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CHAPTER XVIII

SAVING THE WOUNDED AND SICK

O branch of military service courted greater triumph during the war than the medical organization. It cared for the men scientifically in cantonment and in the battle line. Sewers, latrines, bathing facilities, drinking water, camp epidemics, disease from unavoidable exposure to the elements, inhalation of poisonous gas and wounds on the battlefield all came under the ever watchful service of the Medical Department.

More than fifteen per cent of all the physicians of the United States enlisted in active service as medical officers of the army. Major-General William C. Gorgas and his associates worked out plans of sanitation, health preservation and care for the wounded which established a new record unprecedented in warfare.

Secretary of War Baker summarized the wonderful work achieved by this department of the army in this formal state

ment:

It must be a source of the deepest gratification to the country, as it is to me, that the health of the army has been so excellent, not only as compared with the army in other wars, but also as compared with the civilian population.

For the year ending August 30, 1918, the death rate from disease among troops in the United States was 6.4 per thousand; in the American Expeditionary Force it was 4.7; for the combined forces it was 5.9. The male civilian death rate for the age groups most nearly corresponding to the army age is substantially the same as the rate in the American Expeditionary Force. What this low figure means in lives saved is shown by comparing it with the rate of 65 per thousand in the Union Army during the Civil War, and the rate of twenty-six per thousand in the American Army during the Spanish War. Pneumonia, either primary or secondary to measles caused 56 per cent of all deaths among troops and 63 per cent of the deaths from disease.

About the middle of September the influenza epidemic which had been prevalent in Europe gained a foothold in this country. Begin

ning in the New England States it gradually spread south and west until practically the entire country suffered under its scourge. Naturally the camps and cantonments, with their closer concentration of men, provided especially favorable ground for the spread of the epidemic. In the eight weeks from September 14th to November 8th there were reported among all troops in the United States over 316,000 cases of influenza and over 53,000 cases of pneumonia. Of the 20,500 deaths during this period, probably 19,800 were the result of the epidemic. During eight weeks the epidemic caused more than twice as many deaths among troops in the United States as occurred during the entire year preceding the epidemic, and almost as many as the battle fatalities during the eighteen months of the war up to October, 1918. By the middle of November it was apparent that the epidemic had spent its force. The number of deaths was still above normal, but was showing a steady decline. The American Expeditionary Force suffered somewhat from the epidemic, but far less severely than the troops in the United States.

A vigorous campaign has been waged by the War Department for combating the great social evil of venereal disease. The program of attack has included the repression of prostitution and the liquor traffic in zones near cantonments, provision for proper social surroundings and recreation, education of soldiers and civilians in regard to venereal diseases, prophylactic measures against them, and prompt medical care. The Commission on Training Camp Activities has been very active in carrying forward this campaign and has received splendid co-operation from local authorities, and local and national health officials.

During the year ended August 30, 1918, among the troops in the United States the number of venereal admissions to sick report was 126 per thousand men. This figure includes duplicates and does not show the number of men sick at any given time. The great majority of these cases, moreover, were contracted before entering the army. Large increments of new recruits from the draft were generally followed by great increases in the admissions to sick reports on account of venereal diseases. A special study of all cases of venereal diseases reported at five typical camps (Dix, Lee, Meade, Upton, and Pike) during a typical period of thirteen weeks (June 22d to September 20th) shows that ninety-eight per cent of all cases were contracted before enlistment and only two per cent after enlistment.

Among the troops in France, where there were no recruits fresh from civil life, the record was even better than at home, and conditions improved steadily and rapidly until, in September of the year 1919, the cases were less than one among each thousand men. This is a showing unequaled in the records of any other army of modern times.

Figures as to the health of our soldiers, bear eloquent tribute to the efficiency of the Medical Department of the army. With the invaluable assistance of the American Red Cross, it found itself in a position to render great service from the very beginning. In this connection it is significant

to note that the first casualties in the American Expeditionary Force occurred in the Medical Corps, when, on September 4, 1917, one officer and three men were killed and three officers and six men wounded in a German airplane attack on one of our base hospitals.

On November 11, 1918, the army had eighty fully equipped hospitals in this country with a capacity of 120,000 patients.

There were 104 base hospitals and thirty-one evacuation hospitals in the American Expeditionary Force and one evacuation hospital in Siberia. In addition, a special hospital for head surgery, an optical unit, and eight auxiliary units operated abroad. The capacity of the hospitals attached to the Expeditionary Force is shown in the following table;

CAPACITY OF ARMY HOSPITALS IN THE AMERICAN EXPEDITIONARY FORCE,
NOVEMBER 11, 1918.

