The army behind the army

Beneath the crest of the British Royal Artillery appears the word “Ubique”—“Everywhere.” It is a motto which might more fittingly be applied to the Medical Department of our own army, however, for that corps has its representatives in every branch of the service—on land, afloat, and in the air. It directed the designing and production of our first gas-masks and from it was drawn the nucleus of our original Gas Defense Service. It provided the medical staffs for the hospital ships and for the army transports. By means of the ingenious system of tests which it devised, it selected our flying-men, determined on the form of aviation work for which they were mentally and physically fitted, and, by a system of unceasing observation, kept them constantly in condition to fight the Boche in the skies. It organized an ambulance service which won the admiration of the world. No battery or battalion went into action without its quota of medical officers, who shared all the perils and privations of their comrades of the line and worked longer. Only two units in the American Army were granted by the French the coveted distinction of wearing the fourragère: one of them was an Air Service squadron, the other a unit of the Sanitary Corps of the Army Medical Department. Our medical officers were actually the first in the field and the first to sustain wounds; the first American killed after the declaration of war was a medical officer.

A list of the Medical Department’s activities would include the Dental Corps, the Sanitary Corps, the Veterinary Corps, the Nurse Corps; laboratories for the study and prevention of infectious diseases; organizations for the isolation and the special care of the tuberculous, the insane, the victims of war neuroses; convalescent centres and sanatoria; a division of psychology for gauging the mental capabilities of the army’s enlisted personnel; a division of physical reconstruction for the rehabilitation of the sick and wounded; a hospital division which planned and equipped hospitals to meet the constantly increasing needs of the army; a motion-picture industry which enabled the staffs of the various hospitals to see depicted on a screen the latest methods of surgery and medicine and which also illustrated to the soldier the danger of breaking sanitary regulations; the publication of a chain of hospital papers to strengthen the morale of the soldier patients; a system, working in co-operation with the War Risk Insurance Bureau and the Adjutant-General’s Office, designed to expedite the settlement of war claims, and a remarkable statistical classification of the sick and wounded, including a complete medical history of each individual case. To this array of extraordinary activities must be added, of course, the features usual to any well-organized medical department: services of internal medicine and surgery working in the closest harmony in every hospital unit; divisions of head surgery (including eye, ear, nose, and throat), orthopedics, urology, and Roentgenology; and finally that vast organization for the care of the wounded whose operations began with the stretcher-bearers out in No Man’s Land and ended only when the men had passed out of the great general hospitals in the homeland with the wound-chevrons on their sleeves.

When, in the past, we have been suddenly confronted by the necessity of making war, we have had to do our organizing after the beginning of hostilities. And, though the titanic conflict had been in progress for more than two years and a half before we entered it, we ran true to form, being as unprepared for war from a medical standpoint as we were from an ordnance, an artillery, or an aviation, point of view. Barring the superficial experience gained by some of our medical officers during the mobilization on the Mexican border, our medical preparations were all made after war had been declared. This unpreparedness was not the fault of the heads of the Medical Department, mind you; it was not due to carelessness or lack of foresight, but was, instead, the logical result of a deliberate policy of those who held that to be prepared for war was to invite war. When the war-cloud broke, it became necessary, therefore, to build overnight, and virtually from the ground up, a mammoth and highly complex organization. When war was declared, the Medical Department, including the Medical Corps, the Dental Corps, the Veterinary Corps, and their respective reserves, had barely 700 commissioned officers on duty in the United States and its possessions. Though the regular Medical Corps included many officers whose achievements had contributed very largely to the prevention of disease and the amelioration of suffering in all parts of the world—it has been said of former Surgeon-General Gorgas that he “made the Canal possible and the tropics habitable”—and though these officers were skilled in preventive medicine, field sanitation, and other phases of the work of the army surgeon, there was, after all, only a handful of them. It became necessary, therefore, to provide, on the instant, not only for an enormously augmented personnel but also for new and unconsidered conditions. An ambulance service had to be organized and vehicles for it had to be designed and manufactured; hospital trains had to be built—there was only one in the United States when the war began; antiseptic methods in field surgery had to be devised as a substitute for the complete surgical cleanliness possible only under peace conditions; a system had to be devised and put in operation which would insure the prompt collection of the wounded on the battle-field and their rapid evacuation; measures had to be taken for the reconstruction of the severely wounded and their training for future efficiency in civil life.

