CHAPTER VCARING FOR THE WOUNDED
The story of the development of the Medical Department of the Army, its care of the human wreckage of the battlefield and of the physical welfare of the fighting forces both at home and overseas recounts one of the finest and most wonderful of the achievements of the War Department. It is the same story of marvelous expansion in quick time, of high resolve and determined effort to achieve the apparently impossible, and of results that seem almost magical in their bigness and importance and the rapidity with which they were brought about that is true of all the American war activities.
At the beginning of April, 1917, there were in the Medical Department 750 medical officers in regular service and 2,600 in reserve. The army nurse corps numbered 400 and there was an enlisted personnel of 6,600. There were seven army hospitals with a bed capacity of 5,000, aside from a few small and unimportant post hospitals. A year and a half later it had a larger personnel than that of the entire American army at the outbreak of the Spanish-American war. It numbered then 40,000 officers, 21,000 nurses and 245,000 men. In the United States there were over eighty fully equipped hospitals with a capacity of 120,000 patients and operating with the AmericanExpeditionary Force were 219 base and camp hospitals having a capacity of 284,000 patients. It was estimated that nearly one-third of the entire medical profession in the Union went into active service with the Army and among their numbers were many of the most distinguished physicians and surgeons in the country. Of those who went overseas, nearly half that number, over 1,000, were detailed to serve with the British forces.
As an instance of the speed with which it was necessary to work to secure the needed expansion for the care of war’s wreckage the story of the building of one of the New York City debarkation hospitals is illuminating. Several acres of ground on Staten Island were secured for it and the entire plant, consisting of eighty-six buildings, including a theater of seven thousand seating capacity, with heating plant and electric light, water and sewage connections, was finished and ready for use within one hundred days from the turning of the first spadeful of earth in the preparation of the site. Its normal accommodation was for 1,500 patients, but it was so planned that it could be easily and quickly expanded to care for three times that number. One of its buildings, measuring 230 by 30 feet, was begun in the morning, finished by noon of the same day, and equipped by night. Hospital facilities in France had also to be created quickly and equipped at once with all the means of treating the victims of scientific warfare that the needs of the time had evolved. One such big institution in the Cote d’Or region, for the building of which railways had to be run to the site and concrete mixers set up and kept going day and night until it was finished, had 600 buildings of a permanent typeand was, in effect, a series of ten hospitals in one, each devoted to its own specialty and having its own staff of thirty physicians and surgeons, a hundred nurses and twice as many men of the Medical and Sanitary Corps, and its own operating rooms, laboratories, kitchens, officers’ and nurses’ quarters, administration buildings and buildings for patients. A laundry capable of doing the work for 30,000 people served the entire plant. The hospital cared for 25,000 at a time and beside it was a convalescent camp having facilities for all manner of outdoor games with a capacity for 5,000 more into which the men were graduated for recovery. Nearly 800,000 soldiers of the American Army were treated in our overseas hospitals during our war period.
Of the hospitals in the United States a considerable number were in cantonments and camps and were chiefly used by the troops in training. The others, specialized for the use to which they were put, were for debarkation purposes and for the treatment of the wounded, ill, gassed, tuberculous or blinded. Debarkation hospitals received them as they were landed and from these they were transferred to receiving hospitals in and about the port city. Afterward, as soon as physically able, they were sent by hospital boat or train to a specialized hospital, if that were necessary, or if not to the general hospital nearest the patient’s home. These specializing hospitals were so located as to secure for each one whatever advantages were possible of situation and climate. Several hospital trains, each complete in itself, with kitchen, dining and ward cars, special beds for stretcher cases, and a car for the medical staff, were provided for transportation of the wounded by land,while a number of hospital boats properly equipped and staffed with physicians and nurses afforded transportation by water. In addition to the hospitals, convalescents were cared for in numbers of convalescent homes all over the country that were donated for that purpose by individuals and organizations who offered use of their homes, estates, clubhouses and other buildings. The Red Cross erected and staffed convalescent houses at all of the base and general army hospitals in the United States, which gave welcome, cheer and recreation to the recovering patients.