Army hospitals in the United States cared for 1,407,191 patients during the war; those with the American Expeditionary Force cared for 755,354, a total of 2,162,545.

In addition to furnishing its medical personnel for the operation of the above units, the War Department, through the chief surgeon, detailed 931 American officers to serve with the British forces and a further 169 for service in base hospitals that we turned over to the British. Furthermore, several ambulance sections have been operating with the Italian Army.

In order to provide properly trained personnel for the medical needs of the army outlined above, training camps were opened on June 1, 1917, at Fort Oglethorpe, Fort Benjamin Harrison, and Fort Riley. The need for similar facilities for colored officers and men was quickly recognized, and on July 21st a camp was opened at Fort Des Moines for the training of colored personnel. Simultaneously, special intensive training was given to all army medical officers, 1,724 receiving instruction in war surgery and six hundred in roentgenology.

The vital importance of good teeth has been fully realized by the department. On November 11, 1918, there were 4,429 dentists in the army and 5,372 in the Reserve Corps not yet called to active duty.

Up to the end of July about fifteen per cent of the entire civilian medical profession of the United States went into active duty as medical officers of the army. Probably no working force has ever been organized which contained more distinguished men of a single profession than were enrolled in the Medical Department of the United States Army.

No praise is too great for these men and their many brothers who freely gave themselves to the country in the time of her need, sacrificing homes and positions that they might render their greatest service to the cause of democracy.

The answer made by the graduate nurses in this country has been no less splendid than that of the doctors. When the armistice was signed an adequate staff of nurses was on duty at every army hospital in

the United States. Eight thousand five hundred and ten were on duty in Europe, 1,400 were mobilized and awaiting transportation overseas, and 2,000 more were available for immediate foreign service. The part played by these heroic women can best be told by our sons and brothers when they return from the battlefields; they, and only they, can pay proper tribute to the love and devotion with which our American nurses watched over them and cared for them.

During the period of the war over $500,000,000 was made available for the uses of the Medical Department. The expenditure of this vast sum was not merely a matter of placing contracts and awaiting deliveries. New sources of supply had to be created to meet the unprecedented demand for surgical instruments, medical and surgical supplies, bedding and beds and anesthetics, and everything possible had to be done to standardize all staple articles so as to reduce manufacturing difficulties to a minimum. Under the direction of Major-General William C. Gorgas the Medical Department worked out a most satisfactory program.

The War Department has believed that preventive as well as curative duties should be performed by its medical personnel. Accordingly, eight "survey parties" have been maintained to inspect all stocks of food and the manner of serving meals to troops in camps or hospitals. Provision was also made for the education of cooks and bakers in the science of their trades.

During the first fifteen months of the war, all matters pertaining to the protection of troops against poison gases were under the charge of the surgeon-general, who devised, contracted for, and produced during this period over one and a half million gas masks. The magnitude of this work became so great, however, that a special "Chemical Warfare Service" was created to handle both the defensive end, formerly under the Medical Corps, and the offensive branch, theretofore under the Engineers.

One of the most important activities under the direction of the Medical Department has been the reconstruction work planned for soldiers, sailors, and marines. At ports of debarkation, arrangements have been made for the rapid classification and assignment of returned sick and injured to the nineteen general hospitals selected for reconstruction work. At each of the hospitals courses of instruction are conducted which are adapted to the physical and educational qualifications of the men. These courses range from the most elementary instruction in the "three R's" to highly specialized trades; all of them, however, have the single purpose of enabling the man to overcome the handicaps resulting from his wounds and to resume his place as a productive member of society as speedily as possible. This work is being prosecuted in the greatest variety of subjects at Walter Reed Hospital, Washington, D. C., where important experiments are being made and where special attention is being given to fitting men with effective artificial legs, arms, and hands. At the beginning of the war there were only 750 officers, 393 nurses, and 6,619 enlisted men belonging to the Medical Department. In November, 1918, the corresponding figures were 39,363 officers, 21,344 nurses, and 245,652 enlisted men. During the period of greatest expansion, the department's program was guided by Major-General William C. Gorgas, the surgeon-general. After many years of conspicuous service in the army, Major-General Gorgas has retired in accordance with the provisions of the law, and was succeeded by Major-General Merritte W. Ireland, chief surgeon of the American Expeditionary Force.