Beginning, as I have already said, with a peace-time personnel of barely 700 officers, and a peace-time organization, the Medical Department expanded as the army expanded, until, when the Armistice was signed, it was serving 4,000,000 American soldiers at home and overseas and had, in addition, spread its safeguards over millions more of the civil population on both sides of the Atlantic. Several years prior to the war there had been organized a Medical Reserve Corps which included in its membership many prominent physicians and surgeons. The National Guards of the several States also had their respective medical organizations. The Medical Department at the outbreak of the war consisted, therefore, of nine corps: the Medical Corps, the Medical Reserve Corps, the Medical Corps of the National Guard, the Dental Corps, the Dental Reserve Corps, the Dental Corps of the National Guard, the Veterinary Corps, the Veterinary Reserve Corps, and the Veterinary Corps of the National Guard, to which were added before the war had been in progress a month a Medical Corps, National Army, a Veterinary Corps, National Army, a Sanitary Corps, and an Ambulance Corps, making a total of thirteen distinct services in the Medical Department. By the act of August 7, 1917, however, all of the above were merged into the Medical Corps, United States Army, thereby greatly simplifying administration. But it was quickly realized that, even by calling to the colors every medical officer in the Reserve Corps and the National Guard, the personnel would still fall far short of the number required to provide for the proper care and treatment of the enormous armies which were rapidly being placed in the field, for already the Secretary of War had made his celebrated remark: “Why stop with an army of 5,000,000 men?” Some conception of the problem confronting the surgeon-general may be had when I explain that the Medical Department was expected to furnish each infantry division with approximately 111 officers and 1,400 enlisted men. In addition, an enormous number of medical officers was required for the camp, base, and general hospitals which were springing up like mushrooms, almost in a night, throughout the land. In order to obtain these officers it became necessary, therefore, to appeal to the medical profession of the United States and to the various medical societies, the American Medical Association taking a particularly energetic and enthusiastic part in the work of recruiting. The response of the medical men of America was as prompt as it was gratifying. Specialists whose names were as familiar to the public as those of Cabinet officers and who for a single operation received fees equal to the annual salary of an ambassador; obscure country practitioners who made their daily rounds in mud-bespattered buggies and who, as often as not, received their pay—when they received it at all—in produce; prosperous middle-aged physicians with established and lucrative city practices; struggling young internes; lecturers on medicine and surgery at universities and colleges, put aside their private affairs and offered their services to the nation. So universal was the response, indeed, that numerous communities found themselves facing the prospect of being wholly without medical attendance, for all their physicians were in or were trying to get into khaki.

The same patriotic enthusiasm was shown by the dental profession. At the outbreak of the war there were only 86 dental officers in the Regular Army, this number being based upon the ratio of one dentist to each thousand enlisted men. And, though the importance of a clean, healthy mouth was fully recognized as being essential in maintaining the health of the individual soldier, no Dental Reserve Corps existed at this time. It was evident from the very beginning, therefore, that, in order to care for the teeth of millions of fighting-men, it would be necessary to strain to the very limit the resources of the dental profession. Moreover, before the war had been in progress half a year, it was found necessary to raise the authorized quota of one dentist to every thousand men to one dentist to every 500 men. But the dentists lagged not a whit behind their fellows of the medical profession, so that when Germany threw up her hands and cried “Kamerad!” there were 6,284 officers in the Dental Corps.

When the Secretary of State intimated to the German Ambassador that his immediate departure for the Fatherland would cause no tears, there were barely 400 members of the Army Nurse Corps, 170 of whom were reserve nurses, having been called into active service as a result of the mobilization on the border. Yet when the war ended, the corps carried on its rolls the names of 21,480 nurses, nearly half of whom were serving overseas. As long as a veteran of the Great War lives, the work of these young women will be referred to with something akin to reverence. They displayed a courage, self-sacrifice, and devotion beyond all praise. Among them were capable, experienced executives who wore on the breasts of their trim blue jackets ribbons showing that they had seen previous service in Cuba, in the Philippines, and on the Mexican border. Others, hundreds upon hundreds of them, came from the hospitals of the larger cities. But by far the greater number of them were graduate nurses who left assured and lucrative private employment for the fatigues, the discomforts, and ofttimes the dangers, of army work. Nurses with wide executive experience were brought into the service as chief nurses of the great army hospitals, some of which had from 300 to 600 nurses on their staffs while the influenza epidemic was at its height. Their work in this emergency requires no comment, for they were untiring in their efforts, taking no heed of the number of hours they worked and frequently staying at their posts until they dropped from exhaustion. During the epidemic 127 nurses died in this country and 35 overseas from influenza or pneumonia resulting from it. Though a number of American nurses have been decorated by foreign governments, our own government has seen fit to recognize the heroism of only four: Miss Beatrice McDonald, who received the D. S. C. for staying by her patients when the hospital in which she was on duty was bombed by German airmen, though severely wounded herself, Miss Helen G. McClelland, Miss Isabelle Stambaugh, and Miss Julia Stimson, who received the D. S. M.

Meanwhile the enlisted personnel had increased enormously. At the outbreak of the war there were in the Medical Department approximately 6,900 men. During the nineteen months of hostilities this force steadily expanded, the recruits including medical students, pharmacists, and others of a medical turn of mind. Not every one in the corps had had experience in medicine or kindred subjects, however; the chief orderly at the hospital in which I was in France had been one of the editors of Vanity Fair, another had been engaged in the importing business, and one of the enlisted men at Fort McHenry Hospital, Baltimore, was a motion-picture actor whose features are known to “movie” fans all over the United States. The Medical Corps reached its maximum strength in November, 1918, when its records showed a total of 264,181 officers and men. Thus it will be seen that the personnel of the Medical Corps alone at the close of the Great War was much greater than that of the entire Regular Army before the beginning of hostilities.