Through the port of New York flowed the main stream of the American Army on its way overseas and there its individual factors had to undergo final physical examination. The work of the Surgeon of the Port expanded from week to week, as his duties in connection with the army and the army transports grew, keeping pace with the increasing numbers that were sent month by month to Europe. In one mid-summer month in 1918, and subsequent months saw even greater numbers, he put his final approval of physical fitness on 272,000 soldiers bound for the battlefields of France. On the first of July, 1917, the staff of the Surgeon of the Port of Embarkation, New York, consisted of two officers and one private. A year later there were under him 530 commissioned officers, 110 contract surgeons, 340 nurses and 2,640 men, while directly under his control, exclusive of other hospitals in the same region, were thirteen hospitals having 12,500 bed capacity of which 11,000 were ready for use.
A more than fifty-fold expansion in the number of army nurses, from 400 to 21,000, was necessary to meet the need for their services. Graduating nursesentered the nurses’ corps and an army School of Nursing was established, with headquarters in Washington and branches in a score of military camps throughout the country. Many hundreds of young women enrolled, took the course of training which, intensive and somewhat specialized for army work, prepared them quickly for duty.
The developments of scientific warfare, with its new and fearful weapons of death and its new modes of attack, laid new duties upon the medical profession and new demands upon its knowledge and its methods of healing. It restores one’s faith in human nature, after realizing the devilish ingenuity of the death and wound dealing instruments of the world war, to find how incessantly the ministers of healing worked in hospital and laboratory behind the lines to evolve new agents and new methods for the mending of the wreckage from the front. Whatever else may or may not have been won out of the vast destruction of the world war, the medical profession can be assured that its devotion and its heroic labors have been rewarded by a wonderful advance in the frontiers of its knowledge.
The army medical officer found new problems facing him at every fresh development of the conflict, and to fit him for grappling with these new phases of human needs the Medical Department of the Army established numberless schools and courses of study at medical institutions, at hospitals and wherever could be brought together the factors necessary for this specialized and intensive training. Physicians and surgeons in overseas hospitals had evolved a number of new and effective methods for the treatment of casualties of various kinds and medical officers newlyinducted into the service had to have instruction in these developments, while for those who had to undertake recently specialized work it was necessary to have whatever training in that specialty had become possible.
Intensive training and clinical opportunities were provided for instruction in new methods in war surgery and fractures and in the treatment of infected wounds; there were schools for the training of medical officers in the use of X-rays; of laboratory specialists; for special work with diseases of the heart; for treatment of pneumonia and of those infectious diseases that are of frequent occurrence when large bodies of men are brought together. A particularly determined effort was made along preventive lines to lessen in the American Army both at home and in France the menace of venereal disease, always feared for its power to lower the efficiency of armies. Instruction by various means, an incessant campaign of vigilance by specially trained physicians, treatment of infected men, military punishment of offenders, endeavors to control the surroundings of camps, all were among the methods with which this scourge of all armies was combated, with remarkable success. The percentage of such diseases in the Army was below what it is in civilian life and very much below that of its prevalence in the Allied Armies.
One of the schools made necessary by the new methods of training instituted in the American Army was that for the instruction of military psychologists who were needed for the work of examining the men, as they came from their local boards and were inducted into the training camps, in order to eliminate those mentally unfit for army service and grade thoseaccepted according to their mental qualifications, for the information of their officers, as already described in the chapter on “The Making of the Army.” Under the supervision of the Medical Corps, this school trained many officers for psychological work at the cantonments, the course lasting two months. This development, an American idea, was something new in the making and training of armies, but it proved its value in the higher efficiency gained by enabling officers to select for special duties the men best fitted for them and so increasing the efficiency of the fighting units.
A new development of wartime medical science was made necessary by air warfare which soon brought into being the flight surgeon who kept under his observation the men in training at flying fields. So important did this division of the Medical Corps quickly become that special facilities were provided for the training of flight surgeons and laboratories were established for the investigation of the medical problems connected with the air service.
Until the influenza epidemic swept the country in the autumn of 1918, after devastating the populations of Europe, the disease figures of the American Army had set a new low record both at home and overseas. For the year ending with the first of September, 1918, which covered the time from the first gathering of men in the cantonments, the death rate for all troops in the United States was 6.37, which is a lower rate than that in civilian life for similar ages. But when the plague of influenza, which on its way around the world took a toll of 6,000,000 lives, descended upon the camps and cantonments in the United States the death rate rose to 32.15 per thousand. For the entireterm of the war the disease death rate was 17 per thousand in the expeditionary forces and 16 per thousand in the army at home. The comparison of these figures with the rate maintained before the passage of the epidemic shows how deadly it was. During the summer months of 1918 the death rate for the troops both at home and overseas fell to 2.8 per thousand. During the Mexican war the disease death rate was 110 per thousand, during the Civil War in the Northern Armies it was 65 per thousand and during the Spanish-American war 26 per thousand. During the last named war the most important cause of death was typhoid fever, before which medical science was then as helpless as it was during this war under the influenza scourge. It had conquered that menace and typhoid, by its precautions, was almost eliminated from our army both at home and abroad. But notwithstanding the devastations of influenza the disease death rate in the American Army was cut to a lower figure than had been reached by any army in previous wars. The lowest previously recorded was that of the Japanese during the Russo-Japanese war, which was 20 per thousand.
