instruction in the work of medical administration of convalescent centers and of acting as instructor-inspectors.21 At Camp Dix, N. J., a convalescent center had been established and now was operating efficiently, so this group of instructor-inspectors was sent to that camp where several days were spent in studying the convalescent center.21
The reconstruction division of the Surgeon General's Office endeavored to set forth general principles relative to medical work in convalescent centers and in the connection of this work with the whole physical reconstruction program in the base hospitals.21 The medical administration of the centers necessarily was left to camp surgeons, since the men in the centers were on a duty status. As a result, each camp had some distinctive feature in its convalescent center, but, on the whole, three types of centers were developed.21
The first type of convalescent center comprised those established in a part of the camp which was some distance from the base hospital, adjacent either to the recreational center or the existing shops of the camp. In such a center an educational system or curative work schedule was established independent of that conducted at the base hospital.21 The automobile shops, carpenter shops, telephone offices, and other activities of the camp were utilized for educational purposes. Usually a director for this work was found among members of the Young Men's Christian Association; otherwise, line officers were assigned to this duty by the commanding officer.21 Massage and other forms of physiotherapy were applied in the center. The physical development of the men in the center was carried on by the director assigned to this work by the War Department commission on training camp activities.21 The surgeon of the convalescent center usually divided the convalescent soldiers into groups A, B, and C, according to their ability to perform physical exercises.21 Thus, Group C men could have only light exercises for one or two hours a day; Group B men were able to have a moderate amount of exercise for three or four hours a day; group A men could have strenuous exercise several hours
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a day, since they represented men undergoing their final training preliminary to their discharge from the Army. As the convalescent soldiers developed strength and hardening, they were promoted from Group C to Group B, and thence to group A for discharge in the depot brigade, after being finally passed on by the local medical demobilization board. If in the judgment of this board the maximum physical restoration had been attained, the men were discharged; otherwise they were returned to the convalescent center for further treatment and training. Examples of this type of convalescent center were in Camps Dix, N. J., Gordon, Ga., and Kearny, Calif. 21
The second type of convalescent center comprised centers which were established as near as possible to the base hospital. Some of these convalescent centers used the curative workshops in the base hospital, and the educational activities established there; in others, workshops and educational courses were established in the center itself.21 All of this work, however, was under the immediate direction of the chief educational officer of the base hospital. Very little medical treatment was carried on in these centers, the convalescent men who needed further treatment being referred back to the base hospital as out-patients. In this type of camp, it was the custom for the ambulance from the hospital to carry a certain number of the convalescents to the base hospital each day, for either treatment or curative work, since it was the rule for the soldiers to go to the physiotherapy center in the base hospital for this form of treatment. The training under the physical director of the center was some-what similar to that described under the first type above. When ready for discharge, the soldiers were referred to the local medical demobilization board. Examples of this type of center were at Camps Meade and Lee.21
The third type of convalescent center, fortunately only a few in number, functioned more as a demobilizing center than as a convalescent center, and very little effort was expended in educational or curative work or in physical development.21 The convalescents were sent, after a few days in camp, to the medical demobilization board for action by the board, looking to immediate discharge.21
With the view of securing uniformity in the convalescent centers, the Surgeon General on January 25, 1919, issued the following instructions to consultants and instructors in convalescent centers: 22
1. Consultants and instructors in convalescent centers should visit the camps for the purpose of establishing the general policy of the division of physical reconstruction as outlined in various circular letters.
2. From these circulars it is seen that the curative workshop schedule should be centered under one administration applicable to both the patients in the base hospital and to the men in the convalescent centers. It should be your endeavor to influence the authorities in the camps to place the various shops and other trade activities at the disposal of the educational officers in the base hospital. By your efforts you can further influence the proper cooperation and coordination between the line and the medical officers of the convalescent center, the educational officer of the base hospital, the physical director of the training camp activities, and the various recreational camp activities, all with the view of stimulating the general morale and up building of the men in the convalescent centers.
3. It is evident that the educational work started in the hospital should be a continuous process for those men in the convalescent centers who need this form of training. You should therefore ascertain if arrangements have been made for their attendance in the shops and schools established in the base hospital or located elsewhere in the camp.