The Medical Corps naturally divides itself into two main branches: the Division of Surgery and the Division of Internal Medicine. The latter, as its name indicates, deals almost entirely with non-surgical diseases and conditions; in other words, medicine as distinguished from the knife. One of the principal functions of the Division of Internal Medicine consisted in obtaining, training, if necessary, and assigning to duty in the various hospitals and camps expert examiners in diseases of the heart and lungs, these officers being charged with the duty of determining the fitness of recruits for military service and their condition on discharge, with special reference to heart disease and tuberculosis. This latter phase of their work assumed such important proportions, however, that it was eventually taken over by a separate division. Another function of the division was to obtain mature and highly trained internists of long experience to serve as Chiefs of Medical Service in base and general hospitals, these officers, who included many of the ablest physicians in the United States, being responsible for the professional care of all medical patients. For a time a school was maintained to train these medical chiefs, practically all of whom were fresh from civil practice, in the details of army-hospital administration. Younger men, usually with little or no hospital experience and, therefore, less highly qualified, were assigned to serve under the medical chiefs as ward surgeons in direct charge of sick soldiers. A small number of highly experienced men were also brought into the service as medical consultants, their duties being to visit the various hospitals and to maintain helpful and sympathetic relations between the medical staffs and the surgeon-general in Washington. The above is, of course, merely a hasty sketch of the great work done by the medical internists. The vast majority of them were desperately anxious for service in France and moved heaven and earth to obtain overseas assignments, being bitterly disappointed when they found that the needs of the army required that they should remain on duty in the homeland. By comparison with those of their fellows who were serving within sound and often within range of the guns, domestic service seemed quiet and prosaic. But, as a matter of fact, there was nothing commonplace about it at any time. The nearest approach to it was after the Armistice, when the main impulse and motive for military service, the winning of the war, became a thing of the past. But during the continuance of the war the medical officer, whether his duties kept him on the firing-line itself, in the camp and base hospitals in the rear, far from the thunder of the cannon, or at the cantonments on this side of the Atlantic, never had reason to complain of his work being monotonous or uninteresting, for every day, almost every hour, indeed, brought new experiences and new problems. I doubt if there is a single officer who wore the uniform of the Medical Corps who will not willingly admit that his army work better fitted him for civil practice and afforded him a deeper understanding of the needs of suffering humanity.

The great and crowded days of the medical internist in the United States came with the influenza epidemic. Thrilling, trying, and tragic was this period. At first in driblets, then in streams which increased with appalling rapidity, the men poured into the hospitals. In civil life a hospital with 250 beds is considered a very considerable institution and one of which the community it serves has reason to boast, yet the great base hospitals, sometimes with as many as 2,500 beds, were literally swamped with new cases, occasionally as many as 1,000 “flu” patients being brought in during a single day. These men had to be cared for and carried through. But how? Not only were there not enough hospitals in the land to hold them, but the medical profession, already drained of its practitioners by the demands of the army overseas, was unable to find enough, or nearly enough, physicians, nurses, and attendants, for the influenza, remember, showed no discrimination, attacking soldiers and civilians alike. When the epidemic descended upon the cantonments, barracks near the hospitals were taken over by the medical authorities, the well men being evacuated to tents in favor of the sick. In many instances buildings which did not have a stick of furniture in them in the morning were ready to receive patients by mid-afternoon. In the meantime cots, pillows, sheets, and blankets, three or four to each cot, had been moved in. Medicines, glasses, and all the other paraphernalia of modern medicine had been obtained. Fires had been started. Cooks, stoves, cooking utensils, food, and dishes appeared as at the wave of a magician’s wand. Medical officers and nurses had been assigned and had reported for duty. The Red Cross and other war service agencies were on hand. Arrangements had been made to care for the clothing and valuables of the patients and a hundred other details had received attention. And all this, mind you, in a few short hours. Surgical officers volunteered for medical service. Officers from the training-camps of the Medical Corps were sent by tens and twenties to help out. Every city, town, and village between the oceans was combed for nurses. There were not enough ambulances to transport the sick, so private motor-cars, taxicabs, even motor-trucks, were pressed into use. The drivers sat at their steering-wheels day and night until they could no longer keep their eyes open. Medical officers were on duty from daybreak until long after midnight, day after day, week after week. Nurses and orderlies kept at their work until they dropped from sheer exhaustion. This was the home equivalent of battle service. No sterner, no more gallant, resistance to the Hun assaults was ever made by the men on the firing-line in France than the battle which was waged against an equally formidable, equally treacherous, enemy by the men and women who wore on their sleeves the silver chevrons of home service.