The battle death rate of the American Expeditionary Forces was 57 per thousand, considerably higher than it had been in any of our previous wars. In the Mexican war it was 15, in the Civil war in the Northern Armies 33, and in the Spanish-American war 5 per thousand.
Overseas, during the eight months ending with mid-October, 1918, only four per cent of the admissions to hospital because of disease resulted in death. Of the wounded and injury cases treated during the same period a little less than nine per centdied and over 85 per cent were returned to duty. Of the American Expeditionary Forces 4,000 were permanently crippled and 125 were totally blinded.
The medical officers of all the armies won remarkable results in the quick healing of wounds and the reduction of death from battle casualties by establishing hospital stations immediately behind the fighting lines, regardless of danger. This brave course, together with the efforts of the enemy to annihilate them and their hospitals, caused much loss of life among them. The Medical Corps of the American Expeditionary Forces had 46 killed and 212 wounded in action, and a total of 442 casualties of all kinds.
It was a comprehensive system of caring for the physical welfare of the American troops that was devised and carried out by the Medical Department. It had the fighting man constantly under its eye from the moment of his physical examination for induction into the army until he was examined for his final discharge. It analyzed his water supply, it examined his food and inspected his kitchens, it waged war against flies and mosquitoes in his camps, it made his environment sanitary and it devoted itself to his welfare if he was ill or wounded.
One of the finest of all its multifold and varied works was the scheme for the reconstruction of disabled men and their preparation for a life as useful and successful as they would have enjoyed if unhurt. The principles of occupational therapy were applied to the treatment of ill or wounded soldiers in hospitals, beginning with manual work for the redevelopment of strength and dexterity and continuing with occupational aids for the restoring of thenervous system and the bringing about of a cheerful outlook. Nurse-teachers were prepared for this work by courses of intensive training, lasting from two to four months. By the time the tide of injured men returning to this country was at its height this reconstruction work was in progress in nearly fifty hospitals, some 700 officers and men of the army had been detailed to serve as instructors and assisting them were 1,200 nurse-teacher aids trained in occupational therapy.
After he had been restored to physical and mental health in the hospital any soldier who was permanently disabled was given the opportunity of reëducating himself, if necessary, in order that he might continue to take a self-supporting part in the work of the world. The nation had pledged itself thus to care for its disabled defenders. With the exception of Canada, the United States was the only country to make this duty, from the first, the affair of the whole people, functioning through the Government. By act of Congress, the work of re-training war cripples was placed in the charge of the already existing Board of Vocational Education, whose agents would get into touch with the disabled men as soon as they arrived from France, tell them that the nation would engage to make them economically efficient again and show them that their rehabilitation depended only upon their own desire and energy. The crippled soldier could choose any line of work, agriculture, industry, commerce, any of the professions, and either add to the training he had previously acquired, or, if it was necessary, undertake a new kind of occupation. There lay before him the possibility of a variety of education that ranged from sixmonths of shop work to a complete college course of four years. Whatever artificial limbs or appliances he needed were supplied and if he were short of cash a civilian outfit was furnished. Until this training was completed his pay continued at the same rate as during his last month of active service, or it equaled, if this were greater, the monthly sum to which he was entitled under the War Risk Insurance law. Injured men in all branches of the nation’s defense who needed this reëducation were made to feel that in no sense were they receiving charity but that the country was only, and gladly, discharging a sacred obligation.
Educational institutions all over the land offered their coöperation and the use of all their facilities in the carrying out of this scheme of re-training and so also did shops and factories and industrial and commercial bodies of all sorts. A few months after the wounded began to return about 13,000 men had registered with the Federal Board for Vocational Education and it was estimated that there would probably be about 10,000 more who would need to share in the benefits of the plan.