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4. One of the chief functions of the consultants and instructors in the work of convalescent centers is to observe carefully from every standpoint the end results which are being obtained and to report to this office concerning the same, with any suggestions for their improvement.
During January, 1919, 17,439 soldiers were admitted to the 19 convalescent centers, and 10,210 of these were discharged within two weeks.21 Reports from all camps showed only 145 men who remained in the centers for more than six weeks during the first two months of their operation,21 which raises the question as to the probable value of the curative workshop schedule in such centers, other than as a means of occupying time, when the length of the courses was necessarily so short. Thirty-five thousand soldiers passed through the convalescent centers in February and March, 1919, and only 6,000 in April. Certain centers were abolished from time to time as the need in a particular locality declined, and in the latter part of April the War Department authorized the demobilization of convalescent centers by camp commanders, when the functions of an existing convalescent center could be taken over with advantage by the base or camp hospital. 21
REFERENCES
(1) Letter from Maj. A. S. Begg, M. C., to the director, orthopedic division, S. G. O., May 27, 1918. Subject: Special training organizations. On file, Record Room S. G. O., 353.94-1.
(2) Letter from The Adjutant General to commanding generals of all Regular Army, National Army, and National Guard divisions, March 8, 1918. Subject: Rehabilitation of the physically unfit. Copy on file, Record Room, S. G. O., 353.91-1.
(3) Letter from Lieut. Col. E. G. Brackett, M. C., to the Surgeon General, March 22, 1918. Subject: Physical training organizations. On file, Record Room, S. G. O., 353.91-1.
(4) Report of development battalions made to the Surgeon General by the chief of the division of physical reconstruction, August 31, 1918. On file, Record Room, S. G. O., 322.171-1.
(5) Instructions concerning operations of development battalions, issued by the War
Department, undated. On file, Record Room, S. G. O., 322.052.
(6) Letter from the Surgeon General, United States Army, to Major Lantz, General Staff. War Department, Washington, D. C., August 8, 1918. Subject: Development battalions (and attached papers). On file, Record Room, S. G. O., 322.171-1.
(7) Plans of venereal infirmary for development battalions, August, 1918. On file, Record Room, S. G. O., 322.171-1.
(8) S. O. No. 135, W. D., June 10, 1918.
(9) Office Order No. 84, S. G. O., September 9, 1918.
(10) Letter from the Acting Surgeon General to camp surgeon, Camp Meade, September 21, 1918. Subject: Medical personnel for development battalions. On file, Record Room, S. G. O., 210.3 (Camp Meade) (D).
(11) Report of sanitary inspection, Camp Meade, Md. On file, Record Room, S. G. O., 721.5 (Sanitary Report).
(12) Memorandum for medical officers, instructors in medical functions in development battalions, September 28, 1918, source unknown. On file, Record Room, S. G. O., 322.171-1.
(13) Development battalion summary report, November 1, 1918, prepared in the division of sanitation. On file, Record Room, S. G. O., 322.171-1.
(14) Report on development battalions and limited service, by Col. Harry E. Mock, M. C., undated. Copy on file, Historical Division, S. G. O.
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(15) Memorandum from chief operations branch, General Staff, for Chief of Staff, November, 1918. Subject: Development battalions and their part in demobilization. Copy on file, Record Room, S. G. O., 322.171-1.
(16) Circular No. 90, W. D., November 25, 1918. Subject: Oversea convalescent detachments.
(17) Letter from The Adjutant General, United States Army, to the Surgeon General, Decem- ber 19, 1918. Subject: Modified program of physical reconstruction (and attached papers). On file, Record Room, S. G. O., 353.91-1.
(18) Circular No. 188, W. D., December 31, 1918.
(19) Circular Letter No. 29, Surgeon General's Office, January 14, 1919.
(20) Circular Letter No. 33, Surgeon General's Office, January 18, 1919.
(21) Report on convalescent centers, by Lieut. Col. Harry E. Mock, M. C., undated. On file, Historical Division, S. G. O.
(22) Memorandum from the Surgeon General's Office, for consultants and instructors in convalescent centers, January 25, 1919. On file, Historical Division, S. G. O.