The Division of Tuberculosis is one of the four branches of the Division of Internal Medicine, it being the only division that has to do with a single disease. This is due to the fact that tuberculosis is admitted the world over to be the most prevalent disease known, one out of every seven of the earth’s inhabitants dying from some form of it. In order to detect the presence and combat the spread in the army of the Great White Plague, the Medical Corps very early in the war took steps to standardize the chest examinations of soldiers, all recruits being examined upon their arrival at the camps according to the standard thus devised by doctors who were specialists in tubercular troubles. These measures resulted in excluding from the army about 80,000 cases of active tuberculosis. Had the methods pursued in former wars been adhered to, a considerable proportion of these would undoubtedly have escaped detection, and, as tuberculosis is a highly communicable disease, thousands of perfectly healthy men would have become infected. Most of these tubercular cases would have had their disease aggravated by field service, and, moreover, the resources of the Medical Corps would have been heavily taxed had it been called upon to treat so large a number of patients. Soldiers who were suspected of having tuberculosis, or who developed it while in the service, were examined by specialists, who confirmed or rejected the original diagnosis, those who were found to have the disease being immediately sent to special hospitals or sanatoria for treatment. The location of these sanatoria in such recognized and widely scattered health resorts as Asheville, North Carolina, Denver, Colorado, the Catskill Mountains, Arizona, and New Mexico enabled the medical authorities to send the soldier patients to regions which, as experience has taught, promote recovery from the disease, and which were at the same time as close as possible to their homes. Patients sent to these hospitals were not discharged from the service until they were cured or until the maximum improvement had been obtained. Thus soldiers received treatment which few civilians could afford, no multimillionaire being able to purchase better medical attention than that which Uncle Sam gave his boys. As tuberculosis is a chronic disease, and as a certain number of cases will relapse after its progress has apparently been arrested, special efforts were made to teach the patients how to live in order to prevent further retrogression, particular emphasis also being laid on the necessity of observing the sanitary precautions which will prevent the transmission of the tubercular germs from the patient to the members of his family.

Though for a number of years prior to the war there had been a steadily increasing appreciation of the importance of neurology and psychiatry in the organization of a fighting-machine, the theories which had been evolved along these lines were never put into practice, at least on a large scale, until America’s entry into the great conflict, when there was organized the Neuropsychiatric Section of the Division of Internal Medicine. When the section was created, about fifty neuropsychiatric officers were commissioned; when the Armistice was signed, this number had risen to nearly 700. The chief function of the section was the exclusion from the army, by means of special tests, of men who, because of mental and nervous diseases, were considered unfit for military service. At first this section was treated with open derision or contemptuous tolerance by certain of the narrow-minded or the prejudiced—for the Medical Corps, like all other branches of the army, is not without its fogies who regard with suspicion anything that is new. The best proof of the success of its work, however, is the fact that it discovered the presence in the army, at home and overseas, of more than 72,000 men suffering from nervous and mental disorders, every one of whom was a potential menace to our success as long as he remained in active service. Thanks to the simple but highly effective tests which the psychiatrists devised, certain men were discovered to be moral perverts; the tests showed that others, if exposed to the strain of battle, probably would have suffered mental collapse, and that still others did not possess a sufficiently developed mentality to understand or to carry out orders. Imagine how grave a menace a single pervert might have proved to the morals of the men with whom he was associated in the intimacy of army life. Picture the danger to the success of a military operation of a single soldier who did not possess sufficient intelligence to understand the orders which were given him or the courage to carry them out. Such men were of far greater potential danger to the welfare of the army than were those suffering from tuberculosis. By means of the psychiatric tests given at the camps and cantonments, more than 1 per cent of all the men brought into the army by the draft were discovered to be mentally unfit and were at once rejected. On the other hand, many drafted men were found to possess exceptional mental qualifications and were thus marked out for assignments where their special aptitudes would prove of the greatest value, in many cases being recommended for the officers’ training-camps. This was the first war in which mental tests have been employed. Men with undeveloped minds, unstable nervous systems, or inadequate self-control are very bad risks for armies. They are unknown quantities and their behavior in moments of stress cannot be relied upon. Such men may cause disaster in action, they are liable to shell-shock, and they are likely to swell the lists of pension claimants. But the psychological tests, though they did not entirely eliminate these dangers, certainly reduced them to a minimum, enabling line-officers to equalize the mental strength of their commands by the reassignment or transfer of men to less exacting duties, or, in the case of those who were actually feeble-minded, securing their discharge from the army and returning them to their homes.

To the Division of Laboratories and Infectious Diseases were assigned the duties of ascertaining the causes of communicable diseases and of establishing methods for their control. The immensely important work of this division was handled by five sections, as follows: (1) The Section of Laboratories, whose duty it was to furnish and train personnel, supervise the work of the laboratories, and standardize the equipment. (2) The Section of Epidemiology, which followed the progress of disease and recommended measures of control. (3) The Section of Urology and Dermatology, which was specially charged with the treatment of venereal disease. (4) The Section on Combating Venereal Diseases, which elaborated and executed measures for educating the soldier on this subject, for the enforcement of legal measures against immoral conditions, and for venereal prophylaxis or early treatment. (5) The Army Medical Museum, which collected pathological material and other specimens of interest to medical men, the scope of its activities being greatly enlarged by the formation of an organization for collecting material in the field.

The problems handled by the Division of Laboratories and Infectious Diseases were both varied and vitally important in preventing wastage of troops. The view held by the experts of the division that the enteric group of diseases, which wrought such havoc in other wars, could be controlled by typhoid and paratyphoid inoculation and by adequate sanitary measures, was confirmed by the fact that, though typhoid occurred in the devastated and extremely insanitary regions along the Western Front, it never became a serious menace to the American Army. With the practical elimination of the enteric diseases, the respiratory diseases provided the most important problem for the Medical Department. The most vigorous measures were pursued in studying and attempting to control the incidence and mortality of respiratory diseases, and many facts were ascertained which proved of great value during the period of operations and which, when the lessons to be drawn from them have received sufficient study, will eventually place in our hands more adequate means of control. Epidemic cerebrospinal meningitis is another disease which always has to be feared when troops are mobilized. Infection is transmitted by the discharges from the respiratory passages, usually being disseminated by “carriers,” who spread the disease without having it themselves. In order to detect these “carriers,” any one of whom might unintentionally create as much havoc as an enemy agent in a munitions plant, hundreds of thousands of men were examined, our knowledge of the methods by which the disease is transmitted being thereby greatly increased. The problem presented by the venereal diseases has always been of vital interest to all armies and the fight against this class of infections has been vigorously waged in the American Army for many years. With the passage of the Draft Act it became evident that it would be necessary to extend the fight to the civilian population not only because it was a source of infection of the army but in order to diminish the occurrence of these diseases among drafted men. To accomplish this a close alliance was formed between the Section on Combating Venereal Diseases of the Medical Department and the War Department’s Commission on Training Camp Activities. The methods pursued in preventing venereal diseases aimed, first, at diminishing exposure to infection, and, second, at giving medical treatment to soldiers who have been exposed in order to prevent the development of the disease. One of the most immediately effective measures in preventing exposure was the repression of prostitution and its ally, the liquor traffic, in the neighborhood of army camps and to a lesser degree throughout the country. The surgeon-general assigned specially qualified officers of the Sanitary Corps, mostly lawyers, to the Law Enforcement Division of the Commission on Training Camp Activities, with orders to see that the federal and local laws against prostitution and liquor-selling were rigidly enforced. The results exceeded all expectations. In a year and a half about 130 red-light districts were closed at the instigation of these officers working in the name of the Law Enforcement Division. Street-walking and the connivance of lodging-house and hotel-keepers, taxicab drivers, and others was kept down. Trained women social workers, experts in the management of reformatories and detention houses, and civilian investigators co-operated with the military authorities in the work. Seven hundred and fifty cities and towns were investigated and a thorough clean-up was made in 453. As a result of this work, it is estimated that to-day not more than five openly recognized red-light districts remain in the whole United States. It has repeatedly been asserted that military life is conducive to immorality and that the army reeks with venereal diseases. This charge is effectually disposed of by the statement that of a total of approximately 225,000 cases of venereal disease found to exist in the army, 200,000 were contracted before enlistment.

The Division of Surgery is subdivided into sections of General Surgery, Orthopedic Surgery, Head Surgery, and Genito-Urinary Surgery. In each of the forty-five army hospitals in the United States a surgical service is maintained, the chief surgeon and his assistants having practically the same freedom of judgment in deciding upon the kind of treatment that is to be pursued that they would exercise in civilian institutions. To some extent, however, the matter of treatment is governed by the rules laid down in the Army Medical Manual and the regulations established by the Surgeon-General’s Office. Thus, each month a duplicate of the record of every operation performed, a list of the patients who have died and the reasons for their deaths, and a list of the supplies used by the surgical service must be sent to Washington. In addition, the hospital must report upon the number of patients received from overseas and the character of their injuries, and the number of cases of peripheral nerve, empyema, fractures, osteomyelitis, etc., which are in the hospital, together with the classification of the stage of the disease, that is, whether it is improving, whether it is stationary, or whether it will require operation. In this way the Division of Surgery is enabled to maintain a supervision over the operation of each hospital without interfering with its actual workings. In other words, the surgical service is permitted to exercise its own judgment untrammelled and without interference, but it must render a faithful report of all its doings. These monthly returns are carefully scrutinized in Washington and the work of the entire surgical personnel is carefully watched and card-catalogued. Monthly reports from the various commanding officers and from consultants, as well as information picked up here and there, are entered on these cards, so that no officer can remain for any length of time in the surgical service without the department knowing exactly what he is doing and having a very accurate estimate of his ability.

When war was declared, the army possessed in the United States two hospitals for general cases, one for tuberculosis, one for rheumatism, and 113 post hospitals, with a total capacity of 6,665 beds. In order to meet the anticipated needs of our great new armies a vast programme of hospital construction was started in August, 1917, and, though it was greatly curtailed after the sudden collapse of the German war-machine, by March, 1919, the Medical Department had at its disposal in the United States alone a total of 130,564 beds. In other words, the capacity of our army hospitals was increased 1,850 per cent in twenty months—a record which is, I imagine, without parallel in the history of medicine. The total number of medical officers, nurses, and enlisted men on duty in these hospitals during the period of the war was equal to the population of Albany, New York, and the number of cases which were treated—2,000,000 in all—was equivalent to the total population of Chicago. These gigantic hospitals, with their cool, clean wards, their ridge ventilation, their wide corridors, their elaborate heating, lighting, water, and fire-fighting systems, are not surpassed by any civil hospitals of their size in the world. To realize this, one has only to visit them. Indeed, it is not the slightest exaggeration to say that the American soldier received the most expensive kind of medical treatment, in hospitals of the finest type, at the hands of physicians and surgeons many of whom had given up princely incomes and leisurely lives in order to work eighteen hours out of the twenty-four at a captain’s or major’s pay.

It did not take the Medical Department many months to realize that it not only had on its hands thousands of sick and wounded soldiers but it also had the great American public—and the public required the most careful and tactful handling. Before we had been at war a year every conceivable sort of rumor in regard to the way in which the men in the hospitals were being treated was making the rounds. It was whispered that they did not get enough to eat, that they were not properly clad, that the physicians played poker and the nurses danced while their patients lay dying, that out-of-date methods of treatment were the rule, that the medical officers were incapable or overbearing. No rumor seemed too fantastic to receive credence. One woman alighted from her limousine at the entrance to the Walter Reed Hospital in Washington and asked to be shown the “basket cases.” Upon being asked by the puzzled attendants what she meant, she explained that she wished to see the soldiers who had lost both legs and arms, and who, she understood, were kept in baskets! And she was quite frankly sceptical when assured that neither at Walter Reed nor at any other military hospital in the United States was there a soldier who had lost both of his legs and both of his arms. In order to combat such ridiculous and harmful stories, to keep the public informed of the splendid treatment which the soldiers were receiving, and to cheer up the depressed and lonely soldiers themselves, the Publicity Section of the Surgeon-General’s Office established a series of hospital papers which covered the entire country. The Come-Back, edited and published at the Walter Reed Hospital, Washington, D. C., jumped in one issue to the ranks of the big dailies and steadily held its place in everything—news, editorials, cartoons, advertising, and circulation—that makes a successful newspaper. The Right About, published by the patients of Debarkation Hospital No. 3, located in the former Greenhut store in New York City, soon ran up a circulation of more than 50,000—at five cents a copy, too. Among the other papers was The Trouble Buster, published at Fort McHenry Hospital, Baltimore; The Ward Healer, at General Hospital No. 12, Biltmore, North Carolina; The Pill Box, at Debarkation Hospital No. 1, Ellis Island; The Reclaimer, General Hospital No. 34, East Norfolk, Massachusetts; The Stimulant, General Hospital No. 19, Lakewood, New Jersey, and a score or more of others with equally amusing names. The joyous, humorous, American spirit of these papers set a fashion of good cheer and sportsmanship among the patients, their attitude being characterized by the slogan shouted from the top of the first page of one of them: “The Come-Back chirps so loud that nobody has the nerve to growl.”

Even before the first of the constantly growing streams of wounded began to trickle home from France, it was recognized by the Medical Department that a system must be devised and put into operation whereby these men, instead of being mended and turned loose to shift for themselves as best they could, must be carried along, receiving treatment and pay, until they had attained the maximum degree of physical and functional restoration. For a quarter of a century after the close of the Civil War the streets of American cities were filled with disabled men who eked out their scanty pensions by selling shoe-laces, pencils, novelties, or by begging, because no intelligent measures had been taken to refit them for their former occupations or to fit them for new ones. It was determined that this condition must not occur again. The plan for physical reconstruction of the soldiers, as ultimately adopted, was simple, direct, and effective. It involved primarily the establishment of an administrative organization known as the Division of Physical Reconstruction, divided into departments of physiotherapy and education. Certain subdepartments were also made necessary by the special requirements of those soldiers who had lost their speech, their hearing, or their sight. The sympathy and interest aroused by this work throughout the country quickly drew into it as officers or advisers many men eminent in those walks of life which best fitted them for the exacting duties demanded by this service. The work of physical reconstruction has been eminently successful in its effect upon the disabled soldier, bringing him to a realization that, however great and disheartening his impairment, he might hope for usefulness, happiness, and self-support in the future, and in many cases leading to the adoption of a new and better vocation and a better standing in life. I knew one man who had had both legs blown off by a shell at Château-Thierry. He was a young, fine-looking, exceptionally intelligent fellow, but, with the prospect of spending the rest of his days in a wheel-chair staring him in the face, he had sunk to the depths of misery and discouragement. But one day one of the experts of the reconstruction service sat down beside his bed, offered him a cigarette, and started a conversation.

“What did you do before you went into the army?” the reconstructionist inquired.

“I was a carpenter,” the man answered. “Made good money, too. But I guess the only thing I’ll be good for in the future will be peddling shoe-laces,” he added bitterly. “No one wants a legless man.”

“Ever have any other occupation?”

“No. I always wanted to be an architect, but my people didn’t have the money to send me to college, so I went to work after I finished high school.”

“Would you like to take up architecture now if you could get the training?” the reconstruction expert asked.

“Would I?” the soldier gasped incredulously. “Would I? Say, friend, what’s the use of hitting a fellow when he’s down and out?”

“You’re not down and out,” was the cheery answer. “Not by a damned sight! If you want to be an architect, Uncle Sam is ready to give you a chance. He will give you an education, and pay you while you are getting it, and then he will get you a job. Don’t get the idea into your head that he has forgotten what he owes you boys who have fought for him.”

The last time I saw that soldier he had already commenced his architectural education.

“If he keeps on as well as he has begun,” one of his instructors told me, “he will make several times as much money without any legs as he did with them.”

The educational work starts at the bedside as soon as the patient feels the need of some activity or diversion. Each patient is treated as an individual, an educational activity being selected for him which will have the greatest curative effect and will at the same time present the greatest interest and incentive because of the future usefulness which it holds out to him. Simple crafts, light, desultory, and diverting, gradually give place to more exacting, more purposeful studies and occupations. For one man the series may be bead-work, mechanical drafting, wood-shop, carpentry; for another, knitting, basketry, penmanship, and accounting; for the illiterate it may be some textile project followed by instruction in reading and writing. Since the work began, 75,000 men have been enrolled in some form of educational work in fifty hospitals. Many have regained control of palsied muscles, limbered up stiffened joints, revived dulled mental sensibilities, steadied shaken nerves, or obtained improved physical tone by the application of these methods. To thousands the educational service has brought the discovery that, in spite of the handicap of their disabilities, they possess unsuspected ability in certain lines of useful and profitable endeavor, thus substituting hope for despair and showing them the way to a useful and contented future.

M—— was illiterate; in fact, he could not sign the pay-roll or read the simplest orders; he was bedridden with wounds in his shoulder and arm. He came from a remote mountain community, where the need of even a rudimentary knowledge of the three R’s was not deemed necessary. For thirty minutes a day for six weeks he studied reading, writing, and arithmetic. When he was ready for discharge from hospital he was able to write short letters, though he found spelling puzzling. In reading he made unusual progress, though his oral inflection left something to be desired. His greatest pleasure was to receive a letter from his brother, who had had five years’ schooling but could not write as well as M—— himself, or to write to his mother instead of being compelled to ask the other boys to write his letters for him.

Many of the soldiers are country boys and will go back to farming when they leave the hospital. For them there are courses in farm accounting and work in the gas-engine shop and with the hospital’s tractor. Clerks who were unable to obtain promotion because they did not understand stenography and typewriting are learning those branches, and some are taking courses in the newest systems of cataloguing and bookkeeping. A boy who had lost both legs above the knee became proficient in Spanish in order that he might assist his brother in the management of a ranch near the Mexican border. Others are taught woodworking, gardening, the operation and repair of gas-engines, shoe repairing, oxyacetylene welding, printing, electrical mechanics, lettering, and drawing. One day there was brought into the reconstruction hospital at Colonia, New Jersey, a boy whose hands had been taken off at the wrists. For five weeks he had been fed and cared for by any one who happened to be near. He was helpless and despondent. The able and energetic woman in charge of the educational work in his ward suggested that if a spoon was fastened to the stump of his right arm he would be able to feed himself. At first he said that he couldn’t, but she insisted on his making the attempt. The very next day he called to the sergeant who had told him that dinner was ready: “I can wait on myself now.” Then he devised a way to light his own cigarettes. Before long they had rigged up a device by which brushes could be fastened to his arms and he was set to work painting toys and boxes. And he did it remarkably well, everything considered. And, what was much more important, he whistled as he worked.

I doubt if any branch of the army did more efficient work in its respective line, and received less credit from the public, than the Veterinary Corps. This lack of appreciation was due, in the first place, to public ignorance of the duties of the corps and of the character of its personnel. Most people associate a veterinarian with the old-time country horse-doctor, of rough manners and still rougher speech, who was known to every man and boy in the countryside as “Doc.” The army veterinarian is a different genus altogether. He is usually as smart in appearance and as well-set-up as any officer of the line; he is more often than not a university graduate, and his methods of treatment are as modern and scientific as those of a surgeon or a medical specialist. The impression also seems to prevail that, as a result of the wholesale motorization of artillery and transport and the enormous use of aircraft, animals played but a small part in the Great War, and that consequently the army veterinarian enjoyed something akin to a sinecure. As a matter of fact, nothing could be further from the truth. Probably you were not aware that when the war ended, the United States Army possessed close to half a million horses and mules—the exact figure was, I believe, about 470,000—and was purchasing hundreds of more daily. Not only was the task of inspecting and supervising the care of this great body of animals an enormous one, but, as a result of the extreme scarcity of horse-flesh—for buyers for the European armies had almost drained the markets of the world before we entered the war—and because of the lack of tonnage, the animals of the A. E. F. were, as a divisional commander expressed it in a general order, “worth their weight in gold.”

Prior to 1916 there were only about 75 veterinarians in the entire army, but with the passage during that year of the National Defense Act the number of veterinarians at the call of the government was materially increased by the creation of the Veterinary Reserve Corps. The Veterinary Corps, like other branches of the service, kept pace with the expansion of the army, and when the Armistice was signed it had on duty 2,200 officers and an enlisted force of more than 21,000 men.

When an animal is first led before a purchasing commission its relation to the Veterinary Corps begins. Every horse and mule must be examined by a veterinary officer for soundness and freedom from physical defects before it can be purchased. As soon as the purchased animals have arrived at the various remount depots they become the objects of unceasing attention by the Veterinary Corps, whose duty it is to keep them free from disease and in the highest state of efficiency. This work includes the sanitary inspection of stables, picket-lines, forage and bedding, methods of feeding, watering, grooming, and shoeing, the detection and segregation of communicable diseases and the establishment of proper quarantine regulations, the care and treatment of all sick animals, the operation of veterinary hospitals, the investigation of the cause and cure of equine diseases, and the keeping of records. Another important duty of the corps in France was the prompt evacuation of all wounded animals in order that they might not hinder the mobility of the troops or engage the attention of the men. In order to facilitate the evacuation of sick and wounded animals from the Zone of the Advance, 21 veterinary hospital organizations—each consisting of 7 officers and 300 men, and each having a capacity of 1,000 sick animals—were trained, organized, and sent overseas. There were also sent to France 2 base veterinary hospitals with a capacity of 500 animals each. Besides this, every cantonment in the United States had its own veterinary hospital, varying in capacity from 200 to 600 animals each. As a result of the scientific methods of sanitation and treatment introduced by the Veterinary Corps, the mortality among animals was enormously reduced (in the early days of the war the British estimated that the average life of a horse in France was only sixteen days), thousands of disabled horses which in former wars would have been shot were evacuated, mended, and sent back to the front for further service, and millions of dollars were saved to the American taxpayer.

Even more important than its care of the animals of the army was the work of the Veterinary Corps in protecting the men by guarding the purity of their meat and dairy supplies. The activities of the Meat and Dairy Inspection Service include the inspection of meats purchased for the use of the army at the time of their receipt, while in storage, and upon issue to troops; inspection of storehouses, refrigerators, and methods of operation in handling food therein; inspection of slaughter-houses, butcher-shops, and packing-houses; ante-mortem and post-mortem inspection for soundness and suitability for human food of animals slaughtered; inspection of cows and dairies providing milk, butter, and cheese for the use of the troops. Some conception of the extent and importance of the work of the Meat Inspection Service can be had by remembering that when the war ended, the Packing-House Products Branch of the Office of the Director of Purchase and Storage was purchasing for the use of the army an average of from 15,000,000 to 19,000,000 pounds of meat products weekly. And every carcass, if not every pound, had to be inspected and passed by the Veterinary Corps before it reached the mess-tables of the army. That, in spite of the incredible quantities of meat products which had to be purchased for the use of our forces in the field, and the great distances between the abattoirs and the zone of operations, there was no repetition of the “embalmed-beef” scandal which sullied the history of the war with Spain was due to the efficiency and unremitting vigilance of the men who wore on their collars the insignia of the Veterinary Corps.

I am perfectly aware that the medical officers who do me the honor to read this chapter will criticise me for the omissions I have made. And such criticism is justified. I have dismissed such important phases of the work of the Medical Corps as the Division of Surgery with a few paragraphs; to the Dental Corps and the Nurse Corps I have been able to devote but a few lines; the Sanitary Corps, the Ambulance Service, and a score of other branches I have merely mentioned. Of the marvellous work performed by our medical officers in plastic surgery, in bone grafting, in the disinfection of wounds, in orthopedics, in the treatment of the blind, the shell-shocked, and the insane, I have written nothing—the subject is too great, the space at my disposal too limited to even attempt it. The most that I can hope to do in the limits of a single chapter is to give my readers the same fleeting, cursory view of the achievements of the Medical Department that one obtains of a countryside from an airplane.

If America’s losses in the greatest of wars were relatively slight—and they were slight when compared with the appalling casualties suffered by most of the other warring nations—the reason is not to be found in the superiority of American strategy, in the ability of American commanders, or in the excellence of American weapons, but in the efficiency, self-sacrifice, and devotion of the officers, nurses, and men who wore the caduceus of the Army Medical Department. And I know whereof I speak, for I have not only visited French, British, Belgian, Italian, even German, hospitals all the way from La Panne to Montfalcone, thus affording me standards of comparison, but I spent nearly three months in an American hospital on the Marne, I came home on an American hospital-ship, and for nearly three months more I was under the care of army medical officers in the United States. In dressing-stations, field, camp, base, debarkation, and general hospitals I have watched the Medical Department at its work, and the first-hand knowledge thus gained gives me the right to assert that it was the most efficient service of its kind possessed by any army. To its officers and men, and to the devoted women of the Army Nurse Corps, I lift my hat in gratitude and admiration. The American Army and the American people owe them a debt which they can never fully pay.